Wednesday, March 25, 2015

Are we suffering from “McMindfulness”?

Mindfulness is sexy right now. If you’re even remotely connected to the worlds of psychology, health, fitness, sports, or business, you’re probably being bombarded with messages encouraging you to be more mindful (just take a look at your Twitter feed). On as personal level, I’m pretty happy about this (although not without some significant caveats, hence this article) – when I made the somewhat-unconventional choice of joining a neuroscience lab to study the neural mechanisms underlying mindfulness training 4 years ago for my PhD research, I faced some pushback from a few of my colleagues – wasn't I concerned about being taken seriously as a physician-scientist? Was mindfulness really scientifically and medically relevant, or just fringe pseudo-science? My argument was largely that I was interested in studying the effects of chronic stress and stress reduction on the human brain, and mindfulness-based stress reduction was (and is) a great paradigm for exactly that. Few people will argue with you over whether or not stress is physiologically relevant to health. I’ll still fall back on this strategy (and my interests still do revolve around stress-brain-health pathways), but these days, it’s increasingly trendy to be into mindfulness. There’s a much better understanding that mindfulness entails more than stress-reduction, and its benefits (and neural effects) extend well beyond that scope (e.g. attention, acceptance, non-judgement, affect regulation).

I could talk for a long time about the exciting things going on in health neuroscience re: mindfulness – it rewires brain circuitry involved in attention, emotional processing, executive function, and default mode; it changes the thickness of your cortex and volume of subcortical structures; and we have initial evidence that these brain changes mediate (or are mediated by) endocrine and immune function. This is legitimately cool and highly relevant stuff, potentially with significant implications down the line for treating a variety of mental and somatic pathologies. But what I want to talk about now are some ramifications of the EXPLOSION of media attention to mindfulness in the past year, and things for smart people to keep in mind.

First, mindfulness is now being applied to everything under the sun - a quick perusal of the media would lead you to believe that it's a panacea for anything and everything. As often happens when a complex-ish thing - particularly one that potentially has a lot of benefits - takes off (see: every popular diet ever), we start to look for shortcuts. After all, mindfulness is DIFFICULT. And it takes TIME.  Companies are running crash courses in mindfulness for their employees. We have mindful eating programs for weight loss. You can be mindful on your smartphone in 10 minutes a day. This is where we start to hear the term “McMindfulness” whispered within circles of researchers or experienced practitioners. And yes, while there may be a little bit of snobbery at play there (my meditation is bigger and better than yours), I think the analogy is very apt.

I want to make it clear that I am not against any of these “McMindfulness”-type programs – I think they really can be beneficial (we have studies that show that, too – the attention training aspect helps you at work, more mindful individuals tend to overeat less, etc), and any mindfulness is better than no mindfulness in our increasingly mind-less plugged-in society. We just need to keep in mind, first, the dose-response effect. The concern here is one of expectations – it’s hard to do this type of meditation training for a reason. Like anything else at life, you need to work hard at it to see the major benefits that are reported in the studies, many of which (at least on the neuroscience side) are conducted in experienced mindfulness practitioners with many, many hours of training. Additionally, we know that the specific benefits you get from mindfulness training depend upon one's hours of experience (this is also reflected in the time course of neural changes we see). In novice meditators, practicing mindfulness is still incredibly effortful – you need to go through this effortful struggle for a while (during which time the neural circuitry underlying focused attention is engaged heavily) before it becomes automatic, allowing you to achieve the effortless open monitoring ability you're probably seeking. Many people report huge psychological benefits from regular mindfulness practice, so maybe these mindfulness-lite programs tailored to specific outcomes are a great gateway to more structured, committed practice – that would be great, and time will tell.

