Staying in the Now: Mental Health Through Mindfulness

This program is a UCTV presentation for educational and non-commercial use. Welcome back everyone. My name is Descartes Li and I am the president of this mini medical school for the public at UCSF titled science of mind and I wanted to welcome you. I give it back to you all and thank you for being a really great audience. I'm very pleased with the speakers' comments about you guys saying you've been such a great audience and group, so I hope you'll return the favor. night and not necessarily saying totally wonderful things with this, we could provide honest sexual feedback and suggestions on how we can improve this course for you.

Today is the last presentation of the six we did and I thought it was a very good one. kind of a broad overview of a lot of different topics in psychiatry and we talked a little bit just to remind you that we talked about dr. Volkow who spoke about DNA and stress and depression dr. Steven Holl spoke about aging and maintaining mood throughout the life cycle. Allison Harvey spoke to them about sleep and its importance in maintaining mood. I talked about recent treatments for depression, mainly brain interventions, and what they tell us about the brain and then last week we had a great presentation by Dr.

Paul Ekman on the face and facial expression and today I'm very happy to introduce you to dr. Stu Stuart Eisendrath, who will talk to us about

mindfulness

and maintaining mood through

mindfulness

, and I think it's very appropriate that he talks about some techniques that have been around for thousands of years and I think it's a great way . To end the course at the beginning somehow, let me tell you a little about dr. Eisendrath before we start, he's a professor of psychiatry in our department, he's the director of the UCSF Depression Center, he's also the director of clinical services at Langley Porter, which means he oversees all of the clinical services that we provide in some capacity.

He's my boss, so I have to say good things about him, but I would say good things about him no matter what he has. He has extensive clinical experience. he has been interested in the body-mind. confirmed for a long time. He teaches evidence-based psychotherapies including Mindfulness-Based Cognitive Therapy, which he will talk to you about today. Cognitive-behavioral therapy and interpersonal therapy. I have: a personal note. He has been a great role model for me. He has been a mentor to me. And I have to say that I think he does. It's been five or maybe ten years, Stuart came to see me and we were talking about meditation and mindfulness and how he was very interested in this and I thought to myself that he always is, he's already so wise and relaxed and has so much perspective on the things you do.

I don't need to meditate anymore, it's like he did this, it's like the rich get richer, you know, it's other people like me who need to meditate more, so I'm very happy to introduce you to dr. Iser Drath and thank you for coming. Thank you very much for that nice introduction. I'm happy to be here and close the series. It sounds like you've had a great collection of speakers. I'm going to talk about mindfulness meditation. and sometimes it has various names depending on the setting you're talking about, but we're going to focus on mindfulness meditation and how you can use it in various ways to help you deal with mood regulation and I'm going to do that by discussing it a little bit. about what mindfulness is and then discussing some of the scientific literature on the application of mindfulness meditation to different clinical problems and then we will do some mindfulness exercise, gain some experience and have the opportunity to talk about that a little more. a little bit and then talk about some of the current theories about how mindfulness meditation can actually be helpful, what it's actually doing in terms of its beneficial effects, like Descartes said, mindfulness meditation isn't really something new, it's existed for 2500 years or more. and in fact, if you look at many of the world's religions, some type of meditation similar to mindfulness meditation has been a part of them in one form or another, but let's talk about it really separately from any religious approach in particular and how it can be applied no matter what religion it is and how it can be useful, so what is mindfulness?

What we mean by mindfulness is a couple of different definitions and probably the most cited is Jon Kabat's main one. Zinn, you know that mindfulness means paying attention in a particular way, on purpose, in the present moment, and without judgment, so each of those phrases is important in terms of how you think about mindfulness and we'll look at that in a moment. moment. As we move through this, another way to think about mindfulness is its non-evaluative awareness of one's inner and outer environment, which means seeing things as they are, accepting them as not judging them as good or bad, but simply accept them as they are.

However, I would like to simply illustrate that this is not so easy to do in our everyday life, we often most of the time go through life without much attention. I mean, you know, if you go, you know you're driving and you get you come to a traffic light and you realize, gee, you may have gone through another traffic light or there were three traffic lights, did you stop them or not? You know you may be driving without paying much attention to what was happening in a mindless way, it may still be or an automatic mode, so to speak, which can be beneficial, can help you get through a lot of things.

It's good, you know, we do things automatically, like our breathing, etc., but when we talk about mindfulness, we're talking about bringing. attention to focus on something very specific which is the essence of mindfulness you can think of mindfulness as if it were a spotlight that you are shining and focusing on something and in our mindfulness exercises as we teach them in our classes we can focus in the breath or the body or different sensations, but you can also apply it to practically anything, but it is not that easy. I want to give you a quick example of this.

I want to play something for you and it's a little bit. scene and I want you to pay close attention to it and see if you notice anything unusual about it. Did anyone notice anything unusual happening there? How many didn't notice anything special? Raise your hand. Well, very good number. How many did notice something? maybe about a quarter of you, what did you notice about her, the shirt and different people? Well, what did the others notice? Something else. His eyes were closed. Well, how many noticed a different shirt and how many noticed a different person? So actually maybe 10. percent of you notice we're going to see him again so let's do the same thing you want to see him again it's a different person it's just what this little guy this is from the visual cognition lab usually around 80 % of people do not identify that it is a different person, so 20% in the first round pick it up, 80% do not and you are almost in the same ballpark.

