Factor-Inwentash Faculty of Social Work Applied Mindfulness Meditation

Factor-Inwentash Faculty of Social Work Applied Mindfulness Meditation
PROFESSOR EMERITUS ROB MACFADDEN, UNIVERSITY OF TORONTO MINDFULNESS MEDITATION & NEUROSCIENCE MORE ON NEUROSCIENCE B41 Factor-Inwentash Faculty of Social Work Continuing Education Applied Mindfulness Meditation University of Toronto March 20-21, 2015

MINDFULNESS MEDITATION & NEUROSCIENCE
The brain is the most complex adaptive system known to science We are built for survival of the species, not for happiness Vigilance and fear are key to understanding our human condition The brain is Teflon for positives and Velcro for negatives Need for connection is as fundamental as fear for humans: We are completely wired to connect Many of the circuits for feeling physical pain are the same as those when we experience feeling socially isolated

We are a species that requires the most home assembly: brain continues to mature right into the twenties. It changes throughout all of our lifetimes Emotion powers our lives. It is a background and foreground influence. Understanding fear,safety and love is critical to understanding people and for intervention.

The brain has developed over millennia and this history influences who we are today. The brain is an archeological record. (Triune Brain by Paul MacLean) In general terms, the brain can be seen in terms of three evolutionary components: The reptilian brain was the first core to develop and is basic life sustaining, controlling key functions such as respiration, circulation, the endocrine system, reproduction, arousal & homeostasis. Much is reflexive and drive based- fear, rage, eating, and mating which still retains a degree of control over our actions. (Brainstem)

The paleomammalian brain was added on and brought with it learning, memory and emotion. (Limbic system) The neomammalian brain was a third addition and brought enhanced cognition, enhanced social connection and sense of self and self-awareness. Problem-solving was enhanced and an increased emphasis on social connection enabled us to organize into larger communities, to increasingly plan ahead and to learn more from experience. (Cortex)

Louis Cozolino describes psychotherapy in “It’s a Jungle in There” (Psychotherapy Networker 2008 September/October) is like working with an anachronistic menagerie- a human, a horse and a crocodile within the same body. Our skull shares its space with ancient brain equipment and our functioning requires integrating and coordinating these highly specialized and complex systems. These areas of our brain can vie for dominance and experience conflict with each other without us being conscious of this.

Velcro for Negatives: Tilted towards Anxiety and Fear Evolution favours an anxious gene (Aaron Beck). We can be anxious/fearful about anything (e.g., our furniture) Human condition is tilted towards anxiety or fear Different Neuroplastic Properties Hippocampus Amygdala Etch a sketch-repeatedly Keeps a constant dendritic profile-memory Influenced by experience Generalizes to as many situations as possible Constantly remodeled Can make us rigid Therapists are amygdala whisperers: work to build networks of new learnings in hippocampus & prefrontal cortex Empathy, warmth, positive regard creates the nourishing environment for neuroplastic processes to occur.

During fear and stress, Broca’s area (speech) inhibited. Yet we need to put feelings into words & narratives to support emotional regulation. Involves integration cognitions and emotions. Broca’s area also involved in prediction & anticipation. Impacts good choices & victimization and dissociation.

Most Important Discovery in Neuroscience?
MINDFULNESS MEDITATION & NEUROSCIENCE Most Important Discovery in Neuroscience? Neuroplasticity and Neurogenesis

Neural Circuitry: We’re all electricians. Circuits are being formed, weakened, strengthened, and purged. Experience is like a scalpel. Much happening unconsciously and may be consciously driven. Meditation is an act of circuit building- if you have an awareness of this, then it’s a conscious act of circuit building.The ability to control and to direct your attention is essential to well-being. It is the core of emotional regulation. Secret to deliberate circuit building: paying attention. Intentional attention. The ability to connect with, attune to, and help build new neural connections at the heart of psychotherapy. We are all gardeners, helping each other manage and grow our gardens.

AUTOMATICITY Automaticity drives our lives. We go through life much of the time without seeing others, without tasting our food, without appreciating our loved ones, without being mindful. Our brain thrives on automaticity. It is so much more efficient and we have so little conscious processing power. When we learn something that we do often, it becomes “second nature”- unconscious. Also when problems develop we may lose sight of destructive patterns. We are rarely focused on the present. We are frequently thinking of the past and worrying about the future. It is estimated that our brain wanders 50% of the time. That’s why mindfulness is so helpful. It focuses on the present through following the breath. It enables us to reduce the prevalence of worry and anxiety through consistently returning to the present moment. Being accepting of whatever is experienced, not pushing it away but experiencing it with curiosity and acceptance seems to reduce the occurrence of the worrying.

