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4/5/2011 Meditation and Neuroplasticity Modern Science Illuminates Ancient Mind Development Pre‐Test 1. New brain neurons are not generated after middle to late adolescence (T) (F) 2. Childhood development and genetic inheritance are the sole determinants of the “happiness set th l d t i t f th “h i t point” (T) (F) 15th Annual ETSU Nurse Practitioner/Physician Assistant Primary Care Conference March 29, 2011 Johnson City, TN Jay M Griffith MD Staff Psychiatrist, Quillen VAMC Clinical Associate Professor, ETSU Dept of Psychiatry and Behavioral Sciences Diplomate,, ABPN Psychiatry and Pain Medicine Diplomate 3. Neuroplastic changes develop equally well in both attended and unattended states (T) (F) Learning Objectives Upon completing this one hour CME presentation, participants will be able to: 1. List 4 or more health benefits of meditation 2. Explain how meditation employs neuroplasticity to enhance brain function neuroplasticity to enhance brain function 3. Utilize relaxation meditation for personal and professional purposes 4. Learn one additional form of meditation for personal purposes Outline I. Neuroplasticity II. Review the Science of Meditation and Practice Briefly i i fl III. Introduce a New (Ancient) Contemplation Method 1 4/5/2011 Can You Build a Better Brain? Sharon Begley January 03, 2011 Newsweek Centers Involved with Researching Meditation and Positive Emotions CASEL ‐ Collaborative for Academic, Social and Emotional Learning Center for Compassion and Altruism Research and Education ‐ Stanford School of Medicine Center for Investigating Healthy Minds ‐ University of Wisconsin‐Madison Center for Mind and Brain ‐ University of California, Davis U i it f C lif i D i Center for Mindfulness ‐ University of Massachusetts Medical School Center for Neuroscience ‐ Indian Institute of Science Clinical Research, Education, Services, and Treatment (CREST) Program ‐ University of Colorado Department of Psychology and Neuroscience Contemplative Studies Initiative ‐ Brown University Emory’s Collaborative for Contemplative Studies ‐ Department of Religion at Emory Neuroplasticity Mechanisms 1. Changing activity in activation/inhibition (glutamate/GABA) 2. Long Term Potentiation (NMDA receptor) 3 Increase of synaptic activity 3. I f i i i 4. Increase of gray matter‐ neuronal connections 5. Increase of gray matter‐ neurons Functional Neuroimaging Laboratory, Brigham & Women’s HospitaL ‐ Harvard Medical School Institute for Empirical Research in Economics ‐ University of Zürich The Jha Lab ‐ University of Miami Mindfulness Awareness Research Center ‐ UCLA National Institute of Advanced Studies ‐ Indian Institute of Science Campus, Bangalore, India Neuropsychology, Emotion, and Memory Lab ‐ University of Arizona Department of Psychology Omega Institute for Holistic Studies ‐ University of Toronto Positive Emotions and Psychophysiology Lab ‐ University of North Carolina, Chapel Hill Prevention Research Center ‐ Penn State Social Neuroscience Department ‐ Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig Neuroplasticity Brain changes that occur in response to experience Davidson and Lutz 2010 2 4/5/2011 London Black Cab TX1 “The Knowledge” Website “All‐London drivers ‐ need a detailed knowledge of London within a six mile radius of Charing Cross. All London drivers have All‐London drivers have to learn 320 routes. to learn 320 routes They also need to know all the landmarks and places of interest along the runs. It takes between two and four years to pass the All‐London Knowledge.” “The Knowledge” • The Knowledge makes your brain grow • Doing the Knowledge makes your brain bigger, says research by the Wellcome Department of Imaging Neuroscience Imaging Neuroscience. • Researchers scanned the brains of 16 London taxi drivers who had spent an average of two years learning the Knowledge. They found the cabbies had a larger hippocampus ‐ an area associated with memory ‐ than control subjects. Navigation‐related structural change in the hippocampi of taxi drivers Maguire et al. 2000 Posterior Hippocampus – Navigation 3 4/5/2011 Other Findings • Positive correlation between posterior hippocampal volume and years served as a black cab driver • What causes the increase in volume, neurogenesis or synaptogenesis? • What are the implications of smaller anterior hippocampus sizes in drivers? Neuroplasticity – Increases in Gray Matter Neuroplasticity Summary In medical students’ hippocampi after preparing for major exams in Germany Increases of dentate gyrus volume with exercise‐ synaptogenesis vs neurogenesis (in mice synaptogenesis vs neurogenesis (in mice neurogenesis is meaningful only in the