The reason I show that particular thing is mainly for fun, but it also stands out for paying attention. It's not that easy to do even though I asked you to look at it and observe it, it can be quite challenging. There are, but they are all, they were good there, but there are a lot of things to focus on. You're right and what you're going to focus on is something that you have to direct that spotlight on and that can be a challenge at times, but there are many things where you can notice that we are different from one to another. affects your shirt, your glasses, your eyes and the person, there are a lot of things going on there that you can notice that are quite different and that's one of the things about mindfulness: you can actually bring your attention to different elements in different points. over time and the nice thing about mindfulness is that you're actually free to choose what you're going to focus on so we'll talk more about how it's used and do some exercise with it as well as we.

Continue here, but that was just an example of trying to focus your attention and how challenging that can be and the idea of ​​learning mindfulness in our classes and in the various classes that I will mention is that it takes a while to train your attention to be able to focus. at all, so what has mindfulness been used for? It has been used for a variety of things. Actually, Jon Kabat-zinn brought it to this country in a modern, stress-reduction-based version about 30 years ago. and that in turn has been applied to a variety of conditions such as chronic pain psoriasis eating disorders fibromyalgia cancer lately it has been used for parenting and childbirth discomfort and on the psychiatric side it has been used to treat anxiety, depression, borderline personality disorder, addictions in mindfulness based relapse prevention and to some extent for bipolar disorder, so it has been used for an increasing number of different conditions and this is not really an exhaustive list, it's just to give you an idea of ​​what it's been used for in recent years and in For most of these things, there are studies that show their effectiveness for these conditions and I'm going to give you some of those studies now.

This is a study that was done for generalized anxiety disorder where a person doesn't have a particular phobia or panic disorder but generally feels anxious most of the day and I don't want to go into all the details but this is Beck's anxiety inventory and as you can see at the beginning the score was 19 and at the end of the training that lasted 8 weeks it was halved to eight point nine one and similar, well, some of these other things are Similar. This is the mood profile that shows a similar pleasant change and where a decrease in score is good, so it was. very useful for these people and this has also been shown in several other studies.

If you have a question, this particular study did not have a control group. This was an open trial and we will talk about the control groups a little later as we move forward. This is a scale of mindfulness. Oh, the mindfulness awareness scale increased as expected with the training, so it went from three point six eight to four point two, so it's a particular scale that's used to measure mindfulness. People became more aware at the end of training, so as attention increased, anxiety levels decreased in another study that did have a control group, a small study of people with bipolar disorder that looked at people between episodes, not people in full episodes. of bipolar disorder that analyzes levels of anxiety and depression, this is the Becca Anxiety and Depression Inventory.

In the control group you can see that the previous anxiety level was 11 and it actually worsened to 20, while in the group that received mindfulness-based cognitive care. The therapy of a special form of mindfulness, I'm going to tell you more about it, dropped from 12 to 6 and the depression levels increased again a little in the control group and dropped by about half in the people who received mindfulness cognitive based on mindfulness. therapy that was a wait-list control, but the typical two-visit control group would be to have the other half of the group wait and not receive the intervention and receive treatment as usual, so what is cognitive therapy based on full attention?

Well, there are basically two types. Well, one main form of mindfulness that many people learn is called mindfulness-based stress reduction and as I mentioned earlier, it is something that was developed by Jon Kabat-zinn and has been used to treat many physical ailments, like chronic pain. or dealing with a heart condition or stress reduction, etc., but in terms of dealing with emotions, a derivative of that type of mindfulness-based stress reduction is mindfulness-based cognitive therapy, so sounds pretty close to mindfulness-based stress reduction, if you were looking. Looking at it from above you would see it's the same thing, it's eight weeks long, once a week, group format and the sessions are actually two and a quarter hours long and then people usually come for a monthly maintenance session and also They practice while they go to eight once a week for eight weeks, they have homework and practice at home the other six days of the week, they do meditations on their own, listen to CDs or do other forms of meditation and the size of the groups varies from six to fourteen.

They usually do things like formal meditations called body scans and we're going to do a little bit of a little bit later, mindful stretching things like yoga or mindfulness of breathing or listening to sounds carefully and then we teach them informal techniques like how to be mindful in your daily life, for example, when you are eating a meal, how to eat it mindfully or when you brush your teeth, what it really feels like to pay attention to it. I mean, these are things we normally do. Thinkin eating normally when you eat Do you taste your food?

I mean, usually we know we're talking to someone else, we're reading the newspaper, we're watching TV, we're doing anything but actually trying the food we can. It would be extraordinary to sit in silence and just taste the food and pay attention to the texture of the food, the smells, the taste, just doing that for five minutes can be really extraordinary. I'll give you some homework. I will tell you. something you can try doing just as an illustration that one of the mindfulness-based stress reduction exercises or mindfulness-based cognitive therapy is to eat a raisin mindfully and I know some people don't like raisins. raisins, others yes, but whatever you do, try to eat a raisin so attentively that when you get the chance, pick up some raisins, take one in your hand, and look at it as if you've never seen it before. like you are fresh with fresh eyes notice what it is like slowly bring it to your mouth smelling it and then put it in your mouth close your eyes and taste it move it around in your mouth and then slowly start chewing it and you may try it for the first time.

