I am so grateful that my review regarding the mechanisms behind mindfulness’s positive impact upon psychological well-being was recently published by Dove Medical Press (with a video included!)
The following blog post is based off that review.
Let’s Thrive! – Dr. Wolkin
This blog post originally appeared on Mindful.Org
There is a lot of research conveying mindfulness meditation’s positive impact upon psychological well-being. In fact, a vast literature of controlled studies has found that mindfulness meditation is related to improved mental health across a variety of disorders, including different anxiety disorders, depression, eating disorders, substance abuse, and chronic pain symptom reduction.
Yet, the idea of mindfulness has become a buzzword of sorts, and despite research regarding positive outcomes, specific mechanisms associated with mindfulness and psychological well-being are unclear. (Additionally, the ambiguity in the term mindfulness, and how it’s approached in research, makes it difficult to parse out particular mechanisms responsible for clinical outcomes.)
Mindfulness and Attention Mechanisms
Despite these limitations, many research studies seem to indicate that cultivating different aspects of attention is a feasible and consistent starting point to bridging mindfulness practice and psychological well-being.
The question remains: How can cultivating multiple aspects of attention through mindfulness meditation account for psychological well-being?
This blog post is based on a review that supports a previously suggested idea that cultivating all aspects of attention through mindfulness leads to greater well-being by decreasing rumination.
Like mindfulness meditation itself, attention is not easily defined. Over two decades ago, researchers conveyed a conceptualization of attention as a multifaceted construct made up of the three unique and differentiated, yet overlapping networks called Alerting, Orienting, and Executive Attention—the latter includes regulatory processes like conflict-monitoring and metacognition.
Attention is also described in terms of the way it is regulated. In fact, meditation practices are usually described by the degree to which they entail “Focused Attention (FA)” and “Receptive Attention (RA).” Although sometimes likened specifically to RA, mindfulness practice is distinguishable by its utilization of both FA and RA.
Focused Attention: When our attention is focused, it is restricted to a specific object, which is commonly the neutral sensory experience of the breath going in and out.
Ideally, attention is sustained, but as thoughts, and/or feelings and/or physical sensations arise, a conflict is presented; different stimuli are pulling for attention.
Receptive Attention: After consistent practice, there is often less need for a specific object of focus (the breath), and we broaden the focus of our attention so that it is receptive to our entire field of awareness, including whatever thoughts, feelings and sensations arise in the moment.
Rumination: Rumination has been defined as a passive dwelling upon negative thoughts and/or emotion and is negatively correlated with aspects of psychological well-being.
As mentioned, this review supports mindfulness meditation’s role in improved psychological well-being, through the mechanism of reducing rumination via attentional processes.
The question remains as to how this actually plays out.
Distraction and Decentering
Rumination is decreased through a two-step process including distraction and decentering. These steps correspond to the attention regulation styles inherent to mindfulness meditation.
Early on in one’s mindfulness meditation practice, when it entails focused attention, attention is sustained on the neutral sensation of the breath. While this skill is being cultivated, ruminative thought processes likely interrupt the effort to sustain this attention.
The ability to monitor conflicts of attention, however, ensures that one is constantly distracting oneself from ruminative thoughts through the redirection of attention from rumination back to the breath.
According to the research, distraction is a healthier response to stress than rumination and entails a deliberate direction of attention away from ruminative thoughts onto a pleasant or neutral stimulus. Yet, research also indicated that although distraction is important, it only serves as temporary relief, because with distraction, avoidance is taking place.
In the long term, avoiding and pushing away thoughts through distraction is as inefficient as clinging to them through rumination. So, there is a process beyond distraction. Mindfulness meditation utilizes the benefits of distraction, but then goes beyond it in cultivating a more adaptive response to distress.
This is enabled through receptive attention, during which attentional focus is broadened and one is encouraged to be aware of all experiences. One now has the space to actually notice patterns of over-engagement in negative thoughts as opposed to suppressing them through distraction.
The ability to cultivate a broader range of awareness also cultivates the ability to decenter, which is enabled through enhanced metacognition, and allows for a stepping back from any possible secondary elaboration of ruminative thoughts.
This means that thoughts are nonjudgmentally accepted as just thoughts that come and go. When thoughts are seen as transient, one is more likely to feel disconnected to them.
