Meditation and Neuropsychiatry


Picture Credits: NeuroStar

The field of psychiatry is constantly evolving as we are discovering more about the brain and innovating new technology to study it. In this blog post, I will be integrating the concepts of neuropsychiatry and brain stimulation with meditative and yogic practices. I will be suggesting that the combination of interventional psychiatry and meditation can drastically improve the process of therapy and recovery from mental dysfunction. Mental illness is a serious issue in today's century, and various things are being researched to find what is the best course of treatment. Traditional treatments such as psychotherapy, cognitive behavioral therapy, and medications have often resulted in resistance over time. But if there is one thumb rule of therapy that we have learned throughout our trials it is that the combination of therapy and medication is by far the best way to treat any mental illness. It is with this hope, that I write about the integrative approach to medical treatment.


Mindfulness has been the great mantra in today's psychology world. Everyone wants to talk about how mindful they are in various situations and with various people. Many neuroscientists such as Sam Harri and David Eagleman have expressed the importance of meditation. There is a new surge of secular meditation practice that aims to bring mindfulness into the field of the non-religious, non-dogmatic hardcore empirical world. And certainly, this mission is only predictable given the vast amount of support for scientific discovery. As we discuss various concepts in this post, I will be referring to secular meditation, one that doesn't involve gods, religion, or any spirituality. But that isn't to say that meditation is restricted to the secular viewpoint. Meditation can be practiced from a religious perspective, but when taken in the medical context, there is less appreciation for its cultural roots. Therefore, when I refer to meditation, I refer to the act of introspection. The literal activity of meditation is to sit with your eyes closed and focus your attention on the sensations of inhalations and exhalations. The role of the meditator is to remain disenchanted and nonreactive as various thinking patterns begin to emerge. This trains the mind to remain balanced regardless of what types of feelings or thoughts come into the field of consciousness. Why is this so useful? Someone I was talking to said that meditation is just like sleeping. And certainly, the doubt is justified. What makes this practice of introspection so useful in the therapeutic sense? The reason why meditation has been so useful is that it allows you to observe your thoughts and feelings from a third-person point of view. The major mechanism of most mood disorders is the inability to stop spiraling into further emotional loopholes. When a feeling arises, if we aren't aware of it, it starts to produce an exaggerated behavior. 

Our nervous system is designed in a way that allows our emotional circuitry to overrule the cognitive pathways. In this case, we become impulsive, aggressive, and sometimes even dangerous. It is here when meditation comes in handy and allows us to disenchant from our obsessive thoughts. as Mark Epstein, author and psychiatrist states, it isn't the thoughts themselves that cause damage, but rather our relationship with those thoughts that leads to psychological distress. Through meditation, we learn to have a positive relationship with our thoughts, even those that may be negative. We start to learn that thoughts are simply transient states of the mind that occur due to the exchange of sensory input. Nonvolitional thoughts, such as suicidal ideation or obsession with self-harming, are an example of how quickly our thoughts can take control of us. These thoughts are triggered by the smallest changes in our world, but because of our sensitivity and inability to step back, we suffer the consequences of feeling overwhelmed and out of control. The first skill any therapist teaches a suicidal patient is to ground their senses and be aware of their breath.  In short, meditation allows the patient to observe the feelings as they arise, and apply control through the regulation of breath. Metacognitive introspective awareness, which is thinking about your thoughts, is known to strengthen prefrontal cortical activity. When our frontal lobes are more engaged in an emotional situation, we are likely to develop resiliency and courage. So how does all this tie into neuropsychiatry? Well, meditation sounds good on paper, but when people start doing it, they find it hard to continue their practice. The initial hurdle is difficult for people, especially those who may have traumatic experiences in the past and have difficulty staying still. It is here where neuromodulation and other biopsychiatric treatments enter. 