I know I made this when I was 50 and you know we normally eat raisins. You know, a clove if you eat them. I mean, you know you're throwing them away, you don't really taste them. This is the little secret task for you when you start chewing the raisins. You could test them by rotating a specific portion of your mouth. Your job is to figure out where we also do things like three minutes. space to breathe and teach people a very short portable meditation that they can take with them wherever they go, but the heart of mindfulness-based cognitive therapy or mdc-t is to help teach people to see that there are thoughts that develop and are only

mental

. events and not facts many times when we have thoughts, first of all, when thoughts occur, we make a critical mistake when we have thoughts, we believe them and thoughts are just

mental

events, they are transient and for people who are prone to anxiety or Depression, those thoughts tend to run in negative directions, so thoughts are things that arise.

Silvia Borstein talks about this, as you know, our thoughts are like popcorn, you know, thoughts just pop up and you know maybe you're sitting there. Concentrate very quietly on your breathing or some other focus and you may notice that a thought just emerges and you may know something negative, but if you are prone to depression or something negative, you know it in terms of an anxious thought and those thoughts if you start to believe that those thoughts can get you into a lot of trouble like, oh, I realize, you know, I wonder how giving this talk will go today, maybe you know it's like reviewing really well and this is happening to this friend. he doesn't seem too awake and you're falling, you know, immediately a cascade of things happens and pretty soon I'm like, well, I guess I'll say goodnight, you know, and that would be moving toward catastrophic thinking.

Catastrophizing, you know, is very common in anxiety disorders or depression, so those types of thoughts, what we learn in mbc t is that those thoughts are just thoughts, they are not real, they are not facts and once the people learn this, it really sets them free. move up a bit so I can respond to them more skillfully, so if I have that thought I can decide whether I'm going to pay attention to it or not. I have a choice. I don't have to pay attention to it, so how can I do it? We make people recognize that it is just a mental event.

We do it in several ways. Let's take an example here. Let's take an example like this. Imagine you are walking down the street and you see someone you know on the other side. side of the street and you greet that person and the other person keeps walking and doesn't return the greeting you think you feel or you just raise your hand if you have a lot of reaction they don't why they don't like me okay it was because they didn't see me okay Rock / I didn't see them right okay they're on the phone they're not paying attention okay they didn't recognize me okay maybe they're rude okay anyone else they're rejecting me okay anyone else how do you feel in this situation?

We have 16 people, we go around and say, okay, what's happening now? What's the fact of that particular situation? No, it's true, nobody knows. You may be having all these thoughts and you may be reacting to, you know, in one of our classes where he did this someone said that's exactly what happened with this guy they haven't talked to him since you know that's what happened and I was sure that I had been rejected by this person that I had seen and that was it and versus me' I will tell you that at the end of the eight weeks the guy says you know I may have made a mistake, so that's what the attention full gives you some space.

Some people think that mindfulness gives you space between the spark and the flame, so there's a little bit of a gap there, so instead of having to react, say angrily like I just got rejected. I will never speak to that person again. In fact, I'll send him an angry email or you know who knows you. I might say, well, maybe there's another possibility, maybe I feel rejected, but you know, maybe they were talking on their cell phone, maybe they're depressed and they're not paying attention, or maybe their boss just scolded them and they're. discomfort or all kinds of different possibilities, so there is no particular fact, so it helps people realize that there is no fact, even if we believe it and the initial response is to believe it absolutely, the reality is that there may not be any facts there to hang. your head is just a thought I had the thought and instead of believing it and following it we said well I thought it may or may not be right and with mindfulness you have the choice to let that thought go or not.

What we'll talk about, we call it D focused mindfulness, where you get some thought distance from a thought. Sometimes called metacognition or cognition. Do you know what psychiatrists use for a thought? Fancy word and metacognition because it is beyond thought. like looking at the thought process like you know there's only we have 20 different possibilities for what happened in that transaction and those are different thoughts about it there's no there's no fact that we can hang our hat on it instead of saying well this That's right How can I choose? I can choose one that works better for me than the one I just chose.

Let me give you an example of this and contrast mindfulness-based cognitive therapy with cognitive behavioral therapy, which is more traditional in cognitive behavior. therapy let's say let's use an example of someone who is depressed in cognitive behavioral therapy the typical type of image could be like this a person who is depressed would say something like you know I'm not a good person or I'm a guilty person I'm an unworthy person I'm a failure I haven't done much I'll never be a success Those are typical depressive thoughts I mean, actually, we have some scales where you can where I have a list of Top 30 depressive thoughts are very well resolved and the problem is now in cognitive therapy.

It could be said when the person says that I am not a worthy person or that I am not a good person in cognitive behavioral therapy. I would say okay, that's a negative thought. Try to weigh the evidence and respond to that thought. So when you say I'm not a good person, what is the evidence that supports that idea or refutes that idea? What is the evidence that you are not a good person? person, what is the evidence that you are a good person and then you say well, I did it, I was successful at this or I failed at that, then maybe I am not a complete failure maybe yes I am okay as a person but I am not a very good person person, but I'm not a terrible person either, so maybe a more balanced thought would be: I'm okay as a person, but I'm not really a good person, so you help the person make a change.

