The Mindful Brain: Enhancing the Doctor-Patient Relationship Family Medicine Conference May 2013  Dr Simon Whiteman Division of Family Medicine, Stellenbosch University Institute for Mindfulness South Africa

Mindfulness Awareness of present experience with acceptance Secular applications and Mindfulness- Based Interventions (MBI’s)

Two Evolutionary Threads…     Default Mode Network Resonance Circuitry Doctor-Patient Relationship

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” Killingsworth MA, Gilbert DT. Science 2010; 330:932

The Three Primary Neural Networks Default Mode Network (medial PFC; post cingulate cortex) Salience/Attention Network (anterior insula; anterior cingulate) Executive Network (lateral PFC; lateral parietal)

The Default Mode Network “Thinking about something other than what one is currently doing” Self-referential processing Associated with mind wandering Can we shift this network?

Shifting Modes with Mindfulness Hasenkamp W et al. Mind wandering and attention during focused meditation: A fine- grained temporal analysis of fluctuating cognitive states. NeuroImage 2012; 59:750–760 Epstein RM. Mindful Practice. JAMA 1999; 282: 833

Widening the Integral Embrace The brain, body and the mind immersed in a relational world Relevance to the clinical encounter Evolutionary roots…

Stepping Out into the Plains

The Prefrontal Cortex Integrative function: a hub for self-regulation and social communication Social Engagement System: PFC, mirror neurons and T-P junction Secure/insecure attachment and PFC development

Resonance Circuitry & Attunement Social Engagement System Take in ”other” through 5 senses Insula Changes in limbic/body states Insula “We feel felt”

Mindfulness & Attunement Receptive, Attentive, Accepting of Flow of experience from moment to moment “Other” Interpersonal Attunement “Self” Intrapersonal Attunement

Functional MRI during Awareness of Breath Meditation

Does Empathy Matter? Del Canale S et al. The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy. Acad Med. 2012; 87:1243–1249

Mindfulness and the Clinical Encounter Intrapersonal and interpersonal attunement in practice Activating resonance circuitry in both clinician and patient From Integral perspective how we are is as important as what we know “True and lasting change in medical practice …has to come first in the hearts and minds of physicians themselves.” McWhinney, I. R. & Freeman, T Textbook of Family Medicine, 3 rd Edition, Oxford University Press, New York.)

A Final Thought… Present-centered awareness is the thread that binds brain, self and other in service of a more integrated and compassionate clinical encounter