Staying in the Now: Mental Health Through Mindfulness

this program is a presentation of uctv for educational and non-commercial use only welcome back everyone again my name is Descartes Li and I'm the chair of this UCSF mini-medical school for the public entitled science of the mind and wanted to welcome you all back and thank you for being a really great audience I've been very pleased with the feedback about from the speakers about you saying what a great audience and group you've been and so I'm hoping you'll return the favor this evening and not necessarily saying totally wonderful things with this we could be giving a sexual honest feedback and suggestions about how we can make this course better for you today is the last presentation out of the six that we did and I thought it was a very good kind of broad overview of a lot of different topics in psychiatry and we talked a bit just to remind you we talked about dr. Volkow which talked about DNA and stress and depression dr. Steven Holl talked about aging and maintaining mood throughout the life cycle dr. Allison Harvey talk to you about sleep and its importance in maintaining your mood I talked about kind of the recent treatments in for depression mostly brain interventions and what they tell us about the brain and then last week we had a great presentation by dr. Paul Ekman about the face and facial expression and today I'm really pleased to present dr. Stu Stuart Eisendrath who's going to be talking to us about mindfulness and maintaining mood through mindfulness and I think it's very appropriate that he's going to be talking about some techniques that have been around for many thousands of years and look and it's I think a cool way to kind of end up the course kind of at the beginning in some ways let me just say a little bit about dr. Eisendrath before we get started he is a professor of psychiatry in our department he is the director of the UCSF depression Center he's also director of the clinical services at Langley Porter meaning he kind of oversees all the clinical service that are provided by us in a way he's my boss so I have to say good things about him but I would say good things about him no matter what he has extensive clinical experience he's been interested in the mind-body confirmed for a very long time he teaches a evidence-based psychotherapies including mindfulness based cognitive therapy which he's going to talk to you about today cognitive behavioral therapy and interpersonal therapy I have - a personal note he has been a great role model for me he's been a mentor to me and about I have to say about I think it was five or maybe ten years now Stuart came to me and we were talking about meditation mindfulness and how he was very interested in this and I thought to myself he's always so he's already so wise and relaxed and has so much perspective on things he doesn't need to meditate anymore it's kind of like if he does this it's kind of like the rich getting richer you know it's other people like me who we need to meditate more so I'm very pleased to introduce dr. Iser Drath and thank you for coming thank you very much for that nice introduction I'm happy to be here and be closing out the series it sounds like you've had a great collection of speakers I'm going to be talking about mindfulness meditation and sometimes it goes by various names in depending on the setting that you're talking about but we'll be focusing on mindfulness meditation and how you can use it in various ways to help your self deal with regulating moods and I'm going to be doing that by discussing a bit about what mindfulness is and then discussing some of the scientific literature about applying mindfulness meditation to different clinical problems and then we'll do some mindfulness exercise a little bit of experience and have a chance to talk about that a little bit and then talk about some of the current theories about how mindfulness meditation actually may be helpful what is it really doing in terms of its beneficial effects as Descartes said mindfulness meditation isn't really something new it's it's been around for 2,500 years or more and in fact if you look at many of the world religions some type of meditation similar to mindfulness meditation has been a part of it in one way or another but we're going to talk about it really separate from any particular religious focus and how it can be applied no matter what religion you might be and how it can be useful so what what is mindfulness what we mean by mindfulness is a couple of different definitions of it one and probably the most commonly quoted one is the top one by Jon kabat-zinn you know where mindfulness means paying attention in a particular way on purpose in the present moment and non-judgmentally so each one of those phrases is important in terms of how you think about mindfulness and we'll see that in a little bit I think as we go through some of this another way of thinking about mindfulness is it's non-evaluative awareness to one's inner and outer environment that means seeing things as they are accepting things as they are not judging them good or bad but just accepting them as they are I'd like to just illustrate though that this is not that that readily done in our everyday life often most of the time we go through life without much mindfulness I mean you know if you go to you know you're driving along and you get to a stoplight and you realize geez you may have gone through another stoplight or there were three stoplights did you stop them or not you know you may be driving not really paying much attention to what's been going on sort of a mindless way may still be or an automatic mode if you will which can be beneficial it can help you get through a lot of things that it's good you know we do things automatically like our breathing is automatic and so on but that when we talk about mindfulness we're talking about bringing attention to focus on something very specifically that's the essence of mindfulness mindfulness can be thought of as if it's a searchlight that you're bringing to bear and focusing on something and in our mindfulness exercises as we teach them in our classes we may focus on the breath or the body or different sensations but you can also bring it to bear on virtually anything but and it's not so easy I want to give you a quick example of this I want to I'm going to play something for you and it's a little scene and I want you to pay close attention to it and see if you notice anything unusual about it okay did anybody notice anything unusual happening there how many didn't notice anything special raise your hand okay so pretty good number how many did notice something okay maybe about a quarter of you what what did you notice her the shirt and different people okay what do others notice anything else his eyes were his eyes were closed okay how many noticed a different shirt and how many notice a different person so really about maybe 10 percent of you notice that let's look at it again so let's the same you want to see it again it is a different person it's just what this little this is from the visual cognition laboratory usually about 80% of people do not identify