A beautiful example of how mindfulness can change the mind -- Book excerpt from Mindsight
I’m currently reading three books in parallel, Mindsight, Buddha’s brain and The Buddha walks into a bar. All three books show how we can rewire our brain with practice although, from slightly different angles. That’s what makes it so interesting to read them at the same time. Yesterday I read a few chapters of Mindsight in which the author tells an anecdote about how one of his patients was able to overcome his aggression and depression through mindfulness meditation. It is the best accounts of the power of mindfulness I’ve read so far so I want to share it. You will learn how through practice, we can switch to an observer perspective in our brains – more specifically, the prefrontal cortex – so that we don’t get swiped away by our emotions as easily as before.
What shapes the currents of our sea inside? When we hit rough waters, is there anything we can do to calm the storm? In this chapter I will explore how we can use focused, conscious attention first to sense, then to alter, the wild flow of energy and information that can plague our lives. This focused attention permits us to use awareness to create choice and change. This is the domain of the integration of consciousness. The term mood refers to the overall tone of our internal state. We express this emotional baseline through our affect, the external signals that reveal our feelings, and by way of our actions and reactions. Simply sitting with Jonathon in my office, I could begin to pick up his feelings of despair and depletion. As he readily admitted, his down mood also included tearfulness, irritability, difficulty sleeping, and decreased appetite. He also admitted that his feelings of hopelessness and despair were sometimes accompanied by suicidal thoughts, but I was able to determine that he had made no attempts and had no plans, at least at the moment, to hurt himself. In a psychiatric textbook this cluster of symptoms would point to a probable diagnosis of major depression, but as a clinician I wanted to keep an open mind about other potentially relevant issues. Jonathon’s family history included both drug addiction in an uncle on his mother’s side and manic-depressive illness (also known as bipolar disorder) in a grandfather on his father’s side. This made me cautious about a premature diagnosis of only depression. Because of the family history of drug abuse, Jonathon’s family had already been screening him regularly for drug use. The tests were consistently negative, and Jonathon himself asked, “Why should I take things that would make me more up and down? They just mess me up even more than I already am.” I was struck by his insight, and I believed him. The abrupt explosions that took him down the low road might signal the irritability that is a hallmark of major depression, especially in children. But they could also be a symptom of bipolar illness, which often runs in families and can emerge in childhood and adolescence. In its initial presentation, bipolarity can be indistinguishable from what is called “unipolar” depression, in which the mood disturbance moves in one direction only: toward down, depressed states. In bipolar disorder, however, these depressed states alternate with the “up” (or, more accurately, “activated”) state of mania. Adults and adolescents with mania can experience rapid thinking, an infuriating sense of self-importance and power, decreased need for sleep, increased appetite (for both food and sex), excessive spending, and irrational behaviors. Making the distinction between unipolar and bipolar mood disorders is crucial for proper treatment, so I often get a second opinion from a colleague regarding this diagnosis. In Jonathon’s case we also got a third. Both confirmed my concern that Jonathon’s mood disturbance might be emerging bipolar disorder. Described in brain terms, bipolar disorder is a condition characterized by severe “dysregulation,” meaning difficulty in maintaining equilibrium in the face of daily life. The sense one gets as a clinician is that there is a problem with the coordination and balance of the brain’s mood-regulating circuits. As you’ve seen in the first Minding the Brain section, our subcortical regions influence our emotional states, altering our moods, coloring our feelings, and shaping our motivations and behaviors. The prefrontal cortex, sitting atop the subcortical areas, regulates how we bring these emotional states into equilibrium. The regulatory circuits of the brain can malfunction for a number of reasons, some of them related to genetics or the constitutional (not learned) aspects of temperament. One current theory is that people with bipolar disorder may have a structural difference in the way their regulatory prefrontal circuits connect with the lower, emotion-creating and mood-shaping limbic areas. This anatomical difference, perhaps established by way of genetics, infection, or exposure to neurotoxins, may lead to the unbridled firing of lower limbic areas. When revved up, these subcortical circuits shape the rapid thinking, heightened appetites, and overall driven quality of the manic state. While mania may appear attractive and pleasurable to an observer, and the person experiencing it may indeed enjoy some periods of euphoria, he is also likely to have periods of agitation, irritability, and restlessness that feel out of control and desperate. And when the dysfunction in the subcortical circuits goes in the opposite direction, thought slows down, mood becomes depressed, the vital functions of sleep and appetite are disturbed, and the person may withdraw almost entirely from social contact. When impaired prefrontal regulation results in failure to bring these two extremes of the emotional continuum into equilibrium, both the manic and the depressive states can be experienced as extremely distressing. The standard treatment for bipolar disorder is medication, which has clear benefits for many patients. However, the side effects of the medications used for bipolar