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How mindfulness changes the brain

4/5/2021

 

I admit, I was a skeptic. I kept reading all the articles about Jon Kabat-Zinn’s mindfulness-based stress reduction (MBSR) program and how it was beneficial for every medical condition imaginable including arthritis, chronic back pain, and even hot flashes. My curiosity about this wonder treatment was piqued. I kept reading the new research studies and subsequently moved to New York City and started working in a clinic for individuals with anxiety disorders. If you live in Georgia, it was very much like the  that you may know about. Mindfulness is one of the skills taught to individuals with anxiety; it provides a way to distance from emotions and accept that emotions such as anxiety ultimately pass and don’t last forever. As the girl who used to leave yoga class before savasana (relaxation at the end)—terrible, I know, I was that girl?!—I thought I should learn how to practice mindfulness myself, so that I could at least practice what I was preaching. I told myself I had to do the homework because if I got to the end of the eight weeks and my life hadn’t changed, I would have no one to blame but myself. So I suffered through four weeks of doing an hour-long body scan daily while my mind behaved like a drunk monkey that had been bitten on the tail by a scorpion. Much to my surprise, after four weeks, everything shifted. My thoughts started settling. The two things I found the most stressful about NYC—grocery stores (people who live in Manhattan behave as though it is Russia and there isn’t enough food) and public transportation—suddenly were easier. I was less irritable. I was sleeping better. I was sold.

This article is for the skeptics like me. Research has literally exploded in the last several years examining how mindfulness (the psychology term used to describe awareness of the present moment) and meditation (the broader practice) change the brain. We used to think that brain development ended around age 25; now we know just how flexible the brain is and how activities such as exercise and meditation can promote new functions, connections, and even structure. This ability is called neuroplasticity and describes the ability of the brain to physiologically change over time in response to the environment and behavior.

There are several brain networks that act in concert to regulate our experience. The cognitive control network includes prefrontal regions (towards the front of your brain, behind your forehead) and serves the function of the linear thinker/problem-solver. The emotional salience network includes regions deep in the brain like the amygdala that detect emotional stimuli and decide how relevant they are to you and your current experience. The default mode network is the network that is running when we “aren’t doing anything,” meaning in the absence of an explicit external task. The default mode network includes regions such as the posterior cingulate cortex, and these regions contribute to mind-wandering and other types of self-referential thinking. In other words, the default mode network governs what we tend to do with our mind when we aren’t really paying attention to anything in particular.

When these networks are healthy, the cognitive control network downregulates the emotional salience network and tells it when to chill out; and the default mode network knows when to turn off and let the cognitive control network pay attention to the outside world. Among individuals with anxiety disorders, the emotional salience network seems to be working overtime, with less input from the cognitive control network. Depressed individuals spend too much time focusing on how bad they feel and are too in tune with internal stimuli at the expense of external stimuli. In other words, their default mode network is working overtime.

The ability to switch between internal and external tasks involves a key region of the default mode network called the posterior cingulate cortex. This region has been directly linked to meditation practice. Cutting-edge research uses real-time functional magnetic resonance imaging (fMRI) to examine what this region is doing during meditation. A friend, practitioner, and colleague, Judd Brewer, used real-time fMRI with novice and experienced meditators to conduct a study at Yale University in 2013. While individuals were meditating he showed them a visual display of what their posterior cingulate cortex was doing. He found that the posterior cingulate cortex was active when people became caught up in thought and quieted when they were meditating. In fact, the type of meditation did not seem to matter so much. Across different forms of meditation (concentration, loving-kindness, choiceless awareness), he found that meditation involved quieting the posterior cingulate cortex. So science tells us that quieting this region is required to dip into the bliss of selflessness.

Meditation influences brain activity during different tasks, but also influences the connections between brain regions and the strength of various networks. Additional work by Brewer in 2014 examined the specific technique of loving-kindness. When asked to practice loving-kindness in the scanner, experienced meditators exhibited different connectivity patterns when compared with novice meditators. Novice meditators had greater connections within their default mode network, whereas this was not the case among experienced meditators. Meditation practice is also associated with increased connectivity between the dorsolateral prefrontal cortex, a key hub in the cognitive control network, and the insula, a key region in the emotional salience network involved in detecting and sorting through emotional stimuli. Meditation appears to improve the brain’s ability to complete emotional and cognitive tasks as well. For example, research in 2013 by Rimma Teper and Michael Inzlicht at the University of Toronto found that meditators demonstrated better cognitive control and more emotional acceptance.

