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  • >> ALLEN: Hi everybody. Welcome. Today, I'm here-- my name is Peter Allen. I'm the Director

  • of Google University and I'd like to introduce Philippe Goldin. Philippe, just a moment aback,

  • his background is a Postdoctoral Researcher. Philippe Goldin is a Postdoctoral Researcher

  • in clinically applied Affective Neuroscience in the Department of Psychology at Stanford.

  • Hold a PhD in clinical psychology from Rectors. He also spent six years in India and Nepal

  • studying languages, Buddhist Philosophy and Debate, which means that he can prove you

  • wrong in a nonviolent way in languages that you don't even understand. Philippe is currently

  • doing clinical research funded by the NIH in three areas. And here I have to read because

  • otherwise, I'll say it all wrong. Neuroimaging Investigations of Cognitive Effective Mechanisms

  • in Healthy Adults and Individuals with various forms of Psychopathology. The Effective Mind

  • fullness Meditation and Cognitive Behavioral Therapy on Neural Substrates of Emotion and

  • Attention Regulation. And the Effect of Child Parent Mindfulness Meditation Training. The

  • question is, "Why does this matter?" Philippe and his colleagues are working on understanding

  • how meditation affects the brain. And I can think of at least four implications for this.

  • One is that meditation is moving out of the realm of faith-based practice into the realm

  • of recognized science. Two, as this research is better accepted, more people will practice

  • and benefit from meditation. Three, you will be able to submit cost of your Zafu and Zabuton

  • as medical expenses, although not this year. And fourth implication, if you haven't already,

  • you should immediately go to go/siy and sign up for the next round of Search Inside Yourself,

  • Google's own mindfulness-based emotional intelligence class. So without further ado, please take

  • a deep breath, focus, and join me in welcoming Philippe Goldin whose talk today is entitled

  • the Cognitive Neuroscience of Mindfulness Meditation.

  • >> GOLDIN: Wow! Thank you so much. That was a beautiful introduction. So, without further

  • a do, just thank you very much for the opportunity to be here, and to share some ideas and open

  • questions and suggestions, and well, let's start. So today I'm going to speak briefly

  • a little bit about Attention, Mindfulness and Brain Systems, some cutting edge research

  • where there's a huge amount of interest, both from a clinical side, because I'm trained

  • as a clinical psychologist, psychotherapist, and also Neuroscience. I'm also trained as

  • a Neuroscientist. But how--what really--how does the brain work, how is it plastic, how

  • is it influenced by different types of training? I'm only here in front of you because there

  • are hundreds of people who've influenced me, some of whom are here, people who've taught

  • me brain imaging, how to sit with patients, how to become a husband, how to practice meditation

  • and so forth. So really, I'm here, but there's hundreds of other people who really, through

  • their kindness, that's why I can stand here in front of you. So, in brief, I'm going to

  • speak a little bit about Mindfulness Meditation, one particular type of meditation practice,

  • and then look at a clinical application: how might one type of practice, Mindful Based

  • Stress Reduction, be used as a clinical intervention for adults suffering from Social Phobia or

  • Social Anxiety Disorder? There are many types of mediation practice. And that's something

  • that's very important. The word gome in Tibetan, bavna in Sanskrit, really refers to cultivating

  • a certain quality of mind. So its practices that help us cultivate a quality and there

  • are many ways to do that. So there's--just simply put, there are some classes of meditation

  • practices that really have to do with harnessing attention, focusing and developing concentration.

  • So, for example, breath, body, focused meditation, visualizing an image, a mantra, or listening

  • to a sound, or certain object list open field. These are different kinds of meditation practices

  • that they have different types of results. Then there's also linguistic, analytic linguistic

  • or reasoning, as exemplified by monks doing analytic debate which I did when I was I India

  • in Tibetan Buddhist monasteries and it's really, really fun. And this here could be taking

  • a topic like the precious human rebirth; working here at Google, why is that such an amazing

  • thing; the death meditation, generating love and kindness, these would all be objects of

  • analytic thinking, linguistic, logic types of meditation. And then, the gem of all, the

  • actual medicine, well, one form of medicine is meditation on emptiness, in Sanskrit, shunyata.

