Mindfulness, Psychotherapy, And The Brain Part I
Dialectical Behavior Therapy and Mindfulness-based CBT are more familiar psychotherapies that utilize mindfulness training (MFT). MFT teaches the user to regulate the flow of energy and information in the mind. This leads to changes in the patterns of activity in the brain. With practice certain patterns and pathways can be inhibited and others amplified. Initially this requires effort and is state dependent, but with practice it becomes effortless, a trait. MFT helps the user identify separate “streams” of information flow in the mind, to shift attention, and learn the difference between the “bottom-up” experiential input (ie. “Just the facts”) versus the “top-down” chatter of our narrative– the stories and meanings we’ve made up. This helps to “objectify” the mind, and separate ourselves (“dis-identify”) from the mental activities of the mind.
We can consider “experiential” versus “meaning” flows. The narrative chatter of the mind includes memories, biases, and explanations we’ve filled in about ourselves, others, and how life works. Its like a running commentary. The medial prefrontal regions are likely where this “narrative circuitry” lies. This is what MFT helps separate from, “quiets the mind”and allows more clarity with the experiential flow. Why is this important?
Our patients are slaves of their narrative chatter. This contains the negative perceptions, distortions, self-doubts, beliefs about being bad, weak, different. When they learn that much of this comes from meanings and interpretations they made up as children, which stick, they can learn to selectively focus on experience and more and more easily disregard the chatter.
The right prefrontal cortex (PFC) is involved in negative emotions, such as anger, anxiety, depression, and when activated leads to avoidance and withdrawal. In depression and anxiety this area and the amygdala are hyperactive, relative to the left PFC which is oriented toward approach, reward, and positive emotions. Studies at UCLA have shown that when we use words to identify emotions, the left PFC is activated and the amygdala is down-regulated, and that MFT leads to a more pronounced effect.
MFT probably enhances regions of the brain involved in regulation of emotion, executive attention, insight and empathy, and moral reasoning. An article by Daniel Siegel, in SCAN (2007) reviews brain research and MFT. (Available online).
For our patients this translates into learning to calm and clear their mind, make better decisions, feel more confident, and be less worried about what others think. This improves self-esteem, self-confidence, hope, and generates further initiative and work in other areas, for example skills training, relationship improvement, and helping others.
The two key components of MFT are learning to be present, and nonjudgmental. MFT starts with identifying when our thoughts are in the past or future, and labeling judging as judging. We don’t control our thoughts or feelings, just identify them in the present, not judge them as good or bad, not hold on nor push them away. That’s a great start for many. Beyond that, people can learn to better understand their emotions, when to trust and act on them and when not to. They can learn to identify their thoughts, and weed out distortions. MFT does not require a therapist but applying it to symptoms and “life problems” may.
Adding mindfulness training to our treatment plans enhances many aspects of what we do, from treatment to relapse prevention to wellness. We do not need to teach mindfulness ourselves, instead there are many resources we can refer patients to. (See my website www.thepotentmind.com) You may be starting to see how mindfulness can even be applied to medication management. More on that next time