Neural Bases of Meditation, Emotion Regulation and Self-Processing Philippe Goldin, PhD Clinically Applied Affective Neuroscience Stanford University

Goal Social Anxiety Understand and Reduce Suffering Meditation Methods Brain- Behavioral Mechanisms Regulatory Cortical System Emotion Limbic System

Mental States Fly stuck on sundew leaves Fluid mountain stream

Lutz et al Attention-based meditations: -Focused Attention - Open Monitoring Lutz et al. 2008

Focused Attention Directing and sustaining attention on a selected object (e.g. breath sensation) Detecting mind wandering and distracters (e.g. thoughts, images, memories, emotions) Disengagement of attention from distracters and shifting of attention back to the selected object Cognitive reappraisal of distracter (e.g. ‘just a thought’, ‘it is okay to be distracted’)

Contemplation Focused attention on the breath

Open Monitoring No explicit focus on any object Non-reactive meta-cognitive monitoring Awareness of automatic cognitive and emotional interpretations of experience

Contemplation Open monitoring of any and all experience

Mindfulness Based Stress Reduction (MBSR) Formal meditation practice –Breath focused –Body scan –Attention shifting to different sensory modalities –Compassion / Loving-kindness Informal meditation practice –Meaningful pauses Yoga / Stretching

Many Types of Meditation Concentration –Focused attention –Image (visualization) –Sound (mantra) –Open monitoring Analytic-linguistic-reasoning –Death meditation –Generating loving-kindness, empathy, compassion Emptiness/Shunyata –Dissolving mistaken view of nature of self

Definition of Mindfulness “Paying attention in a particular way, on purpose, in the present moment, and non-judgmentally” Kabat-Zinn, 1994, p. 4 Attention Alerting re-orienting, executive control Intention, motivation Experiential approach Attitude Acceptance, Curiosity

In the Present

Process Model of Mindfulness Meditation Follow Breath Attention Concentration Focused Open Distraction Attention Ruminate / Worry Mindless wandering Fantasizing Regain Attentional Focus Attitude Self-Judgment Self-Criticism Kindness Curiosity Intention Stress / symptom reduction Increase well-being Self-exploration

Mechanisms of Mindfulness Training? Emotion Regulation Attention Regulation Self-Referential Processing

Regulatory Cortical System Emotional Reactivity Limbic System Neural Model of Emotion Regulation +/- Threat Affective state Fear, Anxiety Regulatory Systems Self Language

Functional Magnetic Resonance Imaging

Levels of Brain Analyses

fMRI Brain Activation Negative Self-Belief Neural FiringNeural Circuit Oxygenated hemoglobin Amygdala ↑CBV, CBF, OxyHb, BOLD signal People think I am socially incompetent

Tasks Emotion Regulation of Negative Self-Beliefs Self-Referential Processing of positive and negative social traits

Social Anxiety Disorder

Lifetime prevalence: 12.1% 4th most common psychiatric condition Early onset –80% before age 18 (Otto et al., 2001) –Usually precedes development of depression, substance abuse, other anxiety disorders –Highest high school dropout rate for all anxiety disorders

Autobiographical Social Situation At a job I had about 6 years ago, I was supposed to introduce myself to a group of 5 or 6 new employees. The president of the company was speaking first, and then I was supposed to say a few words. My anxiety grew to such a heightened level right before I had to get up to speak, that I needed to leave the room and the building. I had to take a walk for about a half an hour before I even got up the courage to go back into the building to admit to my manager what I had done and how I had failed. Client x

Negative Self-Beliefs 1.Something is wrong with me 2.I am inferior compared to others 3.People think I’m an idiot 4.I am going to blush and make a fool of myself

Contemplation Lean back Rest in your mind & body Source of suffering? Deep held distorted self-belief What would freedom look like for you?

Study Structure Baseline Assessments WellnessMBSR Post-Assessments CBTWaitlist Follow-Up Assessments BehaviorEmotion Cognition

Rate Reactivity to Negative Self-Belief 12s Implement Regulation Strategy 12s Rate 3s 60s Emotion Regulation Task Autobio Social Situation Mindful Awareness Attention Distraction Cognitive Reappraisal Meta-cognitive shift to observation Count backwards from 168 by 1s Rate 3s Re-interpret the meaning of the belief

Emotion Regulation Results Emotion Limbic System threat Regulation modulation

Improved Emotion Regulation Post-MBSR ** p<.01 ** % Reduction in Negative Emotion Cognitive Reappraisal Mindful Awareness Attention Distraction

Clinical Symptom Results

Pre- to Post-Intervention Improvement CBT MBSR Waitlist Wellness * P<.05, ** P<.005, *** P<.001 *** *** *** * * Pre-to-Post Reduction

Neural Results Regulatory Cortical System Emotion Limbic System

REACT Negative Self-Beliefs Wellness –No changes MBSR –Right DLPFC –Bilateral posterior Insula –Left Inferior Parietal Lobule Cluster threshold: Voxel p 162 mm 3 Cluster p<.01 R RR

REACT: Amygdala BOLD % Signal Change Relative to Neutral 1.5s3s6s4.5s9s12s7.5s10.5s Negative Self-Belief 0s Emotion Rating y=-4 L 35 SP Baseline

REACT: Amygdala BOLD % Signal Change Relative to Neutral 1.5s3s6s4.5s9s12s7.5s10.5s Negative Self-Belief * p<.05 0s Emotion Rating y=-4 L 35 SP BASELINE 15 SP Post-WELLNESS

