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Head First Podcast

Ep8 - Meditation, Mindfulness, and Psychology of Anxiety with Dr. Lobsang Rapgay

Dr. Lobsang Rapay joins Dr Hill to discuss his early experience as a Tibetan monk and how it lead to a life in clinical psychology. Dr Rapgay talks about distancing yourself from your emotions in order to not be controlled by them. He speaks about techniques for extinguishing learned fear responses after the fact, as well as using mindfulness to conquer fear and anxiety. Dr. Lobsang Rapgay, PhD, Adjunct Assistant Professor Lobsang Rapgay, Research and Clinical psychologist at the Department of Psychiatry UCLA. He was the Director of the Behavioral Medicine Clinic and Program and an Assistant Clinical Professor at UCLA Semel Institute at UCLA for over six years. He is currently studying the behavioral and neural correlates of fear re-consolidation.

Episode Summary

On a recent episode of my Head First podcast, I sat down with Dr. Lobsang Rapgay, a research and clinical psychologist in the Department of Psychiatry at UCLA. He spent 18 years as a Tibetan Buddhist monk before training in Western clinical psychology, and he now studies the behavioral and neural correlates of fear reconsolidation. The conversation moved from monastic training in Tibet to the brain circuits that mindfulness actually changes. This article pulls out the mechanistic substance worth keeping.

What does mindfulness actually do to anxiety?

If you live with persistent anxiety, you already know the body part of it. The knot in the stomach on a Sunday night before the work week. The tightness in the chest that shows up before anything has gone wrong. The nervous system is running an anticipatory threat response, generating arousal ahead of the event being feared. That physical signal is real, and it is generated by specific machinery.

Anxiety itself is healthy machinery. If a tiger is chasing you, the arousal is exactly the right response. The problem shows up when the arousal does not ramp back down after the environment stops being threatening, and when the human capacity to simulate every way things could go wrong keeps the threat circuits firing. For more on the circuits behind this, see Biohacking Anxiety: Targeting the Circuits That Won't Shut Up and Biohacking Fight or Flight: Mastering Your Stress Response.

Dr. Rapgay's approach starts with a skill he calls mental distancing. You learn to experience yourself as the observer, with spatial distance between you and the sensation. The knot in your stomach is there. You are watching it. He pairs this with a lot of pausing. When the watching gets to be too much, you pause, return to abdominal breathing, regulate, then come back to watching. He told me the transformation in mindfulness shows up at the moment a person can hold that observer stance and watch a thought unfold without being dragged into it.

The mechanism is de-identification. When you have a fearful thought, the self, the observer, and the observed collapse into one thing. A person in pain does not say "my foot hurts." They say "I hurt." The first move is to separate those, and once you can watch from a distance, being non-evaluative and non-reactive becomes much easier. Skip the distancing step and "non-judgmental" turns into a forced attitude you are performing rather than a stance you actually occupy.

How does watching your body change your mood?

Equanimity follows tolerance, and tolerance follows the ability to watch. Once you can accept a sensation while staying present to it, you can do something anxiety usually blocks: you can read the data accurately. Pain on a scale of ten is a seven today and was a five yesterday. Without equanimity, that reads as a downward spiral, proof the technique is failing. With it, that is just information.

Depression and anxiety both rob you of foresight. How you feel right now becomes how you believe you will feel forever. Re-training attention toward present sensory experience helps the brain re-learn that states change.

There is brain imaging behind this. In recovered depression patients, training in present-moment body awareness activates the right anterior insula, the region tracking your internal bodily state, while subjects who did not get that training showed less insula recruitment and a more analytical, ruminative pattern of processing (Farb et al., 2007). The insula matters past mood, too. Long-term meditators are partly spared the cortical thinning of the right anterior insula that comes with aging (Lazar et al., 2005), and lesion work has linked damage to the insula with the abrupt disruption of smoking addiction (Naqvi et al., 2007). The aging side of this is something I cover in The Critical Aging Window: Why Your Brain Starts Aging at 44, Not 70.

Why does sensing the body lower distress without removing the pain?

This is one of my favorite findings from the conversation. In experienced meditators, when experimenters induced pain, the subjects reported less unpleasantness than controls, even while the sensory pain regions were as active or more active. The difference sat in how the regions that regulate the reaction to sensation, including the anterior cingulate, decoupled from the raw sensory signal (Gard et al., 2012; Grant et al., 2011). The meditators were not blocking the physical signal. They were regulating the aversion to it. The sensory event fired; the affective and cognitive interpretation of it did not run away.

