9UNP0120SD_Richard Davidson_WordPress

- Thank you very much. It's a pleasure to be here today and to give you a taste of the work that we've been doing, and discuss its implications for what many of you may do in the broad domain of spiritual care. I don't know the details of people's background here. And I may drift into things a little bit technical. But I'll try to skip over them if I see some glazed eyes, and make sure to leave some time at the end for questions, which I suspect will be particularly interesting. So what I'm going to talk about today is our research on meditation and what it may imply for spiritual care in healthcare settings in particular. And I want to frame this in the larger context in which this work is occurring. So this was the cover of the Time Magazine issue on the Science of Happiness that was published about a year ago, in which some of our work was featured. This kind of stuff is very much in the news. 

This was the cover of a National Geographic. And this photograph was taken in my lab. This is a Tibetan Buddhist Monk, who is being set up to have his brain monitored while he engages in particular kinds of meditation practices. This is the cover of a program, a meeting, a small meeting, that I was asked to organize for the Dalai Lama that was held at his home in India on the theme of neuroplasticity. Neuroplasticity in the idea that our brains can change in response to experience, can change in response to training. And this really is probably one of the most central findings, if you will, or most central themes in neuroscience over the last decade. There are many different mechanisms of neuroplasticity that have been discovered, but the way that we think about the impact of certain kinds of practices, like meditation, as it may affect an individual's behavior and experience, is through its effects on plastic changes in the brain. The work of this kind, I believe, will place this on a much firmer scientific footing so that the healthcare establishment will indeed take these practices much more seriously, because a scientific mechanism for them will be much more well understood. This is just some pictures from that meeting in India, which was held a couple of years ago. And speaking in the hot seat next to the Dalai Lama is truly an amazing and unusual experience, different than any other kind of scientific talk. 

This is what the room looks like there. In fact, I just got back this past weekend. We had a meeting with the Dalai Lama at Emory university on the theme of compassion and depression, where we showcased some of the recent scientific evidence in that area. It was really a spectacularly successful and interesting meeting with about 3,500 people in attendance. So, there are two points that I want to make in my talk today, two big points. The first point is that people differ in their levels of happiness, and things related to it, including qualities like loving kindness and compassion. And these differences are associated with different underlying biological characteristics. The second big point that I will make is that happiness, compassion and loving kindness can all be regarded as the product of skills that can be enhanced in training. And that this training induces plastic changes in the brain. And these changes also have effects on the body in ways that may be consequential for physical health. 

So those are really the two broad points that I want to make. Everything else is really a footnote to these two points. I want to remind all of you though, that in our country in particular, in addition to being a state, or a trait, or a skill, happiness is an inalienable right. Something that may be not so apparent in the current environment, and with our current political administration. But these indeed are the words penned by Thomas Jefferson, which you all know. But it doesn't hurt to remind us that this is one of the founding principles upon which our country is based. Now I want to just very briefly show you at the outset that happiness, and qualities like this are not just ephemeral mental states, but they also have consequences for morbidity and mortality. This is from a Finnish longitudinal study that was done a number of years ago with about 30,000 individuals who were followed over the course of a 20-year period, where investigators monitored their level of happiness. And people here are divided from very happy to very unhappy, and then followed over this 20-year period. People who reported themselves to be very unhappy over this 20-year period were more than ten times likely to actually commit suicide. 

So the qualities of happiness are something to take seriously. This is a more recent article that was published in the proceedings of the National Academy of Sciences from a group in the U.K., where they were specifically monitoring levels of happiness and well-being, and looking at specific immune, endocrine and cardiovascular indices that are very importantly related to health. In this large sample, they found that individual's level of happiness was strongly associated with each of these domains, and suggests that, again, these qualities have potentially very important consequences for health. And so it's not just trying to make a patient feel better subjectively, trying to increase their well-being, but that these changes that you may be able to induce in patients will likely change the brain and have downstream effects on their biology, which may be beneficial for health. So that is a central theme of this work. I want to just show you at the beginning some fun slides that relate to this issue of the malleability of happiness and other characteristics. In the next three slides, I'm going to show you are based on real data. I promise you, I did not make them up. But they serve to illustrate a very important point. So we're going to ask the question whether social and economic factors modulate our level of happiness. 

