Mindfulness has gone mainstream
A few years ago, I took a trip to Cambria, a small, quiet town along the Northern California coastline. Soon after I arrived at my lodging, I realized there was no internet or cell phone connection. I spent the next couple of days feeling restless, anxious and cut off from the world. I felt I was missing out on my social media feed and wished I could visit my favorite apps on my smartphone. I then realized how much I was preoccupied with things that had nothing to do with my current experience. After a few days of meditation and quiet bike rides, I started to calm down. I am no mindfulness guru. However, learning about mindfulness and how it affects the brain has been simply fascinating.
Mindfulness refers to practices that help to cultivate an awareness of the mind and body and living in the immediate environment. It helps us connect with the present moment without any filters or lens of judgment. Mindfulness meditation is historically rooted in Buddhism and the concept of being present is an important concept in many spiritual practices including Christianity, Hinduism, Islam, Judaism, and Taoism. However, many contemporary mindfulness practices are secular in nature. The therapeutic application of mindfulness became popular in the US in 1979 when Dr. Jon Kabt-Zinn’s developed the Mindfulness-Based Stress Reduction (MBSR) Program which was based on his studies of Buddhism. At the University of Massachusetts Medical Center, patients who went through Dr. Kabt-Zinn’s program had significant reductions in anxiety and depression symptoms.
As a psychiatric mental health nurse practitioner, I incorporate mindfulness when working with clients. However, mindfulness can be used in many situations outside the clinical setting. Regular mindfulness practice can help decrease stress levels, increase focus, improve self-worth, and support mental wellness. Functional neuroimaging studies demonstrate strong evidence that mindfulness meditation is associated with structural and functional changes to the brain. These new discoveries have contributed to the popularization of mindfulness practices in recent years.
On October 1st, 2019, the term ‘mindfulness’ was rated at 100 points on Google Trends. This indicated that more people were searching for the term than any time in the last 15 years. The prevalence of mindfulness practice is also on the rise across the United States. According to the National Health Interview Survey, the number of people using mindfulness yoga practices in the US workforce increased by almost 50 percent (6 to 11 percent) between the years 2002 and 2011. In addition, more schools, hospitals, and businesses are implementing mindfulness programs. MindUP, an organization founded by actress Goldie Hawn in 2003, has created curricula to teach children about empathy and emotional self-regulation through mindfulness practice. In a 2016 Washington Post article, Principal Carlillian Thompson of the Robert W. Coleman Elementary School in Baltimore, Maryland, said that mindfulness practices helped the school’s “378 students leave behind the stresses of their lives, including problems at home, violence on the streets and conflicts with friends, so they can get ready to learn.” In addition, there is a growing number of online and peer-reviewed articles in which mindfulness-based interventions have been used to manage stress, anxiety, depression, chronic pain, and even substance abuse. Furthermore, there has been an exponential proliferation of apps dedicated to mindfulness and meditation. In a 2017 press release, Apple stated that “never before have we seen such a surge in apps focused specifically on mental health, mindfulness, and stress reduction.” The fact that more people are downloading these apps is a testament to the value mindfulness practices may provide.
Growth in the use of mindfulness coincides with record-high prevalence of stress and mental health issues. According to a survey of 41 million Blue Cross Blue Shield insured patients, the rate of major depressive disorder increased by 63 percent for teens and 47 percent for millennials between 2013 and 2016. Dr. Laurel Williams, Chief of Psychiatry at the Texas Children’s Hospitals, attributed these changes to the increased busyness of our lives, more time spent in front of our screens, decreased social networks and decreased sense of community.
Being distracted and multitasking is the norm
The advent of the internet and smartphones has brought tremendous changes in every area of modern life. People now have access to unlimited amounts of knowledge in the palms of their hands. This has led to great advances in different industries including entertainment, retail, transportation, education, and health care. However, because we are connected 24/7 we are constantly distracted and multitasking has become the norm. According to the Pew Research Center, there are over 5 billion user mobile devices and over half of these devices are smartphones. In the United States, 95 percent of teens have access to smartphones and 45 percent are “almost always” online. The flood of information from online sources across multiple devices competes for our attention at the expense of sustained focused work. This can lead to a loss of satisfaction in our daily lives and decrease our sense of mental wellness and fulfillment.