  • And this has to do with dissolving a mistake in view of how I exist, how we exist, and

  • transforming that into a view of how one exists that is a lot more fluid and healthy. So that's

  • another form of meditation practice that is really these two build up to doing this. So,

  • in the field of clinical interventions, clinical psychology, etcetera, there's a huge, huge

  • bursting interest in applying eastern concepts, eastern meditation practices, acceptance,

  • mindfulness, into western clinical practices, interventions. So for example, one of the

  • most popular Mindfulness Based Stress Reduction, I believe you had John Kabat-Zinn here recently.

  • So this is really fascinating because he took people who were basically coming out of pain

  • clinics in UMass who the doctors were like "Look, we've done surgery, we've drugged them

  • up with lots of medications, we've done everything we can, we're tired of them, you take them."

  • And he basically said "Okay, I'll do it." And he caught a fad and created this program

  • "Mindfulness Based Stress Reduction" to help people with chronic, physical and emotional

  • pain, 30 years ago. Next year it'll be 30 years. So he's infiltrated the medical system

  • in a away that no one else has done to make it legitimate, to bring techniques, to help

  • people deal with themselves in a way that's really concrete, fundamental. Beautiful. Another

  • derivative that's really fascinating is Mindfulness Based Cognitive Therapy, literally a hybrid

  • of one of the best forms of psychotherapy, cognitive therapy and Mindfulness Meditation,

  • specifically as a treatment to prevent relapse into major depression. So this is to help

  • people who have three or more previous major depressive episodes, and helping them to prevent

  • relapse into the subsequent depressive episode. So this has been very, very efficacious and

  • wonderful clinical trials across three different study--three different continents. Another

  • form is Dialectic Behavior Therapy which specifically incorporates Mindfulness Meditation as one

  • of the techniques to help people primarily with borderline personality disorder, but

  • it's been extended to eating disorders as well. And then acceptance and commitment therapy

  • is another kind of clinical practice that is explicitly incorporating mindfulness and

  • Buddhist's ideas without talking about Buddhism at all. So these are just some examples of

  • how it's being incorporated in clinical practices right now. What I'm going to focus on for

  • today is Mindfulness Based Stress Reduction as a type of intervention. First question

  • is what is that? So it consist of three different components: formal meditation practice, breath

  • focused, body scan of sensations, being able to shift attention volitionally from different

  • sensory modalities, generating compassion, loving, kindness state of mind, and then there's

  • informal meditation practice which is just as important as the formal sitting which is

  • 10, 15, 20 times per day, just for even one breathe. So you can do it even right now,

  • just shift your attention to your own breathe just for one cycle, to breathing in and breathing

  • out. So we ask people to do this anytime, anywhere, any situation, multiple times a

  • day to build the muscle of attention, to generate the habit of checking in, dropping in. Oops!

  • And then the third component is Hatha yoga, physical stretching which is also a way of

  • getting into the body, noticing sensation. So this is the program, so to speak, that

  • we used for adults with social anxiety. Mindfulness has been shown over the past 30 years across

  • numerous clinical studies to be very effective and robust for reducing stress, pain, anxiety

  • and depressive symptoms overall. Mindfulness Based Cognitive Therapy has been shown to

  • be excellent as a relapse prevention, not a treatment for major depression, but a treatment

  • to help prevent the next depressive episode. What is mindfulness? As defined by John Kabat-Zinn,

  • paying attention in a particular way. From the psychological side, what we think about

  • that is, attention has many components. Here, we're focusing on the ability to alert, place

  • your attention on an object. The ability, when the mind becomes distracted, to reorient,

  • the ability to have a specific goal and to use top down or executive control to stay

  • on target. All kinds of qualities that are needed to get anything done. Doing this on

  • purpose, meaning I have an intention, a motivation why I'm engaging in this training of my attention.

  • Doing it in the present moment, meaning avoiding, avoiding now. So it's experiential approach.

  • Most of our life is about avoiding, avoidance of things that are not pleasant. Here, this

  • is really bringing a sense of equanimity to what's changing from moment to moment to moment

  • without pushing away things that I don't like, pulling in things that I do like. Embracing

  • anything, everything. So it's experiential approach, not easy to do. In trying to do

  • this non-judgmentally, meaning bringing, instead of an attitude of self-deprecation "I really

  • suck at this. I'm not good at this. I'll never learn how to meditate. I can't stand my mind."