So the first question is whether marriage buys you happiness. And here's the answer. If you get married at this point, again, these are real data based on tens of thousands of people. This is a measure of life satisfaction, a proxy for happiness. At the time you get married, there's a big boost in your happiness. But look what happens as you get further from the time you get married. So at five years-plus, you're actually doing worse than before you started. Now these are average data. I recently celebrated my 31st wedding anniversary, and I'm very happily married. So there are many violations of this normal pattern. 

But this is in fact, what the data say in our culture. The related question is whether widowhood produces unhappiness. And here's the answer. 
(laughter)
 So again, you take a big hit. But you come right back down to baseline. Now, of course, the question, which is a question that our culture is particularly obsessed with, is the question of whether money can buy you happiness. Here's the answer to that. So if looking from 1945-2000, if you plot the real income per head in the United States, our country has been, by and large, spectacularly economically successful. If you superimpose upon that the percentage of people who report themselves to be very happy in our country, it's flat. 

It's absolutely unrelated to the economic success. Now it's not to say that money is completely unrelated to happiness. If you look across cultures, those countries that are doing much, much worse, in fact, are also worse in terms of levels of happiness. But within western culture, and countries that are part of western industrialized democracies, there is no relation between money and happiness. So where does that leave us? Can happiness, compassion, and loving kindness be enhanced or are we all stuck at our respective set points? And I'm going to suggest to you that while the data that I showed you are in fact, what the data reveal in terms of the relative imperviousness of well-being and happiness to certain social and economic factors, that doesn't mean that happiness and well-being cannot be enhanced. So the work that we do, I frame within the context of neuroplasticity. There's a lot of work which suggests that there are many domains. I've just listed a few here. 

One is musical training. We know that as a person learns to play a complex instrument, there are actually changes in the brain that are induced that can be tracked with modern neuroimaging methods, both structural and functional changes. So this is an example of how the learning of a complex skill is associated with important changes in the brain. Certain motor skills are similar. There was a recent paper published in the scientific literature showing that jugglers, as they become masters at juggling, have induced changes that can be tracked in their brain. We know from research at the animal level, that there are profound maternal effects that can be induced in the brains of their offspring. The differences that a mother expresses toward her offspring in nurturance, in love and compassion, actually induce changes down to the level of gene expression in the brains of those offspring. And those changes persist for the entire life of that organism. These are phenomena that can be addressed using rigorous scientific methods. We also know that stress and exercise have effects on a very recently discovered and extremely important mechanism of neuroplasticity. 

And that is neurogenesis. Neurogenesis refers to the growth of new neurons, something that even, ten years ago, there was a lot of skepticism about; 15 years ago, no one believed. We now know that neurogenesis is a robust phenomenon. It occurs in all brains. It occurs throughout the entire life of an individual. And we know that stress impairs neurogenesis. We also know that neurogenesis plays an extremely important role in aspects of learning and memory. So, imagine that there are two individuals. I've labeled them "A" and "B" here. And imagine that they're both exposed to some stressful life event here. 

The way I've drawn these curves is meant to illustrate differences in the rapidity with which these individuals recover from the stress to which they have been exposed. So in this diagram, person "B" recovers much more quickly compared to person "A". We believe that these differences reflect important features of differences among people in the capacity to regulate emotions, which can be tracked using modern neuroscientific methods. I won't bore you with the details. But if you show a person a picture like this, that depicts human suffering and you instruct them, instead of reacting with disgust or anxiety to a picture like that, to change their response so that they have compassion toward that individual who is suffering, it transforms the way the brain responds to those kinds of stimuli. I won't go through the details of this. But one important area in the brain which is modified is the amygdala, which we know to be a very important site for the mediation of negative emotion. Now it turns out that the differences among people in their capacity to modulate the amygdala, is associated with downstream biology, peripheral biology that may be consequential for health. In this particular study, we measured the stress hormone cortisol, and found that the differences among people in how able they are in regulating their amygdala is actually related to differences in cortisol profiles, which may be very important for health. And I'm just going to skip that in the interest of not boring you with scientific detail. 

