Am I Meditating Correctly?

I’m gradually working on a selected list of mindfulness links, some favorites. You could certainly do a lot worse than taking a look at Mindful.org, which has a large selection of information on the possibly overly sexy topic of mindfulness. In particular, their selection of articles for beginning practitioners is very nice.

Here’s an excerpt from one of those, a piece by Norman Fischer titled “Getting Started”, which addresses the concern that “I must be doing this wrong…”

There are many approaches to meditation. In my tradition, the Soto Zen tradition, meditation is not considered a skill that we are supposed to master. It is a practice that we devote ourselves to. So if you are meditating in the morning feeling half asleep, with dream-snatches passing by, and your mind not crisply focused precisely on the breath, the way you think it is supposed to be… this is perfectly all right. It is considered normal and possibly even beneficial. The biggest obstacle to establishing a meditation practice is the erroneous idea (firmly held by most people who want to establish a meditation practice) that meditation should calm and focus the mind. Therefore, if your mind is not calm and focused, you are certainly doing it wrong. Struggling with something that you are consistently doing wrong, and in your frustration can’t seem to get right, does not inspire you to continue (unless you are a masochist, and there are more than a few meditating masochists).

Better to assume the Soto Zen attitude that meditation is what you do when you meditate. There is no doing it wrong or right. That is not to say that there is no effort, no calm, no focus. Of course there is. The point is to avoid falling into the trap of defining meditation too narrowly, and then judging yourself based on that definition, and so sabotaging yourself. You evaluate your practice on a much wider and more generous calculus. Not: Is my mind concentrated while I am sitting? But: After meditating in the morning, how is my attention during the day? Not: Am I peaceful and still as I sit? But: Is my habit of flying off the handle reducing somewhat? In other words, the test of meditation isn’t meditation. It’s your life.

Mapping the Mindful Brain

Very briefly, came upon some fascinating work by Judson Brewer, MD, interviewed here, at Buddhist Geeks. Dr. Brewer, an assistant professor of psychiatry at Yale is studying the effects of meditation on the brain.

The research, utilizing fMRI brain scanning, finds that meditating deactivates the parts of the brain associated with preoccupation with self, called the “default mode network”. Now, if you could limit the activity of the part of the brain that tended to make people unhappy, would you?

We found a clinical signal and went back to study the mechanism to see what’s actually going on. We compared the neural activity of 12 Buddhist meditators to those of novice meditators that we instructed that morning. As I’m sure your listeners are aware, the instructions are simple “pay attention to your breath” but they are maddeningly hard to do. It’s easy to teach someone, but it’s not that easy to change your brain. We had them do three different kinds of meditation and looked for what was similar among all three.

The researchers found that not only is there a common neurological association to meditation, but using fMRI scans to provide real-time feedback with meditators showed that “an active posterior cingulate correllated very highly with self-referential wandering brain activity” and when it was de-activated they were focussed or in a “flow” state.

So, what of it? Well, not long ago another study, done by Matthew Killingsworth, looked at the effect of the wandering mind. They concluded that about half the time we are thinking about ourselves, and when doing so we are generally unhappy. (Here’s a write-up of that research in Science Daily.)

So could you increase your odds of happiness by taking up a mindfulness practice — by taking that preoccupied self “off-line”, so to speak? There’s lots more research to be done, but it seems to point in that direction. One interesting thing about Brewer’s work, is his team is providing real-time feedback to meditators so that they are able to learn to meditate more efficiently. They had people who learned to meditate, whose meditation looked like those of longtime practitioners, within 9 minutes. (I’m not suggesting that this is a fast-track to learning to meditate like a long-time practitioner, but it does seem to make the learning much more efficient.)

You can also read an article about Brewer’s research at Yale Scientific.

Neurons That Fire Together, Wire Together

He’s Got Google’s Ear. Who gets to speak to an audience at Google? Well, this guy did. He’s Rick Hanson, Ph.D., a neuropsychologist, who spoke on the Google campus a little over two years ago. He is one of the guys recruited by Chade Meng-Tan to speak to the search engine’s employees on the topic of mindfulness, and how it might be beneficial to them. He is also the author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom.

Three Goal-Directed Systems of the Brain. Hanson posits three goal-directed systems in the brain. The avoidance system (the example of sticks v. carrots), the approach system (which seeks opportunities, rewards, pleasures) and finally, the attachment system (which seeks social proximity, bonding, feelings of closeness). He goes on to map these systems and their associations with various parts of the brain and neurobiological processes — of the attachment system he notes it is part of our “mammalian heritage.” Bonding is a very important part of our survival.

