FRIDAYPRESENTATION N ORTH C AROLINA N EUROLOGICAL S OCIETY 2017 - PDF document

FRIDAY฀PRESENTATION N ORTH C AROLINA N EUROLOGICAL S OCIETY 2017 ANNUAL MEETING F EBRUARY 17-19, 2017 T HE P INEHURST R ESORT , V ILLAGE OF P INEHURST This continuing medical education activity is jointly provided by the North Carolina Neurological Society and the Southern Regional Area Health Education Center

A Program for the North Carolina Neurological Society Meeting February 17, 2017

 Assistant Consulting Professor  Department of Psychiatry and Behavioral Sciences  Duke University Medical Center  brantley65@gmail.com

“I’m trying to create a really thriving environment,” he says. “That means making it as rich as possible. So there’s noise, competition, activity, energy— like when we play. It’s better than a pristine vacuum-type environment, as far as I’m concerned. Because we never play there. We don’t talk about mindfulness that much, but that’s how we operate. We focus on what’s right in front of us. We don’t care about the other team or the environment we’re playing in. We just take every game as if it’s the most important in the world and focus right on that. That takes great mindfulness.” ̶ Pete Carroll, NFL champion coach of Seattle Seahawks

"Now that I’m in a ’meditation cycle,’ it feels good… Let’s listen to silence. The more you understand silence, that’s where the balance comes." Ric ick R Rubi bin, C Co-Fo Founde der o r of Def J Jam Reco cords rds

“Simply put, mindfulness is moment-to- moment non-judgmental awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment’s thought to.” --Jon Kabat-Zinn

Component mponents o of Mindf dfulnes ulness “Paying “On purpose.” attention.” Mindful Awareness “In the present moment, non- judgmentally.” Attitude Adapted from Shapiro et al. (2006). J Clin Psychol.

"If you just sit and observe, you will see how restless your mind is. If you try to calm it, it only makes it worse, but over time it does calm, and when it does, there's room to hear more subtle things- that's when your intuition starts to blossom and you start to see things more clearly and be in the present more. Your mind just slows down, and you see a tremendous expanse in the moment. You see so much more than you could see before.“ ̶ Steve Jobs, Co-Founder, CEO of Apple

 Acute vs. Chronic Stress  The Power of Thoughts to Create Stress, or “Why Zebras Don’t Get Ulcers” (Robert Sapolsky, PhD)  Mindfulness-Based Stress Reduction  Selected Research Findings

 freeze—flight—or fight  acute reaction in mind and body prepares you to meet danger.  When the elements of the acute stress reaction become chronic, health and well-being are endanger.

“Man i an is not ot di distur urbed b d by event ents, but ut by by t the he view he he takes of of them hem.” - Ep Epic ictet etus us Gr Greek ek Ph Philo iloso sophe pher

Fear and negative affects stimulate widespread sympathetic nervous system activation (Thayer & Brosschot, 2005) Fearful cognitions and interpretations can manifest in somatic symptoms, and the same physiological responses arise for either real or imagined threats (Brosschot, et. al.,2005;2006; Thayer and Brosschot 2005) Example of how “depressogenic thinking” can transform momentary emotional distress into longer-lasting mood disturbance (Segal, Williams, & Teasdale, 2002)

…who tends to blame themselves for anything that goes “wrong?” …who is never satisfied when things go “right?” …who has that “little voice inside” that is always criticizing (usually themselves even more than others)?”

Your “Inner Narrative”— what you are telling yourself, moment-by-moment, about what is happening and why.

 Imagined scenarios of threat or failure  Self-criticism or judgment  Recall of disturbing events  Rumination about a negative event  Perceived stress  Hostility  Denial or avoidance  Comparison to an imagined ideal

 How we judge others affects empathic brain responses.  Lack of empathy-related brain activation in the anterior insula when a person in pain was perceived as unfair in their social behavior Singer, T., Seymore, B., O’Doherty, J.P., Stephan, K.E., Dolan, R.J., & Frith, C.D. (2006). Empathic neural responses are modulated by the perceived fairness of others. Nature, 439 , 466-469.

