Meditation and Mindfulness for Alcoholism and Addiction
By Olga Megwinoff, MD
There is so much referring to meditation and mindfulness. Every mental health guru speaks of mindfulness and the media outlets are saturated with everything meditation. It is definitely trendy, in fact, even in my neighborhood in the non-trendy suburbs we started a meditation group. When something is so trendy it can be easy to dismiss as a valuable and important tool in psychotherapy. I am ever grateful that I pursued this method of treatment and it changed my views and opened the door for me to the great teachings and understanding of the mind from the eastern psychology perspective.
The main goal of meditation in the Buddhist and Hindu traditions is spiritual enlightenment. Nevertheless, western psychology has appropriated a version of it for the treatment of mild to moderate Anxiety and Depression, Obsessive Compulsive Disorder (OCD), and Addiction. Meditation’s benefits on the mind are difficult to ignore given that at even the beginner’s level, it’s participants get a good glimpse of these benefits.
In this, my first blog, I will try to explain in simple terms a novel theory of why mediation works for anxiety, depression, OCD and addiction.
Beyond the effect of slowing down the nervous system via purposeful control of the respiration and its secondary effect on slowing down the heart rate, (the “fight or flight” response) meditation also has immense and immediate effects in the brain.
The first goal of meditation at the beginner’s level is to draw attention to the breath in an attempt to get rid of any other thoughts. It doesn’t really matter what you focus on, it can be your big toe or your right ear. The objective is to chose a part of your body you can feel, therefore you don’t think. The focus is on the feeling, on the somatic sensation of this body part. The only purpose of this initial learning phase is to train the mind to focus on only one thing fully.
A lot of people say, “I can’t do this”, “I have ADD”, “it’s too much work”, but I am fully convinced that if you have a brain, you can certainly develop the ability to meditate. It does take effort and discipline (maybe this will be the topic of my second blog, I find this is the aspect that most people struggle with, the discipline to practice every day, NOT with the ability to sustain attention).
If the participant can focus on the breath fully, and therefore clear the mind of any other thoughts, for a few seconds, the relaxation is immediately palpable. This was a big surprise for me, that the mere absence of thoughts created relaxation in the mind. My training in psychiatry was heavy on psychoanalysis and Cognitive Behavioral theory, the basis of anxiety and depression is understood as a conflict arising from conscious and unconscious thought (psychoanalysis) and/or distorted thoughts (CBT). Therefore, the content of thoughts are indirectly considered ever present.
However, in meditation, if you achieve the goal of having an absence of thought, (not a resolution of any unconscious conflict, or the identification and correction of a distorted thought pattern), just a quiet mind for a few seconds, this relieves symptoms for those few seconds.
Eastern psychology is not as invested in the content of the mind as western psychology is. The target, at these early levels, is absence of content. If a patient is able to achieve this for a few minutes every day, they can ultimately achieve relief from these symptoms during a greater period of time.
As you continue to progress in meditation, you can “open” the mind to thoughts and feelings, and as you ‘notice” the thoughts and feelings, the participants learn that they don’t have to react to them, introducing some distance from negative thoughts and feelings and realizing that they do not define you.
There is a lot of research demonstrating correlations between the positive effects of meditation with changes in particular brain structures like the medial prefrontal cortex, the posterior cingulate cortex, the amygdala, the hippocampus and limbic system. However, there is not a global hypothesis integrating all these structures functions and meditation correlates. The first such theory I have read about comes to life with the “discovery” of the Default Mode Network (DMN). The DMN was identified via neuroimaging in 2001 by Marcus Raichle, a neurologist at Washington University. He published his findings in the Proceedings of the National Academy of Sciences. See also Randy L. Buckner, Jessica R. Andrews-Hanna, and Daniel L. Schacter, “the Brain’s Default Network,” Annals of the New York Academy of Sciences 1124, no1 (2008). It is important to note that the concept of the default mode network is not yet globally accepted.
The DMN forms a critical and centrally located locus of brain activity that links parts of the cerebral cortex to deeper and more primitive structures involved in memory and emotion. It is stipulated that the DMN is responsible for wandering, daydreaming, rumination, worrying and self-reflection. It is also involved in mental constructions, moral reasoning and the concept of “the self”, among other functions. Some neuroscientist call it “the me network”.
Self-reflection can be responsible for powerful thinking and understanding but it can also be responsible for destructive forms of self-regard. Psychologists have identified a strong correlation between unhappiness and time spent in wandering, a principal activity of the DMN.
The DMN stands opposite to the attentional networks, when one is active, the other goes quiet, and viceversa. Scans of experienced meditators brains show the the DMN activity decreases significantly. (Judson Brewer, a researcher previously at Yale, now at the University of Massachusetts Medical School, Center for Mindfulness).
A theory by the British neuroscientist, Robin Carhart-Harris, is of ‘the spectrum of cognitive states”. He describes high-entropy mental states (psychedelic states, infant consciousness, early psychosis, creative thinking) and low-entropy mental states (rigid thinking, addiction, obsessive-compulsive disorder, depression, anesthesia and coma). Carhart-Harris suggests that the psychological disorders at the low entropy end of the spectrum are not the result of lack of order in the brain (as the established theories postulate), but rather an excess of order.
When self-reflective thinking becomes excessive, heavy self-consciousness gradually shades out reality, this may be the result of a hyperactive default mode network, which can trap us on repetitive and destructive loops of rumination – this is a substantial part of addiction, obsessions, anxieties and depression.
With a regular meditation practice, many people with Substance Use Disorders, Anxiety, Depression and OCD can transform their minds by lowering the volume of the DMN and therefore quieting the self-consciousness, ruminations, and worrying that so characterizes these disorders.