We all carry baggage. In psychotherapy we need to be centred and present with the client to the greatest extent possible. Bringing in the baggage is like having an elephant in the room. It impairs the therapist’s ability to be present, to hear the client, to focus on the client and to resonate and attune. Clients are engaged in an interactive processes with therapists. The can feel whether you are feeling them. For a distracted therapist, the connection could become problematic and the client might feel unconnected. Daydreaming while the client is talking, answering the phone, checking your watch are examples of common distractions.

Mindfulness helps with being centred and present. Recent research suggests that doing mindfulness before conducting session for only 5 minutes can improve aspects of the relationship with clients (Dunn, R. et al., 2013, Effects of pre-session centering for therapists on session presence and effectiveness. Psychotherapy Research, Vol. 23, No. 1, 78-85). Therapists viewed themselves as being more present when they engaged in pre-session mindfulness, while clients perceived therapists in both groups as being highly present. Clients where therapists practiced brief mindfulness rated the sessions as more effective.

Presence (from Geller & Greenberg, 2013 and Geller & Porges, in preparation). Being centered and mindful helps us with being: Curious, open to experience, accepting and feeling love and kindness. This improves the quality of the alliance and leads to feeling felt, the sweet spot for clinical change. Therapeutic presence involves therapists being fully in the moment along several dimensions: physical, emotional, cognitive and relational Therapists need to be first grounded, centered and steady as well as open and receptive to the client’s whole experience. When present, therapists are in direct contact with themselves, the client and the relationship

Presence (from Geller & Greenberg, 2013 and Geller & Porges, in preparation). A present centered therapist creates a feeling of safety in the client through a warm facial expression and prosodic voice. This feeling of safety creates a shift in body regulation which inhibits defenses and creates a response of calmness, openness and trust. Feeling engaged like this by a therapist who is present encourages clients to feel open and present. This is a shared biobehavioural state that has healing qualities and allows for deeper work. In mammals there are two distinct vagal pathways. The vagus cranial nerve exits the brainstem & provides bidirectional communication between the brain and several visceral organs like the heart.

Presence (from Geller & Greenberg, 2013 and Geller & Porges, in preparation). The newer myelinated vagal nerve regulates the heart and lungs in particular and helps to slow heart rate and calmness. This newer circuit is linked to the cranial nerves that regulate the striated muscles of the face and head which are primary to social engagement behaviours. This is a face-heart connection the creates the “social engagement system”. It involves facial expressions and voice prosody and conveys the person’s physiological state to the other. When working well, this newer vagal circuit inhibits sympathetic excitation (flight or flight), promotes regulation of emotions, rich vocal prosody and spontaneous social engagement behaviours.

Presence (from Geller & Greenberg, 2013 and Geller & Porges, in preparation). When the person feels safe, the bodily state is regulated through the new vagal circuit which slows heart rate, inhibits fight/flight and dampens the HPA (e.g., cortisol) and reduces inflammation by modulating immune reactions (e.g., cytokines). Evolutionarily, the nuclei that regulate the myelinated vagus (new) became integrated with the nuclei that regulate the face and head. So this social engagement system links the visceral systems (e.g., heart) with the musles controlling gaze, facial expression, head gesture, listening and prosody (Porges, 2001, 2007, 2009).

Presence (from Geller & Greenberg, 2013 and Geller & Porges, in preparation). Not only bidirectional communication between the brain and body but also between nervous systems of others. Frequently outside consciousness, but left with a “gut” feeling that alerts us to discomfort within a social interaction. This automatic evaluation of risk is called neuroception. Neuroception can either turn off defenses or prepare us for defensive strategies. May bias our perceptions negatively during fight/flight or positively during social engagement. Being with someone who feels safe, positive social engagement behaviours initiated, calmness increases and defenses are inhibited. Bias towards positivity which can promote growth and change.