disorder—called “mood-stabilizing agents”—are much more significant than those of the antidepressants used for unipolar depression. These risks present a serious set of considerations for child psychiatrists, making us hesitant to rush to the more long-term medications called for by a bipolar diagnosis. Furthermore, if someone with undiagnosed bipolar disorder presents first with depression and is given an antidepressant medication, that clinical intervention can actually trigger the onset of manic episodes. It may also make the individual prone to an intense form of the disorder with rapid cycling between mania and depression and sometimes the emergence of a “mixed state” of both extremes at the same time. Taking all of these concerns into account, I asked Jonathon’s parents to come in with him and we discussed the issues openly, including the role of medications in the treatment of serious psychiatric disturbances. Many clinicians focus primarily on the concept of “chemical imbalance,” and how various neurotransmitters, such as serotonin or noradrenaline, take you “up” or “down” as their levels rise or fall. However, I actually find that a deeper discussion of emotional regulation in the brain gives patients a larger view of the problem—and what we can do about it. I introduced Jonathon and his family to the hand model of the brain and described the prefrontal region’s crucial role. We didn’t know why these circuits were not working optimally in Jonathon, I told them. We just knew that his severe mental storms likely correlated with such prefrontal dysfunction. “What can be done to help those circuits work well?” Jonathon’s mother asked astutely. One theory about depression, I said, is that the brain’s ability to change in response to experience is shut down. (In terms of our river of integration we can see this as rigidity.) Antidepressants such as the familiar serotonin medications, the selective serotonin reuptake inhibitors, or SSRIs, and mood stabilizers such as lithium seem to help reignite neuroplasticity. They help change the brain both by altering the way neurotransmitters function and by enhancing the brain’s ability to learn from experience—as in therapy. Medications and psychotherapy combined often make an excellent treatment strategy for major mood disorders. Even psychotherapy alone has been shown to change the way the brain functions. In fact, I told them, some recent findings have revealed that chronically relapsing episodes of depression, like the ones that Jonathon might be experiencing, may actually be prevented by a form of therapy based on an ancient technique called “mindfulness.” A MINDFUL APPROACH TO CHANGING THE MIND At the time Jonathon came to me, I was in the midst of writing a book that reviewed the existing neuroscience research on mindfulness. Being mindful, having mindful awareness, is often defined as a way of intentionally paying attention to the present moment without being swept up by judgments. Practiced in the East and the West, in ancient times and in modern societies, mindful awareness techniques help people move toward well-being by training the mind to focus on moment-to-moment experience. People sometimes hear the word mindfulness and think “religion.” But the reality is that focusing our attention in this way is a biological process that promotes health—a form of brain hygiene— not a religion. Various religions may encourage this health- promoting practice, but learning the skill of mindful awareness is simply a way of cultivating what we have defined as the integration of consciousness. As I’d told Jonathon and his parents, research had clearly demonstrated that mindfulness-based therapy could help prevent relapse in people with chronic depression. I had found no comparable published research on using mindfulness for those with bipolar disorder. However, I had reason to be cautiously optimistic. Controlled studies had shown that mindfulness could be a potent part of successful treatment for many conditions, including anxiety, drug addiction (both treatment and relapse prevention), and borderline personality disorder, whose hallmark is chronic dysregulation. In fact, one of the first studies to reveal that psychotherapy could actually change the brain—a study of obsessive-compulsive disorder done at UCLA—used mindfulness as a component of the treatment. In addition, in our own pilot study at the Mindful Awareness Research Center, also at UCLA, we found that mindfulness training was highly effective for adults and teens who had trouble paying attention at work or school. Would Jonathon’s mood disorder respond to such an intervention? The family’s cooperative stance, coupled with their concerns about medication’s side effects, made me think it was worth trying. I sought Jonathon’s and his parents’ informed consent, keeping in mind his recent suicidal thoughts and the serious risks of untreated depression, whether unipolar or bipolar. We elected to do a trial of mindfulness training, agreeing that if it did not begin to work within a few weeks’ time to reduce his suffering and stabilize his mood, we would turn to the next phase of treatment, which would probably include medication. FOCUSING ATTENTION, CHANGING THE BRAIN As I’d explained to Jonathon and his parents, the brain changes physically in response to experience, and new mental skills can be acquired with intentional effort, with focused awareness and concentration. Experience activates neural firing, which in turn leads to the production of proteins that enable new connections to be made among neurons, in the process called neuroplasticity. Neuroplasticity is possible throughout the lifespan, not just in childhood. Besides focused attention, other factors that enhance neuroplasticity include aerobic exercise, novelty, and emotional arousal. Aerobic exercise seems to benefit not only our cardiovascular and musculoskeletal systems, but our nervous system as well. We learn more effectively when we are physically active. Novelty, or exposing ourselves to new ideas and experiences, promotes the