How Mindfulness Meditation Creates a Shift
The idea inherent in both distraction and decentering is that a shift is taking place. During the former, one’s ability to distract and redirect attention away from rumination and to sustain attention on the neutral breath is a literal shift in attention that cultivates regulatory processes intrinsic to psychological well-being. During the latter, one has the opportunity to figuratively shift attention from the content of a thought toward the process of having one. That vantage point allows for a more objective and less judgmental perspective. This perspective is more adaptive and reflected in greater psychological well-being. Ultimately, engaging in mindfulness meditation cultivates our ability to both focus and broaden our attention, which is a practical way to elicit psychological well-being.
I’ve been writing recently about the profound connection between the brain and our gut! Most of my writing was intellectual, sometimes metaphorical, maybe a bit poetic, and also humbly instructional (i.e., the way mindful eating fosters health vis a vis this connection).
Today, here is part of my own journey with #AlimentaryAngst, the story that sparked my personal and professional quest to help heal mind through body, and body through mind.
Thank you to Further Food for publishing this and thank you for all the support. I hope this resonates-ultimately, that is why I’m putting THIS forth! What has YOUR journey been like? Comment below with your thoughts, I look forward to responding to each one.
To Thriving, xo, Dr. Jen
This blog post originally appeared on Further Food.
Let’s rewind. February 2013, I noticed that I’d become more bloated than usual after a hearty meal. I experienced a feeling of pressure in my stomach, as well as visceral pain, both of which converged to create a really uncomfortable experience. I also had GERD, and my heart felt fiery. My xiphoid process felt irritated. I was a hot digestive mess.
As uncomfortable as it was, I kept my cool. It was only a few weeks later, when I looked down towards the floor and couldn’t see my own feet, that I gasped with every ounce of guttural energy I had in reserve. I looked six months pregnant.
I used my hands to cradle my inflamed belly and I cried. I cried for so many reasons: the pain, the discomfort, the cruel joke of hearing my biological clock tick so loud I thought I’d go deaf. I only looked pregnant, but wasn’t. Was this some kind of phantom pregnancy? Was that even a thing? Was I about to be catapulted into psychological stardom with my new discovery? This faux-preggers state was characterized by the undoubted lack of a fetus, but a great yearning for one, and a belly the size of six-month gestational equivalence.
I went to the doctor. Gave her a history, which was mostly sparse, except for the few things I seem to always be relaying to doctors. I felt lethargic and tired all the time, and I couldn’t seem to ever get enough sleep. I never woke up feeling rested. Overall, I’m healthy, and thankfully so, but there’s health and then there’s “HEALTH.” The difference is the same as that between surviving and thriving. I prefer to do the latter.
My diagnosis: Small intestinal bacterial overgrowth (SIBO), which had nonchalantly decided to go camping in my gut, like a pesky parasite sucking the life out of every ounce of normal flora to be found. Camping: as in pitching tents, and starting fires, and sleeping in the dark hollows of my alimentary organs.
The road to wellness began with self-compassion. Then, I changed my diet, and embarked on a journey consisting of many lifestyle changes. This was both extraordinarily cathartic and vulnerable to write. Yet, as a mind-body-brain wellness advocate I truly think it is incumbent upon me to share my journey. Why? Well, because my journey is what catapulted me towards the process of researching, reading, conversing, asking, anything I could about the topic. Gut health became a focus of not only my own, but of my practice with my patients.
I am blown away by the connection between mind, body, brain and gut. In fact, the gut is so powerful, and exerts so much impact upon our daily lives, that it’s even been dubbed the second brain. For me, knowing there is a real live brain in my gut makes me think twice about what I put in it, and I’ve never felt better.
Check out my next post on Further Food-I’m going to keep it raw and real, but will get much more technical and science-y about the importance of gut health.
Just to reiterate:
The body is composed of more bacteria than it is cells. Collectively, the trillions of bacteria are called the microbiome. Most of the microbiome reside in our gut, and is sometimes referred to as the gut microbiota. We all have our own unique microbiome. A healthy gut can be different iterations of bacteria for different people, because it is this diversity that maintains wellness.