The face and voice are significant channels through which safety is communicated to another. Face is the area particularly where presence is communicated to the client (Geller and Greenberg). Faces are information centres along with voice. Over time, the therapist’s warm facial connection, receptive posture, open heart and listening presence promotes safety and neural regulation of the client’s physiology, strengthening emotional regulation. Therapist’s preparation involves cultivating personal presence prior to meeting. This is internal attunement which generates calm and safety within the therapist. Therapeutic presence involves attuning to oneself and one’s felt sense of the client. Feeling felt impacts the client’s physiology though calming feelings of safety. Case Vignette

Automaticity or Predominance of Unconscious Processing To survive we have kept many primitive responses and automatic subcortical processes. It takes milliseconds for our cerebral cortex to process experience while the amygdala can react in less than 100 milliseconds. Consciously by the time we have become aware of an experience, it has been processed many times by more primitive regions, activating memories and neural patterns from past learning. As Cozolino points out, so when we think about performing an action, the choice has likely already been made unconsciously. Brain thinks we are living in the present moment and acting of free will. The conscious awareness is mostly a result of what’s already occurred in our brains and over 90% of input to the cortex comes from internal neural processing.

Paradox of therapy: increasing conscious awareness of our unconscious, irrational impulses arising from older parts of the brain. Our unconscious thoughts, emotions, perceptions are based largely on reactions and emotions outside our awareness and not connected with current realities. Mindfulness interrupts automaticity. Slows us down, helps us to be conscious and aware. We see things from a “beginner’s mind”.

Therapeutic Alliance Decades of research into change in psychotherapy identifies the therapeutic alliance as the main active ingredient, regardless of specific model. The alliance is defined as having three components: the bond, the goals and the tasks. The bond is the emotional relationship. It is characterized by positive regard, empathy, resonance and attunement. The social brain and mirror neuron system help to form the bond. Emotion charges the therapeutic alliance with energy. Much neuroscience has focused on the therapeutic relationship and building this relationship. Allan Schore emphasizes the right brain to right brain connections (therapist to client) as being essential to promote deep connection and change.

Much of this is also non-verbal. Therapy is not merely the talking cure, but the communication cure. The therapist’s whole being functions like a tuning fork, resonating, attuning and feeling empathy. This is highly interactional between the therapist and client. The therapist senses the client and is changed from this feedback. Emotions experienced by the client are being experienced by the therapist and his/her feeling and body state changes. The client senses this change and if there is attunement, the client “feels felt” which is the sweet spot for change.

In mindfulness, Siegel believes the process of following your breath in a certain way and with certain mental filters, leads to the meditator developing a positive, supportive relationship with oneself. This is similar to us being a secure parent to ourselves. We are responsive, accessible and attuned to our behaviour, feelings and perceptions. Therapists talk about creating a supportive, holding environment with clients. Mindfulness is a form of a supportive, holding relationship with ourselves.

Goals are essential in change. Goals are navigational beacons that are charged with emotions and values which are reflections of emotion and goals. It is fundamentally essential that a therapist builds a relationship based on an appreciation and commitment to achieving client goals. This is the fuel of momentum- identifying something (i.e., a goal) that is essential for the client to achieve. The goal, anchored by important emotions, becomes both a target and a fulcrum to foster change.

Tasks similarly are infused with emotion/values. The accomplishment of a task must be seen by the client to be connected directly to achieving the goal. The task must make sense and it must generate considerable commitment from the client. So when you have a positive, supportive bond or relationship with the client, this creates the environment for sharing feelings, identifying desired goals which further infuses the process with emotional energy. Topped off by tasks that anchor goal achievement and are emotionally connected, you have the conditions for the therapeutic alliance to work- to promote change. The Engine of Change (i.e., the therapeutic alliance) has its supportive conditions, its direction and its fuel.

Understanding emotions is essential for a professional delivering psychotherapy. It is important to acknowledge the complexity of emotions and that neuroscience is providing many insights but that there is still much to discover. Antonio Damasio makes a distinction between emotions and feelings. Emotions are largely unconscious and occurs within the “theatre of the body”. Different emotions have specific signatures and involvement of parts of the body. Anger, for instance can be signaled by a raised voice, pounding heart, facial features that look aggressive and flushing of the face. Emotions are largely unconscious and difficult to conceal. Our development from infancy involves resonating and attuning to others’ emotions so we become skilled in assessing the emotional state of others.

