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Mindfullness
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Mindfulness: why
attention matters
Dr Craig Hassed
Senior Lecturer
Deputy Head of Department
Monash University
Department of General Practice
Mind wandering and happiness
“In conclusion, a human mind is a wandering
mind, and 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. A Wandering Mind Is an Unhappy Mind.
Science 12 November 2010: Vol. 330. no. 6006, p. 932 DOI:
10.1126/science.1192439
Attention Deficit Trait
Newly recognized neurological phenomenon:
attention deficit trait (ADT)
Response to hyperkinetic environment
Trying to deal with too much input, results in:
Black-and-white thinking; perspective and shades of
grey disappear
Difficulty staying organized, setting priorities, and
managing time
Feel a constant low level of panic and guilt
Hallowell EM. Overloaded circuits: why smart people
underperform. Harv Bus Rev. 2005 Jan;83(1):54-62, 116.
“The body is the shadow of the soul.”Marsilio Ficino (1433-99)
Allostatic load Prolonged stress leads to wear-and-tear on
the body (allostatic load) Mediated through the Sympathetic Nervous System
Allostatic load leads to: Impaired immunity, atherosclerosis, metabolic
syndrome, bone demineralization
Atrophy of nerve cells in the brain Hippocampal formation: learning and memory
Prefrontal cortex: working memory, executive function
Growth of Amygdala mediates fear response
Many of these processes are seen in chronic depression and anxiety
McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.
“Man is not disturbed by
events, but by the view
he takes of them.”
Epictetus
Current trends in happiness
In developed countries depression is currently overtaking heart disease as the leading burden of disease
Mathers CD, Loncar D. Projections of global mortality and burden of disease
from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442.
Burnout and psychiatric morbidity in
new medical graduates
8 months into internship: 75% interns
had burnout
73% (of interns) met criteria for
psychiatric morbidity on at least one
occasion Willcock SM et al. Burnout and psychiatric
morbidity in new medical graduates. Med J
Aust. 2004;181(7):357-60.
Antidepressants and placebo
Antidepressants no
different to placebo for
mild-moderate
depression, and a
relatively small difference
for patients with severe
depression Kirsch I et al. PLoS Medicine 2008
Feb;5(2):e45
doi:10.1371/journal.pmed.0050045
Fournier JC, DeRubeis RJ, Hollon SD,
et al. Antidepressant drug effects and
depression severity: a patient-level
meta-analysis. JAMA. 2010 Jan
6;303(1):47-53.
Albert Einstein
“Any man who can drive safely while
kissing a pretty girl is simply not
giving the kiss the attention it
deserves.”
11
Mobile phone use and motor vehicle
accidents Passenger carriage increased the likelihood of a
crash (odds ratio 1.6)
Carrying two or more passengers twice as likely
to crash as unaccompanied drivers (OR 2.2)
Driver's use of a mobile phone within 5 min
before a crash associated with fourfold
increased likelihood of crashing (OR 4.1) McEvoy SP, Stevenson MR, Woodward M.The contribution of passengers versus
mobile phone use to motor vehicle crashes resulting in hospital attendance by the
driver. Accid Anal Prev. 2007 Nov;39(6):1170-6. Epub 2007 Apr 9.
Multitasking or task-switching?
Multitasking is an illusion (misnomer)
Switching happens so fast that it appears we
are performing multiple tasks simultaneously
like the concurrent performance of several
jobs by a computer
Reality is that we are switching back and
forth between tasks http://ucsdcfm.wordpress.com/2011/07/01/our-brains-
are-evolving-to-multitask-not-the-ill-usion-of-
multitasking/
Multi-tasking
On the performance levels of extreme multi-
taskers: “These are kids who are doing 5, 6, or
more things at once all the time. ... It turns out
multi-taskers are terrible at every aspect of
multitasking! They get distracted constantly. Their
memory is very disorganized. Recent work we’ve
done suggests that they’re worse at analytic
reasoning. We worry that it may be we’re creating
people who may not be able to think well, and
clearly.” Dr. Clifford Nass on his studies at Stanford University from
Dretzin, Rachel. Rushkoff, Douglas. “digital_nation life on the
virtual frontier.” pbs.org Frontline. Feb. 2010. Web. 14 Apr. 2011.