that it's a different person and so 20% on the first go-round pick it up 80% don't and you're just about in that same ballpark the reason I'm showing that particular thing is really mainly for fun but it also highlights of paying attention is not that easy to do even when I asked you to watch it and observe it it's it can be quite challenging there there are but they're all they were all right there but you that's there are a lot of things to focus on you're right and what you're going to focus on is something you have to turn that searchlight towards and that that can be a challenge sometimes but there's a lot of things that you could notice that we're different from one to the other is they affect his shirt his glasses his eyes and the person all there are a lot of things going on there that might be noticed that were quite differed and you can that's one of the things about mindfulness you can actually bring your attention to different elements at different points in time and the nice thing about mindfulness is that you actually are are free to choose what you're going to focus on so mindfulness is is something we'll talk more about how it's used and and do some exercise with it as well as we go along here but that was just an example of trying to focus the attention and how challenging it can be and the idea of learning mindfulness in our in our classes and the various classes that I'll mention is that it takes a while to train your attention to be able to focus on something so what is mindfulness been used for it's been used for a variety of things actually Jon kabat-zinn sort of brought it to this country in a modern version with stress reduction mindfulness based stress reduction about 30 years ago and that in turn has been applied to a variety of conditions such as chronic pain psoriasis eating disorders fibromyalgia cancer lately it's been used for parenting and childbirth discomfort and on the psychiatric side of things it's been used for treating anxiety depression borderline personality disorder addictions in mindfulness based relapse prevention and to some extent for bipolar disorder so it's been used for sort of an increasing number of different conditions and this is really not an exhaustive list it's just to give you a taste of what it has been used for in recent years and in most of these things there are studies that demonstrate its effectiveness for these conditions and I'm going to give you some of the those studies now this is a study that was done for generalized anxiety disorder where a person doesn't have a particular phobia or panic disorder but just generally feels anxious most of the day and this is I don't want to go into all the details of it but this is the beck anxiety inventory and as you can see at baseline the score was 19 and by the end of the training which was 8 weeks it had been cut in half to eight point nine one and similar well some of these other things are similar this is the profile of moods show it a similar nice change and where a decrease in score is good so it was very useful for these people and this has been shown in several other studies as well you have a question this particular study did not have a control group this was an open trial and we'll talk about control groups a little bit later as we go on this is a mindfulness Oh scale the mindfulness awareness scale that that act increased as you would expect it to with the training so it went from three point six eight up to four point two so that is one particular scale that is used to measure mindfulness so the people became more mindful by the end of the training so as the mindfulness went up the anxiety levels went down in another study that did have a control group a small study of people with bipolar disorder looking at people between episodes not people in full-blown episodes of bipolar disorder looking at anxiety and depression levels this is Becca anxiety and Beck Depression Inventory the in the control group you can see that the pre level of anxiety was 11 and actually worsened went up to 20 whereas in the in the group receiving mindfulness based cognitive therapy of a special form of mindfulness I'm going to tell you more about it went down from 12 to 6 and the depression levels again went up a bit in the control group and went down to about one half in the people getting mindfulness based cognitive therapy that was a waitlist control but the typical control group as two-hit would be to have the other half of the group wait and not get the intervention and get the usual treatment so what is mindfulness based cognitive therapy well it's there's basically sort of two main well one main form of mindfulness that many people learn and it's called mindfulness based stress reduction and that's as I mentioned earlier is something that was developed by Jon kabat-zinn and that has been used to treat a lot of physical ailments things like chronic pain or dealing with a cardiac condition or stress reduction and so on but in terms of dealing with emotions a derivative of that sort of modeled after mindfulness based stress reduction is mindfulness based cognitive therapy so it looks quite similar to mindfulness based stress reduction if you were looking at it from up above you'd see it's the same it's eight eight weeks long once a week group format and the sessions are actually two and a quarter hours long and then afterwards people come to a monthly maintenance session typically and they also practice while they're going to the eight a once a week for eight weeks they have homework and practice at home the other six days of the week doing meditations on their own listening to CDs or doing other forms of meditation and the group sizes vary from six to fourteen typically and they do things like formal meditations called a body scan and we're going to do a bit of one a little later mindful stretching things like yoga or mindfulness of the breath or listening to the sounds mindfully and then they we teach informal techniques like how to be mindful in your everyday life so like when you're eating a meal like eating it mindfully or when you're brushing your teeth what does it actually feel like if you pay attention to it I mean these are things that we normally do think about eating normally when you eat do you taste your food I mean typically we're you know we're talking with somebody else we're reading the paper we're watching TV we're doing anything but really tasting the food it can be remarkable to sit in silence and just taste the food and paying attention to what the texture of the food is the smells the taste just to do it for five minutes can be really remarkable I'll give you a bit of homework I'll tell you something you can try doing just as an illustration of that one of the exercises from mindfulness based stress reduction or mindfulness based cognitive therapy is eating a raisin mindfully and I know some people don't like raisin some do but whatever you whatever you do try eating a raisin so mindfully so when you get a chance pick up some raisins take one in your hand and look at it as if you've never seen it before like you're just fresh with fresh eyes notice it what it's like bring it