Toronto is a major centre for mindfulness work. Jon Kabat-Zinn, the originator of mindfulness-based stress reduction (MBSR) taught just south or Toronto, and trained many of the practitioners in the area. So it is fitting that diverse aspects of the study of mindfulness were brought together on the first day of the APA 2015. Dr Norman Farb (University of Toronto) opened the session by discussing neural mechanisms of mindfulness.
Mindful not Mind Full: how meditation changes the brain
Clinical studies show mindfulness fosters resilience against stress and reduces risk of relapse in depression. The likely explanation, according to Dr Farb, is that meditation rebalances neural networks in the brain, shifting the emphasis away from areas involved in cognitive appraisal to those mediating immediate sensory awareness.
Intention, attention and attitude
A working definition of mindfulness is purposeful attention to the present moment in a non-judgmental way. Focus on the physical sensations of breathing is the tool. Thoughts are noted as they arise and pass. When the mind wanders, as it inevitably will, it is gently brought back to the breath.
The majority of the packed audience were already using mindfulness in their clinical work. But all of us started by experiencing a few minutes meditation for ourselves: very likely a first at the APA.
The instructions are simple. Why, then, is mindful meditation so hard? The answer seems to lie in the default brain network that comes into play when we try do nothing in particular. As soon as we are not absorbed, we habitually – almost automatically – jump into conceptual self-evaluation based on past and future events. Such self-evaluation has a place. But when the events are negative, and consideration becomes rumination, the consequence can be a spiral of distress and self-doubt.
Lighting up the brain
MRI studies suggest that self-evaluation is mediated by activity in midline structures of the prefrontal cortex. Attention to breathing and other immediate bodily sensations is associated with activity in limbic structures including the thalamus and insula and in primary sensory regions. Before-and-after imaging shows that mindfulness training alters the balance of activity between these two neural networks. We are doing something measurable: meditation lights up the right side of the brain, said Dr Farb. We are not just rebranding relaxation!
Walking the line of the here and now
Dr Katalin Margittai from the University of Toronto discussed some clinical aspects of the application of mindfulness in relieving stress-related suffering. She reported the results of a 3-year naturalistic research study of mindfulness-based stress reduction (MBSR) in patients with chronic health problems. In the 8-week MBSR programme, these patients were given mental exercises (meditations and focussed awareness), physical exercises (yoga and mindful movement) and homework (using CDs of mindfulness meditations, and reading). Controls were people on the waiting list for the MBSR programme, or those receiving out-patient psychotherapy. All those enrolled were assessed using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS) and a visual analogue scale for pain, as well as two measures of mindfulness skills (the Toronto Mindfulness Scale [TMS] and the Mindfulness Awareness and Attention Scale [MAAS]), at baseline, after the 8-week course, at 1 month of follow-up and after 1 year.
Minding the gap
At the end of 8 weeks, subjects on the mindfulness programme and controls both showed clinical benefits, in terms of improvements in depression, anxiety and stress. Those enrolled in the MBSR programme showed significantly greater reductions in depression and stress than the controls. Moreover, these improvements in depression and in mindfulness skills were preserved beyond the end of the program, at 1 month and 1 year of follow-up. (There was a small statistically significant increase in the BDI at follow-up, but this was not considered clinically significant.) In addition, the reductions in scores on the BDI, BAI and PSS showed modest correlations with the increased acquisition of mindfulness skills (that is with increased scores on the MAAS).
Are you not thinking what I’m not thinking?
Thus, Dr Margittai concluded, the degree to which a person is able to attend to the present moment in their everyday life can be modified by this mindfulness-based stress reduction programme, and this restructuring appears to confer greater resilience to psychological syndromes such as anxiety and depression. This intriguing association between cultivating mindful awareness and a reduction in clinical symptoms requires further study.