In the content of thought now, the problem with this, let's say depression, is that the person usually has many years of evidence and when you ask them for evidence, they may say, well, you want evidence, I have a bushel drop because they have been seeing things in a very negative way. For a long time, mindfulness-based cognitive therapy has a different approach, first of all when they say, "I'm not a good person or I'm a bad person or something like that," what we say is wait, you're actually having the I thought you were a rotten person as soon as you do it you are helping the person start to dissent because they are moving away from identifying with that thought so I am having the thought and now I don't really have to do it.

I don't have to argue about it. I don't have to have evidence for or against it. I can decide whether to hold on to that thought or let it go just like you did now, like I had the thought when the person didn't respond by saying they don't like me. , well, I can hold on to that thought or I say well, I don't really know, maybe they were just talking on the cell phone, they didn't hear me or they didn't. You don't see me or something. I really don't know well. I'm thinking that I'm not a worthy person, but you know, I don't have to wait and start running with that idea.

I can let it go. They begin to learn how to distance themselves from those thoughts and they can do so without having to get into a debatable discussion about whether it is true or not, so their thought process becomes focused and helps the person change the relationship with their thoughts instead of try to change. the content of the thought itself this is a radically different way of being in the world because most of us have the thought a thought and we believe it we actually walk around we even question it we have the thought you know, you know, whatever it is The thing may be that if you're prone to depression you know I'm not a good person or I'm this or that or if you're prone to anxiety like things are going to turn out terrible that's exactly what you believe without even taking a step back. and realizing that it's just a thought, I mean depression, as we understand it, is that the person really feels as if they have experienced a loss. anxiety, are you there anticipating that a loss will occur?

So this ties into something we mentioned earlier about mindfulness that we're trying to bring attention to the present moment and move away from focusing on the past or the future and just focusing on the present moment. It's something we don't normally do, sometimes we do it in certain experiences and in some cases. Many of us are more mindful by nature than others and when we look at people in terms of scales of mindfulness, if we did it right here in this room, there would be variability among the group here, some people who may have never done it. .

I had some mindfulness or maybe very conscious naturally and some less, but it's a different way of looking at things, it's calling attention to things that we don't normally do, that's why remember in that initial definition, it's calling attention with intention, so it's kind of like wow, I'm actually looking at my thinking. I just had this thought, you know about this and I'm looking at it so it doesn't require you to be depressed or anxious, you don't have to do that. Not at all, I mean, certainly, mindfulness meditation doesn't require you to have that, but I'm using it as some examples of how it can help with different moods in terms of me to give you maybe another way of looking at this mindfulness based in full attention.

Cognitive therapy when it was originally developed was first called selective attention training, so it means that you have to have the ability to focus your attention on whatever you are focusing on, your breathing, your body, etc., There is a relationship, they are quite different. You're right, and I'm not sure that mindfulness-based cognitive therapy is exactly the best term, but it is the one that has been used the most. They use cognitive therapy techniques, but they also use them in a different way, like you might use this. exercise with the person waving your hand in a form of cognitive therapy we use it to show attention to thought processes in cognitive therapy you can help the person try to change the content of the thought there is some room for confusion and you have to understand No I want to go into everything, there are many differences, some of the exercises used in the course have similarities, many things, in fact, have similarities with traditional cognitive therapy, things before the example, like when we use the automatic system. thought questionnaire to that list of the top 30 depressive thoughts that was originally useful for cognitive therapy and in cognitive therapy what you would do with a person is say, look, choose what your top ten are, you know your top five Letterman thoughts. and LEM, let's challenge them. and we try to change them like this, but we use the same list but we don't try to change them, what we do is try to notice that those thoughts are quite variable.

Here's just one example of major depression and how mindfulness can be helpful if you look at major depression, that's anotherterm for clinical depression, if you look at, for example, a young person and in their childhood and adolescence, they have a stressor in life that can be significant, can cause symptoms, this is the threshold to present a clinical for a diagnosis. line here, so a person may have symptoms but don't meet the criteria and then here it breaks through, but you've noticed that actually, as a person ages, the amount of stress it takes to precipitate an episode It is actually less. that over time the brain becomes sensitized and can activate episodes of depression with less stress, so we must develop some strategy to prevent these episodes and the way we currently do it is with antidepressants as maintenance or the newest thing is cognitive mindfulness-based So in mindfulness-based cognitive therapy, this is a study by Teasdale that took people who had fully recovered from depression and gave half of the people mindfulness-based therapy. half of the people who followed cognitive therapy did not receive it and were followed for a year, the control was the usual treatment and in the people who followed for a year they had basically faced the possibility of remaining free of depression if they had received therapy This study was replicated by Teasdale and her MA colleague Helen MA and they actually had even better results in this replication study, so they were more than twice as likely to remain free, but this has some weakness because, as you know, this is just the usual treatment.