slowly to your mouth smelling it and then put it in your mouth close your eyes and taste it move it around in your mouth and then slowly begin to chew it and you may taste it for the first time I know I did this when I in my 50s and you know normally we eat raisins you know one tooth if you eat them at all I mean you know you're throwing them in really not tasting them and I'll here's the here's the little secret homework for you when you do start to chew the raisin you could you will taste it on a spin a specific portion of your mouth your job is to find out where we also do things like a three-minute breathing space and to teach people a very short portable meditation that they can take with them wherever they go but the heart of mindfulness based cognitive therapy or mdc-t is to help teach people to see that there are thoughts that they develop it are just mental events and not facts a lot of times when we have thoughts first of all when the thoughts occur we make a critical error when we have thoughts we believe them and thoughts are just mental events they're transient and for people who are prone towards anxiety or depression those thoughts tend to run in negative directions so thoughts are kind of things that pop up Silvia Borstein talks about this as you know as our thoughts are like popcorn poppers we're you know thoughts just pop up and you know you're maybe sitting very quietly focusing on your breath or some other focus and you can notice a thought just emerge and it may be you know something negative but if you're prone towards depression or something something negative you know in terms of an anxious thought and those thoughts if you start to believe those thoughts can get you into a lot of trouble like oh I notice I'm you know like I wonder how I'm doing giving this talk today maybe you know it's like going over so well and this is happening this fellow doesn't look too wide awake and you are we going down you know right away a cascade of things go on and pretty soon I'm saying well I think I'll say good night you know - and that would be moving towards catastrophic thinking catastrophizing you know that is very common in anxiety disorders or depression and so those kinds of thoughts what we learn in mbc t is that those thoughts are just thoughts they're not real they're not facts and once people learn this it really frees them up quite a bit to be able to respond to them more skillfully so if I have that thought I can decide well am I going to pay attention to it or not I have a choice I don't have to pay attention to it so how do we get people to recognize that it's just a mental event we do that in various ways let's take an example right here let's take an example like this imagine that you're you're walking down the street and you see somebody you know on the other side of the street and you you wave to that person and the other person keeps walking by and they don't wave back what do you think what do you feel or just raise your hand if you have a lot of reaction they don't why they don't like me okay what was that they didn't see me okay Rock / I did I didn't see them right okay they're on the phone they're not paying attention okay they didn't recognize me okay maybe they're rude okay anybody else they're rejecting me okay good any other how do you feel in this situation confused I heard what else hurt rejected embarrassed sad angry relieved okay so I so what we do in the class is go we have you know we have 16 people we go around and say okay what's going on now what is the fact of that particular situation no that's right nobody actually knows I may be having all of these thoughts and I may be reacting you know in one of our classes where we did this somebody said that's exactly what happened with this guy they haven't talked to him since you know that's what he that's what happened and he was certain that he had been rejected by this person he had seen and that was it and versus I'll tell you by the end of the eight weeks the guy says you know I may have made a mistake so that's what mindfulness gives you some space some people think of it as mindfulness gives you space between the between the spark and the flame so there's a little bit of a gap there so instead of having to react say angrily like I've just been rejected I'm never going to talk to that person again in fact I'm going to send them an angry email or you know who knows you could say well maybe there's another possibility may I feel rejected but you know maybe they were on the cell phone maybe they're depressed and they're not paying attention or maybe they're they just got chewed out by their boss and they're upset or all kinds of different possibilities so there is no particular fact so it's helping people realize that there is no fact even though we may believe it and the initial response is to believe it absolutely the reality is there may not be any fact there to hang your head on it's just a thought I had the thought and instead of believing it and in running with it we said well it's - thought it may or may not be correct and in mindfulness you have a choice of whether you let that thought go or not which we'll talk about we call this D centering in mindfulness where you get some distance from the thought from a thought sometimes it's called metacognition or cognition is you know what we psychiatrists use for a thought fancy word and metacognition because it's beyond the thought it's like looking at the thought process like you know there's there's we just got 20 different possibilities for what happened in that transaction and those are different thoughts about it there is no there is no fact that we can hang our hat on so rather than saying well this is the way it is I can choose I can choose one that works better for me then the one I just chose let me give you an illustration about this and let me contrast mindfulness based cognitive therapy with cognitive behavior therapy which is more traditional in cognitive behavior therapy let's say let's use an example of somebody who's depressed in cognitive behavior therapy the typical kind of picture might be like this a person who's depressed would say something like you know I'm not a good person or I'm I'm a guilty person I'm an unworthy person I'm a failure I haven't done much I'll never be a success those are typical depressive thoughts I mean we actually there's we have some scales that where you can where we I have a list of the top 30 depressive thoughts they're very well worked out and the issue is now in cognitive therapy you might say when the person says I'm an unworthy person or I'm up not a very good not a good person in cognitive behavior therapy would say okay that's a negative thought try to weigh the evidence an answer back to that thought so when you say I'm not a good person what's the evidence that supports that idea or refutes that idea what's the evidence that you're not a good person what's evidence that you are a good person and and then say well I did do I was successful at this about it was it failed at that so so maybe I'm not a complete failure maybe I'm I'm okay as a person but I'm not a very good person but I'm not terrible either