Mindfulness: why

attention matters

Dr Craig Hassed

Senior Lecturer

Deputy Head of Department

Monash University

Department of General Practice

Mind wandering and happiness

“In conclusion, a human mind is a wandering

mind, and a wandering mind is an unhappy

mind. The ability to think about what is not

happening is a cognitive achievement that

comes at an emotional cost.” Killingsworth MA, Gilbert DT. A Wandering Mind Is an Unhappy Mind.

Science 12 November 2010: Vol. 330. no. 6006, p. 932 DOI:

10.1126/science.1192439

Attention Deficit Trait

Newly recognized neurological phenomenon:

attention deficit trait (ADT)

Response to hyperkinetic environment

Trying to deal with too much input, results in:

Black-and-white thinking; perspective and shades of

grey disappear

Difficulty staying organized, setting priorities, and

managing time

Feel a constant low level of panic and guilt

Hallowell EM. Overloaded circuits: why smart people

underperform. Harv Bus Rev. 2005 Jan;83(1):54-62, 116.

“The body is the shadow of the soul.”Marsilio Ficino (1433-99)

Allostatic load Prolonged stress leads to wear-and-tear on

the body (allostatic load) Mediated through the Sympathetic Nervous System

Allostatic load leads to: Impaired immunity, atherosclerosis, metabolic

syndrome, bone demineralization

Atrophy of nerve cells in the brain Hippocampal formation: learning and memory

Prefrontal cortex: working memory, executive function

Growth of Amygdala mediates fear response

Many of these processes are seen in chronic depression and anxiety

McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.

“Man is not disturbed by

events, but by the view

he takes of them.”

Epictetus

Current trends in happiness

In developed countries depression is currently overtaking heart disease as the leading burden of disease

Mathers CD, Loncar D. Projections of global mortality and burden of disease

from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442.

Burnout and psychiatric morbidity in

new medical graduates

8 months into internship: 75% interns

had burnout

73% (of interns) met criteria for

psychiatric morbidity on at least one

occasion Willcock SM et al. Burnout and psychiatric

morbidity in new medical graduates. Med J

Aust. 2004;181(7):357-60.

Antidepressants and placebo

Antidepressants no

different to placebo for

mild-moderate

depression, and a

relatively small difference

for patients with severe

depression Kirsch I et al. PLoS Medicine 2008

Feb;5(2):e45

doi:10.1371/journal.pmed.0050045

Fournier JC, DeRubeis RJ, Hollon SD,

et al. Antidepressant drug effects and

depression severity: a patient-level

meta-analysis. JAMA. 2010 Jan

6;303(1):47-53.

Albert Einstein

“Any man who can drive safely while

kissing a pretty girl is simply not

giving the kiss the attention it

deserves.”

11

Mobile phone use and motor vehicle

accidents Passenger carriage increased the likelihood of a

crash (odds ratio 1.6)

Carrying two or more passengers twice as likely

to crash as unaccompanied drivers (OR 2.2)

Driver's use of a mobile phone within 5 min

before a crash associated with fourfold

increased likelihood of crashing (OR 4.1) McEvoy SP, Stevenson MR, Woodward M.The contribution of passengers versus

mobile phone use to motor vehicle crashes resulting in hospital attendance by the

driver. Accid Anal Prev. 2007 Nov;39(6):1170-6. Epub 2007 Apr 9.

Multitasking or task-switching?

Multitasking is an illusion (misnomer)

Switching happens so fast that it appears we

are performing multiple tasks simultaneously

like the concurrent performance of several

jobs by a computer

Reality is that we are switching back and

forth between tasks http://ucsdcfm.wordpress.com/2011/07/01/our-brains-

are-evolving-to-multitask-not-the-ill-usion-of-

multitasking/

Multi-tasking

On the performance levels of extreme multi-

taskers: “These are kids who are doing 5, 6, or

more things at once all the time. ... It turns out

multi-taskers are terrible at every aspect of

multitasking! They get distracted constantly. Their

memory is very disorganized. Recent work we’ve

done suggests that they’re worse at analytic

reasoning. We worry that it may be we’re creating

people who may not be able to think well, and

clearly.” Dr. Clifford Nass on his studies at Stanford University from

Dretzin, Rachel. Rushkoff, Douglas. “digital_nation life on the

virtual frontier.” pbs.org Frontline. Feb. 2010. Web. 14 Apr. 2011.

