Transcript Mind/Body Medicine 8

Neurotheology: Mind/Body
Medicine Meets Pastoral
Psychotherapy
Introduction to Neurotheology, Stress
Physiology,
Mindfulness, Brain Plasticity, &
Psychoneuroimmunology
A Format for the Day
 9:00 to Break
 Introduction to
Neurothelogy
 What is Mind/Body
Medicine and how does
the approach differ from
other interventions.
 The Mind of Jesus,
Buddha, and others!
 Newberg,Beauregaard and
others.
 10:45 to Noon
 Brain Plasticity and
Psychoneuroimmunology:
how can they inform the
therapeutic process?
 Emotional Regulation: is it,
at times, a precursor to
effective care?
 What is “down regulation”?
 Doidge, Schwartz,
Davidson and others.
Afternoon Sessions
 1 to 2:30 pm
 Neurocardiology and the
Polyvagal theory!
 Is the Heart a part of the
mind we’ve failed to attend
to?
 Intro. to Hearmath &
emWave
 Childre, McCraty, Porges,
and others.
 2:45 to 4 pm
 Clinical Applications
 What are Mindfulness
Psychology, Buddhist
Psychology, ACT, etc. and
how to they complement
traditional therapeutic
modalities?
 Specific pathologies?
 When not to use a
“mindfulness based
approach”?
What is Neurotheology?
 The Brain Store
 Changing the World One Neuron at a Time?
Neurotheology & AAPC
 In some ways, it was James Ashbrook’s
work found in the text of The Human Mind
and The Mind of God that opened the doors
on neuro-theology.
 Ashbrook focused on the “bicameral brain”.
He was focused on the split activities of the
right and left hemispheres of the brain.
(Ramachadran quote)
His hope:
• In 1976, he wandered into the Medical
School at the University of Rochester in
search of “knowledge about the brain”. Was
in asking the question, “How does the brain
contribute to knowing the mind of God?”
My first interests:
 My interest in this field began in the early 1970’s
through a friend and colleague Samuel Wise, M.D.
and Barbara Hulfish, M.D. at the University of
Maryland who were investigating “limbic system
disorders” using EEG technology to note
abnormalities in many presenting psychiatric
disorders. They began to successfully treat many
different issues with anti-convulsant medication
(initially, Dilantin and then Tegretol
(carbemezapine) at extremely low doses.
Dissertation Topic
 Changed when my professors at Andover Newton felt it
was too “medically focused”
 So I only included a chapter in my thesis paper on Anxiety
Disorders: A Curse or A Call to Wholeness (A Systematic
Approach to Diagnosis and Treatment).
 But I began to read about “The Broken Brain” and the
assumption of a shortage of Gamma Amnio Butyric Acid
(GABA) in many anxiety patients.
 I read about the possible relationship of MVP and anxiety
disorders (which later lost credence when inverse studies
indicated no greater incidence of anxiety in MVP patients
than that of the general population.
 But I was hooked!
The next steps on my journey:
 17 years in community mental health
working side by side with excellent
psychopharmacologists.
 Moving into the field of Oncology and my
introduction to psychoneuroimmunology and
Mind/Body Medicine!
 Primarily, at the Henry/Benson Clinic at
Harvard Medical School.
And the baptism began:
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Mindfulness
Stress Physiology
Psychoneuroimmunology
Brain Plasticity
Neurocardiology
Positive Psychology
Neuro-theolgoy
Introduction
 Exercise # 1- Form a fist! Hold it for 30
seconds.
 Stand up, grab hold of the person’s arm next
to you, and gently squeeze and shake
lightly……..
While yelling,
“Let go of me,
Let go of me!
And yet this is how many of us and our
patients live our lives…not unlike our
friend Nasurdin and his donkey.
Western or Allopathic Medical
Approaches
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Tend to focus on eliminating the external
manifestation rather than getting to the
latent cause within the organism, such as;
1) Negative or harmful emotional states,
2) Focusing on Positive emotional states, i.e.
appreciation and gratitude.
Tendency to focus on the Negative
 It’s good for our survival (especially if you’re
a cave “Person”). Built in to focus on
negative.
 10 things happen in our day…..
 Continuous flow of thoughts, which we judge
as + or - !
How do we know what reality is?
 Brain is not a very good reality making
machine.
Mindfulness: What is it?
 Capacity to be fully conscious and aware.
Capacity for sustained moment-to-moment
awareness-especially in the midst of turmoil.
 Andrew Newberg, M.D. UPenn- studies with
Tibetan Monks and Franciscan Nuns.
 It is a discipline? To learn a skill takes
practice (dosing), training, like anything else
in life.
The Brain
Hallmarks of Mindfulness
 Non-judgmental (tough for us neurotics and
perfectionists)
 Acceptance (struggle with reality)
 Compassion (much better than esteem)
 Pali word “sati” – means “awareness” &
“attention”
It is a focus on the NOW
 Sufi Poet Rumi- We don’t live on that
“torture rack of past and future.
Past ->
<- Future
To be in Now
 Must have and attitude characterized by
curiosity, openness and acceptance.
Choosing Mindfulness vs.
Mindlessness
 Seems to be our typical state of being- day
dreaming, walk into a post….
 Multi-tasking….definition:
Not doing any ONE thing well or with full
engagement!