This group is getting eight weeks of good stuff and the other group isn't as shy. Caen at the University of Exeter in England actually did a very interesting study, which is a better controlled study, where he took people who had recovered from depression on antidepressants and were taking antidepressants and randomly assigned them to receive mindfulness-based cognitive therapy and gradually reduce their medication or continue with the antidepressants that were the control and that is the conventional treatment. This was a high-risk group, although these were people who had multiple episodes of depression. So they were probable and he chose that because they wanted to see what they were going to have, in a sense they hoped to be able to see the relapses in a period of a different year and what they found was that in the comparison between Mindfulness-based cognitive therapy and the Antidepressants were statistically equivalent, one was as good as the other.

Actually, mindfulness-based cognitive therapy had a better relapse prevention rate: 47% relapse versus 60% with antidepressants, but statistically in the analysis they were equivalent, but when they looked at actual levels of depression and quality of life, the mindfulness group was actually better, so this was a very interesting study that is actually a very good control. It was carried out in England and the control was treatment by his GP. Now I just want to mention something that I'm particularly interested in because Descartes mentioned them as director of the depression center here and I'm interested in depression so I'll push it on you a little bit but we have a problem here with treatment resistant depression in this country and In fact, in the world, here is an interesting fact: you know that major depression, clinical depression, is the number one cause of disability in the world after infectious diseases, in developing countries, for example, In North America, in developed countries, it is number one.

Apart from cancer or coronary artery disease, part of this has to do with stigma and not addressing the problems, but that is changing. In part, we know that we have developed the depression center here and there is a bill before Congress that was introduced by Senator Stabenow. of Michigan with the co-sponsorship of three other senators to establish comprehensive depression centers throughout the country, similar to the comprehensive cancer centers that were established thirty years ago, if you remember, understand that cancer used to be the c-word if anyone He had cancer, well, let's not do it. We talk about it and depression is very similar and what we want to do by having depression centers is to get them out there so they can talk about it because you know that depression is a very common entity, it is the most common thing that anyone in this room is going to experience. .

We deal with each other or with our loved ones or friends and it is something we should deal with better, like Silla does. This is something that pharmaceutical companies won't like either if you take the Star D trial, which was a sequence of treatment alternatives for relief. depression, this was the largest IMH trial ever done, $54 million, what he did was he treated people and he said we don't really know how to treat people sequentially and if you know if we treat them and they don't respond, what do we do? Do it, it started with people giving every single person citalopram, they gave it because it was not patented, that's why they selected that drug, they gave everyone citalopram, which is also known as celexa, if they didn't respond, they had a full dose of that. after 12 weeks, they went to a second stage and received a different antidepressant or a combination or cognitive therapy, if they didn't respond to that, they went to a third stage or a fourth stage.

Now if you look at this, this is really remarkable, after a full treatment, only 30% of the people had fully recovered, which means 70% had not recovered. If they then went to the second stage, they added another 20%, so after two full treatments, that means that 50% had fully recovered, but 50% had not fully recovered. % had not done it, that means we have a big problem on our hands and then if you actually follow the four stages of treatment in the end, only 43% of people are still in full recovery after a year of treatment. so it's a very challenging disorder, that's why we need other treatments than just adding another round of medications, we also need other things and I'm not against medications in any way, they can save lives, but we have to add things to it. and mindfulness-based cognitive therapy.

Mindfulness techniques can be a very valuable addition. I'll briefly show you what we did. We take people and I don't have to go into details. They had a Beck score of about 24. We compared them to another group. receive medication management and this shows the results that people who receive MBC in our depression center, the way we follow up is that there is an artifact here, actually, the medication management that patients were presented with was the 12 weeks was their end point because that is the time we fought, we followed them periodically and a MB CT we captured them at the end of eight weeks and there was a decrease in anxiety and a very marked decrease in depression levels to about half in this population, so it was very effective in this group, this alone represents is quite a bit higher, you can see that 30% of people recover completely versus only 10% on medication management alone and these are some other studies that showed that some are open trials without controls but showed similar reductions in depression levels, it probably is.

It's not important except to say that there is now more and more evidence that it is not important to go into detail about this, but there is more and more evidence that mindfulness-based cognitive therapy, which was originally developed just to prevent relapses, in It can actually be used as a treatment modality for depression like Well, this was a study done by Kingston, which was a randomized study that compared mindfulness-based cognitive therapy to treatment as usual, showing a marked effect for mindfulness. . So how does mindfulness work? What we do in our classes is actually a series of different meditations ranging from body scans to sitting meditations to sound meditations and what we find is that some people love the body scan, some people hate the body scan and they like the meditation. sitting or vice versa, you know, and really what we're trying to do is say here's a menu of things and some people like Walking Meditations, for example, we'll give you a variety of things and you know you can choose for yourself and the idea of This is for you to decide for yourself what really works for you and whether body scanning is not something you know. it's what you connect with, you know it's okay, it's just that you know that some people are more oriented one way than another, so sometimes you can pay attention, well, you know what's going on there, I don't realize Realize this, I mean, there are many things. that could be done with that particular thought, I mean, without going into it more specifically, sometimes you might notice things while doing a body scan like, gee, I have a lot of tension in my shoulders, as you know at the end. every day or I'm really angry with my boss today and you know I have a headache, there's a lot of tension here or something's happening and you can notice certain things that come your way, that's where the perception starts.