Multitasking

“In 2005, the BBC reported on a research

study, funded by Hewlett-Packard, and

conducted by the Institute of Psychiatry at the

University of London, that found, workers

distracted by e-mail and phone calls suffer a

fall in IQ more than twice that found in

marijuana smokers.” Christine Rosen, “The Myth of Multitasking.” The New

Atlantis thenewatlantis.com. Spring 2008. Web. 14 Apr.

2011.

Simple and Complex Multitasking

(Continuous Partial Attention) Simple multitasking: each task given the same priority

(e.g. stirring pasta while talking to spouse)

Aim to be more productive

Complex multitasking: two activities which demand

cognition (e.g. driving while speaking on phone)

Aim not to miss anything by maintaining CPA

Continuous overstimulation and lack of fullfilment

“When we do this, we may have the feeling that our

brains process multiple activities in parallel. Researchers

say that while we can rapidly shift between activities, our

brains process serially.” Stone, Linda. “Beyond Simple Multi-Tasking: Continuous Partial

Attention.” Lindastone.net. Nov. 2009. Wen. 14 Apr. 2011.

Multitasking

“Heavy media multitaskers performed worse

on a test of task-switching ability, likely due to

reduced ability to filter out interference from

the irrelevant task set.” Ophir, Eyal. Nass, Clifford. Wagner, Anthony D.

“Cognitive control in media multitaskers.” PNAS.org.

Proceedings of the National Academy of Sciences of the

United States of America, Jul. 2009. Web. 15 Apr. 2011.

Three regions of the brain

Corresponding areas in the brain

Frontal lobes – reasoning and emotional regulation

Higher reasoning (buddhi)

Emotional regulation Left (positive) vs. right

(negative)

Appetite regulation

Directs immune system

Limbic system – emotion and courage

Mesolimbic reward system –appetites

Stress

Performance

Inertia

Poor

performance /

burnout

Stress-performance curve

High performance

Doctor health and medical errors

Study determined prevalence of depression and burnout among residents medical staff in 3 US hospitals

20% of residents met criteria for depression

74% met the criteria for burnout

Depressed residents made 6.2 times as many medication errors as residents who were not depressed

Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ, doi:10.1136/bmj.39469.763218.BE (published 7 February 2008)

“The faculty of voluntarily bringing back a wandering attention over and over again, is the very root of judgment, character, and will. No one is compos sui if he have it not. An education which should improve this faculty would be the education par excellence.” William James, Principles of

Psychology, 1890

What is mindfulness?

Mindfulness

Mindfulness is a mental discipline involving

training attention

It is not a method of distracting ourselves or

tuning out, it is about tuning in – hence people

perform better when mindful (in the zone/flow)

The anxious, stressed or depressed state of

mind is the distracted state

Hence the negative impact upon performance

Applications of mindfulness Mental health

E.g. depression relapse prevention, anxiety, panic disorder, stress,

emotional regulation, addiction, psychosis

Neuroscience

E.g. structural and functional changes in the brain, neurogenesis,

dementia prevention, amygdala, executive function, working memory

Clinical

E.g. pain management, symptom control, cancer, metabolic,

hormonal, genetic function and repair

Performance

E.g. sport, academic, leadership

Spiritual

E.g. deep peace, insight, oneness

23

Results suggest that MBSR

may help a broad range of

individuals to cope with their

clinical and non-clinical

problems. Grossman P. J

Psychosomatic Research.

2004;57(1):35-43.

