Wk 7: Mindfulness and mental health

• “In conclusion, a human mind is a wandering mind, and a wandering mind is an unhappy mind.
• The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.”

• Accumulative wear and tear on the body
• Prolonged stress leads to wear-and-tear on the body (allostatic load)- mediated through the sympathetic nervous system
• Allostatic load leads to:
• 1. Impaired immunity, atherosclerosis, metabolic syndrome, bone demineralisation.
• 2. Atrophy of nerve cells in the brain
• Hippocampal formation: learning and memory
• Prefrontal cortex: working memory, executive function
• 3. Growth of Amygdala mediates fear response

Many of these processes are seen in chronic depression and anxiety.

• The shorter the telomeres, the older we are and the bigger the chances of getting illness associated with ageing.
• Study on healthy premenopausal women showed that psychological stress associated with: higher oxidative stress and lower telomerase activity (telomerase repairs DNA telomeres) leading to shorter telomere length.
• These are known determinants of cell death/longevity.
• Women with highest levels of perceived stress c/w low stress women have shorter telomeres
• q Average equivalent at least 9-17 years of additional ageing
• Implications for how, at the cellular level, stress may promote earlier onset of age-related diseases

• These data suggest that work-related exhaustion is related to the acceleration of the rate of biological aging.
• Shorter telomere length

• Hostility: High-hostile men had significantly shorter leukocyte TL than their low-hostile counterparts
• The relationship between hostility and disease is stronger in men than in women, and men generally have a shorter life expectancy than women

• The greater the level of mind wandering associated with greater the level of telomere shortening (a marker of biological age)
• Maybe worrying more, more stress

• Focused: on task
• Tasks associated with paying attention
• Brain efficient and quiet
• Default state (mode): mind is inattentive, distracted, idle, recalling past, daydreaming
• Operating on automatic pilot
• Imagination circuits

Default brain associated with stress, anxiety, depression, ADHD, schizophrenia, autism, alzheimer's, reduced performance

• Frontal lobes (prefrontal cortex) centre for executive functioning:
• Attention regulation
• Working memory
• Self-awareness
• Reasoning and decision making
• Emotional regulation
• Appetite regulation
• Impulse control
• Directs immune system

• Limbic system: emotion centre
• Mesolimbic reward system: appetites

Mindfulness lights up these areas

“Performance pressure harms individuals most qualified to succeed by consuming the working memory capacity that they rely on for their superior performance.”

• Formal: putting time aside to be mindful eg. meditating
• Informal: being mindful while engaged in daily activities and work

• 1. People generally operate on automatic pilot and unaware of moment-to moment experience
• 2. We are capable of developing sustained attention
• 3. Development of this ability is gradual, progressive and requires practice
• 4. Awareness makes life richer and more vivid and replaces unconscious reactiveness
• 5. Gives rise to veridicality (accuracy) of perceptions
• 6. Awareness enhances perceptiveness, effective action and control

• Mental health: E.g. therapeutic application for depression, anxiety, panic disorder, stress, emotional regulation, addiction, sleep problems, eating disorders, psychosis, ADHD, autism, reduced burnout, greater resilience
• Neuroscience: E.g. structural and functional changes in the brain, stimulation of neurogenesis, possible prevention of dementia and cognitive decline, down-regulating the amygdala, improved executive functioning and working memory, reduced default mental
• activity, improved self-monitoring and cognitive control, improved perception of sensory input
• Clinical: E.g. therapeutic applications for pain management, symptom control, coping with chronic illness (e.g. cancer and MS), metabolic and hormonal benefits (e.g. reduced allostatic load, cortisol), facilitating lifestyle change (e.g. weight management, smoking cessation), improved immunity (e.g. improved resistance, reduced inflammation), improved genetic function and repair, slower ageing as measured by telomeres
• Performance: E.g. sport, academic, leadership qualities, mental flexibility and problem solving, decision-making, sunk-cost bias
• Education: E.g. improved problem-solving, executive functioning and working memory, better focus, less behavioural problems, fostering growth mindsets
• Relationships: E.g. greater emotional intelligence and empathy, improved communication, reduced vicarious stress and carer burnout
• Spiritual

