Not to be copied without authors permission The Mindful Brain self-regulation and social engagement Dr Terry Myers Senior Lecturer (retired) in Cognitive Science University of Edinburgh

Not to be copied without authors permission Introduction The study of mindfulness has a long history within the contemplative tradition, and has been cultivated through a number of practices, including meditation. Mindful awareness now has a central place also in clinical practice. And, motivated by a shift in focus from pathology to well- being, there is a resurgence of interest in it as a discipline for all who wish to enhance their life experience by being fully in the present. However for most people who have experienced trauma, particularly from infancy, their ability to be in the present is severely compromised, as they are continually being drawn back into their past. In order to live in the safe present, and to benefit from therapy, their mastery of mindfulness is a key issue. Being self-aware is critical for making rational life decisions, and being ‘mindfully aware’ of each other is foundational for living harmoniously together. Understanding mindfulness therefore, needs to be brought into the disciplinary framework of systematic inquiry.

Not to be copied without authors permission Introduction ctd Through brain imaging research, neuroscientists are now able to ground the inquiry in measurable activity of the brain. So what are they beginning to find out? We will consider some of the recent research on mindfulness, looking in the first half at the cultivation of mindfulness through meditation and other techniques, and at the role of ‘body maps’ and feelings in the formation of conscious experience. In the second half we will focus on the crucial role of affect regulation in the development of positive social engagement and empathy. Throughout we will note the brain areas that are active during mindful activity as we attempt to form a dynamic picture of the mindful brain. But first, what do we mean by ‘mindfulness’?

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Mindfulness and Meditation ‘Mindfulness’ in common usage: “paying attention or taking care” as in listening closely to what is being said, driving carefully. The key element is direct experience of what is in the present, not doing something on ‘automatic pilot’, while thinking about something else. Awareness through paying attention, on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment-by-moment (Kabat-Zinn, 1990) (i) Five facets of the mindfulness construct used in the clinical field: describing; acting with awareness; being non-judging; non-reactive; observing. The first four are independent facets; observe overlapped with the others except for people who practiced meditation (Baer et al, 2006) (ii)

Not to be copied without authors permission Mindfulness in the contemplative tradition Buddhists see the undisciplined mind as unbalanced, swinging between excitation and laxity. Cultivation of attentional stability has therefore, a central place within its tradition Detailed instructions for achieving focussed attention in a discipline known as shamata (sha-ma-ta), meaning stillness, is practiced by Tibetan Buddhists (Wallace, 2007) The contemplative reaches attentional balance through a series of stages by progressively rooting out more subtle forms of the two mental obstacles: agitation and dullness Ultimately the contemplative achieves the primary state of ‘contentless awareness’, bhavanga, finding that the nature of this state of consciousness is loving kindness From bhavanga arises empathy and compassion

Not to be copied without authors permission Mindfulness in neuroscience Neuroscience recently turned its attention to mindfulness. To get a glimpse of the phenomenon they seek to understand, 100 researchers were provided training in Vipassana meditation, focussing on breathing, at a week’s silent retreat Dan Siegel, a psychiatrist and participant at the retreat, reported that it was difficult at first to just observe one’s breathing. The mind keeps introducing thoughts that take the attention away from the here-and-now activity of breathing He devised for his therapy clients a reflective exercise to enable them to clearly discriminate between the images, thoughts and feelings that intrude in this way and the self that observes them Disidentification, the realisation that we are not our thoughts, is a state of being in which we can decouple from our habits of mind. DEMONSTRATION

Not to be copied without authors permission Mindfulness in neuroscience ctd With diligent practice the student of mindful awareness training gains an ability to regulate thought and feeling and to just be his/her ‘ipseitious self’(Lutz et al., 2007) “Ipseity is the minimal subjective sense of “I-ness” in experience, and as such, it is constitutive of a ‘minimal’ or ‘core’ self. By contrast, a narrative or autobiographical self encompasses categorical or moral judgement, emotions, anticipation of the future, and recollections of the past (Legrand, in press). Is ipseity the core state of mindful awareness? And is it the core state of consciousness ? How does neuroscience approach these questions?