growth of new connections among existing neurons and seems to stimulate the growth of myelin, the fatty sheath that speeds nerve transmissions. Novelty can even stimulate the growth of new neurons—a finding that took a long time to win acceptance in the scientific community. Where we focus our attention channels our cognitive resources, directly activating neural firing in associated areas of the brain. For example, research has also shown that in animals rewarded for noticing sounds, the brain’s auditory centers expanded greatly, while in those rewarded for attending to sights, the visual areas grew. The implication is that neuroplasticity is activated by attention itself, not only by sensory input. Emotional arousal may also be a factor in the activation that occurs when animals are rewarded for noticing sounds or sights, and the same factor may be involved in activating neuroplasticity when we participate in an activity that is important or meaningful to us. But when we are not engaged emotionally, the experience is less “memorable” and the structure of the brain is less likely to change. Other evidence of brain reshaping as a result of focusing comes from brain scans of violinists. The scans show dramatic growth and expansion in regions of the cortex that represent the left hand, which must finger the strings precisely, often at very high speed. Other studies have shown that the hippocampus, which is vital for spatial memory, is enlarged in taxi drivers. A MINDFUL BRAIN The ability to focus the mind is what I wanted Jonathon to acquire through mindfulness training. But what exactly does mindful awareness training stimulate? And why would mindfulness, as research has shown, help with such a wide variety of diffculties, from mood to attention, addiction to personality disorders? Finally, could mindfulness training help Jonathon with his serious problem with dysregulation? In summary, here is what modern clinical research, 2,500 years of contemplative practice, recent neuroscience investigations, and my own experience all suggest: Mindfulness is a form of mental activity that trains the mind to become aware of awareness itself and to pay attention to one’s own intention. As researchers have defined it, mindfulness requires paying attention to the present moment from a stance that is nonjudgmental and nonreactive. It teaches self- observation; practitioners are able to describe with words the internal seascape of the mind. At the heart of this process, I believe, is a form of internal “tuning in” to oneself that enables people to become “their own best friend.” And just as our attunement to our children promotes a healthy, secure attachment, tuning in to the self also promotes a foundation for resilience and flexibility. The way that mindfulness seemed to overlap with the processes of secure attachment and with the key functions of the prefrontal region that I discussed in part 1 made a powerful impression on me. It seemed that the act of attunement—internal in mindfulness, or interpersonal in attachment—might lead to the healthy growth of middle prefrontal fibers. Shortly after I had this realization, I read a report of ongoing research that showed that the middle prefrontal regions were indeed thicker in mindfulness practitioners. So this is the hypothesis that led me to offer mindfulness training to Jonathon: that the practice would help the parts of his brain that regulate mood to grow and strengthen, stabilizing his mind and enabling him to achieve emotional equilibrium and resilience. It is not that I believed he had a history of an insecure attachment, but rather that mindful awareness might directly stimulate the growth of the cluster of neurons called the resonance circuits, which I discussed in the third Minding the Brain segment. These neural circuits, which include the middle prefrontal areas, enable us to resonate with others and to regulate ourselves. It is here that we can see the connection between attunement and regulation: internal and interpersonal forms of attunement each lead to the growth of the regulatory circuits of the brain. When we have attunement—either interpersonally or internally—we become more balanced and regulated. Helping Jonathon achieve this form of internal attunement with mindfulness practice was our goal. This would take focus, time, and careful monitoring to be sure his underlying dysregulation did not worsen or endanger him or others. THE ADOLESCENT BRAIN AND THE PREFRONTAL CORTEX Jonathon was eager to find a way to ease his suffering. Normal adolescence is hard enough: negotiating the changes in one’s body, the emerging and sometimes overwhelming feelings of sexuality; changes in self-identity and relationships; academic demands; uncertainties about the future; and the stresses in family life in anticipation of leaving home. The adolescent brain itself is in flux. The prefrontal regions, including the middle areas, do not mature fully until well into the mid-twenties. Not only is the brain exposed to dramatic hormonal changes, but it undergoes genetically programmed “neural pruning sprees”—the removal of neural connections to hone down the various circuits, preserving those that are used and discarding the unused, so that the brain becomes more specialized and efficient. The normal remodeling of the brain is intensified by stress, and it can unmask or create problems during this vulnerable period. This makes the nine middle prefrontal functions—from fear modulation to empathy and moral awareness —somewhat unpredictable, so that emotional self-regulation can be challenging for any teenager. Jonathon’s mood dysregulation went well beyond normal adolescent turmoil. Most adolescents do not get to the point of suicidal thinking, or to a place where their unpredictable moods create significant chaos in their lives. These eruptive and painful periods had created self-doubt in Jonathon. He felt he could no longer depend on his own mind, that his mind was betraying him. It seemed to me that becoming “his own best friend” was exactly what Jonathon needed. If