Practical Brain-Focused Strategies for Working with Depression

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1 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 1 Practical Brain-Focused Strategies for Working with Depression How to Help Patients Escape the Depression Loop with Elisha Goldstein, PhD National Institute for the Clinical Application of Behavioral Medicine

2 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 2 Practical Brain-Focused Strategies for Working with Depression: Elisha Goldstein, PhD How to Help Patients Escape the Depression Loop Dr. Goldstein: After we tune the heart, we can now work with mindfulness. Sometimes I show people a cartoon about waking up to mindfulness. First of all, from a neuroscience perspective, mindfulness does create that left prefrontal shift. It s been shown that mindfulness cools down amygdala activation, which is what we are looking for in natural antidepressants. Mindfulness has been shown to grow neural connections neural growth in the hippocampus, another area that s really impacted negatively by ongoing chronic stress and in the depressed brain. It s been shown that mindfulness cools down amygdala activation; it creates that left prefrontal shift. Neurologically, mindfulness has some really important natural antidepressant effects. Now, of course, this is with someone who s struggled with depression over time and may not be currently Mindfulness has some really important natural antidepressant effects. majorly depressed, and that s an important distinction. For example, with mindfulness, this idea of being aware or intentionally paying attention to the present moment with an engaged curiosity, we want to use that with people who are not currently depressed or who have mild to moderate depression. If people are currently, emotionally unstable, we don t want them to start going internal they don t have control over their rumination issues so much and it ll just be another experience of failure to actually try to do these practices. So, you may have seen this cartoon there are these cows in the pasture, and one cow lifts his head up and says, Hey, wait a minute this is grass! We ve been eating grass? If people are currently emotionally unstable, we don t want them to start going internal. Mindfulness, as you know, is about waking up stepping into that space between stimulus and response where there is choice, possibility, and freedom.

3 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 3 Mindfulness is about stepping into that space where there is choice, possibility, and freedom. It s that moment awareness is the springboard. Awareness is the springboard to getting in touch with what matters. So, basically, mindfulness is awareness it s a new way of treating emotional suffering. Thich Nhat Hanh, the Vietnamese Buddhist monk says, It s like a way of using a thorn to remove a thorn. In other words, we can learn to pay attention to the difficulty that s here, and in paying attention to it if we re ready to ride the edge of our emotional discomfort and pay attention to it, we re also telling ourselves, saying the message internally, that we re worth paying attention to. Mindfulness feeds worthiness it s inversely correlated with feeling depressed. Mindfulness is awareness it s a new way of treating emotional suffering. The moment we pay attention to our suffering, we re no longer fueling it with the aversion or trying to get away from it: what we resist persists. When we pay attention to it, we re able to hold it much like I can hold this pen here we re holding it and allowing the emotions to do what they naturally do, which is just to come and go. And we learn that there is impermanence to the experience. So, there are some neurological benefits to mindfulness and there are also some psychological benefits to mindfulness as we settle into the training of it. Now, again, let s remember that depression loop I showed you thoughts, emotions, sensations, behaviors and writing those down can be a little trick to popping people into a mode of mindfulness. Mindfulness quite literally helps people get out from that depression loop and allows the depression loop to be there I notice that I m aware of my thoughts, emotions, sensations; I m aware of this behavior I m doing right now, and now I have some more perspective. Within that perspective, I have more choice choices that I didn t even know were here before because I was so in it. Mindfulness helps us wake up to the depression loop.