Not to be copied without authors permission Embodied Self Antonio Damasio (1999) offers a biological base-line for considering the nature of self and consciousness. Although language plays a key role in the formation of the auto-biographical self, with its rich narrative content, the consciousness that underpins this, core consciousness, is non-verbal. He starts from the position that the “roots of consciousness” are feelings and the “sense of self” has a preconscious biological precedent, the proto-self. (i) The proto-self is the foundation on which core consciousness is built. It is not itself conscious. It is a collection of neural patterns that continuously map (record) and regulate the body’s internal state, keeping it within safe limits of variation of the environment. This is the prior life-preserving function of the proto-self. (ii)

Not to be copied without authors permission Structures implementing the proto-self Brain-Stem Nuclei: regulate current body state and map body signals; connect to higher levels of the CNS, and via spinal chord pathways, to the furthest reaches of the body-The highest input to this structure arrives, via the trigeminal nerve at roughly the position shown, from the facial areas. The vagus nerve, also shown, brings signals from the viscera: heart, lungs and stomach Hypothalamus: contributes to the mapping of the body by registering the current state of the internal milieu (glucose, water, pH, ions, hormones) which it helps regulate Basal Forebrain: interconnects the brain-stem nuclei and hypothalamus and constitutes their extension into the forebrain Insular and Somato-sensory Cortices: these hold (in the RH mainly) the most integrated representation of the current internal state of the organism at the level of the hemispheres (along with the invariant design of the musculoskeletal frame).

Not to be copied without authors permission The proto-self and somatosensory system The proto-self represents the body perspective of the individual; it provides the frame of reference for the experiencing of objects and events in terms of the body changes they provoke in the organism. Example: A car is careering suddenly in your direction; you move head and neck as you track its course, and a fear response is provoked. This manifests as increase in blood pressure, heart rate, breathing and activation of the muscles for flight. The changes in body state are mapped by the brain. For an individual observing the incident from an upstairs window the event impacts differently on the structures that implement the proto-self. The body maps (i) of you and the observer will clearly differ, reflecting the difference in body perspective, and the conscious experience arising from them will be correspondingly different. Body maps are formed by the somatosensory system. This is a combination of several subsystems, each conveying information about different aspects of the body state. There are three fundamental divisions: internal milieu and viscera; vestibular and musculoskeletal, and fine touch

Not to be copied without authors permission The somato-sensory system Internal Milieu and Visceral Division: maps changes in the chemical environment of cells throughout the body, signaling the state of the smooth muscles abundant throughout the viscera and under autonomic control: stomach; skin surrounding the whole body (the largest of the visceral organs: contains temperature and communicative emotional touch receptors). The generic term for sensing changes in this internal environment is interoception. Vestibular and Musculoskeletal: this division monitors balance and body position in space, and registers the state of the striate muscles joining moving parts of the skeleton, the bones. Sensation arising here is described as proprioception. Fine Touch: one of the five primary senses, arising from a different type of touch receptors from those of the first division. They enable external objects to be experienced directly on the basis of signals generated at the body surface.

Not to be copied without authors permission Somatosensory system ctd The divisions of the somatosensory system can work fairly independently. They can also work in close collaboration. Example: When you lift your baby out of the bath and cradle her in your arms, your movements for lifting and cradling are regulated by the second division (vestibular and musculoskeletal); the infant’s wet skin activates the fine touch system that guides the careful movements of your hands. And the humoral and visceral reactions that constitute the pleasurable response to the close contact with your loved one are mediated by the first division (internal milieu and visceral) concerned with your own internal environment. Under normal conditions this division is on duty all the time, even in deep sleep, and the brain is also being continually informed about the musculoskeletal system.

Not to be copied without authors permission Building core consciousness When an individual engages with an object the proto-self changes in a way determined by the properties of the object from the perspective of the individual engaging with it. ILLUSTRATION You are sitting relaxed and listening attentively when suddenly I throw you an object, say, a large beach ball. You respond by tracking the object and making movements that change your posture to one that will enable you to catch the ball. Minimally this requires adjustments to the vestibular and musculoskeletal division of the somatosensory system and to the level of arousal, in the internal and visceral division, that readies you for the catch. Let’s try it, with a large, imaginary beach ball. A little reflection will reveal that your body adjustments were tailored to the properties of the object that are relevant to catching it (its size, shape, weight..) and the dynamic parameters of its movement towards you. The adjustments to be made would be different if I threw a different object (say, an imaginary rag doll). Let’s try it

Not to be copied without authors permission Building core consciousness ctd The adjustments are also calibrated to the starting state of the proto-self. Sitting upright you see the object moving to your right, you shift your posture, changing the vestibular- muscoloskeletal part of the body map In this way, the properties and parameters related to catching the object from the body perspective of the individual modify the body maps of the proto-self (i) This second-order process, of object-related modification of body maps, is what generates core consciousness: ‘the feeling of what happens’, and enhances the image of the object bringing it into focal awareness. (ii) The second-order maps are generated by neural structures capable of receiving information from body and object maps: superior colliculus, thalamus, and anterior cingulate cortex

