Dr. B's Blog

Link between psychological stressors and stroke risk

From the American Heart Association:

Higher levels of stress, hostility and depressive symptoms are associated with significantly increased risk of stroke or transient ischemic attack (TIA) in middle-age and older adults, according to new research in the American Heart Association journal Stroke.

This research finding isn't new or news to those of us in the mental health community but whenever there's data to corroborate what is, at times, conventional wisdom, I like to take the time to post it. What was particularly telling from this study was that hostility was also found to be linked.

When I teach mindfulness, I tend to emphasize the connection I've found between judgemental thoughts and emotion, particularly anger. As we know, hostility is a type of anger, whether that be directed towards others or ourselves. As we strive to live more mindful lives, it's worth examining the connection between our judgements and our long-term emotional and physical health.

If You're Too Busy to Meditate, Read This

Mindfulness practice, sometimes equated with meditation, is a very big part of DBT. It helps us focus and manage our emotions more effectively. It helps us live in the moment without judgement and increases our awareness of our current experience. It helps us stay focused.

Research shows that an ability to resist urges will improve your relationships, increase your dependability, and raise your performance. If you can resist your urges, you can make better, more thoughtful decisions. You can be more intentional about what you say and how you say it. You can think about the outcome of your actions before following through on them.

Kids and mindfulness

Jonah Lehrer, one of my favorite neuroscience writers in in the popular press writes:

Children who could better regulate their impulses and attention were four times less likely to have a criminal record, three times less likely to be addicted to drugs and half as likely to become single parents. In many instances, the ability to utilize executive control was more predictive of adult outcomes than either IQ scores or socioeconomic status.

This is an interesting perspective. While he doesn't mention mindfulness by name, it's essentially what he's talking about. Specifically, he's referring to the aspect of mindfulness that helps manage attention. Developing ability to choose where to focus your attention seems to have benefits across the lifespan.

One molecule at a time

The concept of mindfulness is often referred to when initially helping clients with feeling overwhelmed - with work, family, emotions - to help them control and manage their thoughts and feelings. The concept taught during DBT skills groups often revolves around doing one thing in the moment. Technically, this is called the skill of "one-mindfulness" when teaching the Core Mindfulness section of DBT. During teaching, we often refer to multitasking In Real Life like we do when we try to multitask on a computer.

The metaphor goes something like this: before we could multitask, focusing on one window at a time made us more productive. Or rather, we maintain that computers are not able to be as efficient when multitasking because they get bogged down with too many programs open.

That was the way things were back then. We walked both ways, uphill, in the snow, to school and we liked it, darn it!

As a power computer user, I always found this analogy to be lacking. Well, as a power Mac computer user, I found it to be lacking. I'm typing this article on a computer that weighs less than 3 lbs. with a processor that is "slow" by many standards with probably 20 applications open. And my computer isn't slowing down at all. (For those interested, this is what I'm using.)

The truth is, I like multitasking on my computer. As a "good" "mindful" person, I've felt guilty about that. I admit it, it always drives me crazy to see someone use a full screen view on their Word document, with big white borders on the sides (my eyes hate to see all that white screen), or even worse, with text stretching across the length of their computer's widescreen monitor (how does that make for comfortable reading?). It always struck me as a waste of valuable screen real estate to make a window actually full screen. Modern computers have advanced windowing systems and memory management specifically so we could multitask. How could technology be so focused on giving us the ability to multitask if the act is inherently inefficient?

I couldn't reconcile my view on being one-mindful and its importance in developing a sense of balance with my avid use of multiple windows and applications on my computer. That is, until I read an article by Lukas Mathis about how we are incorrectly equating multitasking on a computer with multitasking in real life.

However, the argument that multitasking on computers is bad because humans can’t multitask is flawed. It uses the word «multitasking» in two different ways, but implies that the two kinds of multitasking are somehow the same thing. They’re not: a task (or an app) on a computer, and a task performed by a human don’t map to each other one-to-one. In fact, a single task performed by a human can easily make use of several applications running concurrently on a computer.

(Ed. note: emphasis mine)

Computers and programs are like single atoms. Well designed apps do one thing and do them very well. The idea I'm proposing is that we be mindful one molecule of behavior at a time. In chemistry, a molecule is the smallest unit of a compound that still retains the properties of that compound. Nothing added and nothing taken away. You can't have a molecule of water without 2 hydrogens and 1 oxygen atom. No one would claim that H2O is anything other than one thing - a molecule of water. Similarly, many of the complex tasks we undertake as humans involve more than one atom of behavior but can be grouped into molecules of behavior. Within the molecule of writing, there's typing, reading, cutting, pasting, etc. There isn't, however, listening to music, watching YouTube or responding to emails. Those are impurities in your compound.

