How does mindfulness regulate emotions

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How does mindfulness regulate emotions?

• Mark Williams
• University of Oxford
• Department of Psychiatry
• www.mbct.co.uk

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Outline

• Basic emotions
• Why do they persist and escalate?
• Use of top-down strategies Simulation
• Simulation as a Mode of Mind
• Why is it so compelling?
• Using the simulation mode to fix self and
  mood
• Why can it do so much damage?
• How does mindfulness help?

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Outline

• Basic emotions
• Why they persist and escalate
• Use of top-down strategies Simulation
• Simulation as a Mode of Mind
• Why is it so compelling
• Using the simulation mode to fix self and
  mood
• Why can it do so much damage
• How does mindfulness help?

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1. Basic emotions

• Anger
• Sadness
• Disgust
• Happiness
• Fear
• Time-limited or lose signal function

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.so what goes wrong?

• Critical process
• the inability to switch off something that
  evolved to be temporary

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Automatic vs strategic processes

• Darwin (1872)
• What we seen in humans is a combination of
• evolutionary old, automatic reactions
• evolutionary newer, strategic, representational
  and symbolic reactions

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in depression

• key aetiological factors
• Uncontrollable and inescapable aversive stimuli
  (e.g. learned helplessness)
• Seen in humans as
• low self-esteem / worthlessness
• guilt / shame
• feeling of failure
• anhedonia / lack of interest

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In other disorders

• Maintaining factors have in common
• Use of simulation
• PTSD Why am I still getting upset?
• Panic These symptoms mean I am going to die
• Social Phobia Other people can see me sweat and
  stutter
• Obsessionality What does this say about me?
• Hypothesis MAINTAINED BY OVER-USE OF A MODE OF
  MIND DOMINATED BY IDEAS/SIMULATIONS

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Perceptual and Conceptual Mind
Labeling Elaborating Analyzing Judging Goal-settin
g Planning Comparing Remembering Self-reflecting
Environment
Seeing Tasting
Touching Hearing Smelling Visceral
sensations Musculature and proprioceptive sensing
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Outline

• Basic emotions
• Why they persist and escalate
• Use of top-down strategies Simulation
• Simulation as a Mode of Mind
• Why is it so compelling?
• Using the simulation mode to fix self and
  mood
• Why can it do so much damage
• How does mindfulness help?

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Simulation (doing) mode of mind

• Self-regulation of self in relation to external
  world
• Discrepancy-based processing

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A journey from Oxford to Poole
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After a while I notice something
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Where did I go wrong? - think back
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What shall I do now?- think forward
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Outcome Achieved! How?

• Discrepancy-based processing
• Test-Operate-Test-Exit (T-O-T-E)
• I had to compare
• where I was now (current state)
• with
• where I wanted to be (my destination or desired
  outcome)
• and
• where I did not want to be (outcome to be
  avoided)
• Then take action (operate)
• and monitor effects of action
• (is discrepancy smaller?)

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Simulation (Doing) Mode of Mind

• Automatically activated
• Constant matching against goals
• Uses thoughts (conceptual -
  simulation)
• Takes thoughts as real
• Uses past and future
• Keeps in mind what to avoid

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Effects of simulation mode

• Lost in thought.
• Attentional blindness
• Cornell Campus

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Outline

• Basic emotions
• Why they persist and escalate?
• Use of top-down strategies Simulation
• Simulation as a Mode of Mind
• Why is it so compelling
• Using the simulation mode to fix self and
  mood
• Why can it do so much damage?
• How does mindfulness help?

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Imagine

• .walking by a lake
• It is a lovely day so ..
• I should be feeling better than this
• Why am I feeling so bad?
• Whats wrong with me?
• Why cant I feel as happy as Id like to be?
• Rumination/avoidance

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Why emotions do not turn off

• Mood taken as if external problem to be fixed
  
• Doing mode of mind
• Automatically activated
• Discrepancy-based (striving for goals)
• Brings conceptual/simulation mode on-line

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Discrepancy-based processing and mood

• TOTE
• Test-Operate-Test-Exit

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Strategy A

• Rumination
• Attempt to resolve problem (operate) through
  questions
• e.g. Why cant I be happy?

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Strategy B

• Avoidance
• Attempt to resolve problem (operate) by
  suppressing thoughts

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Effects of rumination and suppression

• Rumination
• Loses touch with world
• Conceptual
• over-general memory
• Impaired problem solving
• Suppression / avoidance
• Reduces creativity
• Mouse in Maze

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Result

• Sense of being on autopilot
• Out of touch
• Preoccupied
• World narrows
• Exhausted by TOTE strategy failing repeatedly

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Outline

• Basic emotions
• Why they persist and escalate
• Use of top-down strategies Simulation
• Simulation as a Mode of Mind
• Why is it so compelling
• Using the simulation mode to fix self and
  mood
• Why can it do so much damage
• How does mindfulness help?

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What is required?

• A way to shift from simulation mode to direct
  experience
• To notice the simulation (TOTE) mode of mind,
  then
• If choose, to disengage
• Shift into different mode of mind

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Shifting attentional focus- from analytic to
experiential
A
Conceptual/ Simulation
Environmental Input
Perceptual/Direct
B
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Two proof of principle studies

• Rawal et al., shifting attentional focus in those
  with eating pathology
• Hargus et al., decentring from relapse signatures

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Analytic self-focus instructions (Watkins
Teasdale, 2004)

• Think about the
• Causes, meanings, and consequences of
• the physical sensations in your body,
• the way you feel inside,
• the amount of certainty you feel
• Eight minutes

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Experiential self-focus instructions

• Focus your attention on the experience of
• the physical sensations in your body,
• the way you feel inside,
• the amount of certainty you feel
• Eight minutes

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Stress test for Eating Concerns

• Imaginary meal procedure (Shafran et al.,1999)
• Participants asked to imagine eating a fattening
  food for a period of 2 minutes.