Currently, there are a couple of noninvasive methods of taking advantage of neuroplasticity and positively shaping the brain. The most common and effective treatment is ECT or electroconvulsive therapy. It is mainly used for treatment-resistant depression, bipolar depression, OCD, and suicidality. Other neuromotor conditions such as catatonia and Parkinson's also use ECT. Nonetheless, it has proven to be very effective when all other methods are unsuccessful. Another procedure is rTMS, repetitive transcranial magnetic stimulation, where a patient goes through several days of magnetic stimulations over some time. The patient's frontal lobes are activated by inducing a change in the magnetic field. This change leads to changes in cell membrane potentials which then eventually lead to more neuronal activation. Repeated activation of the frontal lobes, mainly the dorsal lateral prefrontal cortex, leads to higher mood regulation over time. The goal is to get enough activation so that the neuroplasticity can overtake the role of the magnet once the treatment is stopped. If treatment is successful, the patient will have a better chance of not going into a relapse of depression in the future. rTMS has also shown to be very effective in treating depression and bipolar. Research is going on to determine if it can be used for other conditions such as schizophrenia and anxiety disorders. A couple of other interventions include ketamine infusions, nasal spravato sprays,  and vagus nerve stimulation. All these methods are designed to improve mood regulation and impulse control. Most of the time, these methods are paired with some psychotherapy for maximum success. The reason why I discussed these was that they can very easily be paired with meditation. The goal of meditation is similar to that of a magnet in rTMS. Meditation aims to use the concept of neuroplasticity to improve our cognition, concentration, and impulse control. The physiological explanation for meditation is still unclear but we know that wave pattern activity in regular meditators tends to lean more towards the theta/ gamma range. These ranges are correspondent to our brain states during non-rem sleep. We know that memory consolidation and mood regulation are key functions of our daily sleep. So this leads to the postulation of whether meditation can serve as a mediator between sleep and concentration. You are awake when you are meditating, but there is only minimal sensory input. We know from previous studies on monks that deep meditation can lead to tremendously low waves in the brain, so low that it seems as if the meditator is dead. Such a low level of brain activation may be the key to neuroplasticity. Our neurons rewire and change the most when there is less psychological and physical stress. So like a magnet that induces neuroplastic changes in the brain, meditation serves as a natural way of repairing and maintaining proper neural networks. Oftentimes, charged emotions and thoughts may arise while meditating. These correspond to our cognitive distortions of the past. But if we learn to remain quiet and disengaged with our thoughts, our neurons might be rewiring the experience with a new feeling. If we associate each feeling and thought that comes to mind with a calm attitude, we may be enhancing positive neuroplasticity and perhaps changing some of the negative associations of the past. This brings us back to Mark Epstein's notion of having a positive relationship with ourselves and our thoughts. So the bottom line is that if we can pair one of these neuromodulatory methods with meditation, or even use meditation as a continuum of the initial treatment, then we may find great results. If we can initiate enough effort to meditate through the use of technology and chemical intervention, we may be able to help even those people who are extremely uncomfortable while meditating. 


Another great technique that has been used by any researchers looking at psychiatric conditions is Biofeedback. I like to think of this as physical mindfulness. We know mental mindfulness is being aware of the thoughts and feelings that come into our minds, but now with psychophysiological technology, we can extend the mindfulness experience to much more subtle sensations.  By hooking up electrodes that measure heart rate (EKG), blood pressure, respiration, pulse rate, diaphragmic muscle activity (EMG), skin/ sweat conductance (GSR), and brain activity (EEG), we can show the patients how their bodies change in response to various thinking patterns. Once the patient observes how their thinking affects their physiological measures, they can start to learn which thoughts are beneficial and which ones are not worth ruminating on. There can be creative ways of taking this a step further where the patient is asked to meditate, and each time their heart rate goes up or their EEG goes up, there can be a quick bird chirping sound to relax their response. 