Meditation and cognition

Study on brief meditation training effects on cognition

and mood

Four sessions of either meditation training

Participants were assessed with measures of mood,

verbal fluency, visual coding, and working memory

Mindfulness training improved mindfulness, mood, and

reduced fatigue, anxiety, and increased visuo-spatial

processing, working memory, and executive

functioning Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness

meditation improves cognition: evidence of brief mental training. Conscious Cogn.

2010 Jun;19(2):597-605. Epub 2010 Apr 3.

Stress

Performance

Inertia

Poor

performance /

burnout

Stress-performance curve

Peak

performance

“The zone”

Restful

alertness

Mindfulness and mental health

Meta-analysis on 39 studies totaling 1,140 participants receiving

mindfulness-based therapy for conditions, including cancer,

generalized anxiety disorder, depression, and other psychiatric or

medical conditions

Effect size estimates show mindfulness-based therapy

moderately effective for improving anxiety (Hedges's g = 0.63)

and mood symptoms (Hedges's g = 0.59) in general population

In patients with anxiety and mood disorders mindfulness

associated with effect sizes (Hedges's g) of 0.97 and 0.95

Effect sizes were robust, unrelated to publication year or number of

treatment sessions, and maintained over follow-up.

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy

on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010

Apr;78(2):169-83.

Mindfulness and depression

Patients with 3 or more previous episodes of

depression

Mindfulness-Based Cognitive Therapy

reduced relapse from 78% (what you would

expect with usual treatment) to 36%

Ma SH, Teasdale JD. J Consult Clin Psychol.

2004;72(1):31-40.

Mindfulness, depression and the

stress response Mindfulness negatively correlates with

depressive symptoms and reactivity of the

amygdala Way BM., Creswell JD., Eisenberger, NI., Lieberman MD.

Dispositional mindfulness and depressive

symptomatology: Correlations with limbic and self-

referential neural activity during rest. Emotion. Vol 10(1),

Feb 2010, 12-24.

Mindfulness and craving

Study on the effectiveness of suppression vs.

mindfulness-based strategy for coping with cigarette

cravings

Both groups reported significantly reduced amount

of smoking and increased self-efficacy in coping with

smoking urges

Only participants in the mindfulness group

demonstrated reductions in negative affect (mood),

depressive symptoms, and marginal reductions in

their level of nicotine dependence Rogojanski J, Vettese LC, Antony MM. Coping with Cigarette Cravings: Comparison

of Suppression Versus Mindfulness-Based Strategies. Mindfulness 2011;2(1):14-26.

DOI: 10.1007/s12671-010-0038-x

The ESSENCE of health

Education

Stress management

Spirituality

Exercise

Nutrition

Connectedness

Environment

HEP and student wellbeing

Study of 2006 cohort of medical students found that 90.5% of students personally applied strategies

Improved student wellbeing noted on all measures of wellbeing even in the pre-exam period Reduced depression, hostility and anxiety subscale

Improved psychological and physical quality of life

Hassed C, de Lisle S, Sullivan G, Pier C. Adv Health Sci Educ Theory Pract. 2008 May 31. [Epub ahead of print]

Mindfulness and doctor wellbeing

An 8-week mindfulness program: improvements on all

measures of wellbeing including:

Mindfulness

Burnout (emotional exhaustion; depersonalization;

personal accomplishment)

Empathy and responsiveness to psychosocial aspects

Total mood disturbance

Personality (conscientiousness; emotional stability)

Improvements in mindfulness correlated with

improvements on other scales Krasner MS, Epstein RM, Beckman H, et al. JAMA. 2009;302(12):1338-40.

Mindfulness and the workplace

8 week mindfulness program for ANU staff

Key findings include:

Increased self-rated performance (ECDP)

Improved wellbeing (PANAS)

Improved eudaimonic wellbeing (meaningfulness) (PWB)

Increase in 2 subscales of work engagement (vigour and

dedication) (UWES)

Increased authenticity (self-awareness, authentic

behaviour, open relationships) (AI3)

Increased satisfaction with life (SWLS)

Improvements sustained at 6 month f/up Atkins P, Hassed C. Unpublished data.