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Stress outcomes

• Estimate of actual weight How much do you think
  you weigh right now?
• Moral wrongdoing
• How morally unacceptable/wrong do you feel
  (0-100) it was to think about eating the food
• Urge to reduce/cancel effects
• How strong do you feel is your urge (0-100) to
  reduce or cancel the effects of thinking about
  the food?
• Urge to check
• How strong do you feel is your urge (0-100) to
  check that you havent actually gained weight or
  changed shape?

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Weight estimates post stressor (difference from
real weight calculated in kg).
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Mean ratings for moral wrongdoing/unacceptability
post stressor for high and low ED groups
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Neutralization examples

• imagining exercising
• imagining eating celery
• checking shape in a mirror

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Proportion of neutralisers and non-neutralisers
post stressor for the high ED group
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Anorexic patients?

• N 13 in-patients
• BMI17.2
• Matched controls

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Difference in weight estimate before and after
stressor in anorexic patients and controls
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Post-stressor neutralization in Anorexic patients
(following analytic vs experiential immunization)
Neutralisers
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Non-neutralisers
10
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Frequency
6
4
2
0
An
Exp
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Relapse signatures (Emily Harguss data)

• Individual patterns of prodromal features that
  warn of onset of episode
• Very important for self-management
  (schizophrenia, bipolar disorder, suicidal
  behaviour)
• Not just whether noticed, but how we relate to
  them
• in specific detail
• with meta-awareness

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Meta-awareness of relapse signatures

• How a person relates to thoughts and emotions
  they had (as reality versus mental events)
• Im not ever going to be able to sleep again.
• I felt life was getting difficult, but it was my
  own inability to cope at that time

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Meta-awareness of relapse signature
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Summary

• Basic emotions
• Evolved to be temporary
• But persist and escalate why?
• Use of top-down simulation strategies
• Simulation compelling part of normal
  discrepancy-based processing
• But using simulation to fix self and mood
• - Rumination / avoidance
• Mindfulness helps by training vertical shift in
  attention
• from simulation to direct
  experiential processing

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• Thank you

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Doing mode and Being mode

• Judging discrepancies vs letting be
• Conceptual vs direct experience
• Thoughts as real vs thoughts as mental
  events
• Past and future vs present moment
• Avoidant vs approach (open)
• Automatic vs intentional

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Key practices

• Mindfulness of routine activities (e.g. eating)
• Body Scan
• awareness of sensations in the body learning to
  direct attention to different parts of the body
• Mindfulness of the breath
• Mindfulness of
• Body
• Sounds
• Thoughts feelings

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• Mindful movement
• Three minute Breathing Space
• scheduled regularly in working day, and
  additionally when under stress
• Cognitive therapy components
• Thoughts/feelings depression education M P
  relapse prevention

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Outline

• Basic emotions
• Why they persist and escalate
• Use of top-down strategies Simulation
• The Doing Mode of Mind
• Why is it so compelling
• Using the doing mode to fix self and mood
• Why can it do so much damage
• How mindfulness can help

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Outcome evidence

• Prevention of recurrence in major depression
• Reduction of depression in treatment
  non-responders
• Reduction of residual depression and anxiety in
  bipolar patients
• Reduction of symptoms in
• Chronic depression
• Chronic fatigue
• Schizophrenia
• GAD and panic disorder

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Possible Mechanisms?
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MBCT reduces Overgeneral Memories (Williams et
al., 2000)
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MBCT and Cognitive Reactivity (Raes, DeWulf
Williams, Behav. Res. Ther. in press)

• MBCT (n 18) vs matched Waitlist comparison (n
  21)
• Mindfulness (KIMS Baer et al)
• Cognitive reactivity (LEIDS)

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Mindfulness (Baer scale)
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Mindful attention awareness scale (Brown Ryan)

• Examples
• I find it difficult to stay focused on whats
  happening in the present.
• I tend to walk quickly to get where Im going
  without paying attention to what I experience
  along the way.
• It seems I am running on automatic without much
  awareness of what Im doing.
• I rush through activities without being really
  attentive to them.
• I get so focused on the goal I want to achieve
  that I lose touch with what I am doing right now
  to get there.
• I find myself preoccupied with the future or the
  past.

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Attempted suppression of negative thoughts (past
week)
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EEG Mean prefrontal asymmetry scores(Barnhofer,
et al., Neuroreport, 18, 707-712, 2007)
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Mindfulness training increases viscero-somatic
processing and uncouples narrative-based
processing (Farb et al, 07)
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Jon Kabat-Zinn
Mindfulness Based Stress Reduction

• We may never quite be where we actually are,
  never quite in touch with the fullness of our
  possibilities. Instead we lock ourselves into a
  personal fiction that we already know who we are,
  that we know where we are and where we are going,
  that we know what is happening - all the while
  remaining enshrouded in thoughts, fantasies and
  impulses, mostly about the past and about the
  future (Kabat-Zinn, 1994 p. xv)

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Doing mode and Being mode

• Judging discrepancies vs letting be
• Conceptual vs direct experience
• Thoughts as real vs thoughts as mental
  events
• Past and future vs present moment
• Avoidant vs approach (open)
• Automatic vs intentional

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Subjective weight gain after imagining eating
fattening meal anorexic patients
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