Our behavior is shaped by our use of technology
The ability for the brain to change based on external stimuli and our body’s internal environment is called neuroplasticity. The internet and smartphones gain and sustain our attention through its effects on the brain’s cortical-striatal dopaminergic system, which governs how we link goal-directed activity to reward. When using our phones, each click, scroll, or notification provides a small dopamine surge when we are rewarded with a new message, picture, or video. One article asserted that “it is the social expectations and rewards of connecting with other people and seeking to learn from others that induce and sustain addictive relationships with smartphones”. In addition, the instant gratification and feel-good sensations obtained from our devices offer a quick and reliable way of avoiding or even soothing negative emotions such as loneliness, sadness, frustration, helplessness, disappointment, or low self-worth. Studies suggest that repeat of the cycle of negative emotion avoidance and reward-seeking behaviors lead to structural changes in our brains which make our actions more fluid and automatic. The behavior then becomes less intentional and more impulsive. We then become less mindful, pun intended, of the goals of the behavior and less sensitive to the changes which need to be made to address new goals. When we use technology to address negative emotions, these negative emotions go unaddressed often leading to behavioral dysfunction, decreased work performance and increase risk of mental health issues.
Think of the last time you reached for your phone, swiped and clicked through a number of apps, before realizing you had no intention of using it. You put down your phone only to pick it up a few minutes later to repeat the process. The teenage brain is particularly vulnerable to these impulses. Mindfulness practice can be used to counter the effects of living in a distracted world and help us better hone in on our emotional needs.
The prefrontal cortex and the default mode network
Mindfulness meditation leads to changes in the areas of the brain related to emotional regulation and attention. The prefrontal cortex of the brain is involved in self-control, emotional regulation, planning, and problem-solving. It is divided into different regions associated with specific functions. The ventral medial prefrontal cortex (VMPC) modulates the impact of emotions on judgment. The VMPC also regulates the amygdala, the fear center of the brain. In one study, showing negative images to experienced meditators produced decreased activation of the VMPC and amygdala compared to non-meditators. This means meditators are better able to tolerate distressing stimuli with a decreased response in fear or alarm. Also, functional magnetic resonance imaging (fMRI) of long term meditators showed decreased activity in the dorsomedial prefrontal cortex, which modulates how one perceives and internalizes an experience. Think “I am sad” versus “I am experiencing sadness.” The latter is more likely to occur with meditators. Other studies showed increased activation in the parietal lobe, which modulates external attention, and anterior insula, which modulates awareness of physiological sensations coming from one’s body. It was concluded that mindfulness decreases the impact of emotions on decision making and helped improve attention through the strengthening of attention networks in the brain.
Mindfulness meditation was also associated with decreased activation of the default mode network (DMN). The DMN is a system of interconnected structures within the brain that are activated when we are not focused on the outside world. The DMN plays an important role in social cognition and self-referencing thoughts. It modulates our ability to correctly anticipate, and pick up behavioral cues as well as take on the perspective of another person other than ourselves. FMRI images of meditators showed lowered activity of the DMN suggesting changes in the processes of automatic thoughts. It was concluded that Mindfulness meditation seemed to change one's subjective, automatic thoughts towards a more objective and contemplative perspective. This allows for better judgment and planning. At the same time, mindfulness meditation increases our awareness of the present moment and enhanced decision making under stressful situations.
More research is needed to clarify what specific types of mindfulness exercises can be used to target which issues. There are also concerns that the application of mindfulness has been overhyped and may not be as effective in certain situations. However, it is evident that mindfulness leads to decreased emotional reactivity, and as a result, increased tolerance of negative emotions. This may translate to lower levels of perceived stress. The above studies were based on a variety of mindfulness practices and the benefits may not always be achievable for all mindfulness practices.
“No problem can be solved from the same consciousness that created it.” Albert Einstein
As one who practices mindfulness meditation, I recommend it to everyone. It is free and requires only a few minutes of your time. It’s as easy as stopping what you are doing right now. Now slowly, take a deep breath in, and then out. Observe your breathing, feelings, body sensations. Notice where your thoughts go. Gently refocus on your breathing and body sensations. Observe and accept them, without judging or attempting to change them. Then simply proceed with your day.
It may not give you the power to fly, but it can increase your sense of focus, emotional regulation and overall sense of mental health wellness. Now imagine what you could do with that.
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Arnold Fosah is a Psychiatric Mental Health Nurse Practitioner and a co-founder of Neb.