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Stress, Depression & Mindfulness
Teaching Mindfulness Based Stress Reduction – Beginning of the story Science seems to help motivation- universal language
Stress That change is needed to meet a demand As appraised by the subject That change may overwhelm resources Resources as appraised by the subject
Physiology of chronic stress =Physiology of depression Parasympathetic – sympathetic imbalance sympathetic activated too long Not enough parasympathetic activation Rest & relaxation Digestion & cellular maintenance Healing & repair
Not just the Brain Neurotransmitters Heart Immune system Endocrine system Sex Hormones Sleep Gut
Key Brain Areas
HPA axis Hypothalamus ( CRF) -> Pituitary Gland ( ACTH) -> Adrenals ->Noradrenalin -> Cortisol -> Hippocampus ( feedback loop)
Acute stress reaction HPA activation Flood of neurotransmitters Adrenaline, noradrenalin Serotonin Dopamine Inflammatory response ( interleukin 1) cortisol
Studies in chronic stress Whitehall Civil servant study Salposki Baboon studies
Neurotransmitters Adrenaline, Noradrenalin Serotonin – first to go -> depression
Chronic Noradrenalin Increases heart rate, Blood pressure Activates amygdala threat detector Hyper vigilance for threat Negative memory activated, positive memory deactivated
The immune system Hyper activation of non-specific acute phase – Interleukin 1 Suppression of specific immune actions
Inter leukin 1 Part of stress response With chronic activation Fatigue, malaise Sleep disruption, appetite effect Anhedonia Impairs hippocampus memory
Effects of chronic cortisol activation Loss of diurnal variation Switches off prefrontal, hippocampus Suppress immunity Activate amygdala Burns out – adrenaline fatigue Weight gain
Over time cortisol - neurotoxic Loss of connections Decreased branching Loss of neurons Especially prefrontal & hippocampus
Damage to Hippocampus Blocks feedback loop -> increased cortisol Memory impairment Inability to form new associations (30,000 new cells per day)
Chronic stress stops Neurogenesis & Neuroplasticity Increase cortisol Decrease serotonin, trophic factor, oestrogen
Oestrogen & depression Female : Male rate of depression 3:1 Sudden drops of oestrogen associated Menopause Childbirth Premenstrual Oestrogen – powerful Neurogenesis growth factor
Under active – hippocampus, prefrontal cortex & cingulate Overactive – amygdala, hypothalamus & Pituitary
Prefrontal Cortex Asymmetry Left – approach behaviour, positive emotion – under active in depression Right withdrawal behaviour, negative emotion – overactive in depression Hedonic set point
Heart rate variability Healthy heart - high variability Depression/chronic stress = reduction
Sleep in depression Sympathetic>> parasympathetic Reduced slow wave sleep Increased rem density (predicts response to treatment) Insomnia – x4 incidence of depression
Indicators of chronic sympathetic activation Difficulty concentrating Making decisions Remembering Excessive fatigue Motivation Frequent illness Sleep disturbance
Paul gilbert slide here
Activation of stress response Imagined scenario of threat/failure Reality gap – life as you want it to be – as it is Self criticism Recall of unpleasant event Hostility Rumination Avoidance
Filtering reality Activated Amygdala & No hippocampus Habitual mind – tells us what to see & how to react
Cognitive filter Beliefs, attitudes & perspectives Continuous stream of semiconscious commentary evaluating Somatically marked association & memory Neural networks – synapses reinforced – rehearsal Other associations shut down
Example of 4 different filter types Anxious Depressed Type A – angry, hostile Type C – resigned helpless
Anxious Imagined scenario – exaggeration of threat Potential crisis with each event Future – what if something goes wrong
Depressed Continual comparison between some ideal & reality Self –critical evaluation Underestimation of resources & negative memory bias
Type A The world is against me Always scanning for threat Easily made paranoid
Type C Passive pessimistic and helpless Underestimate resources Overestimate threat
Vicious Cycle HPA activation Physiology threat related cognitive filter Perceive threats and failure
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