context of an enriched environment) Increase of gray matter in visual cortex in those recently taught juggling 1. We’ve known that children and adolescents have remarkable neuroplasticity, but we now find this in adults 2 These are 2. These are “attended” attended activities, i.e., people activities i e people direct their attention with some degree of effort 3. This suggests that all attended activities have the potential to evoke neuroplastic changes 4 4/5/2011 Can we use our mind to transform our brain? Would we like to: ‐ slow brain aging? ‐ increase attention? i tt ti ? ‐ shift the happiness set point? Meditation: The act of utilizing g g attention to guide changes in brain function and structure Is this possible? Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 Meditation Barnes and Bloom 2008 Individuals who used meditation in the previous 12 months YYear 2002 2007 Percentage of the population f h l i 7.6 9.2 (20 million) Meditatum (latin) : to ponder India >4000 years ago Even earlier? 5 4/5/2011 Did Meditating Make Us Human? “Campfire rituals of focused attention created Baldwinian selection for enhanced working ld i i l i f h d ki memory among our Homo sapiens ancestors....” Rossano 2007 Cambridge Archeological Journal Meditation Techniques II. Review the Science of Specific q Meditation Techniques and Practice Relaxation Response H. Benson, M.D. 1. Concentration 1. Sit in a quiet area for 20 minutes or more 2. Mindfulness 2. Direct your mind to an object of focus such as your breath, thinking “In” as you breathe b h hi ki “I ” b h in and “Out” as you breathe out 3. Compassion 4. Contemplation 3. When your mind drifts away as it inevitably will, passively direct it back 6 4/5/2011 Relaxation Response Functional brain mapping of the relaxation response and meditation Lazar et al. 2000 1. Is effective even though the mind drifts away as long as it is returned to the object of concentration without judging the “monkey mind” 2. Practice 20 minutes 3. Every patient who experiences anxiety and especially every patient who is prescribed a benzodiazepine is requested to add this technique to their “tool kit” 4. Can be used in clinic Functional brain mapping of the relaxation response and meditation Lazar et al. 2000 Meditation Techniques 1. Concentration – directing attention to a point of focus 2 Mindfulness ‐ 2. i df l awareness that new objects h bj have arisen in the mind 7 4/5/2011 Mindfulness Meditation Mindfulness Meditation 1. Awareness of the mind drifting away from the breath 2. Observe objects arising in the mind 3 Recognize and accurately label emotions 3. i d l l b l i 4. More refined self‐awareness 5. Psychotherapists are taught mindfulness and utilize mindfulness 6. Practitioners can use this in clinic 1. Treats anxiety, pain, depression 2. Mindfulness based CBT was no less effective than antidepressant medications in the long term treatment of depression term treatment of depression 3. Reduces stress 4. Improving emotional regulation 5. Changes frontal cortex dominance (positive emotions) Meditation experience is associated with increased cortical thickness Lazar et al. 2005 Meditation experience is associated with increased cortical thickness Lazar et al. 2005 Meditators (n=20) with 9.2 years of experience who practiced 6.3 h per week compared to controls (n=15) Increases of gray matter volume at Broadman area 9/10 and the insula “Area 9/10 has been shown to be involved in the integration of emotion and cognition” Older meditators demonstrated less cortical thinning compared to age‐matched controls 8 4/5/2011 Mindfulness practice leads to increases in regional brain gray matter density Change in Left Hippocampus Volume Over 8 weeks Holzel et al. 2011 Holzel et al. 2011 8 week intervention of mindfulness versus waitlist controls (n=16/17) Weekly 2.5 hour group meetings plus 1 full day (6.5 h) during week 6 of the course week 6 of the course Include a body scan, mindful yoga, and sitting meditation. Use mindfulness when possible throughout the day Results: mindfulness group practiced 27 minutes a day Brain volume increased at left hippocampus‐emotional regulation, posterior cingulate cortex‐ relevance or significance of a stimulus to oneself, temporo‐parietal junction‐ conscious experience of the self Gray Matter Increases Associated with Meditation The Method 1. Establish concentration on the breath 2. When extraneous thoughts or feelings arise simply observe them 3 Do not judge the thoughts or feelings 3. j d h h h f li 4. When you find that you are no longer observing these phenomena, then either redirect your attention back to them or return your focus to the breath Adapted from Holzel et al. 2011 Study Practice