The Negativity Bias of The Brain. Dr. Hanson makes a point regarding what he calls the negative bias of the brain. What does that mean? Well, in a nutshell, we’ve evolved to avoid danger. Think of it this way — which has a higher cost, a) not noticing the tiger in the bushes or b) thinking there is a tiger in the bushes, when there is none? Though being hypervigilant is annoying and in some sense a waste of time, the cost of not noticing the tiger in the bushes is so astronomically higher that we are naturally evolved to be on alert to risks and dangers. This is what Dr. Hanson calls the brain’s innate negativity. He says, “sticks are more salient than carrots” — meaning we are more geared to being alert for threats than seeking reward. That doesn’t mean that there aren’t strong drives for seeking reward — it’s just that removing threat is higher up on the hierarchy. Once we assess risks to be minimal, reward seeking comes to the fore. He adds, “the brain is like velcro for negative experiences, teflon for positive.”

Negativity Bias and Stress. But this tendency to weigh negative input more heavily can be problematic. We’re pretty much adapted to life 50,000 years ago, perhaps more so than as much as for life today. The avoidance system, perfectly tuned to avoiding threat from neighboring tribes and potential predators, can get overloaded by less dire stimulus such as a traffic jam or a bad report card or what have you. And that avoidance system activates the sympathetic nervous system, the fight-0r-flight system. Chronic arousal of this system (as occurs in anxiety and the  hypervigilance associated with trauma) is unhealthy. Chronic stress can lead to a cascade of health events — it weakens the immune system, inhibits the gastrointestinal system (which in turn reduces nutrient absorption), dysregulates hormones, causes cardiovascular vulnerabilities, and so on.

The Take Home Point. I advise watching the video, if you have the time, because it sketches out in more detail his ideas — but I would say the take home point, if there is one, is that it is possible to shape your brain away from what he calls its negative bias. In other words, focussing, through intention, on the approach and attachment parts of the system. How would that work? Well quite a lot of research seems to suggest, quite robustly, that parts of the brain (particularly the anterior cingulate) used in meditation are the same parts of the brain used to regulate emotion. And sketching the idea out crudely, that through attentive practice, we can essentially train our brain to cultivate positive sensations to calm down the fight-or-flight system. Over time, this can actually strengthen the system that regulates strong, primitive emotions. (Daniel Siegel, MD, has followed and participated in this research quite closely.) Check out the video. It’s worth a look.

Data Leaks of Healthcare Information

A Downside of Digital Ease.

Ken Pope (via his listserv) follows this ongoing story quite closely. The updates come at an alarming rate. For those considering psychotherapy, there is an upside to not using your insurance, since insurance companies are increasingly digitizing their information. The convenience of digital information is also its curse. You can make an near infinite number of copies at the slip of a keystroke — not something you necessarily want with private information. Here’s an excerpt from a recent, overarching iteration, from Gov Info Security “20 Million Affected by Health Breaches” by Howard Anderson:

The federal tally of individuals affected by major healthcare information breaches since September 2009 now exceeds 20 million.

But two recently reported major incidents, estimated to have affected a combined total of more than 675,000, have yet to make the list, which now includes 435 incidents.

As of May 23, the breach list includes 29 incidents in 2012 affecting a total of about 935,000.

By far the largest of those breaches is a Utah Department of Health hacking incident affecting 780,000 individuals, including Medicaid clients, Children’s Health Insurance Plan recipients and others.

Not yet on the list are:

An Emory Healthcare breach involving 10 missing computer disks, affecting 350,000 surgical patients; and

A South Carolina Department of Health and Human Services breach affecting 228,000 Medicaid recipients.

Big Pharma and Psychology

One from the archives, a post on Big Pharma.

This is the first entry in a series on the implications of psychologists pursuing prescription privileges. What those implications are exactly, is far from clear — they ought to be examined very closely. Others in the series include:

Prescription Privileges for Psychologists: An Intro to “Pro” Arguments
Presciptive Authority: Strong Arguments

Here’s a draft I wrote for a professional newsletter.
In the editing down, one part that got lost was how difficult it is to consider the topic of Big Pharma and prescription privileges rationally. It’s a hot-button issue for psychologists. The opposition can easily fall into “the-sky-is-falling” type arguments — prescribing privileges will ruin the profession, and so on. Those in favor, however, appear to see what they want to see.