so maybe a more balanced thought would be I'm I'm okay as a person but not really a good person so you help the person come up with a change in the thought content now the trouble with this in say depression is the person usually has many years of evidence and when you ask them for evidence they may say well you want evidence I have a bushel basket fall because they've been viewing things very negatively for a long time so mindfulness based cognitive therapy has a different approach first of all when they say I am I'm not a good person or I'm a rotten person or something like that what we say is wait actually you're having the thought you're a rotten person as soon as you do that you're helping the person start to dissenter because they're moving away from identifying with that thought so I'm having the thought and now I don't really have to I don't have to argue about it I don't have to have evidence for or against it I can decide whether I'm going to hang on to that thought or let it go just like you just did now like I had the thought when the person didn't wave back to me that they don't like me well I can hang on to that thought or I say well actually I don't know maybe they just were on the cellphone they didn't hear me or didn't see me or so I don't really know well I'm having the thought I'm not a worthy person but you know I don't have to hang out to it and start running with that idea I can let it go so they start to learn how to distance themselves from those thoughts and be able to be without having to get into an arguable argument about whether it's true or not so it's thought process focuses it helps the person change the relationship to their thoughts rather than trying to change the thought content itself this is a radically different way of being in the world because most of us have the the thought a thought and we believe it we actually go around we'll even question it we have the thought you know you know whatever the case may be if you're prone towards depression you know I'm not a good person or I'm this or that or or if you're prone towards anxiety like things are going to turn out terrible that that's that's that's exactly what you believe without ever stepping back and realizing it's just a thought I mean depression the way we understand it is really the person feels as if they have experienced a loss anxiety is there anticipating a loss occurring so this relates to something we mentioned earlier about mindfulness we're trying to bring attention to the present moment and getting away from focused on the past or the future and just focus on the present moment it's it's something that we don't we don't do typically sometimes we do do it in certain experiences and some of us are more mindful in our naturally than others and when we look at people in terms of mindfulness scales if we did it right here in this room there'd be you know a variability amongst that amongst the group here some people who perhaps have never had any mindfulness or maybe very mindful just naturally and others less so but it is a different way of looking at things it's bringing attention to things that we don't typically do that's why that remember in that initial definition it's bringing attention with intention so it's something like wow I'm actually looking at my thought I just had this thought you know about this and I'm looking at it so it doesn't require that you be depressed or that you be anxious you don't have to do that at all I mean certainly mindfulness meditation does not require that you have that but I'm using it using these as some examples of how it can help with different mood states in terms of my to give you maybe another way of looking at this mindfulness based cognitive therapy when it was originally developed was first called selective attention training so it means you have to have the ability to focus the attention on to whatever you're focusing on the breath the body or so on there is a relationship they are quite different you're right and I'm not sure that the weather mindfulness based cognitive therapy is exactly the best term but it's the one that has been utilized the most they use cognitive therapy techniques but they use them too in a different way like you could use this exercise with the person the hand waving in a cognitive therapy way we use it to show attention to thought processes in cognitive therapy you might help the person try to change the thought content there is some room for confusion and you have to you you have to understand I don't want to go into all the there's there's a lot of differences some of the exercises that are used in the course have similarity a lot of the things in fact have similarity to traditional cognitive therapy things before example like when we use the automatic thought questionnaire to that top 30 list of depressive thoughts that was originally welp for cognitive therapy and in cognitive therapy what you would do with a person is say look pick out what are your top ten you know your Letterman top five thoughts and LEM let's challenge those and try to change them like this but in we use that same list but we don't try to change them what we do is try to notice those thoughts are quite variable here's a just an example of major depression and how mindfulness can be useful if you look at major depression that's another term for clinical depression if you look at in say a young person and childhood and adolescent you have a life stressor that may be significant it may lead to symptoms this is the threshold for exhibiting a clinic for a diagnosis this line here and so a person may have symptoms but they don't meet the criteria and then here they break through but you've noticed actually as a person gets older the amount of stress that they need to have precipitate an episode is actually less so that with time the brain gets sensitized and may activate episodes of depression with less stress so you have to develop some strategy for preventing these episodes and the way we currently do it is either with antidepressants on a maintenance basis or the newest thing is mindfulness based cognitive therapy so in mindfulness based cognitive therapy this is a study by Teasdale they took people who had recovered from depression completely and gave half of the people mindfulness based cognitive therapy in half didn't get it and followed them for a year the control was treatment as usual and in the people who followed for a year they had basically face the chance of staying free of depression if they had received mindfulness based cognitive therapy this study was replicated by Teasdale and his colleague MA Helen MA and they actually had even better results in this replication study so they had over twice the chance of staying free but this has some weakness in it because the this is just treatment as usual that you know this group is getting eight weeks of the good stuff and the other group is not getting that so coy Caen at Exeter University in England actually did a very interesting study which is a better controlled study where he took people who had recovered with antidepressants from depression and they were on antidepressants and randomized them to