The second thing I want you to keep in mind is the quality of the training you’re engaging in. If listening to your 10 minute daily mindfulness script on your phone is what you can do, please, please keep doing it. It is helping something; your amygdala just might not be shrinking quite yet. Similar to my pet peeves about “you’re not a real runner unless you’ve done a marathon” or “you’re not a real triathlete until you’ve done an Ironman” – misguided, frustrating attitudes that I think push people into things before they’re ready, or just for the purpose of checking off a box – you don’t need to do a billion minutes per week of body-scan meditation while sitting in the lotus position in your closet to use or benefit from mindfulness practice. Your 2 head-clearing mindful breaths to hit the re-set button at various points throughout the day, or the breath-focused movement practice that’s already part of your life (yoga, swimming, running, fill in the blank) is just fine. But if you’re doing your 10 minutes on your iphone while also checking Twitter and walking into a fountain, you’re shooting yourself in the foot. It’s like most diets – everyone went paleo/gluten-free/whatever and we saw lots of success stories initially because it was impossible for them to eat crap. Then, we had companies make paleo-cookies, cakes, and bars and now everyone can eat crap again while still on their magic diet. Same will apply to brain training – no shortcuts, quality is key.

Let’s end with some of the things that mindfulness will not do:

(1) Cure your cancer/autoimmune disease/HIV, without appropriate adjuvant medical therapy. Might it have beneficial effects on your immune system and mental health when added to traditional medical treatment? Absolutely, and there are peer-reviewed studies showing this. Am I going to try to mindfulness-away my deadly disease, though? Absolutely not.

(2) Make your business instantly successful.

(3) Make you crap glitter.

My advice? Take the long game. Like anything else that’s worth doing, it requires consistency and time. Stay away from the frenzied hype, and certainly don’t send anyone on the internet $1299 for a life-altering mindfulness potion. Find what works for you; as I've said before, you don’t have to necessarily sit in the corner and meditate to practice mindfulness. Eventually, the rewards will come – and when they do, let me know, because I’d like to scan your brain.

Sunday, March 22, 2015

SOAS Racing Team Gear & Discount Code!

This face is because I got a nice big box of SOAS Racing team happy to be a part of this amazing team of ladies this year! And for cycling and tri shorts that have gotten me through 11 hour trainer rides with zero chafing, which is a miracle if there ever was one. Also, sports bras with pockets. You can tell that women run this company. They also do an amazing job supporting a variety of female athletes, including ultra-ironwomen, off-road Xterra gals, super swimmers, and marathoners.

Friday, March 13, 2015

Swim Form: Part 1

Above-water video shot at the end of mastér's practice this week, swimming an easy, smooth ~1:40/100yd pace.

Comments welcome! For my part, I think I'm seeing my thoracic mobility limitations show up in my shoulder motion, head could come down more, but body position is much improved...what do you think?

Underwater will be the interesting video - on tap for next week...

(switch to HD for clearest view)

Monday, March 9, 2015

The Case Against Music, TV, and Netflix While Training

Yeah, I said it.

I don't wear headphones. I don't put Netflix on while biking in my living room. I hate that blank TV screen right at eye-level on the treadmill.

And I'm someone who has swum in a pool for 4 hours. I sit on the trainer for 2-4 hours at a time regularly (and once, 11 hours, but that's another story). I've done 10-15 mile runs on the treadmill this winter thanks to our persistent negative temperatures and onslaught of ice. And God bless me, I have aquajogged by myself for 2 hours, in a narrow pool lane where you have to turn around every 8 feet.

So why voluntarily do all this without external entertainment? Do I really enjoy self-flagellation that much? (some sarcastic friends might say "yeah, maybe", but that's not the answer this time). Did I do it all so that I could write a blog post about the superiority complex I've developed from being headphones-less? (also no. I don't have a problem with your entertainment - you do you. But here's why you might want to mix it up occasionally.)

The primary reason is that it's mental training. Everyone knows how to physically prepare for competition...some maybe better than others, but particularly at the top, everyone's in great shape come race day. More and more, what separates 1st from 5th isn't that extra tempo run you did, it's how you held up psychologically when the race pain hit, particularly in endurance events.

(1) Most likely, you get to race day, and you're not going to have that distraction. I can pretty much guarantee you won't have Netflix on the course, and many races don't allow headphones either (and even if they're allowed, doesn't it detract from your race experience??)