Damasio describes feelings as occurring within the “theater of the mind” and are conscious and the result of changes in the body that get transmitted through the insula to the prefrontal cortex. These changes are sensed as a difference and as a conscious feeling. Emotion, also plays another fundamental role in our life and mental health. The word, “e-motion” describes this motivating influence that emotion has on our mental life. As Siegel points out (2012), emotion is more than the categorical descriptions we think of such as anger, sadness, etc.. Emotion is also a type of background activation state that underlies what we pay attention to, our feelings, perceptions and actions. Richie Davidson- Emotional Life of the Brain (43)

Humans are built to be constantly vigilant, aware of stimuli from outside and from within our body, for potential threats and opportunities. Emotion is a background force that allows us to be alert and scanning for these stimuli. Through the amygdala we appraise stimuli to determine if it is a threat. If it is, our sympathetic nervous system is activated which prepares us to freeze, flee or fight. What we normally think of as an emotion such as fear, anger, joy, surprise and sadness can be viewed as a special type of discrete or categorical emotion that are characterized by specific and common body and mind changes. Sadness, for instance, can be signaled by a droopy face, low energy, quiet voice and lower levels of activity.

Viewing emotion in this variegated and complex way allows us to understand its fundamental nature. It powers so much of our lives and it is fundament to integration. Indeed Siegel views emotion as being shifts in integration. Integration is a process that involves the activation of individual components as well as the linking or collaboration of these components with each other. When we are experiencing integration, there is a FACES flow to the system which reflects: flexibility, attunement, coherence, being energized and stable. Emotion, as integration, creates a flow to the system that avoids the dual dangers of rigidity and chaos. Siegel notes that all DSM diagnoses reflect essentially a disruption of this flow through excessive rigidity, chaos, or a combination of both.

Emotions, Emotional Regulation (Taken from Emotional Regulation in Psychotherapy by Robert Leahy, Dennis Tirch, and Lisa Napolitano. NY: Guilford Press, 2011) and other sources So integration is mental health and emotion is fundamental to this. Mental illness can be viewed as a form of disintegration. Neuroscience has underscored the importance of emotional regulation to mental and physical health and social functioning. When we are infants, we lack emotional regulation capabilities and basically react directly to stimuli. A crucial part of a parent’s role is helping the infant to learn how to emotionally regulate.

We do this through the process of emotional resonance, attunement and empathy. The parent manages the infant’s emotions through this process and the infant develops self-soothing skills. Gradually as the child is able to self-soothe more and develops the neural ability to regulate his or her emotions. The child and young adult also learns how to co-regulate emotions of others and contribute to the regulation and integration of important others in his/her life. Thus emotion helps to regulate mental activity and is also regulated itself.

Why is emotional regulation so important? The inability to emotionally regulate can cause problems in a wide range of areas. It can create aggression, lead to personal and social problems. It can fuel depression and lead to withdrawal. It can lead to overstimulation and/or under stimulation. It can hamper the development of relationships, reduce motivation and activity. The flow of energy and emotion can be blocked and lead to disintegration. For instance, there can be problems between left brain and right brain integration. Recall that the left brain is the centre for language and logic and is digital in the sense of right or wrong, fostering order and patterning. The right hemisphere is especially important for processing emotion. It views things more holistically and contains attachment schemas, autobiographical memory and how to understand body language, including faces and social communication.

If these two hemispheres are not functioning well both independently and collaboratively, the integration may be impeded. An example would be an individual who has learned to suppress emotion and to stay logical and rational in life. The richness of the right hemisphere would not be available to this person and he or she would likely have problems in establishing and maintaining close relationships. This would be an example of a problem with horizontal or bi-lateral integration. Similarly, an individual may have a problem with the up and down flow from the body to the brain and vice-versa. An example would be a person who has experience a trauma to the body (e.g., rape) and has managed, over time, to ignore or block sensations from the neck down. Not being able to be aware of these sensations from the body can impair vertical integration. The individual is not able to use these feeling to help understand what’s happening to his or her body.

Many of the problems that the client brings into social workers are related to problems with emotional regulation. Couples may be arguing constantly and experience deterioration in their relationship. An individual may be depressed and unable to be motivated enough to attend school. Parents may be at the end of their rope in dealing with an adolescent who has violent outbursts at school and in the home. There are many ways for social workers to foster emotional regulation. The development of a positive therapeutic alliance that promotes safety and security can enable a client to express and manage feelings that have become dysregulated.

In trauma, for example, the client may be troubled by images and emotions that recur and victimize the client continually. These images and emotions may not be remembered from past events so they appear mysterious, frightening and disorienting. Within a safe therapeutic environment, when these emotions and images are shared, they begin to be associated with more calmness and safety (right brain). Discussing these experiences and fitting tem into a life narrative (left brain) helps the client to make some sense of the experience which enhances coping. These new feelings and associations about the experience are recorded into memory and they progressively lose some of their frightening nature. The more times these are discussed within the safe therapeutic relationship, the less frightening they become.