The thing is that when you sit down and give yourself a chance to look at these things, you can learn a lot from these kinds of seemingly small things, there are variations, something you can do a body scan starting with your head and some teachers do that. That way, some people do it more with their feet. I wouldn't say one side versus the other to stimulate one side of the brain versus the other. Oh, that's something interesting that could be tried. People do it in various ways. Sometimes people start with their feet. feet because they think it's further from the head and what we're trying to do is bring people to the present moment and not thinking and starting with the feet is kind of a vehicle to get some people to start what they had.

There is no particular convention or reason why you can specifically scientifically say that you should do one thing over the other, but it is very common that people, like probably all of you, have experienced their minds wandering, it is what most People have a misconception about meditation. I'm doing it wrong because my mind wandered but meditation is actually your mind wandering and you notice it and then you bring it back your mind wanders you bring it back and if it wanders a thousand times you bring it back and that's what meditation it is. My mind was just missing in my toes and that's it, you are becoming gentler and kinder to yourself about your mind wandering, so let's talk about this a little, let's focus on the here and now, the breath coming in. and it comes out and what's happening. on the left leg and the right foot and leaving everything else and this relates to moods, how good, as we talked about, you know, with a lot of anxiety and depression, types of moods, people are there, they are looking towards future disasters that are going to occur. happen or those that have already happened, they feel like they have happened, so if you help them say, focus, let's not worry about it, let's focus on the present moment, it naturally helps the mood, at least this is what they are our theories. and I have to say that no one is completely clear exactly what this is like.

Here are some of our theories as to why this may be. We know that it can be very useful because we are still working on it and that selective attention itself is focused on let's say the foot or the breathing can be related to this, that you have a tendency, if you are focused on something like that, to not doing things like ruminating, ruminating is something that tends to lead to anxiety or depression, ruminating, you know? most people here is another type of thinking that most people think, you know, I'm reflecting on some that maybe they didn't knit, maybe you hadn't even identified yourself as reflecting, they just say, well, listen, I had this interaction with this person at work today.

You know, I should have told them this. I wish I had said that. If I had said this, this would have happened. You know, and well, if I had said that, it would have been so good, so maybe I should have said this. I think what are they doing, they never take a step back and D Center, what am I actually doing? What I'm pondering if you ask them. Well, I guess I'm preparing myself in case it happens again, but it doesn't lead to resolution of the problem. In fact, rumination tends to lead to a worse mood, so if you're focused on your breathing, it sort of fills your mind's capacity.

You are not ruminating, so focusing your attention decreases. We also think that mindfulness can improve compassion and self-compassion, both for yourself and for others. Decentering is an important element of mindfulness because you begin to be able to notice thoughts as they arise. You usually need to have practice at this and have consistent focus. a while and then you can start to notice when these thoughts ariseand you can start seeing them too. This is actually just a thought and not getting caught up in it and in fact it can be an important element of CBT because what we notice in traditional cognitive behavioral therapy when we have observed that people actually start to improve before change the content of thought, we said well in CBT, you have to help people change the content of thought, actually, it is a slight mistake, people start to improve in CBT as soon as they start to notice that they are having a thought, as soon as the person can say instead of I am an unworthy person, I am thinking that I am an unworthy person, that alone helps them improve.

Here's an important idea about Mindfulness is that mindfulness can help you accept things as they are or in other words, this equation is quite helpful: The modest suffering that one person goes through and we all suffer to some extent is equals resistance multiplied by pain and this can be emotional pain. or physical pain, if you resist it, you will actually end up suffering more, so if you say, what do I mean by that? This does not mean that resistance means acceptance, so if you lower resistance, you are simply accepting and resigning yourself, resistance actually means Lowering resistance means that what we see in depression or pain, for example, is that a person has pain, let's say physical pain, where they can say oh, it's terrible.

I have this pain. I am a weak person because I have this pain. Ought. I don't have this pain, it's unfair, I have this pain, I will never get over this pain, this is all resistance versus saying, you know, I have this adjustment, these physical sensations that are painful and I can accept them as they are right now and that hat and continue living my life with them and if you really lower the resistance, you lower the amount of what Sapolsky has called adventitious suffering that only humans suffer, by that I mean, if you have, you know, if an animal steps on a thorn. the forest the animal feels pain sensations but they don't say you know if he deserved this or you know maybe I should have listened to what my mother said or you know that you should have done this, you know, they don't get into all kinds of things around them, they still have pain, the pain is still there, but the amount of things that are put on top of it and multiply it decreases and that's the same whether you're talking about physical pain or emotional pain, so it can be even with depression, it can be the same. same.

You know, for example, Winston Churchill described depression as the black dog. You would say the black dog has returned today and indeed. In Australia they have a depression clinic for black dogs that is doing a lot of research on depression, very interesting work, but I like that image because you know you could say, well, the black dog is back today and now how am I going to do it? Reacting to this I might be terrified I might, you know, want to escape, etc., but if I say, well, okay, I'll accept it as it is. I can actually look at it, study it, you know, observe what's going on and then. the black dog, it may still not be a beautiful dog, but I don't have to be terrified and that resistance, you know, the terror component can be greatly diminished and that's true in depression, for example, many people we meet They are very depressed.