(2) Sure, some studies have shown that listening to certain types of music increases performance. So yeah, ok, you won't have it in your race - but aren't you still reaping the performance adaptations you got from using it to push yourself harder in practice? Interesting question. I honestly don't know. From a purely physiological standpoint, yeah, sure; but you have to wonder how much whatever you're gaining there is counterbalanced by the opportunity to build psychological resilience that you may have sacrificed. There's true value in learning to push and to have it be entirely intrinsically motivated. No one can take that intrinsic ability away from you on race day. They can, however, remove the band on the sidelines and your personal cheerleaders. You want to be able to cope with that.

(3) This is one of the top 2 best ways to learn to be comfortable inside your head. The other is to meditate. Which also has value, but that's a topic for another time. Most of us are really bad at being inside our own heads. A recent-ish study showed that people would rather administer electric shocks to themselves than be alone with their thoughts. The longer your race, the longer the amount of time you're going to be inside your head. That time can be spent in a mental battle, or in a calm but alert, present-centered state conducive to performance. When people talk about flow, this is often what they mean. It's a great feeling.

Now, I'm not saying you need to train in silence, staring at a blank wall (and there's certainly additional value in learning to deal with unanticipated distractors, too). But learn to stay engaged, to stay with your body. Actually experience what it feels like to hurt during a hard interval, to go up a steep hill. Learn what your heart thudding sounds like, pay attention to your breathing. Begin to associate these physical sensations with different effort levels...learn where you break down, physically and mentally, and see how you can use your mind to push that point out. Learn where your mind starts to fight you, and see how you deal with it.

In the past year, I got into long distance open water swimming. 4-5 hours of nothing but murky water to see and your bubbles & breathing to listen to is a lot of intra-head time - part of what prompted this post...

Friday, March 6, 2015

TNF alpha, your brain, inflammatory diseases, and mindfulness: Thoughts provoked by the new study in Pain

A recent study in the journal Pain (found here - if you don't have access & want full text, shoot me a message) provokes some  interesting questions on the relationship between the brain and inflammation, and perhaps what we can do about these things....

In sum, here's what the authors show:

(1) Thinning in somatosensory & motor cortex is associated with pain reduction,
(2) Thinning in insular cortex (a brain area associated with interoception, empathy, emotion regulation, etc) is associated with fatigue reduction 

....In a subject sample of ankylosing spondylitis patients (an autoimmune inflammatory disease) on TNF inhibitors (which block tumor necrosis factor alpha, an inflammatory cytokine with several roles in the body, including inducing inflammatory processes and regulating tumorigenesis - hence the name).

From Wu et al, 2015
This raises all sorts of questions about TNF alpha pathway effects on the brain. First, cortical thinning has generally been characterized as a bad thing (and associated with excess inflammation, not reduction of inflammation), but here, we see positive correlates with self-reported pain and fatigue reduction, which is interesting in and of itself. Keep in mind that this is a patient population, and the first thing I'd like to know is how cortical thickness in these regions compares to healthy control subjects at baseline - perhaps, due to chronic pain and fatigue, we already see thickening of somatosensory and insular cortices in AS patients (entirely plausible since processing these signals recruits these brain areas). So perhaps controlling disease symptoms with anti-TNF therapy is just bringing these people down to a more normal baseline in terms of brain anatomy, alongside the normalization of inflammatory markers (e.g. C-reactive protein, sed rate) that usually occurs with successful anti-TNF treatment. 

But the most interesting thoughts occur when you try and relate these findings to what we know about how we can alter (a) cortical thickness in these regions and (b) the immune system with cognitive training and stress reduction techniques such as mindfulness. 

In separate studies, mindfulness has been shown to (1) reduce the subjective experience of pain (see Zeidan et al, 2012 for a review - including how insula, prefrontal, and somatosensory cortex activity is modulated by meditation during pain), (2) increase cortical thickness in insula and somatosensory cortices, among other areas (Lazar 2005, Grant 2010), and (3) decrease markers of inflammation (including IL-6, TNF, and cortisol). The Grant et al. study even ties (1) and (2) together, associating decreased pain sensitivity in Zen meditators with thicker anterior insula, cingulate, and somatosensory cortex. So...back to the current study, anti-inflammatory treated patients show less pain/fatigue in conjunction with cortical thinning in insula and somatosensory cortices. But if we think we might get similar immunomodulation with mindfulness as we would on an anti-inflammatory drug (disclaimer: not advocating that anyone ditch their necessary meds to just meditate), why are the brain effects the opposite? 