This is another example of how therapy can foster integration. Instead of being blocked, these implicit memories are shared and the feelings moderated within a secure environment. Siegel says, “If you can name it you can tame it”. Focusing on the emotions stored in the right brain, and using the left brain to identify it and name it enhances integration, coping and well-being. Much of this emotional regulation involves right brain to right brain (therapist to client). Schore describes psychotherapy as essentially right brain to right brain where the therapist resonates and attunes to the client. This leads to a “holding” environment where the therapeutic bond is established and fosters change in the client.

There are many more ways to assist with emotional regulation. A client assessment can be used to identify the ways that are more individualized for each client. For clients who are more cognitively oriented, focusing on negative self-talk and cognitive errors that trigger negative emotions can be helpful. A client who refuses to go outside because of bacteria and disease can be challenged cognitively by pointing out discrepancies I logic and including scientific and medical findings on risk. For clients who value behavior change, using this same example, clients can experience exposure therapy where in a graduated way, the client is exposed to increasing levels of going outside balanced with returning to a safe haven when anxiety intervenes. Gradually the anxiety and fear is reduced and the beliefs change to support the safety of leaving the home.

For clients who are more emotionally oriented, an approach to help clients regulate emotions is through emotionally focused therapy (EFT). This involves working with the couple and having each member share deep primary feelings which are witnessed by the other partner. Gradually the partners come to realize the anxious and fearful emotions being experience by the other and they start listening and connecting with each other. This new bonding experience leads to beginning trust and safety and changes other thoughts and behavior. The partners begin to see the other as caring and are more interested in spending time with each other.

So within a safe, therapeutic environment with a positive therapeutic alliance, the couple are encouraged to explore their relationship and bond with each other. The therapist continues to encourage each person to share deep and frequently painful feelings with each other in the presence of the other. The partner listens and then shares his or her emotions to the partner. Gradually understanding and empathy for each other arises and the relationship bond is strengthened. Each partner develops skills and the ability to understand the emotion of the other and builds trust and safety. The secure relationship with the therapist is replaced by the secure relationship with the partner. Emotional co-regulation is enhanced and positive emotions generated.

Emotional regulation is not only important for clients but it is also essential for therapists. Therapy can be a difficult process characterized at times with negative emotion and sometimes hostility. Based on our previous discussion of how sensitive humans are to the emotions of others, therapists who are involved in environments characterized by intense and frequently negative emotions can find themselves resonating and attuning to these emotions. Like tuning forks, therapists can be impacted by these negative emotions. Back to back sessions involving difficult situations can be an emotional roller coaster for therapists. Therapists need to be able to emotional regulate themselves and become centered for the next client. If they carry excessive negative emotions into the next session, it may impact their ability to be with the client and to attune to their feelings. Clients can sense when a therapist is distracted and this can lead to ruptures in the alliance.

Therapists need to be sensitive to how their minds and bodies are experiencing these emotions and familiar with ways to manage them. Mindfulness meditation, as one example, helps therapists to become aware of and to be able to control their reactions. Taking a 5 to 10 minute break between sessions to meditate or relax can help therapists to regulate their emotions and be “present” with their next client.

Prior to explicit memory development which begins at 2 or 3 years of age, the child develops knowledge based on experiences that saved in implicit memory. This type of memory is used unconsciously and helps to direct decision-making. This knowledge may be expressed as a preference towards or against something. Implicit knowledge helps us to make decisions quickly and automatically. Unfortunately some of this knowledge is faulty and problematic. See the discussion on the unconscious and conscious mental system elsewhere in this book. Another way that emotion is relevant to therapists is that emotion drives learning and therapeutic change. All therapeutic change involves changes in the brain. New synapses formed or older ones reinforced. All learning involves neural change.

