Stressed Out: And what we can do about it together

1. Stressed Out: And what we can do about it together Don McCown Council for Relationships West Chester University dmccown@wcupa.edu

2. Ideas that Might Help Us • “I sat in my sunny doorway from sunrise til noon, rapt in revery…until by the sun falling in my west window, or the noise of some traveller’s wagon on the distant highway, I was reminded of the lapse of time. I grew in those seasons like corn in the night, and they were far better than the work of the hands would have been.They were not time subtracted from my life, but so much over and above my usual allowance.” • Henry David Thoreau, • Walden, “Sounds”

3. Ideas that Might Help Us “We notice after exercising our muscles or our brain in a new way, that we can do so no longer at that time; but after a day or two of rest, when we resume the discipline, our increase in skill not seldom surprises us. I have often noticed this in learning a tune; and it has led a German author to say that we learn to swim during the winter and to skate during the summer.” …William James Principles of Psychology Chapter IV

4. Ideas that Might Help Us “When I was a younger man, art was a lonely thing. No galleries, no collectors, no critics, no money. Yet it was a golden age, for we all had nothing to lose and a vision to gain. Today it is not quite the same, it is a time of tons of verbiage, activity, consumption. Which condition is better for the world at large, I will not venture to discuss. But I do know that many of those who are driven to this life are desperately searching for thosepockets of silence where we can root and grow. We must all hope we find them.” Mark Rothko Yale University, 1969

5. What is Stress? • A biologist would tell you in three words: • Perception • Assessment • Resources

6. What is Stress? • There’s a lot to be said in two words: • Holding • On (Like a monkey in a trap)

7. What is Stress? • We can distill it to one word: • Fear (or anxiety)

8. The Body Under Stress Autonomic Nervous System • Sympathetic system • Fight or flight reaction • Parasympathetic system • Rest and repair response

9. Eustress Distress Performance Boredom Burnout Stress

10. The Body Under Stress Fight or flight reaction: • Going up… • Heart rate • Blood pressure • Breathing rate • Muscle tension • Blood clotting • Endocrine function

11. The Body Under Stress Fight or flight reaction: • Going down… • Digestive function • Immune function • Growth and repair of tissue • Thinking and emotions • Threat detection (scanning) • Negative bias in attention and memory • “Negative” emotions (avoidance)

12. The Body Under Stress Gender differences… • Men — pretty much locked into “Fight or Flight” • Women — also, “Tend and Befriend,” an oxytocin-mediated social engagement response

13. We feel all this in the body/mind/world complex…

14. Here’s a Brain-Based View • This is your brain… • Wrist = spinal cord • Lines at heel of hand = brainstem • Unconsciously scanning for threat and safety

15. The Handy Brain This is your brain… Position your limbic system: Hippocampus = first knuckle Amygdala = second knuckle

16. The Handy Brain • This is your brain… • Fingers = cerebral cortex • First knuckles = prefrontal cortex • Middle two finger tips =medial prefrontal cortex • Connects everything—limbic region, brainstem,nerves of thebody • Regulatory functions —shaping bodily processes,pausing beforeaction, having insight and empathy, making moral judgments

17. The Stress Reaction When activity in the limbicsystem and brainstem is overwhelming, you may “flip your lid”

18. Self-Regulation Bringing your attention to body sensations – like making the handy model of the brain – re-engages the medial prefrontal cortex and makes it possible to come into balance again You might put it this way: It’s nearly impossible to be anxious and curious at the same time

19. What we’re talking about, then, is mindfulness…

20. It’s about choosing to show up for what’s happening in each moment of your life…

21. …with an attitude of friendliness toward your experience, wanted and unwanted, pleasant and not so…

23. Percent improvement over 8-week MBSR program

24. MBSR: Exemplary Study • “Alterations in Brain and Immune Function Produced by Mindfulness Meditation” • Richard Davidson, Jon Kabat-Zinn, et al. • Psychosomatic Medicine, 2003 • MBSR for healthy employees in workplace setting • n=25; randomized to MBSR vs. WLC • Associates changes in brain activity (left side, anterior regions) with: • Decrease in trait anxiety • Increase in positive affect • Enhancement of immune function