Stopping time, turning back the clock.
Within the profession, if you are staunchly opposed to presriptive authority, you risk coming off as being opposed to change, which might seem like being opposed to growth. An awkward and untenable position. History shows us that people that try to “stop time” fail miserably. But progress and growth are two different things.

The upside.
There are a number of potential benefits to prescription privileges for psychologists (rural access to care, the potential to prescribe more conservatively, the right to unprescribe, and so on), which I will cover more fully in another post, however, here I address my concerns that the profession is stepping into some very dicey territory. This is a complex issue.

Anyway, here’s the piece proper:

The potential for undue influence by pharmaceutical companies is considerable. Influence, and how it will effect patients’ best interests, is a key ethical issue in prescriptive authority for psychologists (RxP). The recent SGVPA workshop on RxP was enlightening and thought provoking, soothing and quite balanced. Dr. Doris Penman and Dr. Jarline Ketola did a very nice job of sorting through the issues and keeping the discussion civil. For all that, on RxP, particularly on the question of undue influence of monied interests, I remain unconvinced.

Building a firewall between science and marketing.
Elaine Levine, Ph.D., current president of APA division 55, the American Society for the Advancement of Pharmacotherapy (ASAP), directed me to the watershed article on the challenges related to RxP, Antonuccio (2004) Psychology in the Prescription Era: Building a Firewall Between Marketing and Science. It is well worth reading. It contains a number of useful proposals, none of which address how to limit the influence of marketing on practitioners. There is no credible strategy for doing this. “Big Pharma” will be courting us, and in a big way.

Experts on influence.
Social psychologists are experts on influence. Potential prescribing psychologists need to educate themselves, and quickly, about the powerful influence of Big Pharma. The epithet generally refers to pharmaceutical companies with annual profits upwards of $3 billion. There are thirty such companies. Each year, it is estimated, they spend $54 billion on marketing. For perspective on what corporate marketers are reading, take a look at psychologist Robert Cialdini’s Influence: Science and Practice (2001). The book has sold over a million copies and has been published in twenty languages.

Compromising judgment.
Phil Zimbardo, Ph.D., known for the Stanford prison experiment, has written extensively on influence and social pressure: “When information is systematically hidden, withheld or distorted it is impossible to make unbiased decisions. … people may be subtly led to believe they are ‘freely’ choosing to act…we come to believe in those attitudes and actions for which we have generated our own justifications.” Even small gifts compromise people’s judgment.

Conflicts of interest.
The APA ethics code is quite rigorous in addressing conflicts of interest. But enforcing the ethics code will be challenging, at best. A group of physicians have put together an informative website called No Free Lunch (link below). The site addresses the many ways in which drug companies have successfully influenced the practice of medicine, to its detriment. The site offers practical suggestions for sidestepping influence tactics. Some offer that psychologists are different. We will not let Big Pharma subsidize 97% of our continuing education, as psychiatry has, according to Dr. Penman. Perhaps the latter part is true.

Evolving professional identities.
Big Pharma will approach psychologists differently. The idea that psychologists are somehow inherently different from other prescribers is hubris, regardless of how well established our professional identity. The small group of psychologists working toward RxP strike me as dedicated, competent professionals – often experienced in medical settings – who will probably be thoughtful, judicious prescribers.

I am less convinced about how the larger group of early-career psychologists will prescribe, and how that prescribing will affect their professional identities. Many of them have the time and inclination to pursue RxP. Their curricula are steeped in biological bases of behavior, pharmacology, and evidence-based treatments. Consequently, the professional identity of these psychologists will be different, and more subject to influence.

The role of managed care.
If all this strikes you as reactionary and overblown, take a look at a July 16, 2007 article run on United Press International (UPI), by senior science writer Lidia Wasowicz: “When it comes to treating children with mental, behavioral and/or emotional problems, the cards seem stacked against giving the non-pharmaceutical way a chance, some U.S. Specialists say. ‘Managed-care organizations are less likely to pay for psychotherapy and family interventions,’ said Peter Conrad, professor of sociology at Brandeis University in Waltham, Mass.” There will be many unintended consequences to RxP, and we need to proceed thoughtfully.