Multitasking
“In 2005, the BBC reported on a research
study, funded by Hewlett-Packard, and
conducted by the Institute of Psychiatry at the
University of London, that found, workers
distracted by e-mail and phone calls suffer a
fall in IQ more than twice that found in
marijuana smokers.” Christine Rosen, “The Myth of Multitasking.” The New
Atlantis thenewatlantis.com. Spring 2008. Web. 14 Apr.
2011.
Simple and Complex Multitasking
(Continuous Partial Attention) Simple multitasking: each task given the same priority
(e.g. stirring pasta while talking to spouse)
Aim to be more productive
Complex multitasking: two activities which demand
cognition (e.g. driving while speaking on phone)
Aim not to miss anything by maintaining CPA
Continuous overstimulation and lack of fullfilment
“When we do this, we may have the feeling that our
brains process multiple activities in parallel. Researchers
say that while we can rapidly shift between activities, our
brains process serially.” Stone, Linda. “Beyond Simple Multi-Tasking: Continuous Partial
Attention.” Lindastone.net. Nov. 2009. Wen. 14 Apr. 2011.
Multitasking
“Heavy media multitaskers performed worse
on a test of task-switching ability, likely due to
reduced ability to filter out interference from
the irrelevant task set.” Ophir, Eyal. Nass, Clifford. Wagner, Anthony D.
“Cognitive control in media multitaskers.” PNAS.org.
Proceedings of the National Academy of Sciences of the
United States of America, Jul. 2009. Web. 15 Apr. 2011.
Three regions of the brain
Corresponding areas in the brain
Frontal lobes – reasoning and emotional regulation
Higher reasoning (buddhi)
Emotional regulation Left (positive) vs. right
(negative)
Appetite regulation
Directs immune system
Limbic system – emotion and courage
Mesolimbic reward system –appetites
Stress
Performance
Inertia
Poor
performance /
burnout
Stress-performance curve
High performance
Doctor health and medical errors
Study determined prevalence of depression and burnout among residents medical staff in 3 US hospitals
20% of residents met criteria for depression
74% met the criteria for burnout
Depressed residents made 6.2 times as many medication errors as residents who were not depressed
Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ, doi:10.1136/bmj.39469.763218.BE (published 7 February 2008)
“The faculty of voluntarily bringing back a wandering attention over and over again, is the very root of judgment, character, and will. No one is compos sui if he have it not. An education which should improve this faculty would be the education par excellence.” William James, Principles of
Psychology, 1890
What is mindfulness?
Mindfulness
Mindfulness is a mental discipline involving
training attention
It is not a method of distracting ourselves or
tuning out, it is about tuning in – hence people
perform better when mindful (in the zone/flow)
The anxious, stressed or depressed state of
mind is the distracted state
Hence the negative impact upon performance
Applications of mindfulness Mental health
E.g. depression relapse prevention, anxiety, panic disorder, stress,
emotional regulation, addiction, psychosis
Neuroscience
E.g. structural and functional changes in the brain, neurogenesis,
dementia prevention, amygdala, executive function, working memory
Clinical
E.g. pain management, symptom control, cancer, metabolic,
hormonal, genetic function and repair
Performance
E.g. sport, academic, leadership
Spiritual
E.g. deep peace, insight, oneness
23
Results suggest that MBSR
may help a broad range of
individuals to cope with their
clinical and non-clinical
problems. Grossman P. J
Psychosomatic Research.
2004;57(1):35-43.