Meditation changes not only the function of brain networks, but their structure. Long-term meditators exhibited greater gyrification in a study conducted at UCLA in 2012 by Eileen Luders. Gyrification is a process of cortical folding and is believed to support greater intelligence because it allows for greater surface area of neurons within the same skull volume. In this study, gyrification increased as the number of years practicing meditation increased.

As the evidence for the benefits of meditation and how it changes the brain has grown, the question has shifted to whether or not you need to be an expert who has practiced for 10,000 hours or whether your brain can experience benefits prior to reaching the expert phase. A study by Sara Lazar at Harvard in 2011 found that just eight weeks of practice resulted in structural brain changes including thicker cortices in prefrontal regions and the insula. Similar to gyrification, thicker cortexes are associated with a greater number of neurons and theoretically greater function in these regions.

Meditation even helps delay cognitive decline and aging. A review in 2014 conducted by Andrew Newberg at Thomas Jefferson University summarized evidence suggesting that meditators do not experience the typical decline in gray matter volume and parallel decline in attentional performance with age. Thus, meditation may have a neuroprotective effect, reducing the cognitive decline typically associated with increased age.

Overall, this research suggests that the mental training that occurs through meditative practice is associated with changes in brain function and even structure. One of the primary mechanisms through which meditation functions is the turning down of the “over-selfing” of the default mode network. Research also illustrates that meditators improve their attention and emotion regulation and that these changes may be long-lasting, persisting beyond time spent on the cushion.

Richard Davidson, a key researcher in this growing field at the University of Wisconsin, says the goal of this research is “to use what we know about the brain to fine-tune interventions that will improve well-being, kindness, altruism. Perhaps we can develop more targeted, focused interventions that take advantage of the mechanisms of neuroplasticity to induce specific changes in specific brain circuits.”
​
I’ll OM to that.
originally published in Yoga Chicago in 2014

Transitioning Back to School During a Global Health Pandemic: Managing Your Child's Stress and Anxiety

9/6/2020

 
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I did a webinar on back to school anxiety with the awesome people of Donohoe Pediatrics. Click here for the link to the ~30m recording and enter the following passcode: U99g5M=0. 

Resources for Teachers and School Staff for Back to School during COVID

8/20/2020

 
The attached document lists resources for teachers on how to support their students during this time and how to take care of their own anxiety.
teacher_resources.pdf
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Back to School Anxiety in the time of COVID-19

8/20/2020

 
I have compiled some links and resources for parents in this time. 
parent_resources.pdf
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Five tips for a successful teletherapy session

7/23/2020

 
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This is my adopted kitty Jazzy. If it were time for her virtual therapy session she would not be set up for success.  First of all it looks like she might be playing a video game in bed! She could easily get distracted or fall asleep. Here are some tips for having a positive and useful teletherapy session: 

1. Make sure your device is ready - if you are joining our session from a laptop, there is no need to download an app in advance. If you are using an ipad or phone, the session link will prompt you to download an app, which may take a minute and you probably want to do this before our session time. Close out other notifications and programs on your device so you don't get distracted (I can tell when you are playing a video game at the same time!). 

2. Give yourself transition time - it can be jolting to go straight from a school or work zoom into a therapy session. Without the built in travel time to my office, it can be good to give yourself some time before and after our session to collect your thoughts.

3. Below is a detailed guide about what to expect for your first video session through Simple Practice.

4. Make sure you have privacy - turn on a fan by your door or download a white noise app on another device. Headphones can be helpful in increasing privacy.

​5. Make sure you are on a secure and strong internet connection. Use this tool to check the quality of your connection before our session.
clientportal-telehealth.pdf
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Reducing rumination through CBT reduces risk for depressive relapse

7/2/2020

 
We recently published the two year follow up of the teens who received rumination-focused cognitive behavioral therapy. 
bessetteetalplosone2020.pdf
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Mindful Parenting Class Re-Launches June 16, 2020

6/8/2020

 
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mindful_parenting.pdf
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Insight Meditation Offers Online Retreat for Teens~

6/8/2020

 
June 26-29, 2020 for ages 15-19. Learn more here.  

