The mindful brain: why practicing mindfulness can make you more resilient to stress
Buddha goes West – how mindfulness conquered the capitalist world
An increasing number of people practice yoga and meditation, according to new data from the US National Center of Health Statistics. From 2012 to 2017 the percentage of meditation practitioners among US adults rose from 4.1% to 14.2%  – in Europe we would likely find a similar situation. Meditation apps, the biggest being Headspace and Calm, make millions of dollars in revenue each year and meditation courses and retreats in remote places become increasingly popular, with Europeans spending over 200 billion dollars on wellness tourism in 2017 . The numbers speak for themselves: mindfulness is fashionable.
It all started in 1979, when Jon Kabat-Zinn introduced the first course in mindfulness-based stress reduction (MBSR) at the University of Massachusetts to help patients with chronic illness and cancer deal with the physical and mental symptoms they were experiencing. This program continues to exist today. It combines elements of Buddhist meditation (vipassana), yoga and Zen and is free of any religious concepts or terminology. In an eight-week course participants learn several exercises which they should practice at home on a daily basis. These include body scans, where participants focus on sensations from the different parts of the body while sitting or lying still; breathing meditation, where breathing is in the center of attention; and yoga exercises teaching participants to be aware of the body’s movements and the sensations they generate. Additionally, participants are encouraged to reflect on their experiences during their practice and discuss topics of stress, stress management and how to apply mindfulness in everyday situations.
Mindfulness is defined as the non-judgemental awareness of experiences, which involves paying attention to what you experience in the present moment, meeting this experience with curiosity and free of judgement . The Five Facet Mindfulness Questionnaire, a tool to examine trait mindfulness, divides the substantial processes into five categories: observing internal and external stimuli, mentally describing them with words, acting with awareness while detracting from automatisms, not judging inner experience and not reacting to it . Someone who engages in mindfulness meditation can train both attentional processes and a non-judgmental attitude. They will focus on observing the present experience, letting go of any distracting thoughts and emotions, while not changing or evaluating them. It has been hypothesized that mindfulness can even change people’s relationship to their thoughts, in a process that is referred to as decentering or defusion . Decentering helps to view thoughts as subjective and transient rather than accurate representations of a rigid reality. While mindfulness can be practiced explicitly in meditation, it is also a concept worth carrying into everyday life.
The promises of mindfulness
The scientific validation of the therapeutic effectiveness of mindfulness practice has made ancient Buddhist knowledge suitable for its mass adoption in the West. Nowadays, several empirically supported interventions have been established that involve a form of mindfulness training and are partly subsidized by German public health insurances. These programs have reported high success rates in terms of improving psychological and physiological well-being . For example, mindfulness training proved to have positive effects on stress-triggered symptoms and relapse of diseases, including chronic pain, rheumatoid arthritis, and mood disorders . Non-clinical populations also profit from mindfulness interventions, as they can improve immune function and blood pressure, decrease levels of the stress hormone cortisol  and reduce symptoms of anxiety and depression , thereby counterbalancing the negative impact of chronic stress. The MBSR program is designed to foster greater awareness of the present moment, to generate an attitude of acceptance, to detach from habitual thoughts and rumination and avoid stereotype behavioral patterns. By helping people use effective strategies to cope with stress or illness, it makes them more resilient to adversity.
What doesn’t kill you makes you stronger – what defines resilience?
In the scientific community, resilience is defined as the ability to adapt successfully to adverse or stressful events . Successfully meaning that the individual is capable of maintaining or re-establishing their mental health and normal lifestyle even after experiencing a cruel stroke of fate. Certain personality traits seem to be beneficial to become more resilient: intelligent people may find more creative ways out of crisis, optimists are more likely to have the energy and patience to endure a situation because of trusting in improvement, and extraverts may have it easier establishing a stable social network that holds on to them in troublesome life phases .
However, data also suggest that resilience is not innate but needs to be learned by experience. In a big study collecting data from thousands of US Americans, Seery and colleagues noticed that participants that had already experienced a major crisis were better at coping with everyday stress than participants that had not gone through such a crisis yet . However, the effects seemed to reverse when the burden became unbearable (on average four existential crises, e.g. loss of a beloved person, an accident or a severe disease), suggesting that human ability to overcome stressful life events is not infinite.