There is currently a product in the market called MUSE headbands. They use headbands with EEG electrodes that measure your activity, and send the biodata to the configured app. That app, then, gives simultaneous audio feedback as it receives the EEG data through its Bluetooth connection. The goal of feedback is to tailor the EEG signals to your focus on the breath, and pair the guided meditation to your specific response of being focused and attentive. However, scientific papers conclude that the efficacy of such products is very low and that any neurofeedback product that is marketed as low cost is designed to have poor feedback system. Nonetheless, the goal is to let all the past stress come up and be able to remain still through it. And if they can do this while being mindful of their physical sensations, it can ease their process of recovery. Biofeedback is already being used in many places, but it is mainly in its commercial stage. Currently, there are only very few literature reviews on the efficacy of biofeedback in association with psychiatric illnesses. Nonetheless, the theory is that physical mindfulness or getting feedback about your physical systems will aid the patients to regulate them and not fall into the trap of exaggerating their physiological states. The more we are aware of our bodies and mind, the better we can cope when things go wrong directions. Biofeedback has a tremendous amount of potential and with classical conditioning paradigms, it can be used to treat various conditions that have clear psychophysical markers. A combination of visual imagery, auditory input, and various psychophysical measures can help the patient learn what types of thoughts/ feelings lead to heightened symptoms and which thoughts/ feelings lead to reduced symptoms. 



No Self in the Brain

Meditation's main goal is not only to produce a sense of tranquility and peace within the mind but also to lead to insight into your true self. When we contemplate impermanence, we realize that everything that I call 'Self' is only a transient entity in the world. My body is constantly changing so I can't cling to one or the other version of it and call it myself. My personality is shaped by the people I meet, the videos I watch, and the events I go to, so that too is subject to change based on my future circumstances. My mind and thoughts are also shaped by the environment, but mainly by my previous habitual thinking patterns. I may have memories and thoughts that I never wanted, but they still exist within me simply due to the nature of uncertainty. I can't control all parts of the body, most of the systems within my body work on their own, and if I can't control everything in my body, how can I call it myself. Can an entity be itself if it can't regulate its own parts? These concepts are the foundation of the principle of no-self. If we try to find a self within ourselves, we can't find one. If we say that our 'Self' is the brain, that too is false because there is no single region of the brain that we can point to and call 'me.' So we are in a tough spot where we have to say that the self or this thing that I call 'I' is a construct of infinite different variables. These variables exist within and without the body. 'I' cannot exist if my friends don't because my memories are me and my memories only exist because my friends exist with me. Just like this, there are infinite variables in the world that influence my actions, my thoughts, and my predispositions. This is similar to the Butterfly effect, where small things in the world add up to create a big change in the future. If we want to get to the root of "I" it is best to look at the ego. Freud is famously known for coming up with the word 'ego.' But many other cultures and religions have examined the concept of ego before Freud. Perhaps all of our mental problems arise because our ego tends to hide away from its failures. Our brain is simply the physical machine, but what or who dictates the brain to attend to this rather than that. What or who dictates the brain to think this rather than that, what or who dictates the brain to feel this rather than that? Two people can have the same experience but one may feel depressed after it while the other may burst into a manic episode. So what is the driving factor behind these different feelings and behaviors? The most reasonable answer we can give is the 'ego.' The ego is metaphysical and it cannot be understood through the empirical eye. But through meditation, one can start to dissociate from this ego and feel the aftermath of being ego-less. It is only when you become ego-less that you start to understand and see the ego. This all comes back to the concept of mindfulness. If we train our minds to be disenchanted when an experience occurs, and watch the feelings rise and fall, we don't let the ego build its portfolio. The ego only gets a chance to illuminate if we get caught up in pain and pleasure if we associate with some things and dissociate with others. When there is discrimination between likes and dislikes, there is discrimination between me and the world. For I only emerge when there is a preference for certain objects and events and association with desirable outcomes. And when there is discrimination between me and the world, there are more chances of being psychologically distressed and vulnerable to abusive remarks. Therefore, the root of all psychiatric conditions, at least those relating to mood, lies in this notion of ego. If we can meditate on the destruction of self, and be nonjudgmental to all phenomena in the world, we have a better chance of living a peaceful and calm life.