Intriguing question - as I hinted at before, maybe the effects are different when you've already got aberrant neural circuitry and brain structure from chronic pain/inflammation. After all, your body is pretty good at self-correcting when given the tools to do so.

But what would happen if we combined mindfulness meditation and an anti-TNF in someone with an inflammatory condition? Based on the (self-report, non-controlled study) data out there, good things, in terms of symptom improvement. But again, opposite effects in terms of increased/decreased cortical thickness being beneficial are reported separately - which has to make you wonder, if I meditate while on an anti-TNF, am I shooting myself in the foot because the brain effects of one pain-reduction technique counteract the brain effects of another? I'm still guessing no - .we know that normal inflammatory pathways are dysregulated and brain structure is slightly different to begin with under conditions of chronic inflammation, so most likely the underlying neural mechanisms would work differently too. I'd love to see someone run a brain structure/anti-TNF/MBSR triple-arm randomized controlled trial of this. NIH, any takers? 

In sum, this is a perfect example of the simultaneously awesome and maddening thing about cognitive neuroscience - we constantly bump up against things we still don't know. For now, I suppose I'll keep mindfully swimming along and trust that any changes going on in my brain are in my best interest. 

Tuesday, March 3, 2015

Writing & defending your dissertation, by the numbers

Ever wonder what happens in the last month of a PhD? Yes, I actually tallied all these things as I went along, on a blackboard in my office. Why? Who knows. Much more interesting metrics would've been my salivary cortisol, IL-6, and percent signal change in amygdala activation, but the NIH didn't give me money for here it is:

Words written: 28,168

Last-minute analyses run, "because wouldn't that be interesting?": 92

Doodle polls it took for my committee to agree to be in one place at one time for my defense: 2

Emails sent regarding defense scheduling: 21

Colleagues I called and asked "do you know things about graph theory?": 7

Colleagues who knew things about graph theory: 1

Number of dark chocolate bars utilized as coping mechanism: 18, plus one of those 1 lb solid bricks, which I ate in 3 days

Number of times I googled "dlPFC connectivity" and felt dumb when the first citation that came up was a J Neuro paper authored 2 (fool me once...yeah)

Number of revise & resubmits for unrelated manuscripts that conveniently also landed on my desk during this time frame: 2

Cups of tea while writing: 84 (thank you, Gryphon's tea shop)

# of times I watched this video of a hamster in a competitive hot dog eating contest: 8

# of times I cried in my boss at the Y's office: 2

# of times Pandora asked me if I was still listening: this one I lost track of. But I highly recommend creating the station "Hip Hop BBQ". What, you don't write well to the tune of "Back That Azz Up?"?

Things I said or typed to people while under varying stages of contemplating life:
"if I was going to be an animal, I'd consider being a moose"
"the blizzard better not delay my chocolate delivery."
"basically I asked everyone I knew if they knew things about graph theory"
"I just realized I have chocolate all over my face."
"I'm just going to turn in this colorful flow chart held together by scotch tape."
"I want to be that alpaca."

Sustained swim-bike-run-lift training hours per week: 15ish, because priorities, and also coping

The acknowledgements section I really wanted to write:

David Smith for chocolate & for being willing to quit and start a goat farm with me if need be, Rebecca Kriepke for sending me that video of the hamster and driving 350 miles on a spare tire to get here, Jenny Dorand for general academia commiseration, Joe Stabile for dragging me out to look at some nice art and reminding me I am a smart person, my little brother for offering to beat up people for me, DJ for all the Irish bacon I ate in addition to the chocolate, my swim coach for letting me unload on him at 5am, and my Tuesday evening cycling class for being only slightly miffed that I was slightly late yesterday because I was defending my dissertation.