Kalea Chapman, Psy.D

This is the first entry in a series on the implications of psychologists pursuing prescription privileges. Others in the series include:

Prescription Privileges for Psychologists: An Intro to “Pro” Arguments
Presciptive Authority: Strong Arguments

Recommended Reading

Anderson, S. and Zimbardo, P. (1979). “On Resisting Social Influence.” (Technical report). Stanford University Department of Psychology.

Angell, M. (2004). “The Truth About Drug Companies.” In The New York Review of Books. Retrieved at http://www.nybooks.com/articles/17244 on July 14, 2007.

Cialdini, R. (2001). Influence: Science and Practice (4th ed.) Boston: Allyn & Bacon.

Katz, D. (2003). “All Gifts Large and Small: Toward an Understanding of the Ethics of Pharmaceutical Industry Gift Giving.” The American Journal of Bioethics – Volume 3, Number 3, Summer 2003, pp. 39-46. Retrieved at http://muse.jhu.edu/login?uri=/journals/american_journal_of_bioethics/v003/3.3katz.html

Wall, L. L. and Brown, D. B. (2007). “The High Cost of Free Lunch.” In Obstetrics & Gynecology. Retrieved at http://www.greenjournal.org/cgi/content/abstract/110/1/169
July 14, 2007.

Wasowicz, L. (2007). “Ped Med: Non-drug options slighted?” In Science Daily. Retrieved at http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20070716-09132900-bc-pedmed-drugs-options.xml July17, 2007.

Zucker, A. (2004). “When Your Doctor Goes to the Beach, You May Get Burned.” In The New York Times. Retrieved at http://www.nytimes.com/2004/02/24/health/policy/24ESSA.html July 14, 2007.

Website:

Cialdini. Website: http://www.influenceatwork.com/

Where Are Veterans Returning to Civilian Life? Community College

Suicides of Troops Exceeding Combat Deaths.

The Huffington Post, and other sources, just reported June 7 that deaths from suicide had outpaced combat deaths in the Afghanistan war. During the first 155 days of the years the armed forces lost 154 troops to suicide — an alarming rate of nearly one suicide per day. According to the Huffington Post, who cited Pentagon statistics via the Associated Press, that’s about 50 percent more soldiers lost to suicide than soldiers killed in action. From the article:

The reasons for the increase are not fully understood. Among explanations, studies have pointed to combat exposure, post-traumatic stress, misuse of prescription medications and personal financial problems. Army data suggest soldiers with multiple combat tours are at greater risk of committing suicide, although a substantial proportion of Army suicides are committed by soldiers who never deployed….

The 2012 active-duty suicide total of 154 through June 3 compares to 130 in the same period last year, an 18 percent increase. And it’s more than the 136.2 suicides that the Pentagon had projected for this period based on the trend from 2001-2011. This year’s January-May total is up 25 percent from two years ago, and it is 16 percent ahead of the pace for 2009, which ended with the highest yearly total thus far.

Suicide totals have exceeded U.S. combat deaths in Afghanistan in earlier periods, including for the full years 2008 and 2009….

The numbers are rising among the 1.4 million active-duty military personnel despite years of effort to encourage troops to seek help with mental health problems. Many in the military believe that going for help is seen as a sign of weakness and thus a potential threat to advancement.

One Response: The Soldier’s Project

The announcement was an uncanny reminder of the plight troops face, coming the day before The Soldier’s Project‘s third annual conference. The project is a non-profit group providing free resources to veterans who may otherwise not seek treatment. The tag on their website (a good resource, if you’re interested in learning more) reads: “Free, confidential psychological counseling for military service members and their loved ones.”  I had the pleasure of attending conference, just held at USC on June 8-10, which highlighted the experiences of veterans, not just from Iraq and Afghanistan, but from conflicts as far back as Korea and Viet Nam.

A frontline of Veterans Returning to Civilian Life — Community College

One interesting facet of veterans returning to civilian life is the number of them going back to school, largely in community college settings. Service members from all over the country are discharged in California. Many of them, rather than return to areas where the economy is depressed, or wary of returning home, choose to stay in California. Many service members originally enrolled as a way of financing their education. So, faced with limited options, many do just that. Patricia D’Orange-Martin, the coordinator the Pasadena City College Veterans Resource Center, stated that a full 20% of veterans in community college have been discharged within the last 30 days. In other words, community college is one of the front lines of where returning service members meet civilian life. These are veterans who are still grappling to find their place in civilian life.