  • Instead, bringing an idea of acceptance, curiosity, openness, about what is happening in my mind,

  • my mental experience, my brain. Here's a quick process model. The intention could be simply,

  • "I want to reduce my stress. I want to reduce the symptoms of anxiety." It could be that

  • "I want to increase well-being." Or could even be used as self-exploration and possibly

  • even enlightenment, if that's what you're interested in. So for example, you could follow

  • the breath and you're trying to develop attention, concentration and open awareness, calm, flow,

  • for example. But inevitably, the mind becomes distracted, often within seconds. In that

  • moment, you--either can begin to ruminate, spin. I talked about people going into a soap

  • opera mode for hours or minutes or days at a time, fantasizing, dozing. These are all

  • forms of distraction. But then inevitably, what has to happen with awareness is to redirect,

  • reorient attention and to do this without sub-judgment but in fact, doing it with kindness

  • and curiosity. And in fact, it's when the mind is distracted and when it becomes aware

  • and brings it back, that's a key moment. That's actually where a lot of learning takes place.

  • Mindfulness consists of, in this Japanese calligraphy, awareness, heart, mind. And I

  • think that's telling, trying to bring those qualities together. What mindfulness is not,

  • is equally important to consider. It's not distraction, and I'll show you some data,

  • shortly. It's not suppression of emotional experience or suppressing showing one's emotion.

  • That is not mindfulness. It's not avoidance. It's not ruminating or spinning on something

  • positive or negative, it's not that. And it's not cognitive reappraisal or thinking in a

  • way to change the meaning of something that's going on. It's not a logic thinking language

  • process. Some of the potential mechanisms for mindfulness has to do with decentering,

  • disidentifying from the contents of mind. So as I have thoughts, sensations, images,

  • memories, those are events that are occurring but they're not me. So this is decentering

  • or disidentifying. Another possible mechanism is developing attentional focus, harnessing

  • the ability to place and maintain attention. Regulation of emotion. Obviously as one trains,

  • this can harness your attention, things that would normally distract or evoke emotional

  • off-balance will occur at less and less frequently. Changing in how we view our self arises inevitably,

  • implicitly, through doing this kind of practice. And then, it's also been thought that negative

  • self-focused spinning or ruminating is decreased. So, this is a study that my wife and I did

  • awhile ago where literally, just in a sample of people with mixed anxiety depression; we

  • found that, compared to a wait-list control, no change. We found that people with mind--who

  • did the mindfulness course, actually showed a significant reduction, post mindfulness-training,

  • compared to a wait-list. In negative--I'm sorry.

  • >> What's a wait-list? >> GOLDIN: A wait-list control is people were

  • randomized either to waiting several months before they started the mindfulness class

  • versus people who got it right away. So this is mixed--these are people with mixed anxiety

  • depression and what you see is that there's, from pre to post mindfulness-training, a reduction.

  • But more importantly, the amount of meditation that people practiced during the two and a

  • half months, predicted significantly, 50% reduction in rumination.

  • >> [INDISTINCT] >> GOLDIN: Yes. Good point. So this is actually--people

  • with the mindfulness--for some reason, the people who were assigned to the mindfulness

  • group, reported greater rumination at baseline. So, there way to--there are statistical ways

  • of dealing with that, but that's also why we need multiple studies than you average

  • over them and then those things like that hopefully drop out. Those same question, yeah,

  • yeah. So they were more elevated than negative rumination, the sample at baseline. Giving

  • his talk. So I'm sure that everyone here at Google, almost everyone, probably has to do--to

  • be evaluated on performance. The most fearful, feared, social performance activity in the

  • world is for public speaking. Fortunately I don't have that, but a lot of people do.

  • And not only is it fearful, maybe in the moment, when somebody has to present in front of peers

  • or managers or bosses or CEOs, but people will ruminate, it was what were talking over

  • lunch, some people will actually--in my [INDISTINCT] with me for two weeks, before talk has to

  • be given. Negative, you know, anxiety, diarrhea, fear, sleeplessness. So this is something

  • that a lot of people experience. So this is the most fearful social performance thing,

  • but there are many, many others as well. So what is social anxiety? Well, it has a huge

  • lifetime prevalence in North America. About 12% of adults in North America will meet criteria

  • for social phobia or social anxiety disorder. It's the third most common psychiatric condition

