Doing Mindfulness Therapy with the Brain in Mind
Prof. Freedom Leung Department of Psychology Chinese University of Hong Kong fykleung@psy.cuhk.edu.hk
Psychotherapy from Freud to Beck: From the West to the East
Psychotherapy from Buddha to Kabat-Zinn: From the East to the West
Mindfulness Movement in Psychotherapy
Mindfulness-based Stress Reduction program (MBSR; Kabat-Zinn, 1990) Dialectic Behavior Therapy (Linehan, 1993) The Four-step Approach Mindfulness Therapy (Schwartz, 1996) Acceptance Commitment Therapy (ACT; Hayes, 1999) Mindfulness-based Cognitive Therapy (MBCT; Segal et al., 2002)
Psychopathology = Mind 不由已
Psychopathology of the mind
1 2 3 4 5
Emotion dysregulation and emotional disorders
Anxiety disorders (dysregulation of fear and anxiety) Anger control disorder (dysregulation of anger) Mood disorders (dysregulation of sadness and excitement) Somatoform disorders (negative emotions affect body) Dissociative disorders (negative emotions impair cognitive functioning) Sexual dysfunctions (negative emotions impair sexual functioning) Paraphilia (dysregulation of erotic feeling) Substance-use disorders (pathological mood altering behaviors) Impulse control disorders (dysregulation of hedonic impulses) Adjustment disorders (adjustment stress-induced emotional symptoms)
The minds of schizophrenic patients: mental activities occur at random
Hallucination in action
Emotionally distressed patients: mind driven by amygdala
ACC
Impulse control disorder patients: minds driven by hedonic impulses
With repetitive experiences, all minds will be driven by mental habits
Three types of mental activities:
Random Driven Self-directed
When a mind is out of control .........
A mind out of control
ACC
When mind不由已……
杏仁核
Hippocampus 下丘腦 丘腦
b
a
內分泌系統 (長期抗爭)
自主神經系統 (緊急應變)
Body不由已
Visceral organs不由已
Breathing不由已
Perspective of the world不由已
now you see it now you don’t
Neurobiological consequences of prolonged 心不由已
Kandel, E. (1998). A new intellectual framework for psychiatry. American Journal of Psychiatry, 155, 457-469.
Repeated mental activities result in dendritic changes
Repeated mental activities result in synaptic changes
Pre-
Post-
Repeated experiences result in mindless mental habits
前扣带回
尾状核
壳核
杏仁核
眶部额叶皮质
Goal of psychotherapy: From 心不由已 to 心由自已
From mind 不由已
ACC
To mind 由自已
Drugs
Biological interventions of the mind
TMS
DBS
What is mindfulness therapy?
Evolution of mind
Matter
Cell
Brain
Mind
Panksepp, J. (1998). Affective Neuroscience: The Foundations of Human and Animal Emotions. NY: Oxford.
What is mindfulness?
to direct our minds to observe its mental activities (meta-cognition) from moment to moment non-judgmentally
Goals of mindfulness training
Through actively directing our minds to observe its own activities (metacognition), we develop mindful awareness of habitual affective, cognitive, and behavioral patterns Free the mind from mindless response driven by impulses, emotions and habits
How to train our minds to become心由自已?
Mindfulness of body sensations Mindfulness of breathing Mindfulness of all mental activities
Tuning the body
Body-Breathing-Mind relationships
Body 由已
Breathing
Mental activities
Mind不由已
ACC
Body不由已
Visceral organs不由已
Tuning the breathing
Body-Breathing-Mind relationships Body
Breathing 由已
Mental activities
Mind不由已, Breathing不由已
Tuning the mind
Body-Breathing-Mind relationships Body
Breathing
Mental activities 由已
Always ask yourself these mindful questions:
What am I doing now? Is it a response out of a mindful choice? Or is it just a mindless reaction driven by habitual affective, cognitive, or behavioral response patterns?
How mindfulness therapy works in neuroscience terms?
Davidson’s exploration of Zen Buddhism and neuroscience
Davidson, R., Kabat-Zinn, J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.
How mindfulness therapy works in neuroscience terms?