Mindful practice Mindfulness is essential underpinning for

self-monitoring

“Mindful practice is conscious and intentional attentiveness to the present situation – the raw sensations, thoughts, and emotions as well as the interpretations, judgments and heuristics that one applies to a particular situation.”

Avoids automatic pilot Epstein R, Siegel D, Silberman J. Self-monitoring in clinical

practice: a challenge for medical educators. J Cont Educ Health Prof 2008;28(1):5-13.

Epstein RM. Mindful practice in action (II): Cultivating habits of mind. Fam Syst Health . 2003;21: 11-17.

Roots of Diagnostic Errors

“Cognitive dispositions to respond that influence

the diagnostic process are characterized by a

lack of awareness and responsiveness by the

individual to his or her own cognitive and

affective processes.”

Confirmation bias: the pursuit of data that support

a diagnosis over data that refute it

Anchoring bias: a resistance to adapting

appropriately to subsequent data that suggest

alternative diagnoses Sibinga EM, Wu AW. Clinical Mindfulness and Patient Safety.

JAMA 2010;304(22):2532-3.

Self-monitoring leads to;

1. Early recognition of cognitive biases

2. Avoidance of technical errors

3. Awareness of emotional reactions

4. Facilitation of self-correction

5. Development of therapeutic relationships Epstein R et al, 2008

Mindfulness and the brain Brain scans on long-term

meditators

Regions associated with attention, self-awareness and sensory processing thicker in meditators (E.g. prefrontal cortex) Offset age-related cortical thinning:

“evidence for … cortical plasticity” Lazar SW, Kerr CE, Wasserman RH, et

al. Neuroreport. 2005;16(17):1893-1897.

“The regular practice of meditation may have neuroprotective effects and reduce the cognitive decline associated with normal aging.”

Pagnoni G. Cekic M. Neurobiology of Aging. 2007;28(10):1623-7.

Meditation and compassion

Limbic brain regions implicated in empathic response to another's pain

Meditators have more active empathic response

Activation in insula greater in expert than novices

Empathy w/o stress reduces carer fatigue Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ.

PLoS ONE. 2008 Mar 26;3(3):e1897.

Emotional Intelligence & mindfulness

Mindfulness related to aspects of personality and mental health

Lower neuroticism, psychological symptoms, experiential avoidance, dissociation

Higher emotional intelligence and absorption Baer RA, et al.

Assessment.

2004;11(3):191-206.

EI Definition

Self-

awareness

Ability to recognise and

understand emotions,

drives and effects

Self-

regulation

Can control or redirect

disruptive impulses, can

think before acting

Motivation Passion for work that goes

beyond money or status,

energy and persistence

Empathy Ability to understand

emotions of others, skill in

interacting with others

Social skill Can manage relationships

and build networks, can

find common ground,

rapport

Genetic ageing and pessimism

The combination of lower optimism and higher

pessimism increases risk for disease and early

mortality

Sample of healthy post-menopausal women

Pessimism is independently associated with

over10 years accelerated ageing

Shorter Telomere length and higher Interleukin-6

concentrations Lin J,Dhabhar FS, Wolkowitz O, Tillie JM, Blackburn E, Epel

E.Pessimism correlates with leukocyte telomere shortness and

elevated interleukin-6 in post-menopausal women. Brain Behav

Immun. 2009 May;23(4):446-9.

Mindfulness and cellular ageing

Meditation may slow genetic

ageing and enhance genetic

repair

“...we propose that some forms

of meditation may have

salutary effects on telomere

length by reducing cognitive

stress and stress arousal and

increasing positive states of

mind and hormonal factors that

may promote telomere

maintenance.” Epel E, Daubenmier J, Moskowitz JT, Folkman

S, Blackburn E. Can meditation slow rate of

cellular aging? Cognitive stress, mindfulness,

and telomeres. Ann N Y Acad Sci. 2009

Aug;1172:34-53.