Not to be copied without authors permission Structures implementing core consciousness The superior colliculus turns the eyes towards the object to be engaged. The lateral pulvinar in the thalamus locks on to the object, sending information about it to the relevant areas of the cortex. The thalamus coordinates the cortical and sub-cortical processes that come together in the generation of consciousness.(i) The anterior cingulate cortex receives massive inputs from the somatosensory system, is involved both directly and indirectly in the complex adjustments which re-set the maps of the proto-self, and is crucially involved in processes of attention and emotion. It plays a key role, together with the thalamus, in generating consciousness. (ii)

Not to be copied without authors permission Affect Regulation Affect regulation is a defining aspect of mindfulness. When regulated, feeling and emotion play an essential role in the rational decision making that is conducive to social harmony. Helen has written that “emotion is not the enemy of reason but its powerhouse” (H.Myers, 1990). The ventromedial PFC, in each of the frontal lobes, is dedicated to feeling and emotion. Bilateral damage here can seriously limit the capacity for rational decision making in the personal and social domain. Example: Elliot, following surgery to remove a tumour, could not make rational decisions, and no longer had the gut feelings that would tell him whether a business associate could be trusted. He went bankrupt (a credulity crunch?). Normally, “When a bad outcome connected with a given response option comes into mind, you experience an unpleasant gut feeling” (Damasio, 1994). Because the feeling is about the body and marks the option coming to mind, Damasio called it a somatic marker

Not to be copied without authors permission Non-reactivity Emotion then, is the driving force behind socially appropriate reasoning. But evolution has delivered a brain with an emotion generating system that can over-power its cognitive system, disposing the individual towards reactivity, and even trauma. The amygdala can trigger the fear response ahead of conscious awareness and the appraisal of its appropriateness. How is the flexibility of feeling that is necessary for social harmony to be achieved? Affect may be mindfully regulated through the integrative function of the middle pre-frontal regions (MPFR) of the cortex, mainly in the right hemisphere, together with the social engagement function of the vagal system.

Not to be copied without authors permission Non-reactivity ctd Affect regulation comes about through interconnection of the amygdala with the orbital medial prefrontal cortex (OMPFC), which can moderate the response of the amygdala. The OMPFC-amygdala network, which is shaped by experience, “encodes our learning history of what is safe and dangerous including our attachment schema” (Cozolino, 2007). This enables us to act in a measured way rather than simply react. The orbital medial PFC receives information from the body and the external environment. This information is relayed to the ventral medial PFC, which connects with many parts of the limbic system, whereby it can “mediate the integration of the visceromotor aspects of emotion with information gathered from the internal and external environments” Gusnard and Raichle (2001). This would furnish an explicit mechanism for the formation of somatic markers of events.

Not to be copied without authors permission Affective style and resilience The way people handle emotion, affective style, expresses consistent differences in affect regulation. Richard Davidson (2000, 2004) examined the way that mindfulness training can shift affective style towards non-reactivity. Non-reactivity expresses a central aspect of resilience, which he defines as the “maintenance of high levels of positive affect and well-being in the face of adversity”. Negative affect when it occurs does not persist in a resilient individual. Affective style has deep roots going back to early caregiver-offspring relationships. But resilience can be acquired throughout the life-span through positive social experiences. Siegel suggests that mindfulness as a form of “attention and care focused on oneself” encourages an approach mindset in which feelings become flexible and affective style is shifted towards resilience. With this we gain the capacity to rebound from negative states, not to eliminate them from the rich spectrum of human experience.

Not to be copied without authors permission Development of affect regulation The development of a healthy affect regulation system requires an emotionally stimulating environment and protection from intense, prolonged, and overwhelming experiences. Whilst emotionally stimulating experiences promote brain growth, overwhelming affect and prolonged stress lead to the loss of the neurons required for building the cortical-limbic circuitry associated with adaptive affect regulation. PET scans of babies’ brains show that the areas correlated with bodily regulation ( brain stem), sensation (thalamus), and movement (cerebellum) are very active. Connections are being formed and functional circuits created among cells that are active together. Coupled with this activity is a neural sculpting process referred to as apoptosis or programmed cell death, the function of which in the immature brain is to remove cells and connections that are not being used, thereby improving the efficiency and organization of the others.