Calming down the amygdala (cooling negative emotions and physiological arousal) Shifting ACC’s focus (free ACC from “emotion-driven” or “ impulse-driven” mode) Free VmPFC from emotion-driven or impulsedriven mode Train OPFC to inhibit inappropriate “emotiondriven”, “impulse-driven”, or “habit-driven” mental reactions DLPFC initiates and execute adaptive behaviors Free from mindless mental habits
1) Amygdala: register emotional significance of a stimulus; 2) Hippocampus: retrieve memories associated with the stimulus; 3) ACC: focus on the situation effectively; 4) Orbito-frontal: inhibits inappropriate actions in favor of long-term advantage; 5) Ventromedial: emotions are experienced and situation is evaluted; 6) Dorsolateral: to form plans and concepts and choose actions (Davidson et al., 2002)
Schwartz’s ideas about “mental force”
Schwartz, J.M., Stoessel, P.W., Baxter, L.R., Martin, K.M., & Phelps, M.E. (1996). Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive compulsive disorder. Archive of General Psychiatry, 53, 109-113.
The 4-Step Mindfulness Therapy for OCD
Step 1: Relabel – recognizing obsessive thoughts and urges are symptoms of “oversensitive threat-detecting radar” in the brain Step 2: Reattribute – accept and observe obsessions or urges, understand them as bothersome thoughts and feelings without acting on them (“They are just bothersome thoughts and feelings due to oversensitive radar in the brain, not a real threat!”) Step 3: Refocus – aware of the impulse, actively delay for “15-minutes” not to act on the compulsion, and mindfully directing attention to other constructive activities Step 4: Revalue – recognizing OCD as what it really is – an over-sensitive brain threat-detecting radar (Wisdom)
LeDoux’s ideas about therapy
Therapy is just another way of creating synaptic potentiation in brain pathways that control the amygdala. …. And the way we do this is by getting the cortex to control the amygdala.
LeDoux. J. (1996). The Emotional Brain. New York: Simon & Schuster. p.265.
From mind 不由已
ACC
Therapy is just another way of creating LTP in brain pathways that control the basal ganglia. And the way we do this is by training the cortex to develop new mental habits.
Freedom Leung
References
Allen, N.B. et al. (2006). Mindfulness-based psychotherapies: A review of conceptual foundations, empirical evidence and practical consideration. Australian and New Zealand Journal of Psychiatry, 40, 285-294. Arch., J.J. & Craske, M.G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behavior Research and Therapy, 44, 1849-1858. Austin, J. (1998). Zen and the Brain. Boston: MIT Press. Cahn, B.R., & Polich, J. (2006). Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological Bulletin, 132, 180-211. Davidson, R. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570. Hanh, T.N. (1976). The Miracle of Mindfulness: A Manual on Meditation. Boston: Beacon Press. Hays, S.C. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. NY: Guilford. Ivanovski, B., & Malhi, G.S. (2007). The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatrica, 19, 76-91. Kabat-Zinn, J (1990). Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain, and Illness. NY: Dell. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness Meditation in Everyday Life. New York: Hyperion. Kabt-Zinn,J. (2005). Coming to Our Senses. NY: Dell. Lazar, S.W., et al. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport, 16, 18931897. LeDoux. J. (1996). The Emotional Brain. New York: Simon & Schuster. Linehan, M.M. (1993). Cognitive-behavioral Therapy for Borderline Personality Disorder. New York: Guilford Press. Nielsen, L., & Kaszniak, A.W. (2006). Awareness of subtle emotional feelings: A comparison of long-term meditators and nonmeditators. Emotion, 6, 392-405. Schwartz, J.M., Stoessel, P.W., Baxter, L.R., Martin, K.M., & Phelps, M.E. (1996). Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive compulsive disorder. Archive of General Psychiatry, 53, 109-113. Schwartz, J.M. (2002). The Mind and the Brain: Neuroplasticity and the Power of Mental Force. NY: Regan Books. Schwartz, J.M. et al. (2005). Mindfulness awareness and self-directed neuroplasticity: Integrating psychospiritual and biological approaches to mental health with a focus on obsessive compulsive disorder. In S.G. Mijares & G.S. Khalsa (eds.), The Psychospiritual Clinician’s Handbook: Alternative Methods for Understanding and Treating Mental Disorders. Haworth Press. Segal, Z.V., Teasdale, J.D. & Williams, J.M.G. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. NY: Guilford.