BEING IN THE BODY: MEDITATION, INTEROCEPTIVE AWARENESS, AND HEALTH

Norman Farb, PhD Regulatory and Affect Dynamics lab www.radlab.zone

Outline • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

Outline • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

Mindfulness Training is Helpful • Moderate positive effects (Goyal et al., 2014, JAMA IM) – Anxiety (d = .38) – Depression (d = .30) – Chronic pain (d = .33)

• Reduces physician burnout (Krasner et al., 2009, JAMA) • Specialized programs for pain, depression vulnerability, addiction recovery

Do we know what mindfulness is? • E.g., “paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally” • So, how does it work?

Interoceptive  Attention

Mental  Labeling

Meta‐ awareness

Insight into  change

Deep insight

Cycles of Personal Transformation Visuddhimagga

What is Interoception? The process of receiving,  processing, and  integrating body signals  with external stimuli to  affect ongoing motivated  behavior. (Craig 2009)

Why Interoception? • Interoception reveals reactive habits as they unfold Something  is wrong!

• Interoception helps us to distinguish between  primary and secondary appraisals

Some potential mechanisms • Mindfulness could enhance: Capacity to sense the body • awareness (Pollatos, Kirsch et al. 2005), • sensitivity (Holzl, Erasmus et al. 1996), or • accuracy of the sensing process (Vaitl 1996)

Or, as a set of attentional processes? • How often do we ‘check in’ with our bodies? • What do we do when we feel something unexpected in our bodies?

• Can we use a cognitive neuroscience approach to tease test these explanations?

Outline • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

The Interoceptive Self

Craig, Nature Reviews Neuroscience 2009

Finding the “I” in Insula

Interoceptive Pathways • C‐fiber entering via dorsal horn into  lateral spino‐thalamic tract • Ascending via midbrain homeostatic  control regions • Relay in ventromedial thalamus • Enter Posterior Insula in sensory‐ specific, topographic organization Craig, A.D. 2002. Nat reviews, 655 (3)

In Search of the Experiential Self

Two Selves: Design Attention to trait words: 

Experiential

Narrative

Experiential

Narrative

• e.g., Nervous, Energetic, Cowardly, Powerful, Indecisive

Attentional Training: • Mindfulness group (n = 20) & waitlisted controls (n = 16)

Farb et al., Social, Cognitive  & Affective Neuroscience (2007)

Narrative vs. Baseline

DMPFC

Collapsing across Untrained & Mindfulness Participants

Experiential Focus

Mindfulness

VMPFC (% Signal Change)

Untrained 0 ‐0.2 ‐0.4 ‐0.6 ‐0.8 ‐1 ‐1.2 Untrained

Mindfulness

R. Insula (% Signal Change)

Experiential Focus in the Body 1 0.8 0.6 0.4 0.2 0 ‐0.2 ‐0.4 Untrained

Mindfulness

Taking the High Road

Exteroceptive Attention

Dorsal  Prefrontal Cortex Inferior  Parietal

vs.

Interoceptive Attention

Insula Posterior Cingulate

Farb et al., Cerebral Cortex (2012)

Attention Activates the Network

Craig, 2005 Farb et al., Cerebral Cortex (2012)

Attention Improves The Fidelity of Interoceptive Representation

Farb et al., Cerebral Cortex (2012)

IA Score (% Signal)

Training Brings Interoception Forward

Posterior    <‐‐‐‐‐‐>   Anterior

Farb et al., Social Cognitive & Affective Neuroscience (2013)

Trait-like Changes in Connectivity

Farb et al., Social Cognitive & Affective Neuroscience (2013)

Training and Structural Changes

Training Reduces Pathways for Evaluation

Farb et al., Soc Cog Affect Neurosci (2007)

But, meditators do not seem to be more accurate detectors…

Khalsa et al. (2008), Parkin et al. (2013)

• Plus, recall that posterior insula shows higher activation and better tracking with interoceptive attention, but this does not change with training

So What Does the Science Show? • Not much evidence for a change in capacity • However, there is a change in “connectivity”, i.e. how bodily information is integrated • How does integration change regulatory habits?

Outline • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

A Predictive Coding Model Prediction Error

Prior States

Simulation

Sensation Sensation Intensity

Regulatory Motivation

Example 1: Too Much Sensation

Prediction Error

Prior States

Simulation

Sensation Sensation Intensity

Example 2: Too Little Sensation

Prediction Error

Sensation

Simulation Sensation Intensity

Prior States

Example 3: Mindfulness

Prediction  Error

Prior States

Simulation Sensation Intensity

Sensation

Arousal

Sometimes, no medicine is the best medicine

Stressor Time

Outline • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

Couldn’t this just be about relaxation?