Lazar et al. 2005 Pagnoni and Cekic 2007 Hölzel et al. 2008 VestergaardPoulsen et al. 2009 Luders et al. 2009 Insight 20/15 Zen 13/13 Grant et al. 2010 Holzel et al. 2011 Meditators/Controls Insight 20/20 Tibetan 10/10 Multiple 22/22 Zen 19/20 Insight 16/17 Brain regions greater in meditators Right anterior insula and right middle and superior frontal sulci Meditators showed no age-related decline in the left putamen compared to actives Left inferior temporal lobe, right g hippocampus pp p insula,, and right Medulla oblongata, left superior and inferior frontal gyri, anterior lobe the cerebellum and left fusiform gyrus Right orbito-frontal cortex, right thalamus, left inferior temporal lobe, right hippocampus Right dorsal anterior, cingulate cortex, secondary somatosensory cortex left hippocampus, posterior cingulate, cortex, temporo-parietal junction, cerebellum 9 4/5/2011 Learning Objectives Learning Objectives Upon completing this one hour CME presentation, participants will be able to: Upon completing this one hour CME presentation, participants will be able to: 2. Explain how meditation employs neuroplasticity to enhance brain function‐ 1. List 4 or more health benefits of meditation 2. Explain how meditation employs neuroplasticity to enhance brain function neuroplasticity to enhance brain function 3. Utilize relaxation meditation for personal and professional purposes 4. Learn one additional form of meditation for personal purposes Repetitive, attention‐directed brain activity reinforces brain circuitry and increases gray matter volume. Increased gray matter volume likely reflects greater numbers of neuronal interconnections (and possibly increases of hippocampal neurons) Individual Differences in Anterior Brain Asymmetry and Fundamental Dimensions of Emotion Tomarken et al. 1992 10 4/5/2011 Happiness Set Point Left prefrontal dominance (EEG and FMRI) correlates with positive affect Right sided dominance is associated with g negative affect Stroke victims‐ left sided strokes produce sadness and right sided strokes produce elevations of affect State Effects of Two Forms of Meditation on Prefrontal EEG Asymmetry in Previously Depressed Individuals Thorsten Barnhofer 2010 Three groups: mindfulness meditation (n=8), loving kindness (n=7), and controls (n=8) Response Style Questionnaire (RSQ) total and RSQ brooding subscale) continuing attempts to reduce discrepancies between current and desired states Alpha asymmetry in the PFC High brooding demonstrated increased LPFC activity with concentration meditation Alterations in Brain and Immune Function Produced by Mindfulness Meditation Davidson et al. 2003 25 active; 15 controls 8 week intensive mindfulness meditation retreat Obtained data before, after, 4 months after Significant left sided asymmetry in the meditation group after the intervention Brain activation during compassion meditation: a case study Engstrom and Soderfeldt 2010 Advance meditator practicing compassion meditation Left medial prefrontal cortex extending to the anterior cingulate gyrus anterior cingulate gyrus Activation in brain areas involved with empathy as well as with happy and pleasant feelings (i.e., the left medial prefrontal cortex and the anterior cingulate gyrus). Low brooding demonstrated increased LPFC activity with loving kindness intervention 11 4/5/2011 Compassion Meditation Begin by hoping for happiness and well‐being Then extend this to friends and family Then generalize this so that you are hoping that all beings are happy and well A Contemplation on Impermanence to Decrease the Emotional Effects of Change Everyone in this room has observed nature and its changes Seasons pass, trees change, our bodies change, our minds change minds change Thoughts and feelings arise and pass Everything with a material basis is subject to cause and effect Impermanence Summary Stress arises because we seek to make that which is impermanent permanent Anything that our mind clings onto in a way that conflicts with nature will produce stress The stronger the clinging the greater the discomfort The stronger the clinging the greater the discomfort when the object passes according to nature We are not “judging” as to whether or not such clinging is good or bad We are simply seeing the truth of attachment and letting it go If performed accurately negative affects will not arise 1. Data indicate meditation has the potential to enhance physical and mental health 2. It adjusts brain circuitry and structure 3. Benefits are gained even by brief periods of practice 4. Using sophisticated strategies tailored to the individual may optimize its benefits 5. The greatest benefits may be gained by using these techniques in combination 12