receive either mindfulness based cognitive therapy and taper off their medication or continue with the antidepressants that was the control and that's the conventional treatment this was a high-risk group though these are people who had multiple episodes of depression so they were likely and he picked that because they wanted to see that they were going to have they were in a sense hoping they would have a different be able to see the relapses in a year's period and what they found was that in the comparison between mindfulness based cognitive therapy and antidepressants they were equivalent statistically one was as good as the other actually mindfulness based cognitive therapy had a better rate of preventing relapse 47% relapse versus 60% with antidepressants but statistically in the analysis they were equivalent but when they looked at depression levels and actual quality of life the mindfulness group was actually better so this was a very interesting study that actually is a very good control this was done in England and the control was treatment by their general practitioner now this I just want to mention something that is I'm particularly interested as Descartes mentioned them director of the depression center here and I am interested in depression so I'll impose that on you a little bit but the we we have a problem here with treatment resistant depression in this country and actually in the world here's an interesting fact you know that major depression clinical depression is the number one cause of disability in the world after infectious diseases in the in the development that's in the developing countries in say example North America in the developed countries it's number one more so than cancer or coronary artery disease some of it has to do with stigma and not addressing problems but that's changing part of it is we you know we've developed the depression center here and there's a bill before Congress now that was introduced by Senator Stabenow from Michigan with a co-sponsorship by three other senators to establish comprehensive depression centers across the country similar to comprehensive cancer centers that were established thirty years ago if you remember comprehend the cancer used to be the c-word if somebody had cancer well let's not talk about it and depression is much the same and what we want to do by having depression centers is move it out so it is talked about because you know depression is a very common entity it's the most common thing that anybody in this room is going to deal with amongst ourselves or loved ones or friends that we have and it's something we need to be better at treating as Silla straights here's the something that drug companies might not like either if you take the star D trial which was a sequence treatment alternatives to relieve depression this was the largest n IMH trial ever done 54 million dollars what it did was treat people and said so we don't really know how to treat people sequential e if you know if we treat them and they don't respond what do we do so it gave started out with people gave each person citalopram they gave it because that was off patent that's why they selected that drug they gave everybody citalopram which is otherwise known as celexa if they didn't respond to they had a full dose of that after 12 weeks then they went on to a second stage and received a different antidepressant or a combination or cognitive therapy if they didn't respond to that they went on to a third stage or to a fourth stage now if you look at this this is really remarkable after one full treatment only 30% of the people had fully recovered that means 70% had not recovered if they then went on to the second stage they added another 20% so after two full treatments that means 50% had fully recovered but 50% hadn't so that means we have a big problem on our hand and then if you actually follow it out for all four stages of treatment by the end of it only 43% of the people are still in full recovery after one year of treatment so it's a very challenging disorder that's why we need other treatments besides just throwing another round of medication we need to have other things too and I'm not against medication by any means they can be life-saving but we have to add things to it and mindfulness based cognitive therapy mindfulness techniques may be a very valuable addition I'll show you briefly what we did we took people and I don't have to go into the details they had the Beck score of about 24 we compared them to another group receive medication management and this shows the results that the people who receive MBC t in our depression center the way we follow-up it is that there's an artifact here actually the medication management patients were filed were at 12 weeks was their endpoint because that's how long we fought we periodically follow them and an MB CT we capture them at the end of eight weeks and there was a decrease in anxiety and a very marked decrease in depression levels to about half in this population so was very effective in this group this just represents it so quite a few higher you can see 30% of the people completely recovered versus only 10% in the medication management only and these are some other studies that showed some these are open trials without controls but showed similar reductions in depression levels it probably isn't important except to say there's now growing evidence it isn't important to go into the details of these but there's growing evidence that mindfulness based cognitive therapy which was originally developed just to prevent relapse can actually be used as a treatment modality for depression as well this was a study by Kingston which was a randomized study comparing mindfulness based cognitive therapy to treatment as usual showing a marked effect for mindfulness so how does mindfulness work what we do in our classes are really a series of different meditations ranging from body scans to sitting meditations to sound meditations and what we find is some people love the body scan some people hate the body scan and they like sitting meditation or vice versa you know and really what we try to do is say here's a menu of things and some people like walking meditations for example we're going to give you a range of things and you know you get to pick for yourself and the idea of this is you decide for yourself what really works for you and if the body scan is not something that you know is what you connect to you know that's okay it's just you know some people are more oriented one way versus another so you may sometimes you may pay attention to well you know what's going on there that I don't notice this I mean there's a lot that could be done with that particular thought I mean without going into it more specifically sometimes you get to notice things as you're doing a body scan like geez my I'm holding a lot of tension in my shoulders like you know at the end of each day or I'm really angry at my boss today and you know I have a headache a lot of tension here or something is going on that you may notice certain things that get brought to the to your attempt that's where some of the insight comes from actually is that when