  • after major depression and alcohol substance abuse. Third most common. It has a very early

  • age of onset. Eighty percent of cases of social anxiety begin before the age of 18. In fact

  • it's the model time of onset is really about age 10, 11, 12. And it's often undiagnosed,

  • untreated, or even if somebody shows up treatment for anxiety, the clinicians usually don't

  • ask about social anxiety. So it's usually occurs early and it usually precedes the subsequent

  • development of major depression, substance abuse, and other anxiety disorders. The other

  • very important thing about social anxiety in its early age of onset is that, it's associated

  • with the highest high school drop-out rate of all of the anxiety disorders: OCD, panic,

  • generalized anxiety, agoraphobia, etc, etc. So this is really why people are interested

  • in going younger, younger, younger. So, what is social anxiety from the first person experience?

  • So we--for all of our participants, we ask them to identify four painful social situations.

  • This client offered the following: At a job I had about 6 years ago, I was supposed to

  • introduce myself to a group of 5 or 6 new employees. The President of the company was

  • speaking first, and then I was supposed to say a few words. My anxiety grew to such a

  • heightened level right before I had to get up to speak, that I needed to leave the room

  • and the building. I had to take a walk for about a half an hour before I even got up

  • the courage to go back into the building and to admit to my manager what I had done and

  • how I had failed. So we actually use these scripts, autobiographical scripts, as stimuli

  • in our brain imaging studies, induction of a specific painful social memory. This is

  • about as real as it gets. Then we also ask people with respect to that situation, your

  • own situation, what are the automatic negative self-beliefs that arise? This client offered:

  • What's wrong with me? Why do I get so nervous? I'm going to get fired for not being able

  • to do this. The President must think that I'm an idiot and wonder why they hired me

  • if I can't even speak to a few people. If I get up there, I'm going to blush and either

  • throw up or pass out. So mental tripping, cognitive distortions, fear of physiological

  • arousal that I'm not gonna be able to control. So, one model of social anxiety, a cognitive

  • model says the following: When a person has social anxiety, is in a social situation,

  • it triggers a distorted view of the self, the social self "I'm not good enough as I

  • am. I'm going to screw up." This means the situation is a place we're evaluated as "This

  • is a dangerous place for me. This is threatening to myself." And then there's a very rapid

  • attentional shift to self-focused attention. So much so that in studies were you have other

  • people to say, "Hey, no you're doing fine. You're doing fine." The person is so internally

  • aware, internally driven; they don't process external information which, of course, reinforces

  • the disorder. And this leads to safety behaviors, not showing up to work, not making eye contact,

  • not speaking up, or being assertive when one needs to be, for example. Not going to parties,

  • bodily or somatic and concerns and problems, diarrhea, etcetera, cognitive problems, negative

  • thoughts, etc. Here, I'm going to be focusing on attention as one way to probe the brain

  • in people with social anxiety and how mindfulness might modify the neural basis of attention.

  • So the big question here is integration. Can we take incredible, beautiful, elegant technology

  • the West has to offer which is to basically go under the skull noninvasively and image

  • the brain while it's doing what it does? And ancient wisdom traditions of methods that

  • has been used for 3000 years of how to work with the mind; ways to actually identify and

  • begin to modulate mental patterns. Can we integrate this? A full description of a phenomena

  • would really entail all of these levels of granularity in my library looking at genetic

  • predispositions to people who have different anxiety disorders, to who will benefit from

  • cognitive therapy, from mindfulness, from medications, how this influences molecules,

  • neurons, neural circuits, and in cognition, emotion behavior. This will be a full explanation.

  • Here, today I'm just focusing on brain and cognition emotion. So we use the MRI, Magnetic

  • Resonance Imaging, which essentially is a huge magnet. Beautiful machine. Here's a picture,

  • this one is the Dalai Lama, Richard Davidson, a researcher from Madison showing His Holiness,

  • the Dalia Lama, how this works. And I'm going to give you a one slide primer on what is

  • the dependent variable in FMRI, Funtional Magnetic Resonance Imaging. You're lying in

  • the scanner on your back, like the woman you saw a moment ago, and then what I do is I

  • present you with a negative belief. "People think I'm socially incompetent," you read

  • that. This triggers firing in specifics populations of neurons, having to do with language processing,

  • self reflection that activate neural circuits, brain systems, not just specific areas but