The microbiome is capable of playing a vital role in physical and psychological health via its own neural network, the enteric nervous system (ENS), sometimes referred to as the second brain.
A shift away from “normal” gut microbiota diversity is called dysbiosis, and dysbiosis may contribute to disease. In fact, alterations in the diversity and stability of the gut microbiome has been linked to many diseases, including autoimmune, gastrointestinal, and even brain disorders.
The microbiome is capable of playing a vital role in physical and psychological health via its own neural network, the enteric nervous system (ENS), sometimes referred to as the second brain.
Given the far-reaching health implications that the ENS is now understood to mediate, treatment for many neurological, neuropsychiatric, autoimmune, and gastrointestinal difficulties have taken a new turn. Perhaps one of the best ways to boost our brain is by maintaining impeccable gut health. So to, for functional GI disorders, it might be impossible to heal a distressed gut without considering the impact of stress and emotion.
This all begs the question: What are some lifestyle choices we can make to foster optimal mind-body-brain wellness? I have many suggestions, but in this post, I want to focus on one specific technique that will efficiently elicit holistic benefits: mindful eating.
Mindful eating, in my opinion, speaks to being mindful of both what, and how, we eat. Paying attention to what we put into our mouths protects us from choosing the types of foods that are particularly toxic to both our gut and brain. For different people, different foods are more or less inclined to cause dysbiosis. Generally speaking, however, the more processed the food, the more noxious.
Mindless eating can wreak havoc on our digestive abilities by eliciting stress hormones, and therefore can add pounds, take away pleasure, and maintain functional gastrointestinal difficulties. In contrast, eating mindfully reduces our stress hormones, and gives our body the time and space it needs to thoroughly digest food, without the inflammation.
Aside from reducing stress hormones, mindful eating enables us to slowly and sensually savor the action of eating, creating an experience to delight in. It also allows us to engage with our inner sense of satiety, which helps curb the over-eating that leaves us feeling uncomfortable.
Mindful Eating for the Brain and Gut
Keeping all of this in mind, here are five (A,B,C,D,E) ways to begin a mindful eating practice.
When it comes to mindful eating, we don’t have to have a set formal practice. We can initially begin by asking ourselves some key questions:
• Why am I eating now: am I hungry, or craving something else?
• What am I eating now: will this choice serve my wellness in some way or will my body and mind regret this choice? You can think of this question as a cost-benefit analysis. It is OK to treat yourself to something that isn’t necessarily the healthiest choice, if it is in moderation. Yet, ask yourself if it is worth it, or will it wreak havoc to the point at which it is no longer even a treat?
• What else am I doing now: am I about to eat something while I also read an article, or watch TV, or have a conversation? Give yourself permission to JUST eat.
2. Be grateful
Before you lean in to whatever it is you are going to ingest, take a moment to reflect on how grateful you are for being able to engage in this meal. This can be a formal prayer, or as informal as saying thank you in your mind or out loud to the sun, the earth, the farmers, and even the universe for having a hand in delivering this food to your mouth.
3. Chew, and then chew again
Since our actual digestion begins with chewing, taking the time to chew, and then chew again, helps the enzymes in our saliva do its job so that we can effectively absorb nutrients and get the most out of the food we are eating.
There is eating and then there is dining. Many of us don’t have the time to sit down to a formal meal, especially during a busy work day. Yet, dining can be as simple as allowing yourself to experience every sensation of your meal as it unfolds with each moment. Dine by indulging in the different aromas, textures, and tastes of everything you eat, instead of going from bite to bite—or, more often, swallow to swallow.
5. Engage your attention
Whether you are practicing a formal sitting meditation using the breath as your guide, or eating mindfully, a core component to mindfulness practice is engaging your attention, tuning-in, and regulating if necessary. Our minds inevitably wander—that is just a fact of being human. When you are eating and begin to notice the mental chatter and commentary, without judgment, see if you can redirect your attention back to the experience of dining; of experiencing all sensations.
This blog post originally appeared on Mindful.Org
Most of us can relate to the experience of having butterflies in our stomach, or to a visceral gut-wrenching feeling, and how often are we told not to ignore our “gut-instinct” or “gut-feeling” when making a decision.