you sit down and give yourself the opportunity to look at these things you can learn a tremendous amount from these sort of seemingly small things there's variation something you can do a body scan starting with your head and some teachers do it that way some people do it with the feet more I would not say one side versus the other to stimulate one side of the brain versus the other oh that's an interesting thing that could be potentially tested people do at various ways sometimes people do start with the feet because they think it's furthest away from the head and what we're trying to do is get people into the present moment and not be thinking and starting with the feet is sort of a vehicle for doing that some people start what they had is there's no particular convention or reason that you could specifically say scientifically you should do one thing versus the other but it's very common that people as you probably all experienced for your minds to wander it's it's what mines do most people have the misconception about meditation is I'm doing it wrong because my mind wandered but meditation is really your mind wanders and you notice it and then you bring it back your mind wanders you bring it back and if it wanders a thousand times you bring it back and that's the meditation it isn't just I lacked my mind in on my toes and that's it it's becoming a gentler and kinder with yourself about your mind wandering because so let's talk about this a little bit focus on the here and now the breath coming in and out and what's going on in your left leg and foot right and dropping away everything else and this relates to moods how well as we talked about you know with a lot of anxiety and depression type of moods people are there they're looking towards the future disasters that are going to happen or the ones that have already happened they feel as if they've happen so if you help them to say focus let's not worry about that let's focus on the present moment it is naturally helps the mood at least this is what our these are theories and I have to say nobody is completely clear on exactly how this is these are some of our theories about why this may be we know that it can be quite helpful why it is we're still working on and that selective attention by itself focusing on say the foot or the breath may relate to this that you have a tendency if you're focused on something like that that you're not doing things like ruminating ruminating is something that tends to lead to either anxiety or depression ruminating are you know is most people here's another type of thought that most people think you know I'm ruminating about some they didn't maybe knit maybe you don't even had identified as ruminating they just say well listen I had this interaction with this person at work today you know I should have said this to them I wish I had said that if I'd said this this would have happened you know and well if I'd said that that would have been so good so maybe I should have said this and they think there what are they doing they never step back and D Center what am I actually doing what I'm ruminating if you ask them well I think well I'm getting ready in case it happens again but it doesn't lead to problem resolution in fact rumination has a tendency to lead to worse mood so if you're focused on your breath it sort of fills up your your minds capacity you're not you're not ruminating so focusing your attention decreases this we also think that mindfulness can enhance compassion and self compassion so it's towards yourself and towards others the decentering is an important element of mindfulness because you start to be able to notice thoughts as they emerged it's a it takes usually having a you know practice at this and having a steady focus for a while and then you can start to notice when these thoughts emerge and you can start seeing them as well actually this is just a thought and not be so trapped by it and that may be an important element of CBT in fact because what we notice in traditional cognitive behavior therapy when we've looked at that people actually start to improve before they change the thought content we said well in CBT you have to help people change the thought content actually that is a slight misconception people start to improve in CBT as soon as they start to notice that they're having a thought as soon as the person can say instead of I'm a unworthy person that I'm having the thought I'm an unworthy person that alone helps them improve here's a important idea about mindfulness is that mindfulness may help you accept or things as they are or in other words this equation is quite useful that the modest suffering a person goes through and we all suffer to some extent is equal to resistance times the pain and this can be emotional pain or physical pain if you resist it you actually end up suffering more so if you say what do I mean by that this is not to say that resistance mean acceptance means so if you lower resistance you're just accepting it and resigning yourself resistance actually means lowering resistance means like what we see in in depression or pain for example is that a person has pain let's say a physical pain where they may say oh it's terrible I have this pain it's I'm a weak person because I have this pain I shouldn't have this pain it's unfair I have this pain I'll never get over this pain all of this is the resistance versus saying you know I have this fit these physical sensations which are painful and I can accept them as they are right now and that hat and and go on living my life with them and if you actually lower the resistance you lower the amount of what Sapolsky has called adventitious suffering that only humans do by that I mean if you have you know if an animal steps on a thorn in the woods the animal feels pain sensations but they don't say you know did I deserve this or you know you know maybe I should have listened to what my mother said or you know I should have done this you know they don't go into all kinds of things around they still have pain the pain is still there but the amount of stuff that gets laid on top of it and multiplies it is diminished and that's the same whether you're talking about physical pain or emotional pain so it may be even with even with depression it can be quite the same you know for example Winston Churchill described his depression as being the black dog you'd say the black dog is back today and in fact in Australia they have a black dog depression clinic which is doing quite a bit of research on depression some very interesting work but they I like that image because you know you could say well okay the black dog is back today and now how am I going to react to this I could be terrified I can you know want to escape and so on but if I say well okay I'm going to accept it just as it is I can actually look at it study it you know observe what's going on and then the black dog doesn't it may still not be a beautiful dog but I don't have to be terrified and that resistance you know the terror component can be greatly decreased and that's true in depression for example many people we find are very depressed about being depressed that is