One molecule of behavior at a time.

So, while multitasking for computers is a desired state, it's not in humans. We're more complex than computers and necessarily work on the molecular level. There. In one article, I solved my cognitive dissonance of having 20 applications running at once (and liking it!), justifying how I can be mindful while doing it and proving we're better than Watson. That's a trifecta if I ever read one!

Immersion and Mindfulness

I'm a big fan of games. I think a good game can be a nice distractor (a distress tolerance skill) when we need one, can be a nice reward if we're struggling with motivation (an emotion regulation skill) and help us practice mindfulness if we're, umm, mindful while playing. I came across this article a little while back which highlights some of the reasons games have the effect they do on us.

People who experience immersion tend to only consider choices that make sense in the context of the imaginary world. Someone immersed in Red Dead Redemption, for example, might be more likely to use travel methods, like stagecoaches, that make sense within the game, instead of methods that don’t (like fast traveling from a menu screen). People immersed in media also tend to enjoy it more.

It's not "research" in the sense that there's no hard data, but there is some sound theory in the reasoning and a couple of links to relevant research articles.

Ψ Mind your emotion

One of the complaints I often hear with respect to blogs is that they feel a lot like opinion and very little like research and data[1]. A primary objective of this particular blog is to present to you data that supports my assertions. Since I’m not a researcher (and there are many more talented people doing good work) I’m going to review articles for you. It may be that you don’t have access to these articles or you don’t understand them because of all the research-ese that goes into them. No matter the reason, I hope to help.

First up in our ”mindfulness articles” series is “Minding One's Emotions: Mindfulness Training Alters the Neural Expression of Sadness ” (warning: pdf link). This technical article examines the differences in fMRI data from a control group and a practiced mindfulness trained group in response to induced sadness. [2] As with much rigorous research, the groups were randomly assigned to control or treatment status and data were compared with the same stimuli.

The researchers utilized 3 minute clips of video, alternating in valence between sad and neutral video types and gathered data on participants’ subjective degree of sadness. The data were analyzed using a multivariate procedure designed to test for significant differences between groups and across time points and valence of the video (technically called a 2x2x4 mixed model ANOVA). This type of analysis allows us to draw conclusions about what the actual differences are between these various conditions.

Interestingly, the researchers found no difference between the control and mindfulness-trained groups on level of subjective sadness. That’s right - there was no difference between the participants who were trained in mindfulness and others on how affected they perceived themselves to be by the video clips. They were, however, less physiologically reactive to the stimuli.

Examining the effects of MT, we found that despite similar levels of self-reported dysphoria, the MT group demonstrated less neural reactivity to sadness provocation than the control group.

In other words, their brains reacted differently to the information presented by their “emotional system”. We find some information about what could be occurring in the fMRI data also collected during the study. There appeared to be less activation in the areas of the brain associated with self-referential processing [3] and autobiographical memory. Similarly, the mindfulness trained group exhibit less inhibition in brain areas associated with interoceptive awareness. This difference suggests that they are somehow regulating their emotional response (which, you’ll recall, is similar across both groups) differently/more effectively than untrained participants because they are aware that something is happening to them. In other words, they are mindful of their current emotion.


There appears to be two take-home points from the afore-reviewed article. Our mindfulness-trained participants did not generate self-referential thoughts in response to the video clips. This cognitive distance appeared to allow some separation between the participants and the subject matter. And, secondly, there a marked awareness of the physiological processes occurring during the emotional experience and that process was observed as such - a physiological change.

A plausible mechanism of action for mindfulness effects may include the development of metacognitive skills for detached viewing of emotions, rather than the elaboration of emotional content through cognitive reappraisal.

This suggests a different way forward for dealing with significant negative emotion. Typically, our best efforts at dealing with emotional information is to re-attribute, re-evaluate, re-interpret the events. We work on generating alternative explanations for behavior or shifting “locus of control” to an external object, as well as using perspective taking (e.g., “How would you tell your friend to react to this situation?”). One of the problems with this type of strategy is that we have a tendency to end up in circular arguments with one “side” being more persuasive than the other depending on, guess what? Your mood. And when you’re already depressed, you’ve got a harder time doing this reappraisal work. [4]

By shifting the plane of focus to something other than the cognitive back and forth we typically see, mindfulness can allow a different way to process information. By exiting this necessarily circular argument, we can start to make progress on dealing with emotion as it is: a natural reaction to events. When we start viewing emotions as natural phenomena and not events that need to be challenged or beaten back, we may finally be able to end the fight against reality in which we have been engaged.