That dovetails with work from my UCLA colleagues Naomi Eisenberger and Matt Lieberman, who showed that the regions processing physical pain overlap with those processing social rejection (Eisenberger et al., 2003). Heartbreak and social loss produce real, physiologic distress through shared circuitry. I unpack the social-pain side of this in Where Is Love in the Brain?.

There is also a gut piece. The enteric nervous system holds well over 100 million neurons, and the large majority of the body's serotonin lives in the gut rather than the brain (Gershon, 1999). Anxious people often carry a gnawing sensation in the chest or stomach, an anticipatory response to something they expect. Learning to sense and regulate that interoceptive signal, instead of immediately distracting away from it, plausibly helps people stop pre-loading Monday as a catastrophe. This is mechanistic extrapolation more than settled causal science, but the direction is consistent.

Why do anxious people miss their own pleasant sensations?

Anxiety narrows the attentional field. When the only sensations you track are the uncomfortable ones, you immediately try to escape them, usually by distraction. The result is that you stay locked onto the distressing signal and never pick up the rest of the picture, including the parts of your body that feel relaxed. Broadening the attentional field is a trainable skill, and anxiety tends to shut it down. Mindfulness work that widens attention back out is doing real regulatory work. For the attention-and-self-regulation angle, see SMR Neurofeedback: Train Sleep, Focus, and Self-Control.

At my center we pair mindfulness training with neurofeedback. One client who had meditated only a couple of years, not the usual twenty or thirty, took off into deep absorption states once we started exercising his brain with biofeedback. He moved from breath concentration into jhana-like absorption, with light, body shaking, and profound focus. He also got somewhat stuck there. Strong single-pointed absorption can become its own trap. You get into a blissful concentrated state and start to devalue everything else. Tibetan teachers raise exactly this caution about over-investing in concentration practice at the expense of insight. There is a teaching story where a bodhisattva snaps his fingers to wake a god out of blissful absorption and show him the world again. The blissful state is not the destination.

What is mindfulness, and what is meditation?

There are two broad categories. Concentration practice, called shamatha, trains single-pointed focus, usually on the breath. Insight practice, called vipassana, trains observation of experience as it arises. Both run under the larger heading of meditation.

Dr. Rapgay made a point worth holding onto for anyone practicing in the West. The historical Buddha taught mindfulness primarily as shamatha, and the heavy emphasis on insight came later as disciples interpreted and reorganized the teachings. Over time many schools drifted toward labeling thoughts and watching them arise, because that is more accessible and frankly more enjoyable than hours of single-pointed concentration. The modern Western lineage, running through the 1970s teachers and into Jon Kabat-Zinn's MBSR at UMass, sits further still from the original concentration roots. For more on the practice itself, see Mindfulness: Don't Just Do Something, Sit There and Biohacking Meditation: The Neuroscience of Mindfulness Training.

The caution he raised: a technique can be under-applied or over-applied. Non-judgment is a strong tool for an anxious person drowning in guilt and self-criticism. After that excess is reduced, the same person still has to make judgments, which school for the child, which friends to keep, which decisions to make. Skillful non-judgment clears out the negativistic noise; after that, constructive judgment has to come back online. MBSR practitioners can over-apply acceptance and non-judgment past the point where it serves them.

Can a fear memory be erased after it forms?

This is where Dr. Rapgay's current research lives. Consolidation is the act of storing a memory. Reconsolidation is what happens when you pull an old memory off the shelf, turn it over, and put it back. When you recall a fear memory that has been consolidated in long-term storage, there is a window of roughly a few hours where that memory becomes unstable before it gets re-stored (Nader et al., 2000). People with trauma often cannot recall the full spectrum of the event, which is a clue to how that storage works.

Inside that window, a novel intervention can change what gets re-stored. In animal work, blocking protein synthesis in the amygdala after a fear memory is recalled prevents that memory from re-stabilizing (Nader et al., 2000). Standard extinction, the controlled re-exposure that underlies a lot of exposure therapy, also reduces fear, and behavioral updating during the reconsolidation window can block the return of fear that extinction alone tends to allow (Monfils et al., 2009; Schiller et al., 2010). The catch with extinction alone is that fear tends to return under various conditions later. This is the broad principle behind why therapy works for traumatic and stressful memories: you re-experience the event in a safe context and put it back with less charge.

Dr. Rapgay's design tests whether adding a 90-minute mindful reappraisal training to standard extinction makes the fear erasure stick. His early results, in his words, were blowing the skies. This is preliminary work, so treat it as promising rather than proven, but it is a clean test of whether the regulatory skills described above can lock in a fear extinction that would otherwise relapse.