their laying on additional suffering to an already painful emotional state and it doesn't mean I'm suggesting that they accept it and resign themselves to it but if they can accept it and say okay this is what it is today that then they're in a position actually to do something about it without the terror and so on and as many of you know for example in substance abuse acceptance is again lowering the resistance in a sense acceptance is another is the sort of the reciprocal of the resistance if you excel with substance abuse can never do anything about their condition until they accept that they have the problem if they don't accept to have a problem they will not be in a position to do anything about it here's a little cartoon I also mentioned that we think the self compassion may be playing a role you how does self compassion work well it may help buffer some of the feelings of criticism that one has towards the self in people with depression or anxiety are often very critical of themselves and that you learn with mindfulness to be kinder and gentler to yourself you know if you can accept yourself say okay my mind wandered I can accept that without saying oh boy I'm stupid or boy I'm a failure at this or I you know I'm not doing it as good as the person next to me say am i water I just noted and bring the attention back and for you know I can accept that then you're as one person said in the group if I can forgive myself for my mind wander I guess I can forgive myself for other things the so people start to say things like this I'm gentler on myself and less critical I can talk back to myself more and handle stress better we did another study I won't say more about it except it's yeah it just it highlighted this was a it showed that when we measured certain factors in these people the anxiety levels decreased and just in terms of what is different about this slide compared to some of the other things we actually measured rumination and that people actually did ruminate less using mindfulness techniques okay here's just a couple slides then we'll open up for questions now there are there is evidence about biological changes with mindfulness at the University of Wisconsin Richie Davidson and his colleagues did an interesting study a few years ago they taught people mindfulness based stress reduction and showed that after eight weeks of study they what they did was take a group of employees at a corporation outside of Madison and half of them got mindfulness based stress reduction half of them were wait-listed and the people who received mindfulness based stress reduction after eight weeks had changes in their EEG their electroencephalogram where they had activation of their left prefrontal cortex which is the area of the brain associated with positive mood states so there's a convergence of evidence about these things that activating certain areas of the brain seem to have powerful mood effects and you can do it in various ways directly say with transcranial magnetic stimulation but mindfulness meditation may do similarly and they also measured antibody levels in response to immunization and found that the people who would receive mindfulness training had enhanced antibody response now here's I think my last slide almost left the just a show this is an fMRI scan of people who received mindfulness training eight of mindfulness training and what it shows is that people had activation of this portion of the brain as you see this is sort of midline if you this is a slice here's the eyes right here right this is a slice in these people before the training they had this central focus and here you see it's shifted towards the periphery I don't want to go into all the details because it's a little complicated but what it's showing is that with eight weeks of mindfulness training that these people had a shift in their their brain functioning that was measurable using functional MRI techniques this is there's two ways of measuring well there's two essential ways that we image the brain is either functional MRI or PET scans and these are fMRI scans that show these people having a difference by having the mindfulness training compared to being when they started out and so what were the I think the important element here is that you can make real significant difference in brain functioning through this kind of training and we're just at the verge of understanding exactly how to do it in fact this is our study that we're doing now here for we're taking people who have treatment resistant depression and we're randomizing them to receive either mindfulness based cognitive therapy or the health enhancement program as the control condition and this health enhancement program consists of physical functioning music therapy and nutrition so it's quite an active control and we're going to follow them before and after and then for one year afterwards that we're hoping to add the functional imaging component this is already underway and funded and we're hoping to add this imaging so that a portion of these people will be able to get this as well but one of the exciting things about this area is we're learning that by focusing attention you can actually train the mind have very powerful effects two weeks ago we had our depression symposium here and I think Descartes probably also talked about deep brain stimulation for refractory depression where Helen Mae Berg from Emory spoke and she's found that by putting an electrode into a certain area of the brain called area 25 and stimulating it for people who have severe depression that fails to respond to anything else she can instantly turn off depression and then they implant a pacemaker like device and the people can have continuous relief of depression these are very this is not for everybody because most people don't like they have their head rolled open but but it but it highlights what the amazing thing about it I think is not just that it can work for these people but she's found a key depression circuit in the brain then our next speaker on this actually from Stanford Ian Gottlob spoke about how they're using fMRI feedback to train people to do the same thing without sticking an electrode in but by training them in the fMRI machine to actually learn how to do this through feedback just like biofeedback when they learn how to control this one area of their brain so it's pretty powerful and we think that mindfulness has a somewhat similar effect and we're going to look to measure this in our in that in this study so let me stop at this point I'll mention these are some of the collaborators who have worked with me on our study it's called the prac the all practicing alternatives to heal depression study and it's looking at people who have failed to respond to two or more antidepressant trials and it will we'll be doing it over the next several years back there that's a common one I guess it's called meditation practice early I'm wondering also has there been any do you ever work with dissipating the self so that people can see that they are not necessarily their thoughts and I think that's this culture you know the one of the foundations of Western thought every time you save