we could help him grow the integrative fibers of his middle prefrontal cortex, he might be able to achieve more of the FACES flow I discussed in chapter 4, so that he could find a more harmonious path between the banks of rigidity and chaos. Integration of consciousness might help stabilize his mind. I explained all of this to Jonathon, and reminded him that with regular exercise, a good diet, and sleep, he could set the foundation for promoting neuroplasticity. Jonathon and I made a verbal agreement that he would follow this “prescription” for health. It’s amazing how often these basics of brain health are ignored. Exercise is an underrated treatment—and now we know that aerobics not only releases the endorphins that can combat a down mood but also promotes the growth of the brain. Eating regularly and well, balancing the various food groups, and avoiding excessive sugar and stimulants can help to reduce mood swings. And sleep, though in short supply and difficult at times to initiate for Jonathon, is a healer that can be approached in a systematic way. Sleep hygiene includes setting up a calming routine before bed. Minimizing caffeine or other stimulants once evening approaches, if not before; shutting of digital stimulation an hour or two before sleeping; and quiet activities such as taking a bath, listening to soothing music, or reading a book can all help the body as well as the mind to settle. With these brain hygiene basics in our contract, we could move into our specific efforts to promote integration. Now it was time to use the focus of Jonathon’s mind to change his brain. We began a series of skill-training sessions to help him develop mindful awareness. The idea was that the techniques I taught him would create a temporary state of brain activation each time they were repeated. Induced regularly, these temporary states would become long-term, enduring traits. With practice, a mindful state becomes a mindful trait. THE WHEEL OF AWARENESS: RIM, SPOKES, AND HUB This is the basic diagram I drew for Jonathon to help him visualize how we can focus our attention. A picture in my own mind helped me make sense of the techniques I’m about to describe to you. I call it the mind’s “wheel of awareness.” I drew it for Jonathon as we started our work together. Picture a bicycle wheel, with the hub at the center, and spokes radiating to the outer rim. The rim represents anything we can pay attention to, such as our thoughts and feelings, or our perceptions of the outside world, or the sensations from the body. The hub represents the inner place of the mind from which we become aware. The spokes represent how we direct our attention to a particular part of the rim. Our awareness resides in the hub and we focus on the various objects of our attention as points on the rim. The hub can be seen as a visual metaphor for our prefrontal cortex. To experience this directly, let’s turn to the first exercise I offered to Jonathon. A MINDFUL AWARENESS EXERCISE: FOCUSING ON THE BREATH Over thousands of years of human history, from East to West, virtually all cultures have developed some form of practice that harnesses the power of mindfulness to cultivate well-being. These include body-and energy-centered practices such as yoga, tai chi, and qigong; devotional practices such as centering prayer or chanting; and various forms of sitting and walking meditation that were first introduced into the West by Buddhist practitioners. I elected to teach Jonathon a practice called “insight meditation,” both because I had learned it myself from experienced teachers and because it had the most research backing up its potential to help develop the brain. Other techniques might have been just as reasonable a starting point, but I felt most comfortable with this one. Here is a transcript of the meditation exercise that I teach my patients and students. Feel free to read through this, and then try it out if you’re in a comfortable place that will allow you to dive into the sea inside. It’s helpful to be able to become aware of your own mind. That can be a very useful awareness to have. Yet not much happens in school or in our family life that lets us come to know ourselves. So we are going to spend a couple of minutes now doing just that. Let yourself get settled. It’s good to sit with your back straight if you can, feet planted flat on the floor, legs uncrossed. If you need to lie flat on the floor that’s okay, too. And with your eyes open at first, just try this. Try letting your attention go to the center of the room. And now just notice your attention as you let it go to the far wall. And now follow your attention as it comes back to the middle of the room and then bring it up close as if you were holding a book at reading distance. Notice how your attention can go to very different places. Now let your attention go inward. You might let your eyes close at this point. Get a sense inside yourself of your body in space where you’re sitting in the room. And now let yourself just become aware of the sounds around you. That sense of sound can fill your awareness. (Pause for some moments.) Let your awareness now find the breath wherever you feel it most prominently—whether it’s at the level of your nostrils, the air going in and out, or the level of your chest as it goes up and down, or the level of your abdomen going inward and outward. Perhaps you’ll even just notice your whole body breathing. Wherever it comes naturally, just let your awareness ride the wave of your in-breath, and then your out-breath. (Pause.) When you come to notice, as often happens, that your mind may have wandered and become lost in a thought or a memory, a feeling, a worry, when you notice that, just take note of it and gently, lovingly, return your awareness toward the breath—wherever you feel it—and follow that wave of the in-breath, and the out-breath. (Pause.) As you follow your breath, I’m going to tell you an ancient story that’s been passed through the generations. The mind is like the ocean. And deep in the ocean, beneath the surface, it’s calm