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

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

3. Mental States Fly stuck on sundew leaves Fluid mountain stream

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

5. 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’)

6. Contemplation Focused attention on the breath

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

8. Contemplation Open monitoring of any and all experience

9. 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

10. 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

11. 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

12. In the Present

13. 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

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

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

16. Functional Magnetic Resonance Imaging

17. Levels of Brain Analyses

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

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

20. Social Anxiety Disorder

21. 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

22. 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

23. 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

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

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

26. 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

27. Emotion Regulation Results Emotion Limbic System threat Regulation modulation

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

29. Clinical Symptom Results

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

31. Neural Results Regulatory Cortical System Emotion Limbic System

32. 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

33. 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

34. 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

35. 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

36. Neural Substrates of Attention Alerting Orienting Executive Control http://www.sacklerinstitute.org/~jinfan/ Michael Posner & Jin Fan

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

38. 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

39. 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

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

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

42. Contemplation SELF

43. 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

44. 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

45. Self-Referential Processing Task

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

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

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

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

50. = Psychological Flexibility Regulatory Cortical System Emotion Limbic System

51. 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

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

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

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

57. 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

59. Clinically Applied Affective Neuroscience Laboratory & Collaborators

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

61. Funding

62. Thank you for your attention

63. Resources For social anxiety disorder contact the CAAN lab: –Call 650-723-5977 –Email: caan.cbt@gmail.com –Visit: www-psych.stanford.edu/~caan

64. Meditation Spirit rock: http://www.spiritrock.org –Check out: Sitting Groups Led by Spirit Rock Teachers throughout the Bay Area SF Zen Center –http://www.sfzc.org/ SF Buddhist Center –http://sfbuddhistcenter.org/

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

67. Clinically Applied Affective Neuroscience Psychology Department Stanford University 650-723-5977 caan.cbt@gmail.com www-psych.stanford.edu/~caan YouTube talks: Neuroscience of Mindfulness Meditation Neuroscience of Emotion

69. Study Structure Baseline Assessments WellnessMBSR Assessments

70. Home Practice Minutes per Week Mindfulness Aerobic Exercise

71. 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

72. 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

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

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

75. 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.

76. Cognitive-Behavioral Therapy Regulatory Cortical System Emotional Reactivity Limbic System