25. MBSR: Exemplary Study Mean Trait Anxiety

26. MBSR: Exemplary Study Means of asymmetric activation

27. MBSR: Exemplary Study Means of antibody rise

28. Hölzel BK, Carmody J, Evans KC, Hoge EA, Dusek JA, Morgan L, Pitman RK, Lazar SW.Soc Cogn Affect Neurosci. Mar 5, 2010 Stress reduction correlates with structural changes in the amygdala

29. Brain Changes • Participation in an MBSR program results in increases in brain gray matter density in regions associated with learning, memory, emotion regulation, perspective taking. (Holzel, Lazar et al. 2011)

30. Mindfulnessand Cognitive Function • Recently, researchers have reported improvement in sustained attention and working memory measures in novice meditators(MBSR), relative to controls who did not take meditation training

31. Mindfulness-Based Interventions for Adolescents and Children • New therapies are developed first with adults, then are adapted for children • MBSR, MBCT, DBT, and ACT have all been adapted • Clinical trial: MBSR for teens (Biegel, et al., 2009) • Reduced anxiety, depression, somatization • Improved self esteem and sleep quality • 54% diagnostic improvement (loss of 1 or more psychiatric diagnoses); significant improvement in GAF scores • Interesting study: Teens with externalizing disorders (ADHD, ODD, CD, ASD) (Bogels, et al., 2008) • 8 weeks, mindfulness training • Parents/caregivers also received mindfulness training • Significant results • Kids: improvement on personal goals, internalizing and externalizing complaints, attention problems, happiness • And they performed better on a standardized attention test • Parents: improved on their personal goals as well • Parent mindfulness predicted longer term improvement of parent-rated child symptoms

32. Mindfulness-Based Interventions for Adolescents and Children • Just as important, mindfulness is making its way into schools as a way of preventing or preempting stress and anxiety • Check out http://innerkids.ning.com/ for resources and community • The Mindful Child: How to Help Your Kid Manage Stress and Become Happier, Kinder, and More Compassionate by Susan Kaiser Greenland • Parents and teachers are enormously important in the process • In some structures, parents and children learn mindfulness together • Mindfulness training for parents, teachers, and therapeutic staff supporting special needs children improves outcomes

33. So here’s the thing of it. Mindfulness is not simply about an individual’s experience…The relational effects are tremendous…

34. Effects of Meditation Practice on Therapists and Their Clients • Controlled, double-blind study of outcomes of therapy in clients whose therapists meditated daily (Grepmair, et al., 2007) • Significant difference in symptom reduction measured by SCL-90: GSI, and 7 of 9 subscales – somatization, insecurity in social contact, obsessiveness, anxiety, anger/hostility, and psychoticism • Clients better understood their own psychodynamics, the structure, phenomenology, and characteristics of their difficulties, and the possibilities and goals of their development • Clients better assessed their subjective progress in overcoming their difficulties and symptoms, their development of new behaviors, and implementation in daily life

35. Effects of MBSR Groups on Psychological Outcomes • Studied nearly 60 groups, over 600 participants (Imel, Baldwin, Bonus, & MacCoon, 2008) • Used multi-level statistical models to find how much group participants differed in symptom change from pre- to post- intervention — excluded teacher effects • Group effect accounted for 7% of the variability in psychological symptom outcomes • Authors suggest that: • (a) something about the group impacts the ability of an individual to learn and practice specific mindfulness techniques • (b) something about [the] group influences outcome through ‘non-mindfulness’pathways (e.g., expectation of change, provision of support, group cohesion), or • (c) a combination of these, with the last the most probable

36. A Little Perspective on a Huge Finding From Miller,S., Duncan, B., Hubble, M. (1999). Escape from Babel. New York: Norton.