Not to be copied without authors permission Development of affect regulation - ctd Apoptosis facilitates differentiation of function, removing for example, connections between the auditory and visual cortices which would otherwise mean ‘hearing’ colour say, and ‘seeing’ sound. The downside of apoptosis is that the process can be distorted by abuse and neglect, which inhibit the normal maturation of circuits vital to affect regulation. The baby is left with a loss of neurones but no specialisation, and thus a permanent loss of affective capacity and regulation. Development of a well regulated affect system requires repeated experiences of moving back to a balanced state following short periods of dysregulation, in the safe, stimulating environment provided by positive parent-child interactions. These experiences of parent-guided recovery from affective imbalance become encoded as implicit memories of positive state transitions and dispose the growing child toward self- regulated affect (see Cozolino, 2007).

Not to be copied without authors permission Applying the vagal brake Successful engagement with others plays the key role in the development of affect regulation. Stephen Porges has proposed a polyvagal theory of social engagement (Porges 2001, 2003). According to this, the vagal system has evolved into three separate autonomic subsystems: the ‘vegetative’ vagus, which has an immobilizing role, and is part of the parasympathetic system; the fight-flight, mobilizing system, which depends on the sympathetic branch of the ANS; and the social engagement system, also referred to as the “smart” vagus. The smart vagus exerts a calming influence by inhibiting the phylogenetically older sympathetic-adrenal system that would otherwise trigger the fight-flight response. Beginning in the brain stem it projects, independently of the spinal chord, both sensory and motor fibres that enable the brain to monitor and control the functions of organs and systems throughout the body.

Not to be copied without authors permission Applying the vagal brake - ctd The myelinated smart vagus can rapidly alter the vagal tone of the heart’s pacemaker, which is an inhibitor of heart rate. When the vagal tone is high the inhibitory effect is strengthened and the vagus acts as a brake on the heart rate. When it is low there is reduced inhibition of the pacemaker and the heart rate increases. Accordingly, the ‘vagal brake’ can rapidly act to calm (tone high) or mobilize (tone low) the individual. By modulating visceral state the vagal brake “enables the individual to rapidly engage and disengage objects and other individuals and to promote self-soothing behaviours and calm behavioural states” (Porges, 2001). This addition to our autonomic control system allows us to stay engaged in cooperative relationships with others, despite transient disagreement and conflict, without requiring sympathetic arousal or adrenal activation. It is the evolution and development of this social engagement system that has promoted courting and sustained pair- bonding, in a context of “love without fear” (Porges, 1998).

Not to be copied without authors permission Applying the vagal brake - ctd Development of the engagement system and fine tuning of the vagal brake to regulate affect appears to depend on the quality of attachment relationships in early childhood. The shaping and tuning of the smart vagus is one way that early experience shapes the brain. It integrates with cortical and limbic structures in the regulation of experience and behaviour. ADHD may in some cases at least, result from insufficient vagal tone. In summary: Higher vagal tone is correlated with positive social engagement; ability to self-regulate; self-soothing capacity by 3 months of age; range and control of emotional states; suppression of heart rate variability; enhanced attentional capacity and ability to take in information; consistent caregiver and secure attachment. Lower vagal tone is correlated with behaviour problems at 3 years of age; emotional dysregulation; distractability; hyperactivity to environmental and visceral stimuli; withdrawal; impulsivity and acting out; insecure attachment.

Not to be copied without authors permission Empathic Attunement Dan Siegel has adopted in his work on interpersonal relationships within families the concept of attunement to “examine how one person, a parent, for example, focuses attention on the internal world of another, such as a child.” Building on his studies of interpersonal attunement and the self-regulatory functions of focused attention, he goes on to suggest that mindful awareness is a form of internal attunement. How might we focus on the inner world of another? Work on social mirroring is providing some clues. Mirror neurons were discovered while recording from individual motor cells in the premotor area of a macaque monkey observing another macaque engaged in a specific behaviour, such as grasping an object with her hand. They were labelled ‘mirror’ because they fire both when an individual is observing a particular action and when performing it.

Not to be copied without authors permission Empathic Attunement ctd The observer’s sensory image of the act primes the motor system with an “inner imitation” of it (Iacoboni, 2007). This was an interesting finding in itself, relating back to the earlier work of Meltzoff on our capacity as babies, within hours of birth (41 minutes even!), to imitate adults sticking out their tongues or making happy or sad faces. What particularly surprised the researchers who made the discovery of mirror neurons (Gallese et al., 1996) is that they responded only if the observed act was for a specific purpose, for example grasping a peanut. Mirror neurons seem to fire only when the observer grasps the import of the act.