Being depressed means that you are adding suffering to an already painful emotional state and it doesn't mean that I am suggesting that you accept it and resign yourself to it, but if you can accept it and say "it's okay", this is what is happening today. then you are in a position to do something about it without the terror and so on, and as many of you know, for example, in substance abuse, acceptance again reduces resistance, in a sense, acceptance is another, it is the reciprocal type of resistance if you excel at substance abuse you will never be able to do anything about their condition until they accept that they have the problem if they don't accept that they have a problem they will not be in a position to do anything about it here is a little cartoon I also mentioned We think self-compassion may be playing a role.

How does self-compassion work well? It can help dampen some of the critical feelings one has toward themselves. People with depression or anxiety are often very critical of themselves and mindfully learn to be kinder and gentler with yourself do you know if you can accept yourself say ok my mind wandered can I accept that without saying oh boy am I stupid or boy am I a failure at this or you know I am I don't do it as well as the person next to me says: Am I water? I just notice and bring the attention back and you know I can accept that, so you're like one person in the group said if I can forgive myself for my mind. wander I guess I can forgive myself for other things and then people start saying things like this.

I am kinder to myself and less critical. I can respond more to myself and handle stress better. We did another study. I won't say more about it except that it's yeah, it just highlighted that this was a proven that when we measured certain factors in these people, the anxiety levels went down and just in terms of what's different about this slide compared to some of the other things. , we actually measured rumination and that people actually ruminated less using mindfulness techniques, okay, here's just a couple of slides and then we'll open up to questions. There is now evidence about biological changes with mindfulness at the University of Wisconsin.

Richie Davidson and his colleagues did an interesting study a few years ago. They recently taught people mindfulness-based stress reduction and showed that after eight weeks of study, what they did was they took a group of employees from a corporation outside of Madison and half of them got a mindfulness-based stress reduction, half of them were on the waiting list and the rest People who received mindfulness-based stress reduction after eight weeks had changes in their EEG, their electroencephalogram where they had activation of your left prefrontal cortex, which is the area of ​​the brain associated with positive moods, so there is a convergence of evidence that these things that activate certain areas of the brain seem to have powerful effects on mood and can be done in several ways. ways, directly with transcranial magnetic stimulation, but mindfulness meditation can have similar effects and they also measured antibody levels in response to immunization and found that people who would receive mindfulness training had an enhanced antibody response now here I think that my last slide almost left only a show.

This is an fMRI of people who received mindfulness training and eight mindfulness training and what it shows is that people had activation of this portion of the brain as you see. this is kind of a midline if this is a cut here are the eyes right here this is a cut in these people before the training they had this central focus and here you see that it has shifted to the periphery. I don't want to get into everything. the details because it's a little complicated, but what it shows is that with eight weeks of mindfulness training, these people had a change in their brain function that could be measured using fMRI techniques.

There are two ways to measure well, there are two essential ways that The brain images that we take are fMRI scans or PET scans and these are fMRI scans that show that these people have a difference in having the mindfulness training in compared to when they started, so what were they? I think the important element here is that you can make a really significant difference in brain function through this type of training and we're on the verge of understanding exactly how to do that. In fact, this is our study that we are doing now here because we are taking people who have resistance to treatment. depression and we are randomizing them to receive mindfulness-based cognitive therapy or the

health

improvement program as a control condition and this

health

improvement program consists of music therapy of physical functioning and nutrition, so it is a fairly active control and we will follow them. before and after and then for a year after, we hope to add the functional images component.

This is already underway and funded and we hope to add these images so that a portion of these people can also get this. But one of the interesting things about this area is that we are learning that by focusing attention you can train the mind, it has very powerful effects. Two weeks ago we had our depression symposium here and I think Descartes probably also talked about deep brain stimulation for refractory patients. depression where Helen Mae Berg from Emory spoke and discovered that by placing an electrode in a certain area of ​​the brain called area 25 and stimulating it in people who have severe depression that does not respond to anything else, she can instantly turn off the depression and then they implant a device similar to a pacemaker and people can have continued relief from depression.

This isn't for everyone because most people don't like having their heads open, but it highlights what's amazing about this, I think. It's not just that it may work for these people, but it found a key circuit for depression in the brain. Then our next speaker on this, actually from Stanford, Ian Gottlob, talked about how they're using fMRI feedback to train people to do the same thing without getting stuck. an electrode, but training them in the fMRI machine so they actually learn how to do this through feedback, like biofeedback, when they learn to control this area of ​​their brain, so it's pretty powerful and we think mindfulness It has a somewhat similar effect and we are going to look to measure this in our study, so let me pause at this point.

I will mention that these are some of the collaborators who have worked with me on our studio. It's called practical, all practical alternatives to depression cure study and it looks at people who have not responded to two or more trials of antidepressants and we will do it for the next few years, that is a common thing. I guess it's called early meditation practice. I wonder. There has also been someone who has ever worked on dispelling the self so that people can see that it is not necessarily their thoughts and I think that is the culture that you know and that is one of the bases of Western thought every time you save the car I think Rene.