and clear. And no matter what the surface conditions are like, whether it’s smooth or choppy or even a full-strength gale up there, deep in the ocean it’s tranquil and serene. From the depth of the ocean you can look toward the surface and simply notice the activity there, just as from the depth of the mind you can look upward toward the waves, the brain waves at the surface of your mind, all that activity of mind—the thoughts, feelings, sensations, and memories. Enjoy this opportunity to just observe those activities at the surface of your mind. At times it may be helpful to let your attention go back to the breath, and follow the breath to reground yourself in the tranquil place at the deepest depth of the mind. From this place it’s possible to become aware of the activities of the mind without being swept away by them, to discern that those are not the totality of who you are; that you are more than just your thoughts, more than your feelings. You can have those thoughts and feelings and also be able to just notice them with the wisdom that they are not your identity. They are simply one part of your mind’s experience. For some, naming the type of mental activity, like “feeling” or “thinking,” “remembering” or “worrying,” can help allow these activities of the mind to be noted as events that come and go. Let them gently float away and out of awareness. (Pause.) I’ll share one more image with you during this inward time. Perhaps you’ll find it helpful and want to use it as well. Picture your mind as a wheel of awareness. Imagine a bicycle wheel where there is an outer rim and spokes that connect that rim to an inner hub. In this mind’s wheel of awareness, anything that can come into our awareness is one of the infinite points on the rim. One sector of the rim might include what we become aware of through our five senses of touch, taste, smell, hearing, and sight, those senses that bring the outside world into our mind. Another sector of the rim is our inward sense of the body, the sensations in our limbs and our facial muscles, the feelings in the organs of our torso: our lungs, our heart, our intestines. All of the body brings its wisdom up into our mind, and this bodily sense, this sixth sense, if you will, is another of the elements to which we can bring our awareness. Other points on the rim are what the mind creates directly, such as thoughts and feelings, memories and perceptions, hopes and dreams. This segment of the rim of our mind is also available to our awareness. And this capacity to see the mind itself—our own mind as well as the minds of others—is what we might call our seventh sense. As we come to sense our connections with others, we perceive our relationships with the larger world, which perhaps constitutes yet another capacity, an eighth relational sense. Now notice that we have a choice about where we send our attention. We can choose which point on the rim to visit. We may choose to pay attention to one of the five senses, or perhaps the feeling in our belly, and send a spoke there. Or we may choose to pay attention to a memory, and send a spoke to that area of the rim where input from our seventh sense is located. All of these spokes emanate from the depth of our mind, which is the hub of the wheel of awareness. And as we focus on the breath, we will find that the hub grows more spacious. As the hub expands, we develop the capacity to be receptive to whatever arises from the rim. We can give ourselves over to the spaciousness, to the luminous quality of the hub. It can receive any aspect of our experience, just as it is. Without preconceived ideas or judgments, this mindful awareness, this receptive attention, brings us into a tranquil place where we can be aware of and know all elements of our experience. Like the calm depths of the sea inside, the hub of our wheel of awareness is a place of tranquillity, of safety, of openness and curiosity. It is from this safe and open place that we can explore the nature of the mind with equanimity, energy, and concentration. This hub of our mind is always available to us, right now. And it’s from this hub that we enter a compassionate state of connection to ourselves, and feel compassion for others. Let’s focus on our breath for a few more moments, together, opening the spacious hub of our minds to the beauty and wonder of what is. (Pause.) When you are ready you can take a more voluntary and perhaps deeper breath if you wish and get ready to gently let your eyes open, and we’ll continue our dialogue together. How was that? Some people have a tough time diving in; others feel at ease with the experience. If the breath doesn’t work for you after a few sessions, you may want to find another form of mindful focus. Yoga or tai chi or walking meditation might be a more comfortable place for you to begin. Just a few minutes a day of this or another basic mindful- awareness practice can make a big difference in people’s lives. A number of my patients have reported feeling less anxiety, a deeper sense of clarity, safety, and security, and an improved sense of well- being. I hoped Jonathon would respond the same way. Fortunately, Jonathon took to this exercise well and became committed to doing a mindfulness-of-the-breath meditation daily, initially for about five or ten minutes at a time. When his mind wandered from an awareness of his breath, he’d simply note this distraction and gently return his attention to his breathing. The renowned psychologist William James once said, “The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will… . An education which should improve this faculty would be the education par excellence.” Though James also said, “It is easier to define this ideal than to give practical directions for bringing it about,” we actually do know how to refocus a wandering attention again and again—to use mindfulness practice to educate the mind itself. I truly did feel like a teacher for Jonathon, offering him an education in his own mind developed from 2,500 years of contemplative practice. AWARENESS TRAINING AND