Misconceptions of Mindfulness
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NOT- blank/empty mind
NOT- become emotion-less
NOT- withdrawal from life
NOT- seeking bliss (might be outcome)
NOT- escaping pain.
Way of Life
 Everyday and everything- eating, walking,
relationships, vocation, etc.
 Can and often involves formal meditation
(but numerous types… Newberg cites over
20 types).
 Retreat
Choosing Mindfulness vs.
Mindlessness
 Seems to be our typical state of being- day
dreaming, walk into a post….
 Multi-tasking….definition:
Not doing any ONE thing well or with full
engagement!
Acceptance
 We usually have an aversion to how we are
feeling or behaving:
- examples; we want less anxiety, fear,
anger, etc.
- want to eat less or drink less, exercise
more, etc.
Begin to Understand: How did we
get here?
 Maxim- Neurons that fire together, wire
together.
Research
 Davidson et al @ Univ. of Wisconsin Found increase activity in LPFC after only 9
weeks of mindfulness training (areas that
control introspection and attention and are
associated with feeling of well-being.
 TRAINING THE MIND DOES CHANGE
THE BRAIN
Jon Kabat-Zinn (UMass)
 “Moment to moment, non-judgmental
awareness”
 “Attentional Control”- redirecting tension to
manage emotional distress.
 Loving-kindness Meditation1) Concentration
2) Mindfulness
3) Loving-kindness
The Noble Eightfold Path
1. Right View
Wisdom
2. Right Intention
3. Right Speech
4. Right Action
Ethical Conduct
5. Right Livelihood
6. Right Effort
7. Right Mindfulness
8. Right Concentration
Mental Development
Meditation- “to measure”
Sanskrit- “samadhi” (sam“mind/placing”, dha- “upon object”
 Five Obstacles1- Sense desire
2- Ill-will
3- Restlessness
4- Sluggishness
5- Doubt
Early Buddhist Text
 “Whatever a person frequently thinks and
ponders upon that will become the
inclination of his mind” (Majjhima)
 Pre-cursor to concept of “brain plasticity”
 Discovered by Eduard Taub.
 Constraint Induced Movement Therapy and
Tennis?????
Contemplative Prayer in Christian
Tradition
 Refer to Father Thomas Keating’s work and
history.
 The Desert Fathers.
 Meister Eckhart, St. John of the Cross, and
monastic tradition!
Neurobiology of Mindfulness
 Higher levels of alpha and theta ban activity
in EEG- associated with sleep and rest.
1) Activation of dorsolateral pfc (DLPFC),
associated with executive decision making
and attention (increased cortical thickening)
2) Activation in Anterior Cingulate Cortexmotor control.
Cont.
3) Insula- activate during meditationassociated with interoception- which is sum
of viceral and “gut” feelings…one of the
things that gives us a feeling.
Increased thickening in anterior insula
creates interconnections with amygdala.
Research- Hozel (2008)
 “increase gray matter density in the right
anterior insula, as well as the hippocampus
and left temporal gyrus among mindfulness
meditators.
 Decreases amygdala activity (improves PFC
regulation of limbic system response)
 Known as “Down Regulation”
 Ability to experience a negative event
without getting “caught up” in the event.
continued
 Includes; increased positive affect,
 Improved immune functioning,
 Less stress reactivity (may have initial
heightened response, but then are able to
“let go” and return to a state of calm).
 Correlated with adaptive regulatory
strategies; including acceptance and letting
go of negative thoughts.36
Amygdala- Center of Fear Response
 Which stimulates the hippocampus, AHCHypothalamo-Pituitary-Adrenal (HPA) Axis,
and begins cascade of sympathetic ANS
response…. Hormones (cortisol,
adrenaline),….. And peptides…..
 Cortisol sends messages to store fat
(usually around belly to be easily accessed
by the liver).
Newberg’s Work at Penn with
Tibetan Monks and Nuns
Parietal Lobe Changes
Psychoneuroimmunology
 Immune suppression: increases free
radicals and oxidative stress, decrease in
serotonin, decrease in glucose to the brain.
 Leads to inflammation* (almost all diseases
have inflammatory process).
 30-50 Stress responses a day (Harvard
Research)
Immune functioning
 Daytime Security- block larger organisms,
bacteria/allergic reactions
 Nighttime Security- block smaller organisms,
viruses, tumors….
 Systems communicate through cytokines.
 Normally, at night cortisol is low, but if too high,
nighttime security weakness and doesn’t turn off
daytime system…thus, we over-react to
substances in the environment,
 Increase in allergies?????
Cont.
 Think of a car traveling at 120 mphoverheats, burns out moving parts….keep
the sympathetic and parasympathetic
systems on alert all the time.
 Cellular impact…..chronic low level stressmay be as bad or worse than acute high
level stress….recent studies on
concussions….etc..
Meditation
 Breathe (GK- “pneuma”, Hebrew- “ruach”
 When we control breath we control many of
the bodies systems (including heart rate
variability…stay tuned).
 Must begin with “beginner’s mind” (Monk
filling cup)
Body Scan
 After becoming aware of breathing,
 Become aware of any places that you tend
to hold tension in your body….you can do
this lying down or sitting.
 Where do you get pain, aches?
Guided Imagery
 Imagine (means to image)….have never
created anything without imaging it first.