Another interesting aspect of treating this group is the difficulty in getting service members to seek services. It’s a complicated problem. First off, a significant number of veterans simply don’t identify as veterans. They never expected to do a tour of duty. When they cast off their uniform they left the service behind. As one participant stated, “I used to think of a veteran as an old guy in a baseball cap with a bunch of medals that he wears all the time — it’s not something I wanted to be a part of.” Added to that, many are concerned about how seeking services may adversely affect their benefits or the stigma of mental illness. [Apparently the next revision of DSM-V may have a new name for PTSD, rather than Post-Traumatic Stress Disorder, it may become Post Traumatic Injury.] Moreover, coming from a culture where you simply “get the job done” and “achieve your mission no matter what” it can be very difficult to accept the idea that you might need help.

One clinician in the audience contributed: You’d be more likely to get veterans to attend an event if you advertise something related to learning difficulties. Many vets have Traumatic Brain Injuries (TBI) that mean they process information at a slower rate and have memory problems. Many of them don’t even realize this is related to a TBI.

One participant at the conference shared his experience on returning from several tours of duty. His grandfather had served in the National Guard. So had his father. It was a natural thing for him to do. He never expected to do a tour of duty. He had three days to get his things together. When he returned home the storage unit where all his belongings were packed away had been damaged by flooding.

I was so sick of all the ‘we’re so proud of you bullshit’ and my stuff was destroyed. But I had no ‘Rambo moment.’ I had late onset PTSD and I had no idea what it was. ‘I’m an Army of One. I can’t have PTSD.’  After five nights of not being able to sleep I would miss a class or a show [he is a musician]. And I would say, that’s never going to happen again. But it would happen again. To cope I’d get a case of beer and a bottle of wine. I became good at avoidance and numbing. I made a suicide attempt.

He said he’d been diagnosed with an adjustment disorder. Clearly, some military returning from duty are not aware of the scope of the problems they are facing. Let alone resources they might avail themselves of. Clearly they are doing important, valuable work at the Pasadena City College Veterans Resource Center. (Click on the link, if you’re interested in more information.)

Possible Role of Implicit Memory in EMDR

There’s an interesting section in Dan Siegel’s book, The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, where he recounts a traumatic incident of his own — a horse riding accident in Mexico that happened while he was working for the World Health Organization. Then, years later, while watching the movie Seabiscuit Siegel

suddenly felt this sharp pain in my face and arm and my muscles tighten as I bent over to the side… now watching the movie I felt overwhelmed and out of control. And even though I quickly realized that the accident in Seabiscuit was just like the one I’d had, these feelings felt in the here and now. It did not feel like I was remembering anything from the past. That is the emergence of “implicit-only” memory.

Dr. Siegel suggests that implicit memory is more of a right-brain function. Implicit memory being the more visceral components of memory, which is present throughout the lifespan (unlike explicit memory which only starts encoding roughly around age 3), which does not require conscious attention for encoding, is automatic, etc. Explicit memory (as the theory goes) being the more language centered kind of memory, stored in the hippocampus, is retrieved with awareness, is factual and autobiographical, can be retrieved with intention, and so forth.

Siegel notes that until encoded with left-brain activity, implicit memory has its own distinct, visceral quality. In addition, he notes that through mindfulness practices (such as yoga, meditation, what have you) we can learn to discern the difference between these two states of awareness. He even cites a study on this:

Farb, N. A. S., Segal, Z. V., Mayberg, H., Bean, J. McKeon, D., Fatima, Z., et al. (2007). Attending to the present: Mindfulness reveals distinct neural modes of self-reference. Journal of Social, Cognitive, and Affective Neuroscience, 2, 248-258.

So what does this have to do with EMDR? Well, maybe nothing. The truth is we don’t know why Eye Movement Desensitization and Reprocessing therapy (EMDR) works. Is it possible that the waving of the clinician’s hand in front of the patient and the patient’s tracking of that movement, what’s known as a “bilateral stimulus,” somehow helps the brain to combine left- and right-brain activity to create an integrated memory? Could be.

Does the attention on the waving hand, somehow reduce the intensity of the recalled memory — the “desensitization” piece?  Could be. Might it be a combination of these two factors? Possibly. Is it neither of these explanations? Possibly. More research will undoubtedly be done. In the meantime, Dr. Siegel has offered a very interesting and at least plausible hypothesis, that the processing during EMDR integrates free-floating implicit, right-brain memories, with left-brain tags about meaning, narrative, and fact — a procedure that fundamentally alters the quality of that memory.