What to take from this

If you carry chronic anxiety, the practical sequence Dr. Rapgay teaches is concrete. First, build mental distancing: experience yourself as the observer watching the sensation, not fused with it. Second, pause and return to abdominal breathing when the watching overwhelms you, then resume. Third, practice reading your body's signals as data with a scale and a trend, which builds equanimity. Fourth, deliberately widen your attention to include the neutral and pleasant sensations anxiety usually filters out.

The brain targets the research points to are specific: the right anterior insula for interoceptive awareness, the anterior cingulate for regulating aversion to a signal the body is still generating, and the gut's serotonergic neurons feeding mood from below. These are trainable systems, and the early reconsolidation research suggests the same regulatory skills may help fear extinction hold rather than relapse.

Dr. Rapgay's work is collected at integratedmindscience.org. If you want to start with the practice and the circuitry behind it, the meditation and anxiety articles linked above are the place to begin.

References

  1. Lazar (2005). Meditation experience is associated with increased cortical thickness. doi:10.1097/01.wnr.0000186598.66243.19
  2. Naqvi (2007). A study of ovarian lesions in pre-menarche girls. PMID 17374303
  3. Gard (2011). Mindfulness practice leads to increases in regional brain gray matter density. doi:10.1016/j.pscychresns.2010.08.006
  4. Eisenberger (2003). Does rejection hurt? An FMRI study of social exclusion. doi:10.1126/science.1089134
  5. Gershon (1999). Endothelin and the development of the enteric nervous system. doi:10.1046/j.1440-1681.1999.03176.x
Full Transcript
[Music] so welcome to another episode of head first with dr. hill today's guest is dr. Lobsang Rapp gay dr. rapke is an adjunct assistant professor research and clinical psychologist and the department of psychiatry at UCLA he was the director of behavioral medicine clinic and the program and assistant clinical professor at UCLA Semel Institute UCLA for over six years he's currently studying the behavioral and neural correlates of fear reconsolidation so thank you dr. Graf day for being here with us today thank you for having me thank you so I've known you for a few years I was a grad student at UCLA and I got to sit down and over many a meal and discuss neuroscience and different aspects of things where our interests overlap but I'm sure too many of our listeners they don't know you so if you could please give us a sense of who you are where you came from what what what brought you to this point in your life today oh well I you know I was born in AUSA which is the capital city of Tibet and actually I was born in near the very near descent central temple which is regarded as the most holiest the holiest site in Tibet actually so it's considered a privilege to be born near that site did you plan that not quite that so you know I I was raised dead in Asif till I was about six years of cool and by that time when I was born and around that time the Chinese Communists had already come into Lhasa they came in from Eastern Tibetan and they were already in Lhasa but they were not at that point Oh occupational force they had come true under the guise of helping Tibetans but they're already simmering tensions brewing in the air so it was in that environment I was born and my parents were already thinking of like what should we do should we stay or leave and finally then I left then I we escaped into India where luckily I was able to go to a boarding Catholic school actually a Jesuit Catholic school where I received most my high school high school and then eventually I went to university in India and then finally I left at around that same time my father passed away and I used to be very much a reflective person by nature so already always was drawn to the inner experience in the world and so that coupled with the passing away of my way of my father when I was very young kind of somehow drew me to the monastic community which I remain for about 18 years and while I was a monk I eventually decided to compliment by monastic training with looking into Western psychology I already had a PhD from an Indian University where I studied Western and Eastern psychology and philosophy so I had some exposure there and finally I decided to come to the United States to pursue a degree in clinical psychology and then when I was done with that round in 2000 oh I oh I began to work at UCLA as a staff psychologist and that's a research position or clinical we even did that was a predominantly a clinical position I used to be a consult Asian and Leo's on services under psychiatry and that was a service that gap psycho provided psychiatry and psychology to interface with the medical doctors from various disciplines and provide complementary services to psychiatric and psychological services to medical patients only required maybe psychiatric help primary medication but second release psychotherapeutic short-term psychotherapy and of course you remain involved in both therapeutic the delivering therapy 1 1 as well as researching into some of these neuroscience and psychology topics right well actually after that SSI I became an assistant clinical professor and I directed a outpatient clinic we started the behavioral medicine clinic which provided training in behavioral medicine such as in hypnosis peripheral biofeedback and cognitive behavioral therapy to help work with patients who had predominantly a medical condition that will require or it was sick day at secondary anxiety or depression which we try to help them with including pain mmm interesting I want to ask you more about that but before I do could we go back to your early life I'm really curious about what the experience of joining the monastic community taking vows but what was that like how old were you in that process really when you committed to that I was about 20 years old ok so not a child but still not really formed absolutely I it was kind of high in a place where I was thinking of going abroad to pursue my Western academic interests and studies and I had to make a choice and so I for good for good event that and decided to put pursue a monastic training and what happens