Structural Changes in the Brain Attributed to Mindfulness-Based Interventions
The founder of Mindfulness-Based Stress Reduction Training, Jon Kabat-Zinn, has defined mindfulness as “Paying attention, in a particular way, on purpose, in the present moment, non-judgmentally” (Kabat-Zinn, 1990).
The most researched and gold standard of mindfulness-based programs has been Mindfulness-Based Stress Reduction (MBSR) as developed by Kabat-Zinn in 1979. The program, taught at the University of Massachusetts Medical Center (UMASS), has graduated over 17,000 people from his center alone. The MBSR course consists of 8 weekly 2 ½ to 3 hour sessions and includes daily meditation exercises such as the cornerstone 45 minute body scan. The meditation practice centers on using the breath to cultivate the ability to stay present with one’s mind. There are currently over 250 clinics that offer MBSR and countless other clinical programs utilizing mindfulness-based treatment techniques. In recent years additional programs that include mindfulness have flourished , such as Mindfulness-Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT).
No longer in its infancy, the research on mindfulness-based programs has exploded in the last several years. Mindfulness-based interventions have been shown to be beneficial in reducing a number of unwanted medical and psychological symptoms in various patient populations. For example, the outcome data on these programs reveals that the training leads to improvement in the physical and mental health of participants with regard to improved immune function, pain management, and decreased psychological symptoms of stress and anxiety. The research demonstrates that participants exhibit major changes in health, attitudes, and behavior. Concurrently, studies have shown changes in the brain’s grey matter in areas associated in emotional regulation (Holzel, 2011).
Most recently, lasting changes in the brain were noted in participants who attended an 8-week mindfulness-based program. Research published in Frontiers of Science established that the subjects showed decreased activity in the amygdala in response to images that would be expected to produce negative emotions. The amygdala is an area responsible for processing memory and emotions such as fear. This alteration in the emotional processing of the brain remained even outside of the meditative state. Ongoing study at major research centers across the world continues to investigate the underlying mechanisms involved in these brain changes (MassGeneral.org).
Thus, we are now seeing evidence that individuals’ sense of wellbeing after such training corresponds to structural changes in the brain. This is exciting news as there is increasing confirmtion that mindfulness-based meditation can have long lasting effects on emotional stability. With such profound findings, justification exists for adapting mindfulness programs based on clinical need to fit the unique circumstances of particular clinical populations.
Biofeedback for Pain and Medical Diagnoses
Overview: Several studies have shown that biofeedback based treatments, which successfully teaches people to control physiological processes, are effective in managing pain. People can learn to control abnormal spasms, blood flow, respiration and heart rate to reduce or eliminate cramping and burning pain
Who might benefit from Biofeedback?
People benefit from Biofeedback for a variety of physical and emotional disorders. Some types of conditions which can be helped with biofeedback include:
|Headaches||Neck, shoulder, and back pain|
|Myofascial pain||Repetitive Strain Injury, Carpal Tunnel|
|High blood pressure||Temporal Mandibular Joint Disorder (TMJ)|
|Cardiac Arrhythmias||Raynaud’s Syndrome|
|Diabetes||Post Traumatic Stress Disorder|
|Sleep Disorders||Rheumatoid Arthritis|
|Fibromyalgia||Other types of chronic pain|
|Anxiety and Panic|
How can biofeedback therapy, relaxation and muscle retraining help patients with documented medical disease?
Most chronic pain problems are aggravated or initiated by excessive muscular tension or improper muscle use. Once pain has continued beyond what we would expect to be the healing point from an injury or illness, it is normal to develop automatic habits of bracing and protecting the injured area. In time, these habits cause excessive pain to which individuals often respond by further limiting their daily activities and normal functioning. This begins the cycle of chronic pain and its exacerbation.
Many people cannot recognize the actual level of tension in painful muscles, because of postural problems while working, over-reactions by the muscles to stress, poor habits, etc. Studies have shown that cramping and twisting descriptions of pain are often caused by spasms in the major muscles of the body while burning or tingling descriptions of pain are often caused by too little blood flowing to the extremities. Even patients with known vascular disease can learn to increase blood flow to their extremities. Once a patient establishes negative bodily habits, and pathologizes normal physiological responses, medical treatment is unlikely to heal the problem without behavioral intervention. Psycho-physiological assessments are used to identify which muscles are not functioning correctly and what circumstances lead to the pathological patterns of tension. Biofeedback of muscle tension is used to train people to recognize actual levels of tension and to correct these levels in conjunction with relaxation training.
What does the actual treatment entail?
We utilize state of the art wireless biofeedback equipment that allows for dynamic movement assessment and training. For example, when muscular assessment and training is conducted, we attach surface EMG electrodes to specific muscles or muscle areas designed to measure the amount of muscle contraction that is occurring. Then, we have the patient undergo a series of movements during which we monitor muscle activity. Once we have identified abnormal muscular tension, the visual feedback assists the patient with their muscle retraining protocol. With the use of assistive devices a patient then practices the newly learned body use patterns in their normal life for generalization. Patient graphs and numerical data are used to track progress.
How long does it take?
This varies for each individual and their special pain concern, but people can learn what they need to control pain in 8-10 sessions. The time may vary based on the variety of modalities used (respiration, thermal, EMG, heart rate biofeedback), and the ability of the subject to actually learn and incorporate the techniques into his/her lifestyle. Though the majority of people find that they begin to notice initial results faster, it takes home practice to engage more permanent effects.
What results can the patient expect?
- Patients report less distress and greater physical comfort.
- Patients can reduce their medication use.
- Patients demonstrate an improved level of functioning, as reduced tension will make activity less painful and less difficult.
- Patients become more independent of their treatment team.
The good news is that the patient learns to have progressively more control over their progress by practicing the techniques and completing assignments between sessions. Treatment goals are unique to the particular problem and patients goals. Some people aspire to get more relief from their health problems than they’ve had with other treatments. Others simply want to rely less on medications. Whatever the goal is, the patient will undergo an initial evaluation in order to facilitate the development of an individualized treatment program, which may be developed in consultation with your multidisciplinary team. When the patient is referred by their physician or attending a physical therapy program, biofeedback is coordinated with the patient’s treatment team. Working with the multidisciplinary treatment team enables timely communication of the patients’ needs and progress for a more efficient and cost- effective outcome.
Dr. Klich is a board certified clinical psychologist who has developed the technique of Mindfulness-Based Biofeedback and specializes in using dynamic biofeedback training geared toward the management of physical and emotional pain. To contact Dr. Klich for additional information please call (678) 310-8228.