Regulation. As infants, we move from an automatic, inflexible, nonconscious level to a purposeful, flexible conscious system of self-regulation. We begin to incorporate rudimentary self-regulatory functions at around months of age, when our OFC (orbitofrontal cortex) comes online (Schore, 1994). Impulse control and frustration tolerance are orbitofrontal, self-regulatory functions that are not fully completed until the frontal lobe matures in early adulthood. We learn to self-regulate with the help of our first external regulators, our primary caregivers. Our young self-regulatory system is a duplicate of theirs. Besides some constitutional and genetic factors, we are only as good at arousal regulation as our external regulators. If our primary caregiver was an effective modulator of his/her own feelings of anxiety, fear, anger and excitement, we tend to be effective in turn. 100

Parents may avoid or actively dismiss, discourage or devalue certain bodily states so children must avoid or regulate these states on their own. This can lead to poorly managed internal experience which can produce later negative social consequences. In couples, one person may avoid high states and approach low states and the other may be the reverse. Together they form a biphasic couple. Therapy can help each partner to regulate or tolerate higher states and lower states. 101

Autoregulation is the earliest and simplest level of arousal regulation. It is insular and automatic. Gaze aversion in an infant is an example, preventing over stimulation. Helps to calm down. Looking at eyes very stimulating, baby may need to calm down. If parent persists, may dissociate. Blankie and sucking thumb are further examples. Not just calming down, but also the other way- being stimulated: tv, drugs, fantasy, reading. We regulate our up and down (I’m bored…). 102 These are individual, personal.

For avoidant persons (attachment style), reliance creates a 1 person psychological system of non-mutuality. It confers a pleasantly dissociative state. For angry-resistant style, extended periods of noninteraction with primary figures leads to intensely dysregulated states. For them, autoregulation demands high energy expenditure. 101 Interactive regulation is the process where two individuals co-manage and dynamically balance ANS (autonomic nervous system) arousal in real time. If not available (e.g., neglect), turn to self-regulation which is lonely.

Autoregulation is self-absorbed, internally focused, pro-self, and interactive regulation is interpersonal, externally focused, and pro-relational. Attunement is being on the same page, in alignment, in synchrony. Produces a sense of safety, security, attraction and is sustained by a couple’s capacity to remain predictable and friendly on a micromoment basis. 103 Misattunement is unpleasant. Negative reactions need to be repaired. Skillful couples will repair without much awareness of what they have done. Discomfort arises if the couple takes longer than usual to repair. Too much time without repair breeds insecurity and threat. Time is of the essence. 104

SOME IDEAS ABOUT EMOTION & REGULATION & PRACTICE
MINDFULNESS MEDITATION & NEUROSCIENCE SOME IDEAS ABOUT EMOTION & REGULATION & PRACTICE Understand importance of emotion and now it works Offer psychoeducation for clients re: emotions and the brain and mental health Focus on emotional regulation, identification and naming, horizontal and vertical integration Become mindful of emotions and able to quickly attune, resonate and be empathic Continue to check on emotional bond with clients using Session Rating Scale and others Uses emotion to enhance motivation and as a target for some clients Keep yourself emotionally balanced regulated and integrated Practice attunement and resonance Allow time between sessions to regulate and de-stress Understand importance of mental health, integration and positive emotions

MINDFULNESS MEDITATION & NEUROSCIENCE SOME IDEAS ABOUT EMOTION & REGULATION & PRACTICE Become a specialist in positive emotions, what they are, how they work and explaining to clients After honoring the problem, move to positive emotions: caring days; reminiscence; mindfulness; strengths-based Your therapy context needs to foster learning: work with goals that are highly relevant; tasks that make sense; building positive relationship with bond and security Evaluate process and outcome Practice changes with clients- use homework for stronger circuits Used varied sources: tools, scales, tapes, video, role playing Goals are navigational beacons reflecting valued and emotionally positive things.

MINDFULNESS MEDITATION & NEUROSCIENCE SOME IDEAS ABOUT EMOTION & REGULATION & PRACTICE Watch the client continuously for emotional experiences, ask questions, evaluate. Pay attention to non-verbals and your own resonance Have routines or approaches ready to help clients identify feelings, name them experience them, share them with others Use things that help manage emotions such as structure, rules, positive feedback and review of progress

MINDFULNESS MEDITATION & NEUROSCIENCE SOME IDEAS ABOUT EMOTION & REGULATION & PRACTICE Become an expert in fostering emotional regulation both self and co-regulation Self-regulation: anticipate of negatives, planned avoidance, prevention; self-hypnosis; meditation-self-attunement, interpersonal attunement; supportive relationships; psychoeducation; time-outs, identifying patterns Mutual regulation: psychoeducation, active listening of emotions; eft, bonding; friendship-oriented relations, knowing triggers, knowing supports Mindfulness & Emotional Regulation (from the workbook, Emotional Regulation in Psychotherapy)