is first you have to take a vow as a novice which is a commitment of 36 different vows okay and then as a novice you kind of evolved there into the monastic life which is there are a lot of prohibitions will unite facilitate lifestyle and also on a day to day basis you have to observe a lot of rules and regulations and I went from me into a monastic ask school which was very academic people very much like the Jews Jesuit school sure very philosophically oriented and dialectic dialectics was the means to which you pursuit of philosophical understanding of inquiry inquiry dilemma you know the tibetans user derived their dialectics from my Aristotelian ah yes it was renovated from that tradition so they use very much syllogisms like if they smoke on the hill right or a mountaintop is there fire right you debate that endlessly and that's exactly example of what we used to date on in our early grades that was the focus of the debates where you learn the dialectical elem basics and then it evolved into a pursuit where you looked at more Buddhistic teens and concepts and theories but but along with so it was a very rigorous you know schedule very disciplined we used to get up around five o'clock then when we had a service where it was a confessional service where we did prostrations and prayers as a formal process confessing any any oversight in one's behavior the day before and that would go on for about one hour or so oh and in between breakfast was served during that prayer session and then there would be you know are you have to do your homework which involve lot of memorization of text along with learning dialectical skills and then they would pick classes and the afternoon two to three hours would be spent in individual debate classes and then there would be another period of time where you would do your homework and practice individual practices and then late now there would be a late night prayer followed by long hours of debate sometimes lasting till eleven o'clock o'clock in the night so that was on a daily basis and then every month there would be a night long debate that means it starts from six o'clock in the evening and it was till four o'clock in the morning for the entire night which is that when you were getting up and that's what interests that and this is all in preparation for sort of becoming a monk or this is more academic training but also in the meantime you are learning to familiarize yourself and bigger becoming your habit rated to being a monk and what its life is and if you feel it that's us that's what you want then you become a fully ordained monk - if you walk involves taking two hundred and fifty three different vowels oh that's a life law and it's in our tradition of Tibetan Buddhism it's a lifelong commitment and so once you were you clearly embrace those vows and commit to that what was your life like at that point were you I mean I have no sense really of what a Tibetan Buddhist monk does with his or her time beyond meditate study what would else to do not much I mean it's not a dominantly very in our school organism yeah very academically craven and then between every girl you know every two weeks dark public confessions so that you attend to and actually while we say a lot of prayers and do a lot of memorization the bulk of the time is spent on academic dialectical learning and debating yeah and meditation is something that comes much later actual in our tradition of the idea is that you learn the theory of mind the different components of your mind and you define them and learn to discriminate one mind from the other and learn things like discrimination skills learn the difference between categories as well as a specific item that belongs to the category learn to run of learn all these different basic cognitive and a broad theory of mind and then debate them out so that you really integrator at least analytical understanding of them yeah and then after 10-15 years you begin to meditate that's the kind of structure in a school yeah yeah certainly I mean I have some understanding of Buddhism I practice meditation but really no understanding of that traditional cultural inflection one thing that I've always noticed in general you know sort of Buddhism is there seems to be a bit of a difference in the lay person who's engaging with the world and practicing ways to reduce their own suffering suffering of those around them through you know meditation for not being attached how is the the more rigorous practice of the monastic community different than a lay community in Tibet is it dramatically different is are there yes it does it is different practice of Buddhism where and different way of are integrating Buddhism in the lay community its devoid of all of the academic depth understanding of the mind so it's more devotional and belief oriented so the lay person might see the per the Buddha as a divine figure so for cosmology Les like les technique and the expression of their practice would be in the form of prayer offerings that they would make to the monasteries or the monastic communities and then they might do practices themselves like not only prayers but there were two prostrations or those who are more deeply involved as a layperson then they might do long retreat into the more esoteric form of Buddhism interesting but practices such as mindfulness schemata is something that in the divine body's tradition both in the lay and the monastic community you don't find that many practitioners they tend to do the more esoteric practices of deities and so and make dj2 what we call deity practices now these sort of visualizing different deities and specific chants or specific mantras or $1.00 you're visualizing what else that's right you know in Buddhism they are like three degrees it's good to think about three types of Buddhism the one that the Buddha thought we would be the telev are in type 2 which focus which is based on the concept that there is only one Buddha and that's the historical Buddha he was a human who practiced schemata first which he learned from the hindus and then on his own he decided to that was not enough and then he began to inter integrate with partner Kshama as an extension of schemata and that through that he became enlightened there's a sketch ala Siddhartha Gautama Buddha