If you are unexperienced in dealing with stress, this does not mean you should provoke a life crisis now. Chances are high that resilience can also be learned in an indirect manner, by strengthening abilities that contribute to successful coping. These abilities include a realistic concept of the self and others, emotion regulation, a positive attitude towards one’s own influence and agency, problem-solving, social competence, and calmness in stressful situations . Mindfulness is one way of fostering these abilities.
Training resilience with mindfulness – a focus on emotion regulation
Successful emotion regulation underlies the subjective reduction of stress , supporting the notion that emotion regulation is a major factor of resilience. We can consciously control our feelings, either by suppressing their behavioral expression (e.g. by controlling our facial expressions when we are in pain so that others won’t notice), by shifting our attention away from an emotionally salient stimulus (e.g. by distracting ourselves from thinking about the recent break-up with our ex-partner with activities we like), or by reappraisal (when we start to think that, after all, the break-up was something liberating as we were unhappy in the relationship anyway). Meditation and mindfulness training usually focus on the cognitive strategies, and studies have shown that the conscious attempt to regulate our emotions is reflected in the activity and connectivity of the so-called fronto-limbic network.
When healthy participants in fMRI experiments are asked to deliberately downregulate their affect towards an emotional stimulus, their brains normally show increased activation of areas responsible for conscious regulation of emotions – the prefrontal cortex (PFC) and the dorsal portion of the anterior cingulate cortex (ACC) – and decreased activation of the amygdala, the insula and ventral striatum, which are associated with automatic emotion processing .
Chronic stress and stress-induced psychiatric disorders are often accompanied by dysfunction in this network and by less efficient coping behavior. For instance, during cognitive reappraisal of emotional stimuli, patients with mood and anxiety disorders tend to recruit frontal areas to a lesser extent than healthy controls but show an increase in activity of areas relevant for emotion processing . In contrast, resilient people seem to have superior cognitive emotion regulation abilities, as some studies suggest. These studies compared patients with posttraumatic stress disorder (PTSD) with trauma-exposed individuals that did not develop the disease and non-exposed controls and found that resilient individuals are able to recruit prefrontal cortex and dorsal ACC more strongly during emotion regulation tasks than any of the other two groups .
Mindfulness interventions can directly affect the fronto-limbic network both functionally and structurally. Mindfulness is typically associated with a diminished response of the amygdala and enhanced activation of PFC areas in emotional processing tasks . Long-term mindfulness meditation practice induces widespread structural changes in regions involved in emotion control . Even a regular MBSR in a sample of highly stressed participants proved to already reduce gray matter density in the right amygdala, which correlated with the reduction in perceived stress . The amygdala is particularly concerned with the detection of arousing and potentially threatening stimuli and its diminished responsiveness and structural decline could be a result of reduced sensitivity to emotional stimuli due to enhanced top-down control by the PFC. However, very experienced meditators seem to lack this involvement of cognitive control and instead show predominant activity in sensory and integration areas . It is possible that they use a different coping strategy that does not depend so much on deliberate control of their emotions but on conscious experience.
How paying attention alters the way your brain copes with stress
Paying attention – it could be attending to the single parts of the body in a body scan or simply observing one’s own breath – is a key ability that is trained during mindfulness meditation. It is therefore not surprising that meditators tend to outperform non-meditators on tasks that require selective or executive attention . This competence is likely mediated by structural and functional changes in regions within the PFC and the ACC, which are involved in executive functions including attention regulation.
Enhanced attention also enables meditators to notice subtle bodily sensations, which is what is called body awareness. Meditators often report that they have a clearer perception of bodily sensations and neuroimaging studies have tried to reveal what changes in the brain could be responsible for such an impression. They identified increased task-related activity after MBSR , as well as greater gray matter density in the insula  in experienced meditators. Given its role in body awareness , it is conceivable that enhanced activity of the insula mediates an amplified awareness of momentary experiences and bodily sensations in those individuals.