I can come back if there is interest. I want to now spend the rest of the time on this question. What's the impact of more systematic training of the mind on the signals in the brain that are associated with emotion. And this brings me to a very unusual project, which has been going on in our lab for the past six years. This project was inspired by my first meeting with the Dalai Lama, which was in 1992. Then beginning in 2001, we had a string of long-term meditation practitioners come visit Madison and spend time in my lab. This is one of them here. He actually is named Matthieu Ricard. He's published a number of popular books. He's been a Tibetan Buddhist Monk since 1967. 

He also happens to hold a Ph.D. in Molecular Biology, where he received that Ph.D. from The Pasteur Institute where he worked with Francois Jacob, the Nobel Laureate. So he comes with particularly unusual credentials. This is another monk in our lab. This is actually the one that appeared on the cover of the National Geographic. And when they come to our lab, we actually spend as much time just conversing with them as we do in the laboratory, because they have played a very critical role in helping us actually design these experiments to make them sensitive and appropriate to the kinds of practices that they have learned over the course of the years they have spent training their mind. This is just a shot of me giving Matthieu instructions before he begins to meditate. And this is Matthieu just after he came out of the MRI scanner. He had been in the scanner for about three hours. 

Most people don't look like this when they come out of the scanner. But he was just radiant most of the time. This is just a picture in the lab, in another lab where some of the monks help us run these experiments. I'll show you just a little bit of data from these studies. What we've done in some of these studies is just have the practitioners meditate for brief periods of time. They are alternated with a neutral state. And we've probed the meditation period with, in some cases, strong emotional sounds that we present during the meditation. So for example, during compassion meditation, we've presented very negative emotional sounds, sounds of a person screaming, for example, to see what happens in the brain when the individual is generating compassion and they are exposed to this kind of adversity, to signs of human suffering, if you will. So in this work, which is on the voluntary cultivation of compassion, we've been studying practices that are central to the Dalai Lama's mission and his lineage. These guys engage in specific practices that are designed to cultivate compassion. 

And in the words of Matthieu Ricard, I'll just read part of this. This describes what the practitioners were doing in this experiment. What we have tried to do for the sake of the experiment is to generate a state in which love and compassion permeate the whole mind, with no other consideration, reasoning or discursive thoughts. This is sometimes called pure compassion, or non-referential compassion. Now you know on television there are sometimes those commercials, where they then say, "Don't try this at home." Well, you can try this at home, but the likelihood is that if you are relatively untrained, you are not going to be able to do this, because this is the end point of many, many, many, many years of training, where the mind gets very, very focused and is able to do something like this. Most of us novices are really not able to do this with any kind facility. Now we have observed dramatic changes in the brain when the practitioners engage in these kinds of practices. And this is just the brain electrical activity during a resting period and then during a transition to a meditation period. You don't need, even, any fancy computer signal processing to see that there's just a very dramatic, overt difference in the EEG when the practitioners go from a neutral resting state to a meditation state. 

These are dramatic changes. They actually have never been seen before in the human brain. And we reported them a few years ago in an article that, a post-doc of mine, Antoine Lutz, was the first author on. This just shows from the original article. At that time, we had eight practitioners, and ten age-match controls. The practitioners were showing dramatic increases in these signals, whereas the controls, who were taught to meditate and were meditating for a couple of weeks before they came into the study were showing modest changes at best. And most of them showed no systemic change at all. One of the questions that we asked is whether the length of their meditation training actually predicts any of these changes that we see in the brain. And the answer is yes, it very strongly predicts it. The practitioners that we tested, all had a minimum of 10,000 hours of formal practice. 

