Post on 15-Jan-2016
Zindel V. Segal, Ph.D., C.PsychZindel V. Segal, Ph.D., C.Psych
Distinguished Professor of Psychology in Mood DisordersDistinguished Professor of Psychology in Mood Disorders
Department of PsychologyDepartment of Psychology
University of Toronto ScarboroughUniversity of Toronto Scarborough
How Do Mindfulness-Based Interventions Promote Adaptive Clinical and Neural Pathways of
Emotion Regulation?
What do the Dalai Lama, Aaron Beck and Sigmund Freud Share in Common?
Situation Emotion 0 - 100%
Automatic Thought (AT)
Evidence to support your AT
Evidence Against your AT
Balanced/ Alternative Viewpoint
Re-rate Mood 0 –100%
I asked my sister to look after my son so that my husband and I could go out for dinner. She said no. She said I should spend more time with him now that I am back from the hospital.
Guilty 70% Rejected 80%
She is telling me how to raise my son.
My son said he is worried about me. My husband is doing most of my chores.
My son has made 2 new friends at school. I make sure to read to my son every night before bed.
Having depression doesn’t automatically make me a bad mother. When I condemn myself it is often the depression speaking.
Guilty 40% Rejected 40%
I am a bad mother.
Learning how to Regulate Distressing Emotions is Aided
by…
Insight
Metacognition
Decentering
Mindfulness
Mentalization
Cognitive Defusion
What is Mindfulness?What is Mindfulness?
MindfulnessMindfulness is a type of awareness that is is a type of awareness that is developed by paying attention in a particular developed by paying attention in a particular way: on purpose, in the present moment, and way: on purpose, in the present moment, and without judgment. without judgment.
Like any Like any skillskill it takes practice. it takes practice.
Accesses the present moment, thereby clarifying Accesses the present moment, thereby clarifying the range of the range of choiceschoices that are available to you. that are available to you.
Training Once Offered in Monasteries Is Training Once Offered in Monasteries Is Now Increasingly Available In Health and Now Increasingly Available In Health and
Mental Health CareMental Health Care
Eating MindfullyEating Mindfully
Scanning the Body Scanning the Body
Mindful Walking or StretchingMindful Walking or Stretching
Mindfulness of the BreathMindfulness of the Breath
Mindfulness of Thoughts Mindfulness of Thoughts
Episode
Symptoms
RecoveryTreatment
Episode
Episode
Depressive and Anxiety Disorders are Frequently Recurrent
Hollon, et al., 2005
What Is Required to Help Patients Become their Own Therapists?
Sadness
Worthless
Unloved
Stupid
Failure
Hopeless
Representation of negative views of self and emotion in semantic memory following an
episode of depression
Sadness
Worthless
Unloved
Stupid
Failure
Hopeless
Each additional episode of depression strengthens these links.
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SadnessWarm
Curious
Ambitious
Worthless
Unloved
Stupid
Failure
Honest Hopeless
Generous
These Modes of Mind Can Be Retriggered Even When Depression is Not Present and Inhibit Positive Information
From Coming to Mind
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Two Ways of Knowing
Mindfulness Based Cognitive Therapy Mindfulness Based Stress Reduction
8 weekly group sessions2 Hours per session, 8-12 participantsCommon diagnostic composition – depression / anxiety
Gradient of Attentional Focus in Mindfulness Training
TangibleTangible
IntangibleIntangible
• Mindful EatingMindful Eating• Body ScanBody Scan• Mindful Walking or Mindful Walking or
StretchingStretching• Sitting with the BreathSitting with the Breath• Sitting with Sounds Sitting with Sounds • Sitting with Thoughts Sitting with Thoughts • Sitting with a Difficulty Sitting with a Difficulty
Mindfulness Meditation Trains 2 Types of Attention (Lutz et al., 2008)Lutz et al., 2008)
Open MonitoringOpen Monitoring
• No explicit focus on objects of awareness.
• Non-evaluative labeling of experience.
Focal AttentionFocal Attention
• Directing attention on a chosen object.
• Detecting mind wandering.