• Depression can be looked at as a disorder of attention
• Depressive rumination: default mode
• Not present: foreboding about future and reliving past
• Poor functioning: distracted
• Anhedonia: lack of pleasure / enjoyment through disengagement
• Reactivity: non-acceptance of state of thoughts and emotions
• Poor health: allostatic load, immune dysregulation…
• Mindfulness-based Cognitive Therapy aimed at addressing these issues (MBCT)

MBI group showed pronounced and significantly stronger reductions in depressive symptoms, ruminative tendencies and cognitive reactivity, and an increase in mindfulness c/w the control group

• Default mental activity flourishes in various forms of psychopathology including depression, anxiety, schizophrenia and autism
• Default activity decreased or deactivated when paying attention (e.g. experienced meditators).
• In experienced meditators but not novices, even when the default mode network is active, brain regions associated with self-monitoring and cognitive control are co-activated.
• Reduces vulnerability to default thinking.

Mindful dishwashers had greater state mindfulness, more enjoyment, increase in positive affect (i.e., inspiration), decrease in negative affect (i.e., nervousness), and overestimations of dishwashing time

• Study explored whether:
• A. individuals with larger cortisol (stress) response to an initial stressor exhibit progressively higher cortisol levels before subsequent exposures (progressive anticipatory sensitization)
• B. attention/emotional skills training can reduce the magnitude of this effect on progressive anticipatory sensitization
• Female teachers randomly assigned to attention / emotion / meditation training or a control group
• 3 separate stress tests: at baseline, post-training, and five months post- Preparing and delivering a speech / performing arithmetic task in front of critical evaluators
• Control participants with larger cortisol reactivity to the first stressor showed increasing anticipatory cortisol levels with each successive stressor exposure suggesting progressive anticipatory sensitization
• This association absent in the training group

• Epigenetics: gene expression modified by many factors including mental state and lifestyle
• The RR elicits specific gene expression changes in short-term and long-term practitioners.
• Our results suggest consistent and constitutive changes in gene expression resulting from RR may relate to long term physiological effects.

Less colds

• Mindfulness training improves functioning in areas related to executive functioning, attentional control, self-regulation, sensory processing, memory and regulation of the stress response
• Thickening of cortex in regions associated with attention, self-awareness and sensory processing thicker in meditators
• “The regular practice of meditation may have neuroprotective effects and reduce the cognitive decline associated with normal aging.”

• Mindfulness involves attention and attitude
• Attention regulation has three aspects
• 1. To know where our attention is
• 2. To prioritise where the attention needs to be
• 3. For the attention to go there and stay there
• Mindful attitude e.g.
• 1. Openness
• 2. Curiosity
• 3. Acceptance
• 4. Self-compassion
• 5. Equanimity

• Performed worst when phone is closer
• The effect was greater for people more dependent on phone

According to a Microsoft Canada report, the average human’s attention span is below that of a goldfish (8 sec vs. 9 sec)

• Newly recognized neurological phenomenon:
• attention deficit trait (ADT)
• Response to hyperkinetic environment
• Trying to deal with too much input, results in:
• Black-and-white thinking; perspective and shades of grey disappear
• Difficulty staying organized, setting priorities, and managing time
• Feel a constant low level of panic and guilt

• Average of 64 seconds to recover train of thought  after checking email.
• Check every 5 mins = waste 8.5 hours per week
• Need to micromanage the attention and the  environment e.g.
• Remove unnecessary distractions / interruptions
• Control the environment
• Prioritise where the attention goes – is it urgent?

• Multitasking is an illusion (misnomer)
• Attention switching: Switching happens so fast that it appears we are performing multiple tasks simultaneously like the concurrent performance of several jobs by a computer.
• Reality is that we are switching back and forth between tasks
• Attentional blink: lag time of 200 to 500 milliseconds (0.5 sec). Increased stress
• (black out for that time?)