Even from our simple slang, it’s clear just how symbolically connected the gut is to our emotions. Now, there’s tangible proof to support these popular metaphors.
We all have a microbiome, and they are as unique as our neural pathways
Research has shown that the body is actually composed of more bacteria than cells. We are more bug than human! Collectively, these trillions of bacteria are called the microbiome. Most of those bacteria reside in our gut, sometimes referred to as the gut microbiota, and they play multiple roles in our overall health.
The gut is no longer seen as an entity with the sole purpose of helping with all aspects of digestion. It’s also being considered as a key player in regulating inflammation and immunity.
A healthy gut consists of different iterations of bacteria for different people, and this diversity maintains wellness. A shift away from “normal” gut microbiota diversity is called dysbiosis, and dysbiosis may contribute to disease. In light of this, the microbiome has become the focus of much research attention as a new way of understanding autoimmune, gastrointestinal, and even brain disorders.
The benefit of a healthy gut is illustrated most effectively during early development. Research has indicated just how sensitive a fetus is to any changes in a mother’s microbiotic makeup, so much so that it can alter the way a baby’s brain develops. If a baby is born via cesarean section, it misses an opportunity to ingest the mother’s bacteria as it travels down the vaginal canal. Studies show that those born via c-section have to work to regain the same diversity in their microbiome as those born vaginally. Throughout our lives, our microbiome continues to be a vulnerable entity, and as we are exposed to stress, toxins, chemicals, certain diets, and even exercise, our microbiome fluctuates for better or worse.
The gut as second brain
Our gut microbiota play a vital role in our physical and psychological health via its own neural network: the enteric nervous system (ENS), a complex system of about 100 million nerves found in the lining of the gut.
The ENS is sometimes called the “second brain,” and it actually arises from the same tissues as our central nervous system (CNS) during fetal development. Therefore, it has many structural and chemical parallels to the brain.
Our ENS doesn’t wax philosophical or make executive decisions like the gray shiny mound in our skulls. Yet, in a miraculously orchestrated symphony of hormones, neurotransmitters, and electrical impulses through a pathway of nerves, both “brains” communicate back and forth. These pathways include and involve endocrine, immune, and neural pathways.
At this point in time, even though the research is inchoate and complex, it is clear that the brain and gut are so intimately connected that it sometimes seems like one system, not two.
Our emotions play a big role in functional gastrointestinal disorders
Given how closely the gut and brain interact, it has become clear that emotional and psychosocial factors can trigger symptoms in the gut. This is especially true in cases when the gut is acting up and there’s no obvious physical cause.
The functional gastrointestinal disorders (FGIDs) are a group of more than 20 chronic and hard to treat medical conditions of the gastrointestinal tract that constitute a large proportion of the presenting problems seen in clinical gastroenterology.
While FGID’s were once thought to be partly “in one’s head,” a more precise conceptualization of these difficulties posits that psychosocial factors influence the actual physiology of the gut, as well as the modulation of symptoms. In other words, psychological factors can literally impact upon physical factors, like the movement and contractions of the GI tract, causing, inflammation, pain, and other bowel symptoms.
Mental health impacts gut wellness
In light of this new understanding, it might be impossible to heal FGID’s without considering the impact of stress and emotion. Studies have shown that patients who tried psychologically based approaches had greater improvement in their symptoms compared with patients who received conventional medical treatment.
Along those lines, a new pilot study from Harvard University affiliates Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center found that meditation could have a significant impact for those with irritable bowel syndrome and inflammatory bowel disease. Forty-eight patients with either IBS or IBD took a 9-week session that included meditation training, and the results showed reduced pain, improved symptoms, stress reduction, and the change in expression of genes that contribute to inflammation.
Poor gut health can lead to neurological and neuropsychiatric disorders
Vice-versa, poor gut health has been implicated in neurological and neuropsychiatric disorders. Disturbances in gut health have been linked to multiple sclerosis, autistic spectrum disorders, and Parkinson’s disease. This is potentially related to pro-inflammatory states elicited by gut dysbiosis-microbial imbalance on or inside the body. Additional connections between age-related gut changes and Alzheimer’s disease have also been made.
