Stress, Depression & Mindfulness

Teaching

• Mindfulness Based Stress Reduction –

• Beginning of the story

• Science seems to help motivation-universal language

Stress

• That change is needed to meet a demand

• As appraised by the subject

• That change may overwhelm resources

• Resources as appraised by the subject

Physiology of chronic stress =Physiology of depression

• Parasympathetic – sympathetic imbalance sympathetic activated too long

Not enough parasympathetic activationRest & relaxation Digestion & cellular maintenanceHealing & repair

Not just the Brain

• Neurotransmitters

• Heart

• Immune system

• Endocrine system

• Sex Hormones

• Sleep

• Gut

Key Brain Areas

HPA axis

• Hypothalamus ( CRF) ->

• Pituitary Gland ( ACTH) ->

• Adrenals ->Noradrenalin

• -> Cortisol -> Hippocampus

• ( feedback loop)

Acute stress reaction

• HPA activation

• Flood of neurotransmitters

• Adrenaline, noradrenalin

• Serotonin

• Dopamine

• Inflammatory response ( interleukin 1)

• cortisol

Studies in chronic stress

• Whitehall Civil servant study

• Salposki Baboon studies

Neurotransmitters

• Adrenaline , Noradrenalin

• Serotonin – first to go -> depression

Chronic Noradrenalin

• Increases heart rate , Blood pressure

• Activates amygdala threat detector

• Hyper vigilance for threat

• Negative memory activated, positive memory deactivated

The immune system

• Hyper activation of non-specific acute phase – Interleukin 1

• Suppression of specific immune actions

Inter leukin 1

• Part of stress response

• With chronic activation

• Fatigue, malaise

• Sleep disruption, appetite effect

• Anhedonia

• Impairs hippocampus memory

Effects of chronic cortisol activation

• Loss of diurnal variation

• Switches off prefrontal, hippocampus

• Suppress immunity

• Activate amygdala

• Burns out – adrenaline fatigue

• Weight gain

Over time cortisol - neurotoxic

• Loss of connections

• Decreased branching

• Loss of neurons

• Especially prefrontal & hippocampus

Damage to Hippocampus

• Blocks feedback loop -> increased cortisol

• Memory impairment

• Inability to form new associations

• (30,000 new cells per day)

• Chronic stress stops Neurogenesis & Neuroplasticity

• Increase cortisol

• Decrease serotonin, trophic factor, oestrogen

Oestrogen & depression

• Female : Male rate of depression 3:1

• Sudden drops of oestrogen associated • Menopause• Childbirth• Premenstrual

• Oestrogen – powerful Neurogenesis growth factor

• Under active – hippocampus, prefrontal cortex & cingulate

• Overactive – amygdala, hypothalamus & Pituitary

Prefrontal Cortex Asymmetry

• Left – approach behaviour, positive emotion – under active in depression

• Right withdrawal behaviour, negative emotion – overactive in depression

• Hedonic set point

Heart rate variability

• Healthy heart - high variability

• Depression/chronic stress = reduction

Sleep Cycle

Sleep in depression

• Sympathetic>> parasympathetic

• Reduced slow wave sleep

• Increased rem density (predicts response to treatment)

• Insomnia – x4 incidence of depression

Indicators of chronic sympathetic activation

• Difficulty concentrating

• Making decisions

• Remembering

• Excessive fatigue

• Motivation

• Frequent illness

• Sleep disturbance

Paul gilbert slide here

Activation of stress response

• Imagined scenario of threat/failure • Reality gap – life as you want it to be – as

it is • Self criticism• Recall of unpleasant event • Hostility • Rumination• Avoidance

Filtering reality

• Activated Amygdala & No hippocampus

• Habitual mind – tells us what to see & how to react

Mental filter

Cognitive filter

• Beliefs, attitudes & perspectives

• Continuous stream of semiconscious commentary evaluating

• Somatically marked association & memory

• Neural networks – synapses reinforced – rehearsal

• Other associations shut down

Example of 4 different filter types

• Anxious

• Depressed

• Type A – angry, hostile

• Type C – resigned helpless

Anxious

• Imagined scenario – exaggeration of threat

• Potential crisis with each event

• Future – what if something goes wrong

Depressed

• Continual comparison between some ideal & reality

• Self –critical evaluation

• Underestimation of resources & negative memory bias

Type A

• The world is against me

• Always scanning for threat

• Easily made paranoid

Type C

• Passive pessimistic and helpless

• Underestimate resources

• Overestimate threat

Vicious Cycle

• HPA activation

• Physiology threat related cognitive filter

• Perceive threats and failure

Mindfulness & Depression