4 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 4 Mindfulness creates that left prefrontal shift, deactivates the amygdala, ignites the hippocampus and helps us get that perspective of choice. One of the original studies that ignited the field it was the real marriage between mindfulness and neuroscience was the study that came out in 2003 with Richie Davidson and Jon Kabat-Zinn. They went to a biotech company and they ran them through an MBSR program, and what they found was that they had the common stress reduction and increased well-being what you would expect but when they hooked them up to their fmri machines, they found that there was this left prefrontal shift. You can see a left prefrontal shift in a long-time meditator it will naturally occur and you see a left prefrontal shift in what they call in science the meditation-naïve participants people who haven t had any mindfulness experience before. So, it seems to go across a continuum this left prefrontal activation. When you re able to name an emotion, it deactivates or scales down the amygdala. We also know, through studies by people like Matthew Lieberman and Dr. Naomi Eisenberger, that when you re able to name an emotion, it deactivates or scales down the amygdala. It also brings more activity over the prefrontal in general, and the prefrontal, as we know, is involved with emotion regulation and impulse control. To be able to bring more access to that online while deactivating the amygdala is really important. That was a study called Putting Feelings into Words you can look that up on your own. To me, it was really a seminal study it wasn t a mindfulness study mindfulness helps us become aware and note things, and as we do that it brings more balance to the brain, so that s great. Another thing around mindfulness and neuroscience some of you may have seen the movie The Champ or you may have seen the movie Terms of Endearment. So, here s a study that came out of Norman Farb s lab and Zindel Segal was a part of it, too. Basically, they ran people through an MBSR program, an eight-week mindfulness-based stress reduction program, known as a gold standard of secular mindfulness programs, and then they showed them some movie clips.

5 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 5 Now, Terms of Endearment and The Champ, if you haven t seen them yet you can YouTube The Champ and Terms of Endearment I haven t checked that one out yet on YouTube but if you ever need a completely cathartic cry, you can watch this 45-second clip. Here are two of the saddest movies that have ever existed in the history or cinema. Here you have a clip of a son watching his father die after a boxing match, and you have a clip of the mother watching her daughter die of cancer so, you have two incredibly devastating clips. Both groups, the group that went through the MBSR program and the group that didn t, showed the same perceived sadness, but the group that did not go through the MBSR program showed a statistically significant difference in the Beck Depression Inventory so, more associations with depression. When they looked at the brain scan, they also found that they were activating two different parts of their brain same perceived sadness but different/not as high on the Beck Depression Inventory for the mindfulness people. What was interesting is this area in the center part of your prefrontal cortex you may have heard of this study before called the cortical midline, and that is associated with what is called the narrative network the default mode which is basically the story of me a self-referencing activation. So, as you might imagine with the people who didn t go through the mindfulness program, they had this sadness arise and their brain said, Uh-oh, what s this? I ve got to figure this out. I don t really want to feel this uncomfortable let s get away from it, and maybe even more of that kind of rumination. The other group that went through the mindfulness program probably felt the sadness was aware of it and brought their attention to the sadness and started to just allow it to be and maybe feel into it. And that was associated with obviously some important neural shifts that were inversely correlated with the Beck Depression Inventory. So, here s what we might say: we can turn the volume down on our rumination with mindfulness. We can naturally learn and train ourselves when we re feeling a certain emotion, to pay attention to that emotion physically in the body to investigate it and just allow it to be versus feeling the rumination feeling the cortical midline that s there. We can turn the volume down on our rumination with mindfulness.

6 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 6 In this way, mindfulness is a natural antidepressant. Now, I have to mention, and I touched on this earlier, mindfulness on its own is not a one size fits all. You want to be a trained teacher to be able to work with mindfulness that s helpful, and in fact, some people say it s essential, before just playing with it within your private practice or in your practice as a therapist. There are certain situations where it could be harmful or used in a way that s more associated with avoidance. For example, you could have a breath meditation and be just focused on the breath, and you might be using that over and over again to avoid an uncomfortable feeling. If you re paying attention to the breath, you re likely to distract yourself or reduce the feeling you re We have to pay attention to our feelings and move from them to get to the vulnerability and to learn how to trust ourselves. basically using it as an emotion regulation tool. And the problem with that is sometimes we have to pay attention to our feelings and move through them to get to the vulnerability and to learn how to trust ourselves to have the wonderful antidepressant effects that are there. Often people, who have been doing breathing meditation for years, decades even, come back into therapy and they say, I just don t know what is happening. What we find is that maybe they were using that breath meditation as an avoidance technique, so now we have to work with the feelings that are there. So, mindfulness could be used as an avoidance technique, and we have to be aware of that. We also have to know when people are stable and unstable that s really important in working with mindfulness. I m not going to go into too many mindfulness practices here because there s so many mindfulness programs out there free meditations that you can go and access; I know NICABM has done a tremendous number of series on mindfulness in the past. We have to know when people are stable and unstable that s really important in working with mindfulness.