Mindfulness fosters an adaptive, flexible orientation to emotional experiences Building acceptance of emotions Openness to experience of emotions- don’t have to be surpressed Non-judgmental, reduces guilt, shame Experience emotion in the moment without intense behavioural reactivity Decentered nature: thoughts are thoughts, feelings are feelings, emotions are emotions, physical sensations are sensations THEY ARE NOT YOU

Doing mode is resistant, active, problem-solving, pushing away: negative feelings/cravings. Can lead to dissatisfaction, self-criticism, futility When we suppress feelings, thoughts events, they can come back more intensely and frequently

Being mode not goal-oriented, observational, deep contact with the present Sleepwalking through life. We enter reality with expectations that distort what we are experiencing in the moment. Early memories, for instance, colour the way we see things and people. It sets up a distorted lens which uses expectations to contort present realities. Mindfulness fosters an intentional awareness that creates a paradoxical disidentification from the contents of one’s own conscious mind while gently allowing a non-judgmental, full experience of the present moment. Mindfulness may enhance the functioning of emotional processing by encouraging the direct translation of bodily sensations into emotion.

Somatic Psychotherapy (Pat Ogden) How the body holds PTSD and attachment issues and how we can work through the body to help those issues heal. Body intimately tied to emotion, hormones, Harvard research, Dr. Amy Cuddy, has done studies that show the if people take a two minute power pose (like Wonder Woman- confident and upright- that cortisol lowers and testosterone rises. Movement and posture can impact hormone levels, mood, stress and anxiety. If we take PTSD and explore how it lives in each person’s body, then we can start working directly with the body to help resolve some of those symptoms (Ogden).

Body is a constant influence. If we tighten our bodies, lift our shoulders, widen our eyes- the position of fear- we start feeling afraid. Some clients have a chronic posture- constant vigilance, fear. Constant stress changes our bodies. Constantly holding ourselves in vigilance impacts our immune system and adrenals. Flight, fight or feigned death. These symptoms can show up in PTSD as feelings of immobility, not enough energy to get through the day, losing interest in life. Important to work with posture with PTSD.

Secure attachment gives us a better immunity to trauma and to PTSD. Strong attachment to parents builds resilience. Comforting and soothing the child starts to develop the child’s own ability to regulate those lower-brain structures (Ogden). Mindfulness quiets our automatic responses so we can become aware of them. Pierre Janet said that “…trauma is a failure of integrative capacity”. With normal experience, we absorb it. With trauma we fail to process it fully and often elements become dissociated. Feelings are so overwhelming, we push them away. Our bodies have such strong responses that we might try to supresss them or disconnect from our bodies When trauma is integrated, the trauma looks like it is in the past. When not integrated people feel trauma is happening now.

Positive Emotions: Hanson and Happiness. Inner strengths include character virtues such as generosity, modesty, patience, and also secure attachment, executive self-regulation, distress tolerance, resilience, plus mindfulness, compassion and loving-kindness and positive emotions. These are related to happiness. Have to activate inner states first, then install them. Fostering states until they become traits is the secret. Negative states can quickly become negative neural traits. Most positive states are wasted because they are too short-term. Need to transfer short term states from short-term memory buffers to long term storage or no lasting value.

H-E-A-L PROCESS Have- you have the positive experience – notice one or create one Enrich. Increase duration, intensity, multimodality (bring into body, sit up proudly), Novelty heightens learning and increase personal relevance. Absorb. Visualize it sinking in, sense it, build it. Link. (optional). Hold positive feelings or thoughts or memories in awareness and introduce some painful thoughts, feelings, etc. (natural antidote).

The positive material will gradually associate with the negative material, soothing, easing and eventually replacing it. Have more episodes over the day, even 30 seconds at a time, half dozen times a day. Dozen or so seconds each time. Will turn activated states into traits eventually. It is startling to realize how unwilling the mind is to give the gift to oneself of a positive experience (Hanson).

Let us be grateful to people who make us happy. They are the charming gardeners who make our souls blossom. Marcel Proust

Memory Reconsolidation
MINDFULNESS MEDITATION & NEUROSCIENCE Memory Reconsolidation Excerpts taken directly from Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain. NY: Routledge and from “Is Memory Reconsolidation the Key to Transformation? In Psychotherapy Networker at written by Bruce Ecker, Robin Ticic and L. Hulley. Bruce Ecker Unlocking the Emotional Brain Most currently thinking about working through past based issues is that therapists can help clients develop new emotional and behaviours that work around but don’t change deep emotional programming. These circuits were thought to be ultradurable and immutable.