The insula also plays a major role in subjective emotion, as imaging studies consistently found activation of the right anterior insula in emotional contexts . According to the famous James-Lange theory of emotion, changes in the physiological state of the body precede an emotion, as opposed to the emotion being generated in the brain first, which then triggers a bodily response. Accordingly, the insula contains a highly resolved “map” of the physiological state of all tissues in the body that serves as the basis for the subjective evaluation of how one feels . Conceptually, if there is a discrepancy between the current and the ideal physiological state, an emotion is generated to signal the body’s needs and drive behavior that serves these needs. As such, it is conceivable that improved body awareness translates into improved emotion awareness which would, again, facilitate emotion regulation.
Why mindful individuals suffer less from trauma
The way we cope with a trauma decides a lot about how we will think about the event in the future and whether we develop symptoms or not. If we habitually attempt to avoid any trauma-related thoughts or memories, we would very likely make it worse. This avoidant coping style indeed plays a central role in the maintenance of PTSD .
In contrast, dispositional mindfulness and an attitude of acceptance are associated with fewer psychological symptoms after exposure to trauma . While it might seem counterintuitive at first glance, increased awareness and contact with the present moment through mindfulness may help trauma-exposed individuals to tolerate symptoms of arousal or reexperiencing in the aftermath of trauma without resorting to avoidance. It might also help these individuals not to ruminate about the past or future and to maintain a decentered attitude towards their symptoms and feelings about themselves following trauma. Similar to exposure therapy, which is used to treat some forms of anxiety, meditation practice asks the meditators to expose themselves to any feeling, pleasant and unpleasant and not to change it or turn away from it. Eventually, one will learn to calmly observe these kinds of sensations, as they emerge and as they fade again, in an objective manner, without identifying with them too much.
Meditators indeed report an altered self-concept and reduced self-referential processing through practice. In the brain, this is reflected by a reduction of resting state activity in the default mode network (DMN) during meditation, which is more pronounced in experienced meditators than in unexperienced controls . The DMN is a set of brain areas that are active collectively in fMRI recordings where no task is presented (the so-called “resting state”). Importantly, current literature suggests that the DMN is involved in self-referential thinking and is often altered in psychiatric and neurological disease . Taken together, mindfulness practice may prevent ruminative, self-referential thinking and helps define a more adequate coping style.
Back to the essence – why we should be careful about overhyping mindfulness
With the introduction of MBSR and the invention of a kind of mindfulness stripped of its religious affiliations, it became more accessible to Western society and evoked the interest of neuroscientists and physicians alike. However, sceptics fear that it is being mindlessly overhyped as a tool for self-optimization – as a tool to enhance productivity, make better decisions, earn more money, and to handle the stress that our system imposes on us. Clearly, sitting down and meditating does not make the world a better place nor does it solve just any kind of problem. Mindfulness should not be sold as the panacea, due to the possibility of unsafe or adverse effects in particular patient groups and no clear understanding of its mechanisms of action. It might even be dangerous for people that are emotionally unstable, vulnerable to psychosis or have symptoms of depersonalization. For a lot of conditions, there is not sufficient evidence for the effectiveness of mindfulness interventions: a meta-analysis of 124 studies found that, in reality, mindfulness practice might be less effective in reducing psychiatric symptoms than many studies claim .
However, mindfulness practice reliably relieves the subjective feeling of stress and can potentially have therapeutic effects in diseases that are hard to cure, by providing people with a strategy to cope better with the distress it causes them. Practicing mindfulness may also have preventative properties by affecting neural mechanisms that are involved in stress processing in beneficial ways, including the fronto-limbic network for emotion regulation, the insula for increased body awareness and the default mode network for less self-referential thoughts and rumination.
We get overwhelmed by information, we are required to do multiple tasks at once, and are constantly distracted by a smartphone buzzing every few minutes. In these busy times, just make sure you reserve a few minutes for yourself to just calm down, to pay attention to what is happening inside and outside, and perhaps you will gain a new perspective on things. It could be while eating lunch, while reading a book, while playing sports, while having a discussion with a friend, while taking the bus to the first lecture in the morning – you do not even need to start meditating if that is not your thing. Mindfulness can be practiced anywhere at any time. Thus, there is no need for a fancy meditation studio, a retreat to Bali, or an expensive app – because, honestly, we should rather switch our phones off from time to time.
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Vanessa Kasties is currently a GTC Master Student of Neural & Behavioural Sciences.