REACT: Amygdala BOLD % Signal Change Relative to Neutral 1.5s3s6s4.5s9s12s7.5s10.5s Negative Self-Belief * p<.05 0s Emotion Rating y=-4 L * 15 SP Post-MBSR

Neural Substrates of Attention Alerting Orienting Executive Control Michael Posner & Jin Fan

L Z = 42 X= -2 Y = 27 R MBSR Enhanced Attention Regulation Post > Pre-MBSR during Mindful Awareness vs. Attention Distraction

MINDFUL AWARENESS amygdala BOLD % Signal Change relative to Neutral 1.5s3s6s4.5s9s12s7.5s10.5s Negative Self-Belief * p<.05 0s Emotion Rating y=-4 L 35 SP BASELINE 15 SP Post-WELLNESS

BOLD % Signal Change relative to Neutral 1.5s3s6s4.5s9s12s7.5s10.5s Negative Self-Belief * p<.05 0s Emotion Rating y=-4 L * 15 SP Post-MBSR MINDFUL AWARENESS amygdala

Summary of MBSR for Social Anxiety Negative Self-Beliefs Emotion Reactivity Limbic System Attention Regulation Cognitive Regulation Sensory/ Visceral

Cognitive Reappraisal of Negative Self-Beliefs Post > Pre-CBT Language Self- regulation Attention regulation

Contemplation SELF

Meta-Analysis of Self-Referential Processing Cortical midline structures: ventromedial prefrontal, dorsomedial prefrontal, posterior cingulate/precuneus Statistical analysis based on 27 PET and fMRI studies on self-related tasks published between 2000 and 2004; Northoff et al. 2006, NeuroImage

Forms of Self Processing Analytic/Narrative Self –Past-future oriented –Fixed self-concept –Rumination Experiential Self –Present moment focused –Continuously changing experience of self –Reduced problems with memory, depression, and anxiety Watkins & Teasdale, 2003; Farb et al 2008

Self-Referential Processing Task

Self-Referential Processing 15 Healthy Controls16 Social Phobics Cluster threshold: Voxel p 162 mm 3 Cluster p<.01

MBSR Modifies Self-Referential Endorsement Time x Valence, F=5.60, p<.05, partial eta 2 =.41 MBSR % Self-Endorsement

Mindfulness Training and Self-View Reduction in neural bases of analytic/narrative self Linguistic processing Self- referential processing Cognitive appraisal

Summary of Mindfulness Training Effects Threat Emotion Reactivity Limbic System Attention Regulation Cognitive Regulation Self Language

= Psychological Flexibility Regulatory Cortical System Emotion Limbic System

Empathy/Compassion Neuroscience is investigating: - how we understand another person’s mind - take their perspective and experience emotional resonance - neural bases of training in empathy/compassion

"I feel the capacity to care is the thing which gives life its deepest significance." – Pablo Casals

Paul Ekman’s Model for Compassion Emotion Recognition Emotion Resonance Identical Reactive Familial Compassion Heroic Compassion Sentient Compassion Global Compassion

Motor Imitation in Infants Meltzoff, AN, Moore MK. Imitation of facial and manual gestures by human neonates. Science, 1977;198.

Neural Bases of Understanding Others’ Pain Cognitive perspective taking - mental representation of other; social cognition Empathy - in responses to pain, disgust, taste, and touch - emotion, sensation MPC, medial prefrontal cortex; ACC, anterior cingulate cortex; AI, anterior insula; SII, secondary somatosensory cortex; TP, temporal poles; STS, superior temporal sulcus; TPF, temporo-parietal junction. Hein, Singer, Current Opinion in Neurobiology. 2008

Clinically Applied Affective Neuroscience Laboratory & Collaborators

Mentors James Gross Gary Glover Stanford University UC San Diego Murray Stein Greg Brown John McQuaid Marsha Bates Rutgers University Brenna Bry

Funding

Thank you for your attention

Resources For social anxiety disorder contact the CAAN lab: –Call – –Visit: www-psych.stanford.edu/~caan

Meditation Spirit rock: –Check out: Sitting Groups Led by Spirit Rock Teachers throughout the Bay Area SF Zen Center – SF Buddhist Center –

Study Structure Baseline Assessments WellnessMBSR Post-Assessments CBTWaitlist Follow-Up Assessments BehaviorEmotion Cognition

Clinically Applied Affective Neuroscience Psychology Department Stanford University www-psych.stanford.edu/~caan YouTube talks: Neuroscience of Mindfulness Meditation Neuroscience of Emotion

Study Structure Baseline Assessments WellnessMBSR Assessments

Home Practice Minutes per Week Mindfulness Aerobic Exercise

Autobiographical Social Situations * p<.05 Error bars = SD * 1.How vividly can you re-imagine or re-experience that situation NOW? 2.How much humiliation, embarrassment or shame did you feel when you experienced this situation when it happened? 3.How much humiliation, embarrassment or shame do you feel NOW when you recall this situation? 4.How much do you actively avoid situations similar to this event? Very Much Not At All

Negative Emotion Ratings for Negative Self-Beliefs Negative Emotion  p 2 =.58  p 2 =.41 Mindful  p 2 = partial eta 2 effect size measure 35 SP Baseline 15 SP Post-MBSR 15 SP Post-WELLNESS

Social Anxiety Symptoms Liebowitz Social Anxiety Scale Total *** P<.001 ***  p 2 =.50 PrePost

Depression Symptoms Beck Depression Inventory-II * P<.05 *  p 2 =.31 PrePost

If you are distressed by anything external [or internal], the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment. Marcus Aurelius (Meditations) 167 A.C.E.

Cognitive-Behavioral Therapy Regulatory Cortical System Emotional Reactivity Limbic System