Meditation and cognition
Study on brief meditation training effects on cognition
and mood
Four sessions of either meditation training
Participants were assessed with measures of mood,
verbal fluency, visual coding, and working memory
Mindfulness training improved mindfulness, mood, and
reduced fatigue, anxiety, and increased visuo-spatial
processing, working memory, and executive
functioning Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness
meditation improves cognition: evidence of brief mental training. Conscious Cogn.
2010 Jun;19(2):597-605. Epub 2010 Apr 3.
Stress
Performance
Inertia
Poor
performance /
burnout
Stress-performance curve
Peak
performance
“The zone”
Restful
alertness
Mindfulness and mental health
Meta-analysis on 39 studies totaling 1,140 participants receiving
mindfulness-based therapy for conditions, including cancer,
generalized anxiety disorder, depression, and other psychiatric or
medical conditions
Effect size estimates show mindfulness-based therapy
moderately effective for improving anxiety (Hedges's g = 0.63)
and mood symptoms (Hedges's g = 0.59) in general population
In patients with anxiety and mood disorders mindfulness
associated with effect sizes (Hedges's g) of 0.97 and 0.95
Effect sizes were robust, unrelated to publication year or number of
treatment sessions, and maintained over follow-up.
Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy
on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010
Apr;78(2):169-83.
Mindfulness and depression
Patients with 3 or more previous episodes of
depression
Mindfulness-Based Cognitive Therapy
reduced relapse from 78% (what you would
expect with usual treatment) to 36%
Ma SH, Teasdale JD. J Consult Clin Psychol.
2004;72(1):31-40.
Mindfulness, depression and the
stress response Mindfulness negatively correlates with
depressive symptoms and reactivity of the
amygdala Way BM., Creswell JD., Eisenberger, NI., Lieberman MD.
Dispositional mindfulness and depressive
symptomatology: Correlations with limbic and self-
referential neural activity during rest. Emotion. Vol 10(1),
Feb 2010, 12-24.
Mindfulness and craving
Study on the effectiveness of suppression vs.
mindfulness-based strategy for coping with cigarette
cravings
Both groups reported significantly reduced amount
of smoking and increased self-efficacy in coping with
smoking urges
Only participants in the mindfulness group
demonstrated reductions in negative affect (mood),
depressive symptoms, and marginal reductions in
their level of nicotine dependence Rogojanski J, Vettese LC, Antony MM. Coping with Cigarette Cravings: Comparison
of Suppression Versus Mindfulness-Based Strategies. Mindfulness 2011;2(1):14-26.
DOI: 10.1007/s12671-010-0038-x
The ESSENCE of health
Education
Stress management
Spirituality
Exercise
Nutrition
Connectedness
Environment
HEP and student wellbeing
Study of 2006 cohort of medical students found that 90.5% of students personally applied strategies
Improved student wellbeing noted on all measures of wellbeing even in the pre-exam period Reduced depression, hostility and anxiety subscale
Improved psychological and physical quality of life
Hassed C, de Lisle S, Sullivan G, Pier C. Adv Health Sci Educ Theory Pract. 2008 May 31. [Epub ahead of print]
Mindfulness and doctor wellbeing
An 8-week mindfulness program: improvements on all
measures of wellbeing including:
Mindfulness
Burnout (emotional exhaustion; depersonalization;
personal accomplishment)
Empathy and responsiveness to psychosocial aspects
Total mood disturbance
Personality (conscientiousness; emotional stability)
Improvements in mindfulness correlated with
improvements on other scales Krasner MS, Epstein RM, Beckman H, et al. JAMA. 2009;302(12):1338-40.
Mindfulness and the workplace
8 week mindfulness program for ANU staff
Key findings include:
Increased self-rated performance (ECDP)
Improved wellbeing (PANAS)
Improved eudaimonic wellbeing (meaningfulness) (PWB)
Increase in 2 subscales of work engagement (vigour and
dedication) (UWES)
Increased authenticity (self-awareness, authentic
behaviour, open relationships) (AI3)
Increased satisfaction with life (SWLS)
Improvements sustained at 6 month f/up Atkins P, Hassed C. Unpublished data.