[1] I personally don’t subscribe to this view of blogs. There are a great many that are better, in my opinion, than “real” news

[2] They used movie clips that were chosen for their ability to elicit sadness.

[3] Self-referential processing is defined as one’s tendency to relate information to him or herself

[4] Keightley, M., Seminowicz, D., Bagby, R., Costa, P., Fossati, P., & Mayberg, H. (2003). Personality influences limbic-cortical interactions during sad mood induction. NeuroImage, 20, 2031–2039.

Mindfulness of Eating

The Buddha told monks to take meals silently, with no books or conversations to distract them, only an awareness of what their body needs to get through the day. When they felt full, they stopped eating, even if that meant leaving food in the bowl.

As a full-time therapist at the Carolina House, a residential facility for eating disordered women, I spend a lot of time thinking about how to use DBT skills, particularly mindfulness, to help our residents deal with their various eating issues. For these women, food is terrifying. I teach them mindfulness skills to help them manage their fear around food and prevent the use of symptoms such as restricting or purging. It’s a hybrid of treatment for OCD, with exposure and response prevention, and systematic desensitization.

Regardless of the mixture of behavioral therapies that takes place at Carolina House, the core of my teaching involves mindfulness. A recent book by Jan Chozen Bays called Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food further illustrates the benefit of using mindfulness to bring balance to one’s diet. Pay attention to your hunger and satiety cues and let your body tell you what you need. There is one caveat to that belief: our bodies can be easily fooled into thinking we need more (or less) than we actually do. If you’re having trouble regulating your meals, start by meeting with a nutritionist to get your perceptions in line with reality and then use mindfulness to get you the rest of the way there.

Mmm. (Or: More on Music and Mindfulness)

Following up on my recent blog entry on music and mindfulness, I stumbled across an article on Science Blogs about how music affects our brains. I didn’t read the journal article this article summarizes article before I posted my entry or before my latest DBT-U music and mindfulness practice, though I wish I would have.

The article stated more clearly than I could have why I find music such a good focus for mindfulness and why I find familiar songs to be extremely effective foci for my practices. Essentially, my brain is fooled into expecting patterns in the music and when it doesn’t get what it expects, it wakes up and takes notice.

Music only excites us when it makes our auditory cortex struggle to uncover its order. If the music is too obvious, if its patterns are always present, it is annoyingly boring.

This matches up nicely with my recommendation that the piece of music be complex enough to be interesting. And probably why I don’t really like pop music much.

Using music

Let me get this out of the way at the beginning of this post: I can’t sing. I can’t play any musical instruments. I have not one whit of musical ability in any of my cells. My 3 year-old son will say “Share my song with you tomorrow, baba” as his polite way of asking me not to sing. 

But I love music. I can’t get enough of it. I can listen to the same song endlessly. I’ll listen to the percussion. Listen to the strings. Listen to the vocals. The ups and downs, highs and lows. I find that each time I listen to a familiar song, really listen, I’m rewarded with something new. 

Not coincidentally, I frequently use music a the focus of my mindfulness practices, both for my personal practice and my groups’. There are few characteristics I try to keep in mind when selecting a song for a practice. Obviously these aren’t essential but they’re a good starting point, at least:

  • Layers. Choose a song with some complexity so your exploration is rewarded.
  • Interesting lyrics. I don’t necessarily mean “understandable” lyrics. Some of my favorite songs for mindfulness are in languages I don’t understand. Some are perfectly understandable.  And some I should understand but are completely unintelligible. I doesn’t matter if you’re looking for story-telling or for another instrument.
  • Length. For group practices, I generally look for songs that are about 4 - 5 minutes in length. For my personal practices, I might select something a little longer.

As I said, these are just guidelines to get you started on your search. When you first use this particular practice, remember to be effective. Make sure you will be uninterrupted and, if possible, use headphones. Pick an instrument and follow it throughout the song. Even when it’s not “there”, see if you can hear it. Remember to follow your breath while listening to the music.

Please post in the comments if you find this practice to be helpful and if there’s a song you like to use. Other suggestions are also welcomed.