• Multitasking is a myth – the human brain does not pay attention to multiple complex tasks at the same time
• Efficient attention switching is useful: focus on one thing at a time
• Manage the environment – remove unnecessary inputs
• Avoid interrupting complex tasks
• Don’t multitask

• Mindfulness related to aspects of personality and mental health
• Lower neuroticism, psychological symptoms, experiential avoidance, dissociation
• Higher emotional intelligence and absorption

Found positive effect b/w mindfulness and prosocial behaviour for both correlational and intervention studies

• Mindfulness is essential underpinning for self- monitoring
• Mindful practice is conscious and intentional attentiveness to the present situation – the raw sensations, thoughts, and emotions as well as the interpretations, judgments and heuristics that one applies to a particular situation.
• Avoids automatic pilot

• Unconscious bias often leads to the misreading of a situation and decision errors e.g.
• Confirmation bias: the pursuit of data that support a diagnosis over data that refute it
• Anchoring bias: a resistance to adapting appropriately to subsequent data that suggest alternative diagnoses

• Mindfulness leads to:
• reduced cognitive rigidity via the tendency to be "blinded" by experience
• “a reduced tendency to overlook novel and adaptive ways of responding due to past experience, both in and out of the clinical setting.”

• Divergent thinking: represents a style of thinking that allows many new ideas being generated, in a context where more than one solution is correct (e.g. a brainstorming session, which has the aim of generating as many ideas on a particular issue as possible)
• Convergent thinking: a process of generating one possible solution to a particular problem and emphasizes speed and relies on high accuracy and logic eg. Remote Associates Task (RAT) where participants are presented with three unrelated words, such as “time,” “hair,” and “stretch,” and are to identify the common associate (“long”))

• 1. Open-monitoring: observing and noting phenomena in the present moment and keeping attention flexible and unrestricted
• 2. Focused attention: concentrating on a single object, such as breathing, and ignoring other stimuli

Open monitoring stimulates divergent thinking, a key driver of creativity, whereas focused attention is important for convergent thinking, which is important for narrowing options and formulating a workable solution (i.e. bringing the creative idea to fruition)

• The term vicarious stress or trauma (also called compassion fatigue) describes the phenomenon generally associated with the cost of caring for others.
• Vicarious trauma is the emotional residue of exposure that professionals have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.

• Limbic brain regions (esp. amygdala) implicated in empathic response to another's pain
• Meditators have more active empathic response
• Reduced activation of amygdala
• Activation in insula associated with compassion greater in expert than novices
• Empathy w/o stress reduces carer fatigue

• Neff and Germer define self-compassion as consisting of three main elements
• 1. self-kindness versus harsh self-judgment
• 2. a sense of common humanity versus feelings of isolation
• 3. mindfulness versus over-identification with painful thoughts and emotions
• Self-compassion is important for regulating stress, optimising coping and supporting self-care

• It is not an escape from life’s challenges or a distraction from our worries
• Not everyone will be interested or ready to practice it
• Not everyone will practice it even if they learn about it or want to practice it
• Most people will meet challenges and difficulties in learning mindfulness but may not be supported through them
• It can be poorly taught
• It can be inappropriately applied

• Most ‘side-effects’ are good: better sleep, less stress, coping better…
• Minor ‘adverse events’ (e.g. discomfort, frustration, sadness…) are common
• Not real ‘adverse events’ (e.g. aching muscles are after doing exercise – it comes with the territory)
• This is a necessary part of the process of learning to work with such experiences
• Documented cases of major adverse events (e.g. psychosis):
• q Rare
• q Generally with extended practice and inadequate supervision
• q Amongst less experienced practitioners
• q People with a predisposition to states like psychosis
• q Not in clinical trials

• Formal practice: mindfulness meditation
• Informal practice: mindful while engaged in daily activities and work
• Cognitive practices: perception, letting go (non-attachment), acceptance, presence of mind
• Avoid enemies of mindfulness: multitasking, unnecessary switching between complex tasks, cognitive overload, never unplugging