right okay yeah they only acknowledge one Buddha now and then the there and therefore they focus more their objective or their approach to Buddhist practice which all the Buddhist traditions except like schemata practice or concentration practice and inside practice is uniformly accepted by all Buddhism forms of Buddhist schools but what proportion are harming the telev audience or approach is different they focus on individual liberation first before you can help others you have to and they do it through schemata practice leading to a reporter and then complementing that with loving-kindness and compassion that's wonderful that's how it's done however the second school of Buddhism is called The Grates vehicle or the grade school kumano and that that takes a different approach they accept all the basic teachings of the Buddha like the Four Noble Truths the Eightfold Path of practice but they say are their approaches that one should delay one's own liberation in the interest of helping others becomes liberated and sofala so our approach is very very different and so they focus a lot on using ethical basis is the foundational life is the basis of the enveloping wisdom which is about understanding the nature of your mind and the reality and reality as such and complementing that very heavily with compassion practices however the third school which is exclusive or predominantly dominated by the Tibetan Buddhist tradition is the Vajrayana school Adri allah yes it means diamond-like vehicle it's likes immutable crystalline our heart yes and that's where instead of you know the to earlier schools they tend to see negative thoughts as the source of all suffering like a desire hatred rejection is all considered poisons which you have to are regulate and eventually overcome in order to develop positive thoughts etc that's basically it they approach the Raja Ram is quite different it's quite the opposite in some sense they say don't overcome your anger but learn to embrace it and transform it into a path into your spiritual path so so too with desire and the way they do that is that basically to put it in a nutshell you mobilize the physiological energy associated with anger and desire and strip away it the cognitive defier negative thoughts associated with disassociated to maintain the physiological energy generated by desire and anger trap them and localize them systematically in different parts of the body called chakras which are simply networks of nerves nerves systems at critical points on the body trap that energy and through breathing and yoga training you learn to or generalize that intense energy up the chakras one up like like at the navel for instance and then use that to gradually transfer that energy systematically depending on the state of mind or inner realizations you have achieved two different chakras eventually and the idea is that will unify the masculine and the feminine energy that we all are embodied and when those two unite they give birth just like when a male and a female unites a gift similarly psychic energies mundane unite then they give birth to creative what is called the creative mind which which allows you to vision to become the deity itself you yourself become the Buddha so to speak so instead of leaning away from things that might be tempting or grasping or detrimental you lean into the things learn from them and they transform you absolutely right yeah yeah it sounds very different than very much that's wonderful so at some point your path changed you because you're clearly here in the US now you're a faculty member and a psychologist UCLA what was that change about why did you decide that you no longer wanted to remain a monk well that was because as I Dickie went to school and decided to work in the United States I began to feel like I couldn't really sustain my vows it for you know under without a monastic support system and also forward the number of years I have been away from the monastic structure and order kind of I think played a big role and my changing perception of you know because of my personal psychotherapy and own evolution as a person in a more modern and lay context I think without fully being conscious of how much they were impacting me I suddenly found myself like deciding to leave the order so let's take a tiny bit into your some your interest I know you're of course a research and a clinical psychologist and I believe you have a lot of focus on anxiety that's fine and also some fear and some other things how does anxiety fit into this framework of these passions that are potentially things we learn from or transform us is anxiety a stuck place in your perspective of these or is it something that is a process that we are working through to to transform ah from the vagina perspective you could kind of taking the broad premise of how to work with emotions particularly negative emotions and transform them into positive ones you could say though it hasn't been specifically done with anxiety of here you could apply that principle you could find a way to disassociate the negative cognitive and affective state associated with fear and retain the intense physiological energy an arousal basically the arousal associated with fear and then it will learn yoga and breathing techniques to interfere with the flow of that energy and use it strategy strategically to enter into the desired chakra points there are seven chakras in the body so and that could lead to the chakras being activated in into a harmonious and synchronistic way which leads the brain to so to speak to kind of synchronize and produce insights and perceptions in a very different way than the way you were experiencing a month before it's very interesting so I mean I curse you know I work with people's brains many people have anxiety and I sort of feel that anxiety is to some extent a healthy phenomenon if you be I tell my clients if you're being chased by a tiger you're anxious exactly the right response but humans are you know we can catastrophize and think of what could go wrong and so from my perspective when anxiety is a problem it's when it doesn't ramp back down when the environment is no longer threatening or stressful so when you work with clinical clients who are who have a lot of persistent or triggered anxiety is this a