Further, there is now research that is dubbing depression as an inflammatory disorder mediated by poor gut health. In fact, multiple animal studies have shown that manipulating the gut microbiota in some way can produce behaviors related to anxiety and depression. (Maes, Kubera, Leunis, Berk, J. Affective Disorders, 2012 and Berk, Williams, Jacka, BMC Med, 2013).
Our brain’s health, which will be discussed in more depth in a later blog post, is dependent on many lifestyle choices that mediate gut health; including most notably diet (i.e., reduction of excess sugar and refined carbohydrates) and pre and probiotic intake.
The brain-gut connection has treatment implications
We are now faced with the possibility of both prevention and treatment of neurological/neuropsychiatric difficulties via proper gut health. On the flip side, stress-reduction and other psychological treatments can help prevent and treat gastrointestinal disorders. This discovery can potentially lead to reduced morbidity, impairment, and chronic dependency on health care resources.
The most empowering aspect to the gut-brain connection is the understanding that many of our daily lifestyle choices play a role in mediating our overall wellness. This whole-body approach to healthcare and wellness continues to show its value in our longevity, well-being, and quality of life: that both physical and mental health go hand-in-hand.
This blog post originally appeared, in an adapted form, on Mindful.Org
I don’t know about you, but I feel so much better when my environment is neat and organized. After a long day of work, coming home to a neat space is like coming home to myself. It is a refuge, truly, and I feel soothed.
When I wake up in the morning, before the sun comes up, and stumble to my espresso machine, bleary eyed and still ridiculously tired, a neat space seems to beckon me to use my time in the way I so desire. I try to wake up early to practice mindfulness, set an intention for the day, and then either focus to finish patient notes from the day before, or write creatively…although I’d like this to happen more regularly than it does, I am gentle with myself when it doesn’t.
I do know, however, that there are certain ingredients that will immediately create an impasse for all that to manifest. That is waking up to a messy space. Waking up to a messy space becomes a metaphor for the brain fog and overwhelming feelings that begin to ensue. Decluttering is hard, but it is worth it. The effects impact your mind and body. Some of the behavioral work with my patient focuses on paced organization schedules as well as cognitive work regarding the “letting go” of the clutter that many of us create to protect ourselves. This idea is vast, and I will write a post about that in its entirety at a later time.
My patients find that undoubtedly, as the cutter begins to lessen, they feel a clearing in their minds that they never thought was possible. This is a kind of outside-in decluttering. A physical clearing creates vast mind space. I recommend this extraordinary book to help you get started with the outside in process: “The life-changing magic of tidying up”.
Here’s the thing though, just as we need to declutter our physical surroundings, we need to declutter from the inside-out. I like to call this feat “Feng-Shui-ing the Grey Matter”. Literally, we need to spring clean and give our neural circuitry the room to grow. When this happens, we begin to literally feel the lightness of being.
The irony here: When we declutter, both the environment we inhabit and the minds that sometimes seem to inhabit us, we start to fill our lives with meaning and possibility.
The Brain is now known to be a neuroplastic entity (see my recent Mindful.org post for more on that: “How the Brain Changes When You Meditate“). It is no longer static and by “feng shu-ing the grey matter” we can literally change the neurofunctional space that all the crud and chaos seemed to take up.
Personally, I find this comforting and empowering. What I have found, through my own tedious work, as well as the perseverance of my patients, is that this space is a place where we can mindfully allow for positive Qi to flow within us.
Too esoteric? I hear you. What if I concretized the concept a bit so that we can take actionable steps to feeling better, inside-out.
- Sometimes it seems like all I can do to calm down, to declutter, to make space, is to Take a Vinyasa (flow with breath and body through a sequence of asanas/postures/yoga poses). Sometimes I go from downward dog to plank to upward dog and back. Sometimes I start from a Warrior II pose then straighten my front leg in sync my breath, which is also now in sync to my hands moving from out to the sides to above my head.
- When I am particularly overwhelmed by negative thought clutter, and it seems as though the ruminations won’t end, I Recite a Poem. I literally recite my favorite poem (which I committed to knowing by memory for this VERY purpose), which happens to be Wild Geese, by Mary Oliver. I become so engaged in reciting the poem, mindful of both the rhythm and meaning of the words, that I let go of all other thoughts. My brain can’t BOTH recite a poem and ruminate at once! You don’t have to use a poem…you can use a favorite song, monologue, etc.