Descartes I believe, therefore I am, that is the specific Western thought that conflicts with mindfulness, meaning that what many Eastern traditions see as compulsive ideation or enlightenment, we see as the essence of the ego or self, this being, I believe, therefore, a hand, so it seems. we are at a particular disadvantage and mindfulness presses against some of the foundations. Yeah, I think you're right that I mean there are different cultures that come to this more or less easily and self-view can be an important component of that so you raise some excellent points. I think it's hard to delve into them here, but I think they're very good points.

Yes, some people told me that people can be depressed and not know it. Are there other ways that depression manifests itself as well? Well, you know, I was very surprised when he said that it is a common characteristic of depression, but that it is not mandatory to make the diagnosis and there are people who experience, let's say, not so much sadness, but a lack of ability to enjoy everyday things as they would. they would normally do. enjoy well, they lack energy, they lack it. I'm sure it showed you that you know the nine cardinal symptoms and if you have five of the nine, that's enough to make the diagnosis and a lot of people don't, they certainly don't have all nine and and depressed mood may not be part of it and Sometimes, particularly as people get older, depressed mood may not be the most prominent feature, people may have more physical symptoms, and you know they may go see their primary care doctor more times than usual.

What are they going to see? a psychiatrist and they go to you know, I just have lack of energy, I can't enjoy things and I have this bad back pain and stomach pain or whatever headache or whatever those somatic complaints are and, but if you go through the list of symptoms, they may meet the criteria but do not have a depressed mood. I have treated people. I saw a man some time ago who had absolutely no depressed mood. He had lost six and five pounds in weight. 65 pounds in weight, but if you ask him, are you? depressed no absolutely we did not treat him with an antidepressant and he responded wonderfully he started to function much better as his wife gained weight and asked him again to do everything you thought you were depressed didn't you?

I was never depressed, so I mean, he's a friend, but he's herfunctioning and your ability to enjoy things change dramatically, so it can be a complicated diagnosis. I look at the standard of care around depression quite a bit, it's a depressant, maybe more talk therapy, usually 20 sessions or less, maybe advisable, when do you understand this character, when do we go? Actually, I just want to say that there is no way for me to know that rhetorical question, but this is wonderful, I really see that this is the hope for depression because I have seen people who do not respond to any gift that they are about to. because it is a job for a short period. time and I just want more research to be done, to start prescribing and yes, well, it's a good question, but you know, there are several studies, but this study is actually the first study that is a randomized control trial on the active treatment of depression.

Other studies that I showed you that were randomized trials were for relapse prevention, so this is the first study that actually treats depression and you know we are in the stage of building the evidence base so by presenting this, if you know if This is effective, it will be quite powerful in moving the field along the question: what is the difference or similarity between dialectical behavior therapy? There is a lot of overlap between them. Dialectical behavioral therapy has significant mindfulness. component in it and if you remember from the first slide I mentioned or one of the first slides on borderline personality disorder that is designed specifically by Marsha Linehan for dialectical behavior therapy, it generally differs in that it doesn't have specific discrete meditations like this . of more focused applications of mindfulness, but there's a lot of overlap, there's a lot of things that are developing around this dialectical behavioral therapy, acceptance and commitment therapy, mindfulness-based cognitive therapy, these are all, they have a lot of overlap. between them and there are different variations, but a lot of connection Ellen May burg did deep brain stimulation for area 25 for the treatment of refractory depression back there, okay, so you're asking what's the difference between MBC and MBSR tea, they are Many of the meditations are quite similar and the basic structure is exactly the same.

I would say the difference is that MBC tea is really focused on depression and anxiety and focuses on the emotional side of things. MBSR if you have taken a class like that, there are people, there are people. with anxiety and depression, but there are people with heart disease, cancer, pain, fibromyalgia, everything, so you can't really focus on the emotional aspects per se, so there's a lot less focus and there's a big difference in the feeling of the two. For someone who has something more general, MBSR is a very good option for someone who is dealing with emotional aspects.

MBC t is a focused effort, but a lot of the meditations are the same and you know you can tackle it, you know, if you don't. have access to mbc t for some reason, could certainly give MBSR a first try for someone who qualifies the question is what is NBCT used for, MBC tea was originally developed for relapse prevention, but now I think there are six or seven trials, some small randomized trial showing that it is effective for depression, for active depression, so there are numerous open trials, this will be the first large scale clinical trial, but we are using it here at UCSF to treat people and the results They've been pretty good in our experience with it, but until we finish this study, we can't say for sure and we're the Stanford study. some at Stanford, actually there's one in Pittsburg, also with kids who have I don't know the answer, I don't know, but they might be and you'd think there might be some use in terms of training attention and so on, but I just don't know that area well enough, isn't it true that certain people when they did it did mindfulness, but they're actually moving down one of your studies?

I don't think so, yes, they are there, no, I don't think that's true, yes, those four negative moods, so they were there, yes, you have to be careful when playing some of those instruments, we are going down or going up, it can mean different things. but in that study of generalized anxiety, the moods, the anxiety levels decreased and the mood improved and the vigor profile that the moods have has different components and the moods improved with mindfulness, so thank you.