Benefits of MBCT Depend on Practice Between Group Sessions
• 40 minute Body Scan• Mindfulness of a routine activity
• 40 minute Body Scan• Mindfulness of a routine activity
• 40 minute mindfulness of Breath / or mindful stretching/Yoga
• 3 minute breathing space
• 40 minute mindfulness of emotion / or mindful walking
• 3 minute breathing space
• 40 minute mindfulness of difficult emotions• 3 minute coping breathing space
• 40 minute mindfulness of difficult emotions• 3 minute coping breathing space
• 40 minute practice of your choice• 3 minute coping breathing space
• The rest of your life
S1: Awareness and Automatic Pilot
S2: Living in our Heads
S3: Gathering the Scattered Mind
S4: Recognizing Territory of Aversion
S5: Allowing / Letting Be
S6: Thoughts Are Not Facts
S7: Taking Best Take Care of Myself
S8: Maintaining and Extending NewLearning
ANCHORED IN EMOTIONALLY TURBULENT WATERS
Pre-Post Effect Size Estimates in Mindfulness Pre-Post Effect Size Estimates in Mindfulness Based Treatments – AnxietyBased Treatments – Anxiety
Funnel plot of precision by Hedges’s g for Anxiety measures = .63 (Hofmann et al., 2010)
Pre-Post Effect Size Estimates in Mindfulness Based Treatments - Depression
Funnel plot of precision by Hedges’s g for Depression measures = .59 (Hofmann et al., 2010)
Challenges Remain on the Efficacy Front
Geschwind et al., 2011
MBCT Increases Momentary Positive
Emotions
1. Experience Sampling 6 days pre and 6 days post MBCT.
2. Assessed Domains of Positive Affect, Pleasant Activity and Reward.
3. Compared MBCT to Wait List Control Group.
The ‘Present-Moment’ PathwayThe ‘Present-Moment’ Pathway
(Craig, 2004)
(Craig, 2009)
Attending to the BreathAttending to the BreathBreath Monitoring
(masking out exec function areas)Breath Monitoring Changes
Mindfulness Trained > Waitlisted Controls
Right insula is uniquely related to Mindfulness Training
Farb et al., Cerebral Cortex, 2012Farb et al., SCAN, 2013
Neural Changes Associated with Mindfulness & Sadness Challenge
Terms of Endearment (1983)
The Champ (1979)
HGTV (Crafts & Gardening)
Neutral Clips Sad Clips
Vs.
Following exposure to sadness...Following exposure to sadness...
Evaluation network goes up…
Present moment networkgoes down..
Mindfulness Training: Reducing Mindfulness Training: Reducing the Tradeoff…the Tradeoff…
Post. Midline Reduced
Control MBSR
Insula / ClaustrumRestored
Control MBSR
x = 8
x = 35
Sensory Representations MatterSensory Representations Matter
Right insula reductions may be maladaptive…
Restoration of activity to baseline
during emotion challenge is protective
Farb et al, 2010
Mood Linked Responses in Medial Prefrontal Cortex Predict Relapse @18 Months in Recurrent Unipolar Depression
Farb et al., 2011
Keune et al., 2013
State Effects of Mindfulness Increase Approach and Acceptance: Increases in Relative Right Frontal Hemispheric Asymmetry
Density of Practice Across 3 Treatment Types Within a Single
Week
0
50
100
150
200
250
300
350
400
# Minutes of Practice perWk.
Trad.Psychotherapy
CBT
MindfulnessIntervention
LESS A TREATMENT – MORE A WAY OF LIFE
Conclusions• Mindfulness is relevant to affect regulation.
• Can be integrated into standard treatments for mood and anxiety disorders.
• Benefits depend upon continued practice.
• Neural evidence of increased interoceptive competence combined with approach helps modulate frontal driven fear and ruminative processing.
Future Research Questions• Consensus definition of practice metrics needed.
• Relationship of participants’ practice to behavioural outcomes?
• Relationship of instructor’s practice to behavioural outcomes?
• Maintenance of behavioural and neural changes;
– Thunderclap or Drip Feed model best fit the data?