37. A Little Perspective on a Huge Finding • In individual psychotherapy, the therapeutic alliance accounts for about 5% of variability in outcomes — about 30% of the total “curative factors” (Miller, et al., 1999) • If figured as above, the 7% variability accounted for by the MBSR group would be about 40% of curative factors • So, the people who are with us, and how they are with us are hugely important factors • It’s not about doing something, as an expert, it’s about being with someone, as a person

38. Mindfulness and the Social Brain • Caveat: Neuroscience is a marvelous new language to help us share our inner experiences, but it is new and in flux — we’re still working on “accuracy” • Here’s an explanation that may be helpful, if not entirely “true” • Mindfulness practice is a way of resonating with ourselves the same way we resonate with others (Siegel, The Mindful Brain, 2007) • Starts with the mirror neuron system: which allows us to inwardly feel, track, and predict another’s intentions and actions

39. Interpersonal Resonance • You’ve touched a live wire in the empathic “resonance circuit” (Carr, Iacoboni, Dubeau, Maziotta, & Lenzi, 2003) • In this circuit, the mirror neuron system reflects the action, which is sent to the superior temporal cortex to predict sensory consequences, this information is communicated through the insula to the limbic regions for processing of the emotional content (surprise, anger), and this is fed back through the insula to the prefrontal cortex where it’s interpreted and attributed • The circuit is complete — your somatic and emotional states are now attuned to the other • When you say, “I feel your pain,” you mean it!

40. Intrapersonal Resonance • Siegel suggests that when we practice mindfulness meditation, we activate these resonance circuits in ourselves • These circuits can predict and map our own intentional states and attune to those states in the present moment • Awareness of breath meditation: you notice the in-breath; the resonance circuit predicts the out breath, and it happens! You coincide again and again with your own intention • This is a primal experience, like infant and caregiver attuning in ways that build secure attachment • So, through mindfulness practice, the meditator can actually build – now – the secure attachment she may have missed

41. Dampening Down Reactivity • Mindfulness practice can produce a shift to greater PFC activation, which inhibits limbic arousal (particularly the right amygdala) – so reactivity switches to receptivity (Creswell, et al., 2007; Lieberman, et al., 2007) • As suggested in Steven Porges’s“Polyvagal Theory”, being with others who are practicing mindfulness can influence the unconscious “neuroception” of safety, and inhibit fight, flight, or freeze reactivity, allowing social engagement or “immobilization without fear” — an openness to approach and embrace • When we – and those we are with – are mindful, we can approach and explore our experience – including aversive experience – both intra- and interpersonally • A parent’s presence, when mindful, can assist the child in staying with such exploration

42. This is way more than stress reduction, and far greater than ourselves and our families • By our mindful presence, we can help to create “pockets of silence” where we – and our children – can “root and grow” together • Perhaps we can give William James the last word – from his lecture “The Gospel of Relaxation”

43. “If you should individually achieve calmness and harmony in your own person, you may depend upon it that a wave of imitation will spread from you as surely as the circles spread outward when a stone is dropped into a lake.”

44. Bibliography Carr, L., Iacoboni, M., Dubeau, M.-C., Mazziotta, J., & Lenzi, G. (2003). Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas. Proceedings of the National Academy of Sciences, 100 , 5497–5502. Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic Medicine, 69 , 560–565. Ham, J. & Tronick, E. (2009). Relational psychophysiology: Lessons from mother-infant physiology research on dyadically expanded states of consciousness. Psychotherapy Research, 19 (6), 619-632. Imel, Z., Baldwin, S., Bonus, K., & MacCoon, D. (2008). Beyond the individual: Group effects in mindfulness-based stress reduction. Psychotherapy Research, 18 (6), 735–742. Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18 (5), 421–427.

45. Bibliography Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology, 32, 301–318. Siegel, D. (2007). The mindful brain . New York: W.W. Norton. Tronick, E., & Members of the Boston Change Process Study Group. (1998). Dyadically expanded states of consciousness and the process of therapeutic change. Infant Mental Health Journal, 19 (3), 290–299.