New neuroscience knowledge suggests that under certain conditions therapists can help to unlock neural pathways and actually erase them & add new learning. New therapies called “deep change” approaches all share an experiential component. Examples include EMDR, EFCT, Coherence Therapy & NLP. The brain is built to identify threats and keep the memory circuits active that involve these threats. The staying power of these learnings have survival value & do not reflect pathology. Memories of events and the learnings from these events are different and are stored in separate memory networks. You may not remember a negative event but you remember the emotional learnings or implicit memories from this event (e.g., I have to be loved by everyone). So emotional learnings are the target of the erasure, not the memory of events.

The implicit memory can become triggered by different circumstances and along with it comes an emotional state with no awareness of why this is occurring. Neuroscientists discovered the memory reconsolidation process that turns off a learned emotional response at its roots, not by suppressing it but by unlocking the neural connections sustaining it and then erasing it completely. Whether it is with crabs, chicks, mice or humans, there is a three step process to unlock and erase: reactivate the emotional response; unlock the synapses maintaining it and create new learning that rewrites the unlocked target learning.

Reactivating an emotional memory and at the same time experiencing contradictions (a prediction error or vivid new experience that contradicts the emotional memory) unlocks the synapses. There is a window of a few hours and then the synapses automatically relock keeping the original learning. Experiential methods in therapy can erase and transform the neural networks.

Table 2.3 Comparison of the therapeutic effects of therapeutic reconsolidation process and emotional regulation (p. 33)

Table 3.1 Steps of clinical process for using new learning to nullify or update an existing emotional learning (p. 41). Therapeutic Reconsolidation Coherence Therapy

Case Example: A 37 year old single woman Charlotte who wanted therapy to end her painful daily obsessing about her former lover “Nina” persisting even after two years. She described her connection as “primal”. Finding Coherence Primal suggested an implicit emotional schema driving her obsession consisted of an attachment pattern in which she relied on a deeply merged sense of connection for security. “If I let this end, I lose me”. To integrate this recognition, wrote on a card “An important part of me wants to be you and doesn’t want to give that up” and read daily. Mismatch Detection Over the week Charlotte came to feel that “no boundaries equals death. That’s not right”.

Case Example: This contradiction became emotionally real which is essential. So contradiction revealed: I’m much better off by merging and I’m much, much worse off by merging. Contradiction explored deeply and emotionally. Several explorations and repetitions of the juxtaposition statement. One part feels…. The other part feels this merging is a kind of living death… How could I have possibly thought to leave myself out like that? Taken from Unlocking the Emotional Brain, written by Bruce Ecker, Robin Ticic, & Laurel Hulley.

Related Videos Richie Davidson, Jon Kabat-Zinn & Neuroscientist 1:14 hours

FORMER REFERENCE MATERIALS
MINDFULNESS MEDITATION & NEUROSCIENCE FORMER REFERENCE MATERIALS

From Hanson, R. (2009). Buddha’s Brain.

Anatomy of a neuron and a synapse from “Brain Facts” of the Society for Neuroscience,

“FLIPPING YOUR LID” MINDFULNESS MEDITATION & NEUROSCIENCE
“FLIPPING YOUR LID” Dan Siegel’s Brain Hand Puppet from Siegel & Hartzell (2003), Parenting from the inside out. P.173

From Hanson, R. (2009). Buddha’s Brain.

MINDFULNESS MEDITATION & NEUROSCIENCE Mindfulness Research
See Mindfulness Research Handout

Physical Impact of Meditation
MINDFULNESS MEDITATION & NEUROSCIENCE Physical Impact of Meditation Enhances immune system Reduces stress-related cortisol Increases activation of left frontal regions which lifts mood Thickens & strengthens frontal cingulate cortex & insula Enhances attention, empathy & compassion (Hanson, 2009) Neuroscientist, Dr. Sara Lazar

Mindful Brain by Daniel Siegel (2007)
MINDFULNESS MEDITATION & NEUROSCIENCE Mindful Brain by Daniel Siegel (2007) Developing mindful awareness helps to: Regulate emotion & combat emotional dysfunction Improve thinking Reduce mindsets Reduce stress Enhance immune system and physical well-being Improves the ability to perceive others’ emotions Improves ability to sense world of others Promotes capacity for intimate relationships, increased resilience & well being.

Factor-Inwentash Faculty of Social Work Applied Mindfulness Meditation

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Factor-Inwentash Faculty of Social Work Applied Mindfulness Meditation

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