Not to be copied without authors permission Mirroring children Marco Iacoboni discusses some studies of the role of mirror neurons in human learning and development. When adults watch others moving objects, say placing toys by hand into a bucket, they look at the bucket before it is reached; likewise when they move the toys themselves. Year-old infants also anticipate with their gaze where somebody else’s hand is going to place the toys. Six-to-seven-month old infants, however, do not. Yet, in an earlier phase of the study it had been established (using an optical imaging technique) that motor areas of the younger infants were activated when watching a woman moving the toys, but not when the toys moved ‘independently’. So mirror neurones appear to learn to predict the actions of others, an ability not present at birth.

Not to be copied without authors permission Mirroring children ctd But mirror neurons do not make a special contribution to brain function in virtue of their intrinsic properties. Rather their function is due to their location in the association areas of the frontal and parietal areas of the cortex, the mirror neuron system (MNS). Neural networks converge here to process information from a number of cortical and sub-cortical areas in the coordination of cognitive and emotional experience with sensory motor behaviour. What role may the mirror neuron system play in the development of social competence and empathy? Mirella Dapretto at UCLA is engaged in a longitudal study of this question, focusing on the turbulent years of adolescence, beginning with ten-year-olds. She is examining the link between the mirror neuron system and the emotion-inducing centres of the limbic system.

Not to be copied without authors permission Mirroring children ctd Observation of other people’s facial expressions of emotion is known to activate, in adults, three key neural systems: the mirror neuron system; then the insula that connects the mirror neuron system with the limbic system, and finally the limbic system itself. The ten-year-olds gave the same pattern of activation. What does this say about their ability to empathize with others? To answer this question Dapretto correlated the levels of brain activity with the children’s scores on an emotional empathy index and a social skills scale. She found strong correlations between empathy and brain activity during the observation of emotional expression, and also between interpersonal competence and brain activity during the imitation of emotional expression.. Ten-year-olds then, appear to have already acquired the basic resources for emotional empathy.

Not to be copied without authors permission Resonance Another key aspect of social competence is resonance. Resonance behaviours are triggered reflexively by mirror systems: for example, looking up or yawning when others do. The resonance mechanism is well portrayed in nature: for example, the wheeling flight of a flock of starlings at dusk, or a shoal of fish reacting to the sudden presence of a predator. Movement in any part of the flock or the shoal synchronizes the whole assembly to move as a unit. Research with therapist-client diads has shown that therapists unconsciously mirror the facial expressions, tone of voice, and body postures of their clients. With mindful awareness we can learn to observe our own resonance behaviours and inhibit or voluntarily emit them (Rizzolati and Arbib, 1998).

Not to be copied without authors permission Feeling caringly felt Operating normally below the level of awareness, mirror systems and resonance behaviours play an unobserved role in our attunement to the emotional states of others. Empathic attunement originates in affective resonance within secure attachment relationships. Attuned mothers match their soothing behaviour to the child’s affective state, singing less playfully to a distressed child (Milligan et al., 2003). The emotional resonance between mother and child results in the child spending more time in social engagement, with better affect regulation, symbolic play, verbal intelligence and ability to comment on feelings and inner experience (Feldman et a /99). This provides a foundation for the empathic awareness basic to social relationships.

Not to be copied without authors permission Feeling caringly felt ctd Kohut (1984) described empathy as the attempt to experience the inner life of another while retaining objectivity. Holding our own perspective in mind, we imagine what it is like to be the other. That is, being empathic amounts to maintaining awareness of our own inner world while imagining the inner world of another. Mirror neuron and resonance circuits combine with visual-spatial, cognitive, and abstract networks as we try to read the other’s mind. Emotional empathy is perhaps, more immediate. Dacety and Jackson (2004) propose three requirements: sharing of another’s affect; flexible mechanisms of emotional self-regulation, and maintenance of separate self-representation. They found that brain activation then mirrors the affective experience of the other. People ‘connect’ when they mirror each other’s affect. This state of feeling connected is what we are calling empathic attunement: each feels caring towards and caringly felt by the other (Rodin’s ‘kiss’)

Not to be copied without authors permission Rodin The Kiss

Not to be copied without authors permission Readings Rita Carter 1998; Mapping the Mind Louis Cozolino 2006: The Neuroscience of Human Relationship Antonio Damasio 1999: The Feeling of What Happens Marco Iacoboni 2008: Mirroring People Daniel Siegel 2007: The Mindful Brain Francisco Varela and Jonathan Shear 1999: The View from Within B. Allan Wallace 2007: Contemplative Science