- Jon Kabat-Zinn, Ph.D. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life

“I try to have at least 15 minutes of still time and just kind of sit in my thoughts in the morning and just kind of meditate. And normally what happens with me is my mind would always drift to the game. Always," he said. "And then I found myself sitting there. My mind wouldn't drift towards the game all the time anymore. And that's when I started realizing, ‘You know what? It's getting close. It's getting close.’ Because now I'm not obsessively thinking about the game anymore. It's not wired into my subconscious the way it used to be.” ̶ Kobe Bryant, 5-time NBA champion

 Teaches mindfulness meditation and application of mindfulness in daily life  Emphasis on what a person can do to help themselves—using innate capacity for relaxation, attention, and awareness  Classroom-based training for anyone regardless of religious orientation

Mindfulness-Based Stress Reduction (MBSR)

 Eight week class  Daily home practice  2—2.5 hours each  Formal and week Informal meditation  Participants have  Day of Mindfulness diverse motivations that are health- based  Variety of mindfulness methods taught

 Dis-attention leads to dis-connection  Dis-connection leads to dis-regulation  Dis-regulation leads to dis-order  Dis-order leads to dis-ease --from “Coming To Our Senses” by Jon Kabat-Zinn, Ph.D. 2005. New York: Hyperion

 Attention leads to awareness  Awareness leads to insight and understanding  Insight and understanding lead to increased choices

Mindf ndfulne ness Stud udies es i in MED EDLI LINE N = 1,084 total N = 157 RCTs N = 10 meta-anal.

-- --chr hroni onic pai pain n (Kabat abat-Zin Zinn, 1982 1982, , 1985 1985; ; Mor orone one, , et. t. al., l., 2008 2008) -- --canc ancer (Spec peca, et. t. al, l, 2000 2000; ; Carlso rlson, et. t. al., l., 2007 2007) -- --ins nsom omnia a (Kreitze zer, e et. t. a al., l., 2005 2005) -- --pso soria riasis is (Kabat abat-Zin Zinn, et. t. al., l., 1998 1998) -- --type pe 2 2 di diabet abetes es (Ro Rosenzwe weig, e et. a al., 2007 2007) -- --fib fibromyalg lgia (Gro (Grossman, et. t. al., l., 2007 2007) -- --rheum heumatoi oid d ar arthr hritis (Zaut Zautra, et. t. al., l., 2008 2008) -- --mixed ed medi edical al di diagnos agnoses es (Rei eibel bel, e et. a al., 2001 2001) -- --or organ t gan trans ansplan ant pat patient ents (Gros oss, et et. al al., 2004 2004) -- --hear heart di diseas ease e (Sul ullivan an, et et. al al., 2009 2009) )

-- depr depres ession on (Jai ain, n, et et. al al., 2007 2007) -- --rel elaps apsing ng depr depres ession on (Teas Teasdal dale, e, et et. al al., 2000 2000) -- --depr depres ession on in n bi bipol polar ar pat patient ents (William ams, et et. al al., 2008 2008) -- --anx anxiet ety (Kabat abat-Zi Zinn, et. t. al., l., 1992 1992; W ; Weiss iss, e et. t. a al., l., 2005 2005; ; Orsi Orsillo llo & Roem oemer er, 2005 2005) -- --subs ubstanc ance e abus abuse e (Ma Marla rlatt & & Chaw hawla, , 2007 2007; B Bow owen, en, et et. al., l., 2009 2009; ; Zgie iersk rska, et.al.,2009 2009) -- --eat eating ng disor order ders (Baer aer, 2006 2006) -- --bi binge ea nge eating ( ng (Krist steller, et. t. al., l., 1999 1999) -- --ADHD ADHD (Zylowska ska, et. t. al., l., 2008 2008) -- --aggr aggres essive e behav behavior or in n dev devel elopm opment ental al di disabi ability (S (Sin ingh, et. t. al., l., 2007 2007)

 DBT—Dialectical Behavior Therapy  MBCT—Mindfulness Based Cognitive Therapy  ACT—Acceptance and Commitment Therapy  Addiction and Relapse Prevention Therapies

- Donald Hebb, Ph.D.

--Greater left prefrontal cortical activity is associated with mindfulness practice (Davidson, Kabat-Zinn, et. al., 2003) --Reduced activity in areas of the brain associated with OCD found in patients who practiced mindfulness (Schwartz & Begley, 2002) --Higher levels of trait mindfulness is associated with a greater ability to engage the prefrontal cortex (PFC) to manage emotional reactions in the amygdala (Creswell, et. al., 2007) --Mindfulness training over 8 weeks associated with greater neural activity in areas of the brain believed to subserve self- awareness (dorsolateral prefrontal cortex and medial prefrontal cortex) (Farb, et. al.,2007)