is your clinical approach one that helps them lean into these experiences and and and learn from the to transform or is it more getting control of your mind where's where's the clinical sort of path that that reconciles this approach Rd in clinical use it seems to be much better to use the mindfulness model okay and we'll prime Lee to using our or the technique of how to be fully present in a non-judgmental or accepting way as well as in an unreactive Lee your anxious thoughts and a fearful feelings and to do that you know what I do is first try to teach the clients to first learn to create mental disorder distancing from your thoughts and feelings and that really involves teaching them how to get a sense of spatial distance of you yourself as the observer from your thoughts or the sensations let's say in an anxious patient you might have a sense of knowing or tightness in the stomach so we teach them to get a sense that you are the observer the experience of sensation is there's a spatial distance between yourself or so observer and what's being observed and we train in then and then that's a way to learn people teach people to watch their thoughts and through pausing we teach a lot of pausing when you watch and if it's getting too much you just pause for a while connect back to your abdominal reading regulate your breathing come back to the watching again and the more you can watch your thoughts unfold that's one of the key elements I notice when a patient hits that ability that is where the transformation of mindfulness occurs even though mindfulness provides other things as being man judgmental and accepting but clinically in a measurable way I think that's a key element so it's essentially sounds like you're teaching people how to not identify with their processes quite so much like the very I is not tied into the exact absolutely as you know we things I t when you have a fearful thought or a feeling and there is no differentiation at all or you know the eye and the observer and observed and decide enter fight they are seen as one this mode like when a person has been for instance the pain they don't see my foot hurts they say I like her move so the Buddhists say that the first thing is to decide and just learn how to recite and if I the two and then you can bring to bear the full potential of being non-evaluative and being nonreactive becomes much easier but if you do learn that initial skill of watching from a distance just like watching a video of yourself on a screen if you don't learn that skill then trying to be non-judgmental and nonreactive are we become really a kind of a forced or induced attitudinal state which has benefits for sure and fake it image yeah all right so it sounds like and again I'm not the Buddhist scholar in the room so please correct me if I'm wrong it sounds like this dis identification would lead to essentially equanimity being okay with how things are even if they are not Pettit if they're uncomfortable that someone accurate that's accurate in the sense that once you disappointing you can fully be except the Inga after watching it then you can accept while being fully present to the anxious part of feeling and you can accept it and then that turns into tolerance of it at that time then equanimity the first elements of equanimity begins to unfold after you can tolerate the suffering yeah then it becomes leans towards becoming a positive you know experience because then you can say like okay this pain is on a scale of 10 its 7 and yesterday it was 5 and you can tell you you can be generate equanimity about that information whereas now it feels like oh yesterday was 5 today 7 it's getting worse so there's this technique is not working as a negative spiral that happens equanimity helps to check that interesting and you know from a clinical psychology perspective things like depression and anxiety they seem to have this quality that robs you of foresight how you're feeling now is how you think you are feeling forever that's right and it's very difficult to go ok shift does actually happen the moment I'm feeling right now is not how I'm going to feel tomorrow the next day that seems to be a easily lost perspective when there's mood disorders or stress disorders right some think this would be a way to sort of re-educate the brain about the fact that there is you know the things do change very much so and you know there's like studies which show that when people who have had depression and they they recover to a certain degree and to prevent relapse if you take those subjects and train them in being fully present to their sensory experience in their body what they notice is the right anterior insula begins to activate and that insula is associated with awareness of your sensory looks answers if you add where's in the control group what they found was that it didn't activate interesting and therefore they were more likely to recall negative or negative experiences associated with their depression which in turn showed that they were much higher more likely to relapse interesting some research on the right insula in ageing medicine older older adults that meditate are spared a loss of the right insulated the cortex course thins as we aid I also seem remember that if you do TMS on the right insula people spontaneously stop smoking cigarettes or at least temporarily so sorry about the the body sort of feeding the body and aware of that thing yeah I think this unit is not ability to regulate your aversion to unpleasant sensations versus is also appears to be very critical here if you develop and that is research with the people who meditated five years or more and what they found was that when pain was induced in them and the bottle they reported much less being then the control however when they look at the brain they found that the pain areas were very active as control interesting and what they found was however the anterior cingulate cortex which kind of a disco you know regulates your reaction and responses to sensations what they found that was you know that was well controlled so what they were doing was they were able to regulate the aversion to be interesting even though aim was still physiologically was being activated in the body the affective and cognitive interpretation of the P that was that