STABILIZING THE MIND As a part of his school’s film club, Jonathon had been creating short documentaries exploring various parts of town with his parents’ camcorder. He brought one of these projects in to show me early in our work together, and I was impressed by the creative ways he used camera angles to capture the mood and textures of this city in which both of us had been born and raised. His eyes sparkled with pride when he saw how much I enjoyed his creation. I told Jonathon about the metaphor of a camera on a tripod that I introduced in chapter 2. The lens of this camera is our ability to perceive the mind. Without a tripod to keep the lens steady, the mind can jump around like an amateur movie made with a handheld camera. Jonathon got it immediately—the blurry, bumpy film was like the feeling of being lost in his mood swings. Jonathon also liked the image of the ocean in the meditation exercise. He could identify with being a cork bobbing up and down on the surface of an agitated sea. But whichever metaphor of the mind works for you—wheel-and-hub, camera, sea—the sense is the same. There is a place deep within us that is observant, objective, and open. This is the receptive hub of the mind, the tranquil depth of the mental sea. From this place Jonathon could use the power of reflective awareness to alter the way his brain functioned and ultimately to change the structure of his brain. Let’s look at this process using the three legs of the mindsight tripod: observation, objectivity, and openness. OBSERVATION Jonathon first needed simply to become aware of his awareness, to observe how he focused his attention. As he discovered when he tried to focus on his breath, he would get distracted repeatedly and become lost in his thoughts, feelings, and memories. This is not doing the meditation “wrong.” The point of the exercise is to notice these distractions—and then to refocus on the target (the breath), over and over again. Exercising attention is like developing a muscle: We bend our arm and then straighten it—flexing and relaxing our biceps, focusing and refocusing our attention when it wanders. This practice would not only develop Jonathon’s ability to be aware of his awareness, but it would strengthen his attention to his intention—in this case, to focus on the breath. This monitoring of awareness and intention is at the heart of all mindfulness practices, from yoga to insight meditation, whether the focus is on posture and movement, the breath, a candle flame, or any of the myriad other targets found in the world’s cultures. Bit by bit, Jonathon would build this mindfulness skill of “aim and sustain” and stabilize his mindsight lens. In addition to his mindfulness exercise, Jonathon agreed to keep a journal of his daily activities, noting his shifts in mood, his mindful practice (or not), and his aerobic exercise. This was another opportunity to develop his capacity to observe his internal and external experiences and to reflect on the workings of his mind. Recording his experience with mindfulness quickly revealed his lack of confidence in his mind. Nearly everyone who tries meditation discovers that thoughts and feelings keep interrupting our attempts at focus, even after years of practice. But intense feelings of frustration would flood Jonathon at such times, and he would write in his journal about how out of control this made him feel. He shared some entries with me where his self-disparagement bordered on not wanting to go on living. But there were glimmers of something else in the journal, as well: “My father told me to stop playing my music so loud and I blew up. He’s so mean and doesn’t know how to get of my back… . But tonight I could see my explosion at him like from a watchtower, sitting watching it fume, and it felt bad and I couldn’t stop it.” The next day, he said, he had calmed down, but he still felt that his mind had “betrayed” him again. “Only this time, I could see it instead of just being lost in it.” The observational distance that allows us to watch our own mental activity is an important first step toward regulating and stabilizing the mind. Jonathon was beginning to learn that he could “sit” in his prefrontal cortex and not get swept up by the brain waves crashing in on him from other neural regions. It was an important place to start. OBJECTIVITY If you’re new to awareness training or meditation, you may find it helpful to compare it to what happens when you learn to play a musical instrument. Initially you focus on the characteristics of the instrument—the strings, the keys, the mouthpiece. Then you practice basic skills such as playing scales or strumming chords, focusing on one note at a time. This intentional and repeated practice is building a new capacity—it actually strengthens the parts of the brain that are required for this new behavior. Awareness training is a skill-building practice in which the musical instrument is your mind. The aim-and-sustain skill developed during observation enables you to hold your attention steady, to stabilize the mind. The next step is to distinguish the quality of awareness from the object of attention. We began this phase of Jonathon’s awareness training with what is called a “body scan.” During this practice, Jonathon would lie down on the floor and focus his awareness on whatever body part I mentioned. We would systematically move from his toes to his nose, pausing for him to take in the sensations of each region. When his attention strayed, his job was simply to gently note the distraction, let it go, and refocus—just as he’d done with the breath. What this immersion in body sensation was doing was directing his attention to a new area on the rim of his wheel of awareness. Sitting at the hub of the wheel, he could focus on the various sensations from his body, locating areas of tension or relaxation, and noting mental distractions while moving at will within this sixth-sense sector of the rim. Next I taught Jonathon a walking meditation: twenty slow paces across the room with the focus of attention on the soles of his