Resources for Talking about Race

6/8/2020

 
I am grateful for colleagues who have put together resources for talking about race with kids and mindfulness exercises for healing. I have not yet had time to go through all of these wonderful resources, but I look forward to digesting. 
  • Black Lives Matter Meditations by Dr. Candice Nicole to help reduce stress and heal racial trauma. 
  • Mindfulness of Injustice by Argos Gonzales (Mindful Schools). 
  • Using Mindfulness for Racial Healing - confronting the rage, soothing the exhaustion, healing the grief
  • Self-Care in the Face of Racial Injustice by Dr. Joy Harden Bradford (podcast host of Therapy for Black Girls)
  • Radical Self-Care in the Face of Mounting Racial Stress: Cultivating hope through acts of affirmation
  1. Supporting Kids of Color in The Wake of Racialized Violence Part 1 and Part 2 (by Embracerace)
  2. Racial Stress and Self-care: Parent Tip Tool (from APA's RESilience). This describes caregivers' potential reactions to racial stress or trauma; the impact of racial stress on parenting; and strategies to deal with racial stress and practice self-care.
  3. Engaging My Child: Parent Tip Tool (from APA's RESilience). Includes psychoeducation for caregivers on why they shouldn't avoid these conversations, and developmentally responsive strategies on how to engage in Racial Ethnic Socialization (RES) . 
  4. Talking With Children About Racism, Police Brutality and Protests (from Aha! Parenting.com). This includes developmentally appropriate guidelines on how facilitate these conversations with toddlers, preschoolers, school-age kids, tweens, and teens. Referenced here is the infographic on They're Not too Young to Talk about Race.  
  5. George Floyd. Ahmaud Arbery. Breonna Taylor. What do we tell our children? This article addressed the questions above, and many more, through the expertise of Beverly Daniel Tatum, author of "Why Are All The Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race" and Erlanger Turner.
  6. 8 Tips for Talking to Your Child About Racial Injustice (by Embracerace). Available in English and Spanish. 
  7. 10 tips for teaching and talking to kids about race (by Embracerace). Available in English and Spanish. 
  8. 'Raising White Kids' Author On How White Parents Can Talk About Race. In this NPR podcast, Michel Martin talks to Jennifer Harvey, author of Raising White Kids: Bringing Up Children in a Racially Unjust America, about how to talk with white kids about racially charged events. Related to this is a webinar tonight on "How do I make sure I'm not raising the next Amy Cooper?" with Jennifer Harvey and Embracerace. You can register here. 
  9. Utilizing Trauma-Focused Cognitive Behavioral Therapy as a Framework for Addressing Cultural Trauma in African American Children and Adolescents (Phipps & Thorne, 2019)
  10. EMBRace: Developing a Racial Socialization Intervention to Reduce Racial Stress and Enhance Racial Coping among Black Parents and Adolescents (Anderson et al., 2019)
  11. Bibliotherapy is a powerful medium on how to model and start these conversations. You can refer to guidelines and books by APA's RESilience; Embracerace; Social Justice Books; Charis Books and More. A personal favorite is Something Happened in Our Town: A Child's Story About Racial Injustice. The story is about two families — one White, one Black — as they discuss a police shooting of a Black man in their community. The story aims to answer children's questions about such traumatic events, and to help children identify and counter racial injustice in their own lives. 
  12. Talking about Race (launched by the National Museum of African American History and Culture on May 31)
  13. Teaching Tolerance
  14. Embracerace
  15. Raising Race Conscious Children
  16. RESilience: Uplifting Youth Through Healthy Communication About Race. (APA). Racial and Ethnic Socialization (RES)
Credit: Ritchie J Rubio, PhD, San Franciscon Department of Public Health; Updated Resource List here

Keeping Calm and Carrying On (in the time of COVID-19)

4/2/2020

 
I am compiling online resources for kids yoga and mindfulness (for parents too) here.  Feel free to add additional resources in the comments below. 
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    Dr. Rachel H. Jacobs

    I am a clinical psychologist who specializes in training resiliency and wellness among young adults.

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Meet DR. JACOBS

Dr. Rachel Jacobs, PhD
Ph.D. in Clinical Psychology
Northwestern University Feinberg School of Medicine

Postdoctoral Fellowship
Columbia University
New York State Psychiatric Institute
​
I combine cognitive behavioral therapy (CBT) with strategies from mindfulness to provide a comprehensive wellness approach to help young adults and college students overcome depression and anxiety and live healthier, more fulfilling lives.
Northwestern Medicine Feinberg School of Medicine
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