7 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 7 But I will tell you the nuances of mindfulness, which is important for the time that we have here, and then you can use these nuances to understand it better with all the variety of practices that are out there. With someone who s unstable really depressed, highly anxious or within the midst of trauma it s not a time to say, OK, let s do a body scan or come to the breath. In particular, you might want to do something different that s more stabilizing. So, I m going to give you a practice right now that, to me, is more stabilizing and also, just in general, more helpful and better at integrating mindfulness practices. Most mindfulness teachers don t really teach they jump into the breathing practice or body scan because typically, with the mindfulness-based interventions, you only have eight weeks. One of the fundamentals is around teaching people to relax before they even start paying attention to their Teach people to relax before they even start paying attention to their breath. breath and using it as an awareness practice. We want to help people use their mindfulness to help them to relax to relax their body, tune their nervous system, and create calm in their mind. One way of doing that is quite literally to have people lie down they can lie down on your couch you can do this yourself. The first thing you do is just see if you can feel the ground beneath you and really soften your muscles as best you can soften into the ground the muscles that are in your face and your body. Then, just notice your body naturally breathing you re not trying to do anything with it you re just noticing like you would in a mindfulness practice the body just naturally breathes. Maybe you re focusing a bit on the out-breath. In the out-breath you re just releasing releasing emotions, releasing busy mind you re just releasing releasing. In the out-breath, you re just releasing. In a mindfulness practice, you wouldn t be focusing on doing the out-breath necessarily it s more about equanimity noticing the breath coming in and out. But here, fundamentally and before you can get to that, you have to be focused on a kind of releasing, and you don t know what will come up.

8 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 8 You don t know if you actually release or not, but you re just focusing on that blending into the ground releasing with your breath. You may just do that for five or ten minutes something like that focusing on the out-breath and just releasing. That helps to create groundedness helps to create a sense of, OK, I can be here. You re not trying to deal with what is that s not a mindfulness practice this is something that helps to create the calmness of mind. We can do other practices that are around stability these can help with instability and they can help with then being open to some of these mindfulness practices. Whether someone s stable or unstable, you can certainly do what I m suggesting here: you can see if they can just soften into the couch or into the ground if they can soften their body. We can help them open up to more outward experiences, like listening to sounds or doing visualizations. If they can t, that s OK we re just noticing this and trying this as an experiment. Then, we can help them open up to more outward experiences, like listening to sounds or doing visualizations such as Mountain Meditation and others. These are visualizations that help more with instability. If someone s stable, then we can go to the SAFE practice, as an example it s a good practice that integrates mindfulness and self-compassion. If you haven t done the SAFE practice because you jumped forward in this course, the SAFE practice is described earlier and you can go back to it. With the SAFE practice, you can start to ride the edges of your vulnerability, learning inevitably how to encourage that three-legged stool, the mindfulness, the awareness, and the cultivating at the same time. So, here s the bottom line: you have an intention, and you pay attention to it intention leads to attention, and that leads to a sense of connection. Connection is the essence of doing well, and that leads to a sense of balance and balance feeds itself into feeling well in general. Intention leads to attention, and that leads to a sense of connection.

9 Practical Brain-Focused Strategies for Working with Depression Video 8 - Transcript - pg. 9 Stability practice around mindfulness is something you can adapt for teens and kids. We re going to leave it at that. I might mention just briefly that this stability practice around mindfulness is something you can adapt for teens and kids. With kids, you can have them lie down and put a stuffed animal on their belly; with teens we have this little river rock; we write breathe on it and we just have them lay it on their stomach and just naturally see the rock rising and falling. Not only do they feel a bit calmer so that gives them some self-regulation tools, and the rock now becomes a cue for them. We have stories of teens that have used the rock when they re in their room used it as a self-regulation tool calming them down and then it helped them in their next moment, let s say, with their parents after a big disruption. There are different ways that we can play with mindfulness with both adults and teens.

Mindfulness Matters for Mental Health

15/11/2018 Mindfulness Matters for Mental Health Dr. Eva Hahler, C.Psych. Toronto District School Board Centre for Mindfulness Studies Canadian Educators Conference on Mental Health - Nov 8, 2018 What