They all had done at least one three-year retreat, where they were meditating at least eight hours a day, seven days a week, for three continuous years. The actual range of practice in this study went from 12,000 to about 62,000 hours of practice. There's a very strong relation between the changes in these signals in the brain and the number of hours of practice. Now there is a particularly interesting part of the brain that we've been looking at, specifically in relation to compassion practices. It's illustrated in this coronal brain slice. And it's called the insula. The insula is the only place in the brain that contains a viscero topic map of the body. That is, it actually maps the body states and provides information about what's going on in the body to the rest of the brain. The insula also has descending pathways to the body, and can influence the body in systematic ways. The red lines belong to the long-term practitioners. 

The blue lines here belong to the controls. And this is during the generation of compassion. And these are evoked changes in the brain that we detect with fMRI in response to those emotional sounds that I described. What you can see is this. That the solid line is the meditation period. The dotted line is the neutral period. What you can see is that when practitioners are generating compassion, there is a specific enhancement of the insula response to the emotional sounds. Now that's not the only area of the brain that's changed. Another area that we've been particularly interested in is an area of the brain that has been very strongly implicated in empathy that has been linked to making inferences about the mental state of others. And it is an area that is known as the right temporal-parietal junction. 

It's in the right hemisphere, where the parietal and temporal cortex come together. And again there's a dramatic increase in activity in this area among the long-term practitioners-- Excuse me, when they are generating compassion. Now you may look at this and say, "Well this is all well and good, but probably no one here is about to go off and meditate for three continuous years." So can more short-term training produce effects which are similar. And it's our conviction that even small amounts of training can make a difference. So we're involved now in a study with just two weeks of training. And this is in rank novices who receive two weeks of a compassion intervention. It's a daily practice which they're asked to do. They're asked to do it for 30 minutes a day for two weeks. And we have a comparison group that's taught cognitive reappraisal. 

This is a therapeutic technique that's derived from cognitive therapy, which is used to treat patients with depression. And we actually deliver the intervention online. And so they log-on to a protected Web site. And they actually receive the intervention. And that's a way for us to monitor the number of minutes per day that they're logged on. The intervention is delivered by highly experienced practitioners. And the elements of the compassion training include the contemplation and visualization of suffering, and then wishing the freedom from that suffering for a number of different people, for a loved one, for themselves, for a stranger, for a difficult person, and for all beings. And so they are given that instruction to very intentionally imagine, visualize the suffering of these individuals, and then that these individuals would experience a relief from suffering for each of those categories. And they do this for 30 minutes a day for two weeks. They use phrases that they say to themselves. 

They repeat silently. The most common phrase is, "May you be free from suffering. May you experience joy and ease." And they're specifically instructed to pay attention to the visceral sensations, especially in the area of the heart, that may be elicited by this practice. They also are specifically instructed to feel the compassion emotionally and not to simply repeat the phrases to themselves cognitively. Those are the essential elements of the intervention. They go through this training. We put them in an MRI scanner after they finish their two weeks of training to see how just two weeks of training may have changed the brain. What we do in the MRI scanner is we expose them to these pictures that depict human suffering. You can think of this as analogous to a cardiac stress test. 

When you go to a cardiologist to have your cardiovascular function assessed, you are often given a stress test where you would challenge the cardiovascular system with exercise. Well, this is a brain stress test. We are administering stimuli to the person. In this case to depict these imagines of human suffering, to challenge the person to see how the intervention may have affected their ability to deal with these kinds of stimuli. Now we also administered a number of self-report questionnaires, one of which is a questionnaire called the self-compassion scale. Two of the items on the scale are these. I try to see my failings as part of the human condition. When I'm feeling down, I try to approach my feelings with curiosity and openness. Now on these scales, after two weeks of training, participants report significant increases. And we compared it to the control group, the cognitive reappraisal control group, which shows no change whatsoever. 