• What if similar practices mask distinct therapeutic mechanisms? • Dimensions of efficacy may be as important as dimensions of vulnerability…

(Detective comics #0, 2012)

(Detective comics #0, 2012)

Research question • H0:

• H1:

=

VS

Mindfulness‐Based Stress  Reduction • • •

Manualized, 8 week, group intervention Daily homework including guided attention exercises Established efficacy for affective disorders in general population (Chiesa et al. 2009)

Mechanism? • Focus on body sensation • Accepting and exploring (“turning toward”) physical sensations in response to challenging experiences

Progressive Muscle Relaxation • • •

Manualized, 6 week, group intervention Daily homework including guided attention exercises Established efficacy for affective disorders in general population (Carlson et al. 2003)

Mechanism? • Focus on body sensation • Noticing and releasing (“letting go of”) physical sensations in response to challenging experiences

General Study Design • 22 participants with remitted depression (≥3 past episodes) • Randomized to Mindfulness (n=12) or Relaxation (n=10) intervention groups • fMRI task scans and clinical assessment before and after intervention

Symptom Measures • Mood Symptoms – Hamilton Rating Scale for Depression – Beck Depression Inventory – Beck Anxiety Inventory

• Dysphoric Cognition – Dysphoric Attitudes Scale – Depressive Symptoms Checklist

• Adaptive Cognition – Action and Acceptance Questionnaire (Revised)

Symptoms all  improve with  interventions,  but no  interaction  with group

Effects of Training: Acceptance • Both groups improved in acceptance of negative emotion (F1,20 = 41.6, p < .001, η2 = .68)

• Mindfulness group improved significantly more (F1,20 = 4.6, p < .05, η2 = .19)

Experimental Paradigm: Resistance to Emotional Distraction • Task: indoor or outdoor? • Try to ignore faces • 2 sec / picture • Counterbalanced: – Male vs. Female – Neutral vs. Sad – Indoor vs. outdoor

Accuracy

Accuracy Cost

Face Valence

Reaction Time (ms)

Sad Faces Are Distracting

Face Valence

Improvements in Resisting  Distraction (Accuracy Spared)

Effects of Training: Task • Both groups improved in resisting distraction (F1,20 = 13.1, p < .005, η2 = .40)

• Mindfulness group improved marginally more (F1,20 = 3.1, p = .08, η2 = .14)

Are the two groups doing the same thing? • Both groups improve on task • Both groups improve on acceptance • Moving beyond subjective report may help to distinguish between therapeutic mechanisms • Cognitive neuroscience may be useful

Review: The Interoceptive Pathway

Craig, 2005

Farb et al., Cerebral Cortex (2013)

Neural Effects of Task • Omnibus F-Test of Time (Pre vs. Post) x Group (Relaxation vs. Mindfulness) on Face Reactivity z = 8

Greater Insula Connectivity, Greater Accuracy • Omnibus F-Test of Time x Group on Insula Connectivity

Anterior Cingulate rRelaxation = ‐.06 rMindfulness = .55

Reductions in Sad Face Costs (Accuracy)

Acceptance: A Leap of Faith? R2 = .28

• It’s darkest before the light when learning to accept negative emotion…

Change in Acceptance (AAQ‐R) Relaxation

Mindfulness

Making Mindfulness Concrete • Not all contemplative practices are the same • What is needed from a regulatory point of view? • Is it the ability to let go of persistently aversive visceral tone? • Or is it the ability to engage constructively with challenging thoughts and feelings?

Refining the model • Multilevel modeling for fMRI • fMRI_data ~ time * group * face + (1|subject)

Something old…

Something new?

• Can now include things like acceptance scores

Summary • Why study interoception? • Interoception in the brain • Changing predictions • More than just relaxation?

Acknowledgments Collaborators

Funders

University of Toronto • Adam Anderson • Wil Cunningham • Eve DeRosa • Dan Lee • Lily Riggs • Zainab Fatima

• •

Centre for Addiction & Mental Health  UofT Clinical Psych • Zindel Segal • Katherine Gardhouse • Julie Irving • Richard Bloch • Greg Williams

• • • •

Canadian Institute of Health Research (CIHR) National Science and Engineering Research Council (NSERC) Ontario Mental Health Foundation Women of Baycrest 1440 Foundation Mind and Life Foundation And thank you for your attention!