- One of my favorite ways to instantly declutter is to literally Bust a Move! I bust out one of my favorite dance moves, and even get the added bonus of the endorphins. I grew up with Tapes, not CD’s, so can anyone say THE RUNNING MAN (or the ELECTRIC SLIDE)!
- While I don’t purport to live in the past by way of having regrets and overanalyzing situations which are long forgotten, I DO like to Mosey Down (good) Memory Lane. I find it such a treat to close my eyes and picture myself at that concert at the Boston House of Blues, that time my dad took me to my first baseball game… peanuts and all, playing my guitar solo in front of an audience, passing my licensing exam, getting those roses…the list can go on and on. I get to go back to that time and place, to feel the sensations as I surrender to sweet nostalgia.
- One of the most effective ways to Feng Shui the Grey is to simply Say Thank You. You don’t necessarily have to have a god, or the universe, or anyone in particular in mind. Just a general “thank you” to express gratitude for everything you are or aren’t, and everything you have or don’t have. This is by no means easy, and I do NOT mean to placate you or undermine any difficulty you are experiencing. But there is actual literature in the field of “Positive Psychology” that expressing gratitude is a huge part of mental health, which includes stress reduction.
For those of us who want to have at least SOME control in such an uncertain life, we can actually make the CHOICE to declutter our minds, and in doing so we actually change the map of our lives.
This blog post originally appeared on Further Food.
Fibromyalgia consists of a complex array of symptoms, which include widespread muscle and joint pain along with overwhelming fatigue. It is often a diagnosis with higher prevalence rates in women and has been described as one of the “most controversial conditions in the history of medicine.” To many medical critics, fibromyalgia is one of several “somatic syndromes” driven by sensationalized media coverage, self-interest, and litigation. For these critics, chronic pain syndromes are believed to reside in the minds of the sufferers.
A variety of social and medical critics view chronic pain as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These illnesses, they contend, originate in vulnerable human psyches. Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically “real.”
Psychosomatic explanations ultimately reduce chronic pain to mental factors, the consequences of which are significant.
One consequence is that psychosomatic pain is inevitably devalued and the credibility of its sufferers is questioned. Another consequence is that accepted treatments for “physical” pain, like analgesics, may be discouraged even when they may be necessary. Often, being invalidated triggers depression and anxiety, which increases the burden of the disease, adds to the pain, and results in more stigmatization.
A lot is at stake, then, if chronic pain is conceived as psychogenic.
When it comes to fibromyalgia, there is a lot that Western Medicine continues to ignore. There is still no certain cause or recognized treatment that works for everyone. Many things, however, have become, at least anecdotally speaking, crystal clear:
1. People who suffer with symptoms can find relief by making certain lifestyle choices.
2. The expression and manifestation of Fibromyalgia is diverse and what works for one person might not work for another.
3. Fibromyalgia symptoms can have a significant impact on your life—your work, relationships with family members and friends, and your overall outlook.
4. A combination of treatment modalities is very beneficial.
Many people who suffer with fibromyalgia turn to their diets when making lifestyle choices that will offer relief and improve their overall functioning. The fibromyalgia-diet connection has in part emerged from the idea that people with fibromyalgia have mitochondria dysfunction, and therefore they need to increase levels of certain nutrients in order to produce enough energy.
While research hasn’t indicated specific foods that all fibromyalgia patients should add or avoid, there is a lot of anecdotal evidence that supports eliminating and adding certain nutrients to the diet for relief. For example, caffeine and highly processed foods are often linked to exacerbation of fibromyalgia symptoms. The relief that comes through this kind of mindful eating is buttressed by other healthy lifestyle choices, such as adding an exercise regimen to your day, getting enough sleep, and reaching out to a mental health professional.
Since fibromyalgia is so diverse in its symptom presentation, what works for one person might not work for you. There will most likely be trials and errors as one finds relief, and a multi-disciplinary and holistic approach will likely work best. This might include dietary changes, psychological support, and perhaps medications and/or herbal supplements.
Whatever your journey entails, I know and trust it is worth the hope of a healthier and happier life. You can and will come to thrive, one step at a time!