We also asked them, after the scan, to rate the their experiences on a number of different dimensions. And one of the dimensions that we asked them about is their willingness or propensity to want to approach the person in the picture who is suffering with a wish to help them. And again, the individuals in the compassion training condition actually report significantly more willingness, or interest in want to approach and to help, compared to the subjects in the cognitive reappraisal conditioning. Now when we look at what's happening in the brain, sure enough, that same part of the brain that I talked to you about earlier, it's the insula, shows a significant difference between these conditions. If you look at the compassion training condition versus the cognitive reappraisal condition, there's a huge difference in the activation of the insula when they are generating compassion. Another scale that we used comes from scales of well-being, developed by my colleague here at the Institute on Aging, Carol Riff. Two of the items from this particular subscale are, when I look at the story of my life, I am pleased with how things have turned out. And in general, I feel confident and positive about myself. Well, it turns out that the magnitude of activation in the insula when the person is doing the compassion practice significantly predicts the participant's reports of well-being on this self-acceptance scale. The more activation they show in the insula, the greater the levels of well-being. 

Now one of the unusual things we did in this study is this. We paid people for their participation in this study. They actually got $165 if they completed the whole study. And these actually were students that were the participants in this study. So $165 was a pretty nice sum of money. At the end of the experiment, we gave them an opportunity to actually donate some portion of the $165 we gave them to any charitable cause of their choosing. And this was not deception at all. This was real money. They were doing real donations. So this was all completely straightforward. 

They actually executed the transaction in the laboratory online in the last part of the experiment. So we asked the question whether changes in the brain that we measure, particularly in this same area, actually relate to the amount of money that the subjects gave. And it turns out that there's an extremely strong correlation between activation in the insula and the amount of money that subjects actually donated to a charitable cause at the end of the experiment. We found that the subjects in the compassion group donated more money, and particularly those that showed the biggest boost in activation in this brain region donated the most money after the experiment. Now another dimension that we have assessed-- And I won't spend much time on it now. I'll go through these slides quickly in the interests of leaving time for questions. Is attention-- In the framework of neuroscience, we can think of meditation as operating on two major domains. One is emotion, and specifically positive emotions, like compassion of the sort that I showed you. The second domain is attention. So meditation really can be thought of as a training ground to cultivate more focused attention, more well regulated attention. 

This is a quote from William James, from his two volume tome, the Principles of Psychology. William James was just extraordinarily visionary in his understanding of the importance of attention. And he said here, "The faculty of voluntarily bringing back a wandering attention over and over again is the very root of judgment, character and will. But no one is compos sui if you have it not. And an education, which should improve this faculty, would be the education par excellence. But it is easier to define this ideal than to give practical directions for bringing it about." And I should note that the italics here are in the original. They're not my italics. So James really understood the extraordinary value of cultivating attention. And I'd like to suggest to you that meditation is the premier method that we know something about today, which should be exactly the right set of procedures for educating attention. 

Most practitioners and teachers of meditation I think will tell you that training attention is really the substrate. It's kind of the basic skill which is needed for all other kinds of meditation. It provides the tools for doing other things with meditation. So it's often the first thing that is cultivated. We've recently published a series of papers. One is in long-term practitioners. And the other is in less well trained practitioners, but still intensive meditation, which I'll describe in a minute. But this is from a very recent paper that we just published. Julie Brefczynski was the first author who is a post-doc in my lab. This was a study using functional MRI to interrogate the neurosystems associated with the tension in long-term practitioners while they were doing a particular kind of meditation that involves focusing attention. 