was lovely oh that's such a great finding course also colleagues at UCLA know me Eisenberger and Matt Lieberman found that the right frontal areas that perceived physical pain or also the same areas that perceive emotional pain so heartbreak and loss actually does produce pain in a really physiologic way which seems like a dovetail is pretty well with the clinical work of Judo and links so like to gap on what you said earlier I think was it is very critical there's something about if you learn to sense your bodily sensation there's something about that that has an impact on our mood yeah because there's some preliminary research which shows for instance that cut the stomach contains like over 100 million neurons yeah and these neurons appear to be having some impact on the mood yeah directly so these visitors serotonergic neurons right right right 90 95 % of the serotonins in the gut not not the brain right so again if you have a knowing sensation which most anxious people do like know if well if you take the most anxious people on a Sunday night just before going to work even though they busy themselves with laundry or catching on a late night show etc there are many other reporting annoying sensation in this chest or stomach because they're it's an anticipatory or you know response to me or T so learning to use like mindfulness to regulate and be aware of sensory experiences such as that could play a big role I think in better hell helping anxious people and could do not anticipate or not expect that Monday is awful etc yeah it seems very very crucial so by that same token it's I would guess that people that are habitually anxious anxious or tend to become anxious may not have as much of a sense of their fluctuating physical sensations they might not be as checked in very much so I think because they are locked into ones that are just uncomfortable and immediately seek to avoid it by distracting themselves so so so they are probably not more not attuned to other bodily sensations just because even when they are attuned to the distressing sensations they didn't have a the mind narrows you mean the attentional field narrows and they are not able to pick up other sensations which might be quite pleasant such as the fact that they feel the upper body feel more relaxed so exemption what the fetus feels more relaxed they are not able to pick that up because they lack broadened they can't broaden their field of attention which is very critical skill and which in xiety tends to completely shut down sure interesting so is this mindfulness is this meditation may actually actually that maybe unpack for me the difference our mindfulness and meditation the same thing are they subtly different to the overlap well yeah different in the sense that you know there are only two broad categories of mindful meditation the one is the concentration meditation samatha is schemata single and the other is the insight with also every passion yes that's the broad category okay everything else fits into that off now what happened is when the Buddha taught mindfulness he taught it Bramley as schemata we don't hear how in original pali takes much of insight as being so slotted with mindfulness but yeah you would not know that we're going to any insight tradition cetera in West LA certain right if you look at the original you know suta's you'll find that that's the case and that's more like evolution I think later disciples begin to one-for-one the latest disciples begin to like interpret what the Buddha meant and there was a lot of confusion among themselves so they began to define things with more clearly than the Buddha did and as a result numerous schools began to evolve within the order and what you find is that even in the telev arden tradition of mindfulness when they they began to take it more towards they became more enamored with the proportion area left of it because it was more easy to do there is schemata single-pointed concentration on the breath for hours was just to demand her and all Buddhist school kind of began to shy away from it including the Tibetans including the theravadin school it will certain extent and - to a certain extent they began to shy away and they felt more anarchic you know the idea of just labeling your thoughts yes dis identifying the self from them and then letting thoughts come up watching them arise and that was much more appealing to them it's certainly more enjoyable it can be I have a my own training is sort of in insight tradition against the stream Dharma Punk's which is my understanding is that sort of descending from the Terra Vaadin way of doing things it's it's a little more of a pastime abased and then of course a lot of that came out of the late 70s jon kabat-zinn Joseph Goldstein jack Kornfield that was essentially bringing the insight tradition to this country was not to not to denigrate it sort of watering down a little bit the tera vaada techniques that's right and and now modern you know mindfulness MBSR mindfulness based stress reduction which is core come out of Jon kabat-zinn work at UMass Medical that seems to be even a little more separated from the roots of tera vaada Mahayana etc do you think anything is lost today and how mindfulness is taught to Westerners and especially in this country are we missing something when we do directed attention and just watching things and right I think it's a very good stock you know we you know the clinicians and researchers have kind of you know fine-tuned to original teachings of mindfulness into a form that is you are you know patient friendly its culturally relevant and appealing the danger is of course then to to not go beyond as and you know in Buddhist meditation we have this concept you know you need to learn how to not under apply a technique but also you need to be very conscious of over applying technique off so let's take the concept of non-judgmental it's a great way for an anxious person who feels a lot of guilt and as part of negativistic thoughts about himself and others to kind of learn to use none judgmental to overcome that but after that he has to also learn to make judgments because in real life he has to make choices like which school do I send my child to right you are what our friends what type of friends should I cultivate so no judgment