the car I think Rene Descartes I think therefore I am that's spective Western thought that conflicts with mindfulness sense that that what a lot of Eastern traditions see as compulsive ideation or illumination we see as the essence of the ego or the self being this I think therefore a hand so it seems like we have a particular disadvantage and mindfulness press against some of the foundation yes I think you're right that I mean there are different cultures come to this more or less easily and the view of the self can be an important component of that so as you raise some excellent points I think they're difficult to get into further here but I think they're very good points yeah so I had people tell me that people can be depressed and not know it so are there other ways depression manifest itself besides just having well you know I was very surprised when he said that's a common feature of depression but it's not mandatory to make the diagnosis and there are people who experience say not sadness so much but lack of ability to enjoy everyday things so like they normally would enjoy well they lack energy they lack I'm sure he showed you you know like the nine Cardinal symptoms and if you have five of the nine that's enough to make the diagnosis and many people don't don't have certainly all nine and they and depressed mood may not be part of it and sometimes as particularly as people age depressed mood may not be the most prominent feature people may have more physical symptoms and you know they may go they may go see their primary care physician more than they go see a psychiatrist and they go with you know I just have lack of energy I can't enjoy things and I have this bad back and stomach ache or whatever headaches or whatever those somatic complaints are and but if you go through the list of symptoms they may fit the criteria but they don't have depressed mood I've treated people I saw a man some time ago who had he had absolutely no depressed mood he had lost six five pounds of weight 65 pounds of weight but if you asked him are you depressed no absolutely not we treated him with an antidepressant and he responded beautifully started to function much better according to his wife gained weight and asked him again do all did you think you were depressed no I was never depressed and so I mean it's buddy but it's functioning and his ability to enjoy things change dramatically so it can be a tricky diagnosis I watch pretty much the standard of care around depression is a depressant maybe Plus talk therapy usually 20 sessions or less maybe a recommended when is this understand character when are we going to actually I just I mean there's no way I know that the rhetorical question but this is wonderful it's really I see this is the hope for depression because I've watched people not respond to any presents are about to because it's work for a short period time and I just I want more research research start prescribing and yes well it's a good question but you know it there there are a number of studies but there's this this study is actually the first study that is a randomized control trial of actively treating depression the other studies that I showed you that were randomized trials were for relapse prevention so this is the first study that actually treats depression and you know we're at the it'll be you know we're at the stage of building the evidence base for introducing this if this is you know if this is effective it'll be I think pretty powerful in moving the field along the question is what's the difference or similarity between dialectical behavior therapy there's a lot of overlap between them dialectical behavior therapy has a significant mindfulness component in it and if you remember from the first slide I mentioned or one of the early slides about borderline personality disorder that's designed specifically by Marsha Linehan for dialectical behavior therapy it usually differs in it doesn't have specific discrete meditations like this it has sort of more focal applications of mindfulness but it's there's a lot of overlap there's a lot of things that are developing around this dialectical behavior therapy acceptance and commitment therapy mindfulness based cognitive therapy these are all they have a lot of overlap between them and there's different variations but a lot of connection Ellen May burg did the deep brain stimulation for area 25 for for treatment refractory depression back there okay so you're asking what's how what's the difference between MBC tea and MBSR they're quite similar a lot of the meditations and the basic structure are exactly the same I'd say that where they differ is MBC tea is really focused on depression and anxiety and it's so it's focused on the emotional side of things MBSR if you have taken a class like that it's there's people there are people with anxiety and depression but there's people with heart disease cancer pain fibromyalgia everything so it really can't be focused on the emotional aspects per se so there's much less of a focus and so there's there's quite a difference in the feel of the two of them for somebody who has a more general thing MBSR is a very good choice for somebody who's dealing with emotional aspects mbc t is a focused effort but a lot of the meditations are the same and you know you could approach it you know if you don't have access to mbc t for some reason you could certainly give MBSR a first shot well for somebody who qualifies the question is as what as NBCT being used for it is MBC tea was originally developed for relapse prevention but there are now I think six or seven trials some one randomized small trial showing it to be effective for depression for active depression so so there are numerous open trials this will be the first large-scale clinical trial of it so but we are using it here at UCSF for treating people and the results you know have been quite good in in our experience with it but you know until we finish this study you know we can't say for for sure and we're the study Stanford that well there's some at Stanford there's there's actually one for at Pittsburg also with children that have I don't know the answer to that I'm not aware of it but it they could be and you'd think there might be some use utility in terms of training attention and so on but I just don't know that area well enough wasn't it true that certain people when they did how does that go they did mindfulness but actually they're moving on down in one of your studies I don't think so yeah they're in there's no I don't think that's true yes those four negative moods so there were in yeah you have to be careful in interpreting some of those instruments we're going down or going up may mean different things but in that study of generalized anxiety the moods the anxiety levels went down and the mood improved and the vigor profile moods have has different components and the moods improved with mindfulness so thank

Channel: University of California Television (UCTV)

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Keywords: mindfulness, health, depression, mental health

Id: mdZwybJF8Uc

Length: 80min 43sec (4843 seconds)

Published: Thu Jan 21 2010