I won't, again, bore you with the details. But there are a range of different areas in the brain that have been described as underlying different facets of attention, all of which were significantly changed in the long-term practitioners, compared to several different control groups, which we had in this study. Another study that we also just published in 2007 was a longitudinal study. This kind of evidence is particularly important. This was a longitudinal study over the course of three months. And it was done at a retreat center here in the United States, where we set up a mobile laboratory. And we assessed people before and after an intensive three-month meditation retreat, where participates in this retreat were meditating for about ten hours a day, for three continuous months in complete silence. A very intensive practice. We were specifically looking at a component of attention, which is considered to be relatively fixed and unalterable. And what we are looking at is a phenomenon that is known as the attentional blink. 

What the attentional blink is, is described here. If you are presented with a rapid stream of visual stimuli, let's say in the simplest case here, letters and numbers. Most of these are letters and you occasionally get numbers. They are occurring very, very rapidly. At the short interval, they're about a third of a second between each stimulus. So each stimulus, you're getting three stimuli per second. It's just firing away. And if the person's task is to report each number that he or she sees, what you find, which is really quite startling if you're a subject in the experiment and actually experience it, you do not perceive the second number when it follows immediately an initial number. When it's very closely spaced in time, you don't see it. It's as if your mind goes blank or your attention blinks. 

It was thought to be a robust property of the nervous system, where the nervous system is kind of in a refractory period and you're literally unconscious of the next stimulus. Well, it turns out that it ain't necessarily so. If you meditate for intensively in this way, you become much more aware, moment to moment, of the broad array of information in your environment. And you actually alter your intentional blink, which was thought not to be possible. So I won't go through the details of this, but we found very robust evidence that among these practitioners from before, to the end of the meditation retreat, they showed a significant increase in their ability to detect these stimuli. And another way to say it, they showed an attenuation of their attentional blink. We found corresponding changes in their brain. We monitoring their brain while they were doing this task. And there were important changes in their brain that underly this change in their capacity to pay attention. So the last thing I'll just briefly mention, although I've eluded to it, I haven't shown you any direct evidence for it yet. 

The changes that are occurring in the brain are connected to the body. Through structures like the insula, as well as through our endocrine and our immune systems. Part of the program of research in which we've been engaged is not just to study what's happening in the brain, but also to study how those changes in the brain may be impacting the body. And in one study that we did, I'll just give you one example. This comes from a study that was published a few years ago that we did with employees here in Madison at the Promega Corporation, where we collaborated with the UW Division of Integrated Medicine, and specifically the mindfulness-based stress reduction program directed by Katherine Bonus. We administered MBSR to these individuals over the course of two months and looked at changes in the brain and the body. And one of the things that we looked at was responses to influenza vaccine. All the participants in this study were given an influenza vaccine. And by taking blood samples at different points after the vaccine, you can actually get a quantitative measure of antibody titers mounted in response to the vaccine. And what you can see is that participants in the meditation group actually show significantly enhanced vaccine response compared to the healthy-- compared to the non-meditating controls. 

These differences are of a magnitude where it's likely to make some clinical difference. So let me just offer some final reflections and conclusions. Then we can open it up for questions. I've shown you that compassion, loving kindness and other related characteristics are best viewed as trainable skills. Mental training to enhance these skills changes the brain and the body. Finally, the expression of compassion by a spiritual caregiver can potentially impact a patient, and not only help the patient cope with adversity, but to actually change the patient's biology to change their brain and to change their body in a way that may be potentially health promoting. So what you folks do in your roles is not just to be a source of comfort and understanding, but through that, to actually literally change the patient's biology in ways that may be health promoting. I want to end with, really a remarkable quote from Albert Einstein. It's one of my favorite quotes. And it directly pertains to this topic. 

It was written by Einstein in a letter to a friend of his who was asking for some advice. And in that letter, Einstein said, "A human being is part of a whole, called by us, 'the universe.' A part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion, to embrace all living creatures and the whole of nature in its beauty." Let me end by just expressing my gratitude to the many people in my lab. This is just those who directly participated in the studies that I describe who are actually doing all the work. I just, these days, am a conductor and cheerleader. And also to His Holiness himself. Thank you very much. 

(applause)