Mindful practice Mindfulness is essential underpinning for
self-monitoring
“Mindful practice is conscious and intentional attentiveness to the present situation – the raw sensations, thoughts, and emotions as well as the interpretations, judgments and heuristics that one applies to a particular situation.”
Avoids automatic pilot Epstein R, Siegel D, Silberman J. Self-monitoring in clinical
practice: a challenge for medical educators. J Cont Educ Health Prof 2008;28(1):5-13.
Epstein RM. Mindful practice in action (II): Cultivating habits of mind. Fam Syst Health . 2003;21: 11-17.
Roots of Diagnostic Errors
“Cognitive dispositions to respond that influence
the diagnostic process are characterized by a
lack of awareness and responsiveness by the
individual to his or her own cognitive and
affective processes.”
Confirmation bias: the pursuit of data that support
a diagnosis over data that refute it
Anchoring bias: a resistance to adapting
appropriately to subsequent data that suggest
alternative diagnoses Sibinga EM, Wu AW. Clinical Mindfulness and Patient Safety.
JAMA 2010;304(22):2532-3.
Self-monitoring leads to;
1. Early recognition of cognitive biases
2. Avoidance of technical errors
3. Awareness of emotional reactions
4. Facilitation of self-correction
5. Development of therapeutic relationships Epstein R et al, 2008
Mindfulness and the brain Brain scans on long-term
meditators
Regions associated with attention, self-awareness and sensory processing thicker in meditators (E.g. prefrontal cortex) Offset age-related cortical thinning:
“evidence for … cortical plasticity” Lazar SW, Kerr CE, Wasserman RH, et
al. Neuroreport. 2005;16(17):1893-1897.
“The regular practice of meditation may have neuroprotective effects and reduce the cognitive decline associated with normal aging.”
Pagnoni G. Cekic M. Neurobiology of Aging. 2007;28(10):1623-7.
Meditation and compassion
Limbic brain regions implicated in empathic response to another's pain
Meditators have more active empathic response
Activation in insula greater in expert than novices
Empathy w/o stress reduces carer fatigue Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ.
PLoS ONE. 2008 Mar 26;3(3):e1897.
Emotional Intelligence & mindfulness
Mindfulness related to aspects of personality and mental health
Lower neuroticism, psychological symptoms, experiential avoidance, dissociation
Higher emotional intelligence and absorption Baer RA, et al.
Assessment.
2004;11(3):191-206.
EI Definition
Self-
awareness
Ability to recognise and
understand emotions,
drives and effects
Self-
regulation
Can control or redirect
disruptive impulses, can
think before acting
Motivation Passion for work that goes
beyond money or status,
energy and persistence
Empathy Ability to understand
emotions of others, skill in
interacting with others
Social skill Can manage relationships
and build networks, can
find common ground,
rapport
Genetic ageing and pessimism
The combination of lower optimism and higher
pessimism increases risk for disease and early
mortality
Sample of healthy post-menopausal women
Pessimism is independently associated with
over10 years accelerated ageing
Shorter Telomere length and higher Interleukin-6
concentrations Lin J,Dhabhar FS, Wolkowitz O, Tillie JM, Blackburn E, Epel
E.Pessimism correlates with leukocyte telomere shortness and
elevated interleukin-6 in post-menopausal women. Brain Behav
Immun. 2009 May;23(4):446-9.
Mindfulness and cellular ageing
Meditation may slow genetic
ageing and enhance genetic
repair
“...we propose that some forms
of meditation may have
salutary effects on telomere
length by reducing cognitive
stress and stress arousal and
increasing positive states of
mind and hormonal factors that
may promote telomere
maintenance.” Epel E, Daubenmier J, Moskowitz JT, Folkman
S, Blackburn E. Can meditation slow rate of
cellular aging? Cognitive stress, mindfulness,
and telomeres. Ann N Y Acad Sci. 2009
Aug;1172:34-53.