1. Stress, Depression & Mindfulness

2. Teaching Mindfulness Based Stress Reduction – Beginning of the story Science seems to help motivation- universal language

3. 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

4. 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

6. Not just the Brain Neurotransmitters Heart Immune system Endocrine system Sex Hormones Sleep Gut

7. Key Brain Areas

8. HPA axis Hypothalamus ( CRF) -> Pituitary Gland ( ACTH) -> Adrenals ->Noradrenalin -> Cortisol -> Hippocampus ( feedback loop)

9. Acute stress reaction HPA activation Flood of neurotransmitters Adrenaline, noradrenalin Serotonin Dopamine Inflammatory response ( interleukin 1) cortisol

10. Studies in chronic stress Whitehall Civil servant study Salposki Baboon studies

11. Neurotransmitters Adrenaline, Noradrenalin Serotonin – first to go -> depression

12. Chronic Noradrenalin Increases heart rate, Blood pressure Activates amygdala threat detector Hyper vigilance for threat Negative memory activated, positive memory deactivated

13. The immune system Hyper activation of non-specific acute phase – Interleukin 1 Suppression of specific immune actions

14. Inter leukin 1 Part of stress response With chronic activation Fatigue, malaise Sleep disruption, appetite effect Anhedonia Impairs hippocampus memory

15. Effects of chronic cortisol activation Loss of diurnal variation Switches off prefrontal, hippocampus Suppress immunity Activate amygdala Burns out – adrenaline fatigue Weight gain

16. Over time cortisol - neurotoxic Loss of connections Decreased branching Loss of neurons Especially prefrontal & hippocampus

17. Damage to Hippocampus Blocks feedback loop -> increased cortisol Memory impairment Inability to form new associations (30,000 new cells per day)

18. Chronic stress stops Neurogenesis & Neuroplasticity Increase cortisol Decrease serotonin, trophic factor, oestrogen

19. Oestrogen & depression Female : Male rate of depression 3:1 Sudden drops of oestrogen associated Menopause Childbirth Premenstrual Oestrogen – powerful Neurogenesis growth factor

20. Under active – hippocampus, prefrontal cortex & cingulate Overactive – amygdala, hypothalamus & Pituitary

21. Prefrontal Cortex Asymmetry Left – approach behaviour, positive emotion – under active in depression Right withdrawal behaviour, negative emotion – overactive in depression Hedonic set point

22. Heart rate variability Healthy heart - high variability Depression/chronic stress = reduction

23. Sleep Cycle

24. Sleep in depression Sympathetic>> parasympathetic Reduced slow wave sleep Increased rem density (predicts response to treatment) Insomnia – x4 incidence of depression

25. Indicators of chronic sympathetic activation Difficulty concentrating Making decisions Remembering Excessive fatigue Motivation Frequent illness Sleep disturbance

26. Paul gilbert slide here

27. 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

28. Filtering reality Activated Amygdala & No hippocampus Habitual mind – tells us what to see & how to react

29. Mental filter

30. Cognitive filter Beliefs, attitudes & perspectives Continuous stream of semiconscious commentary evaluating Somatically marked association & memory Neural networks – synapses reinforced – rehearsal Other associations shut down

31. Example of 4 different filter types Anxious Depressed Type A – angry, hostile Type C – resigned helpless

32. Anxious Imagined scenario – exaggeration of threat Potential crisis with each event Future – what if something goes wrong

33. Depressed Continual comparison between some ideal & reality Self –critical evaluation Underestimation of resources & negative memory bias

34. Type A The world is against me Always scanning for threat Easily made paranoid

35. Type C Passive pessimistic and helpless Underestimate resources Overestimate threat

36. Vicious Cycle HPA activation Physiology threat related cognitive filter Perceive threats and failure

37. Mindfulness & Depression