feet or lower legs. Same approach: When he noticed that his mind had pulled his attention away from the target, he simply refocused. These practices continued to build the aim-and-sustain function of observation, but they also were an entrée into objectivity: The focal point of attention changed with each practice, but the sensation of awareness remained the same. Awareness itself was becoming an expanded presence in his internal world. Here is an entry Jonathon shared with me from his journal around this time: “Amazing realization: I can feel this change—my thoughts and feelings come up, sometimes big, sometimes bad—but they used to feel like who I was and now they’re becoming more like an experience I’m having, not who I am, they don’t define who I am.” Another entry described an incident when he was upset with his brother. “I just got really mad … but then took myself outside for a walk. I was in the yard, and in the back of my head I could almost feel this split, something like a part of me that could see, and a part that could get lost in the feeling. It was really weird. I watched my breath, but I’m not sure that did much. Sometime later, I just seemed to calm down. It was as if I didn’t take my own feelings so seriously.” During his home practice Jonathon was alternating among breath-awareness, body-scan, and walking meditation. But now his initial sense of frustration returned in a new form. He reported one day that he would get a huge “headache,” a kind of “voice” that kept telling him what he ought to feel, what he should be doing, that he was doing his meditation all wrong, that he was no good. All of these judgments were activities of his mind, I said, and I reassured him that he was certainly not alone—many of us have a judging voice that critiques our progress. But the next step in his growth would require him to stop being a slave to that voice. I felt this was a challenge that Jonathon was now ready to confront. OPENNESS Observation had enabled Jonathon to focus on the nature of intention and attention, the driving forces of mental life. Objectivity permitted him to distinguish awareness from mental activity, to further free his identity from the storms of his mental sea. But now that stormy rim activity was creeping back into his hub, in the form of the “shoulds” of expectations. These are the prisons of life. Trying to change how we actually feel by ordering ourselves to do so is a strategy that goes nowhere, fast. Open awareness is about accepting what is and not being swept up by those judging activities. Does this seem ironic? Jonathon comes to me to try to change, and now I am encouraging him to accept himself as he is. But here is the distinction: Our effort to combat our actual experience creates internal tension, a kind of self-inflicted distress. But rather than march into our inner world and say “No—don’t do that!” we can embrace what is and notice what happens. Amazingly, time after time people discover that letting things be also allows them to change. We can approach our inner world with openness and acceptance rather than with judgments and preconceptions. Consider this: If a friend came to you with some difficulties, you’d probably listen to her first, invite her to bring up whatever came to mind, and offer her an open heart and a shoulder she could lean on. This is what openness entails—attuning to what is, being kind and supportive to ourselves, letting our state be receptive rather than reactive. Jonathon, however, had not yet learned to be kind to himself. He’d be focusing on his breath, for example, and if he got distracted by some memory of last weekend, some concern about schoolwork, or thoughts about a fight with a friend, then he’d get a “sense” in his head that he was “not meditating right” and that he was “not a good meditator.” I suggested to Jonathon that these harsh self- criticisms were just another mental activity for him to notice. They were judging thoughts, I told him, and when they came up he could try simply labeling them—“judging … judging …”—and then bring his attention away from them and back to his breath. Jonathon decided he preferred using the label “doubting, doubting” to remind himself of the undermining nature of these distracting thoughts. The quality of openness is the third tripod leg stabilizing our mindsight lens. It means that instead of being swept up by shoulds, we come to accept ourselves and our experiences. But to get to this place of inner attunement, of internal acceptance, we must first become aware of when we are our own prison wardens. A STABILIZED MIND Jonathon noticed the changes that were emerging. He would go for a run or ride a bike during stormy times, trying to find some way out of the mood that seemed to take him over. These rhythmic physical activities helped him to calm his body, to get grounded in his awareness, and to bring himself back into balance. As the weeks unfolded, Jonathon described a new experience. He began to sense his raging thoughts and intense emotional storms with more clarity, seeing them but somehow not becoming swept up by them. What surprised him, and thrilled his parents, was that he seemed to find a new way to actually calm the storms. This is what Jonathon wrote in a journal entry one night: “I had a fight with my Mom this afternoon and I went to my room before dinner. I thought of killing myself. There it is again. This will never get better. Just when I think things are changing, they stay the same. I was late coming home from school and she just laid into me, she was SO angry. … I sat in my bed and just thought—what’s the point. But then the feeling of being absolutely helpless seemed to float in my head, like a raft or a boat, some kind of log or something. But instead of the usual feeling of being on that boat, floating away, I was somewhere else. I could see that the raft was just a feeling, just the feeling of me not being able to DO anything to get out of this. And what was really weird was that once I let the boat just be there, kind of in my head but separate from ‘me,’ not being on it, it didn’t make me feel so bad. Then when I looked at it straight on, like just some kind of helplessness, it just disappeared.” In the session that day, Jonathon and I spoke about how this experience of the “boat” let him see that in fact he did not have to just float aimlessly on that feeling of despair. He had learned that he could do something to prevent being ambushed by his feelings. Jonathon also learned that just observing his own inner world with acceptance had a strong soothing effect on his distress. He told me that he began to notice he could soften the violence of his thoughts and feelings by looking directly at them and not running from them. Understanding that he could actually reverse the flow of his feelings and thoughts gave him wonderfully positive feedback about his own abilities. In many ways, Jonathon’s experiences echoed the research finding that people with mindful awareness training have a shift in their brains toward an “approach state” that allows them to move toward rather than away from challenging situations. This is the brain signature of resilience. Later on Jonathon wrote, “I know this sounds lame, but my view of life is changed now. What before I thought was my identity I now realize is just an experience. And being folled with big feelings is just some way my brain gives me experiences but they don’t have to say who I am.” I was moved by his discoveries, and in awe of his ability to articulate such deep insights. Now we had to see how he could refine this newly enriched monitoring ability to begin to alter the way energy and information were flowing in his internal world—to stop his mind from being flooded with those “big feelings” in the first place. Having already learned how to use self-observational skills to see his internal storms, he was now ready to learn techniques that would enable him to do something about them. I next taught Jonathon basic relaxation skills, inviting him to imagine a peaceful place from his memory or imagination that he could evoke at times of distress. We practiced this imagery in the safety of the office and combined it with the grounding feeling he’d get by just noticing his body in the chair or sensing his breath. These relaxation and internal imagery techniques would provide him with some readily accessible ways of calming himself. Over time, Jonathon learned to ward of an impending “low-road” meltdown by noticing his change in bodily state—his pounding heart, churning belly, tense fists—and then the very act of noticing would soothe him. Jonathon was experiencing the power of a stabilized awareness of the mind to achieve mental equilibrium. In our sessions as the months unfolded, Jonathon became more and more confident of his ability to look inward and then to change what was going on. In his journal he wrote, “I am beginning to see how my own way of paying attention to my feelings changes what they do to me. They used to explode and last for hours. Now after a few minutes, I can see how they can crash around and then, as I don’t take them so personally, they just melt away. It’s strange but I’m starting to believe in myself, maybe for the first time.” Change required the ability to accept what was there and have the strength to let it be, until his mind became stable again. He and I both knew how hard this road had been for him. The storms of his life had been a huge challenge, but they also provided the motivation for him to find a way to create a harbor of safety in his own mind. What had changed for Jonathon? We don’t have the brain scans to say for sure from a neural point of view—but what I picture is that over these hardworking months of twice-weekly sessions and essentially daily awareness practice and aerobic exercise, Jonathon was growing his middle prefrontal integrative fibers. His new way of focusing his attention, of integrating his consciousness, would have been made possible by his middle prefrontal areas expanding their connections and beginning to grow the GABA inhibitory fibers that could calm his subcortical storms. The “GABA-goo” could then soothe his irritable limbic amygdala so that it didn’t recruit his brainstem areas into the fight-flight-freeze routine that had been driving Jonathon mad. He was also likely moving more toward a “left-shift” brain state of approach. With this new integration Jonathon was learning how to coordinate and balance the firing of his brain in new and more adaptive ways. He could now “sit” in the sanctuary of his newfound awareness without being swept up by the mental activities that used to overwhelm him. This mental training was more than just a way to alleviate his roller-coaster symptoms—it was a way for Jonathon to become more resilient, and more himself. “I’m feeling almost like a di?erent person—like I’m stronger now. I don’t want to say this too much to jinx it, but I feel really good—really clear.” By six months into our work together, most of Jonathon’s symptoms of emotional turmoil appeared to have dissipated. Sitting with him in the room had a different feeling: He seemed more at ease, clear, and lighthearted. He seemed more comfortable in his own skin. “I just don’t take all those feelings and thoughts so seriously—and they don’t take me on such a wild ride anymore!” We continued to work on his practice and solidified his newfound skills. On our last visit, after a year of therapy, Jonathon stood up to shake my hand and I saw again that sparkle in his eyes that had so often been hidden behind a mask of anguish and fear. Now his gaze was clear, his face at ease, and his handshake confident and strong. He must have grown at least three inches since he first stepped into my office, what felt like ages ago. After high school, Jonathon moved on to attend college out of town. It’s now years later, and I recently ran into Jonathon’s parents at a neighborhood store. They told me that he is “doing great” and has not had a recurrence of his roller-coaster mind. He’s studying film, and psychology.
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