is not apathy or fatalism it's not it's it's skillful judgment right it's a skillful non judgment but for clinically you know people who are clinical patients it's good to teach nuns I found and it's very good strategy to teach them to reduce the excess of negativistic thinking but once you've done that the idea is then how to help them to make constructive yeah beneficial judgments in their relationships in their lifestyle in the type of thoughts or decision making processes so here I think there's always a danger for people who do MBSR to over-apply non-judgement or over-apply being accepting perhaps on the other side too I have them you know we do neurofeedback a lot at my Center and we teach mindfulness and it's generally this sort of insight you know low key technique based thing I have a one client who's been doing a lot of neurofeedback and getting very deep in his in his meditation and he about six months ago found absorption techniques he's been mostly Samana but he's getting essentially the jhanas he's going to incredibly profound seeing light shaking body having absorptive experiences and he's not somebody's been meditating for twenty thirty years it's more like a couple of years and as we start to exercise his brain with the biofeedback suddenly his meditation practice just took off and now he's getting almost stuck in these jhanas where i wonder if going towards the strong absorption the strong single point awareness can also potentially be a trap a little bit can get you stuck in the experience of that is that sure absolutely that's one of the main arguments that Tibetan Buddhist would make okay with passion uh either they would say that you know you should that's one the reason this is even I say to the divine practitioners why don't you practice your motto that's exactly what they will say well schemata is you know you get into this very blissful gana state and you become seduced by it that everything else seems you know you tend to devalue every other practice and that's a stuck point there's actually a story where the gods you know in the Buddhist mythology the ironist state of this blissful state of single-pointed concentration so the Buddhist Bodhisattva who is the you know the Buddha who's out of compassion comes before the God who's in that state and snaps his fingers and wakes him out of that can and exposes him to the reality of his world and that serves as a cue for that God to then begin grew like overcome his desire for this blissful state ha and so we've been helping the deities right and going to a repast ah yeah interesting isn't it isn't that's a teaching story I think weak wonder so tell us about what you're doing with research these days fear reconsolidation so for my limited understanding of trauma and fear this sounds like you're working with people who have experienced profoundly traumatic or anxiety learning events that's right and then the reconsolidation for folks that aren't psychologists in the room or in listening consolidation the act of storing memory reconsolidation appears to be something that happens when you when you experience an old memory you take it down off the shelf look at it from many directions and then put it back into storage after you're done which is probably life therapy works in general for things like stressful and traumatic experiences because you can re-experience something in a safe environment and put it back with less trigger will stuff what is it you're exploring I mean research is always very very narrow so what aspects about are you really digging into you well there's you know over the last couple of decades they've but begin to find that when you recall information such as a fear information from long-term memory which has been consolidated in your long-term memory when you recall it there's a short window of time like right after the recall of that memory so where is traumatic or any other anxiety related issue there's about two to four hours window of time where that information has to be reconsolidated because it becomes unstable when you are recalling it you don't and if you look at a person who has trauma when you ask them to you can see how they have difficulty recalling the entire spectrum of the trauma now within that two hours or two falls if you can if you can intervene with appropriate novel intervention because the original memory of the trauma is unstable if you put interjected with the appropriate keyword is your appropriate novel treatment such as let's say standard extinction at that time it's been shown that the fear is risk so they actually have tried out cases where let's say someone as a automobile accident and is rushed to the emergency they're actually in injected you know protein synthesis inhibitors which during that short period of Wyndorf before four hours and they found that the person pretty much lot of the fears erased it on it it doesn't turn into a disorder or and so based on those studies what i've been looking at is can we use standard extinction as the normal intervention to see if fear is raised which there's good evidence that it does erase fear unfortunately we just stranded extinction the fear returns under various condition so what i did was then create a primary experimental group where they in addition to standard extinction they would get a 90 minute training in mindful or reappraisal training and hypothesis is see if that ensures it is your fear that i saying some early results that was just they're just blowing the skies yeah it sounds very promising it's very exciting site it is so what what else have you been doing with uh with your life in the past few years I think you've written some books would you like to tell us about this yeah I've written some books and I've written publish in a peer-reviewed in peer-reviewed journals as well and then a couple of research I written a book in terms of the book evasion a book on medication Oh wondering why did not know that is what what's the title tell us it's on meditation introduction to meditation great yeah great I will I will take up a copy okay thank you yeah wonderful so dr. Rocca is so lovely to have you here it's been a year too since I've actually seen you face to face I feel like I'm poor for it so it's nice to get a nice catch up on you certainly on air if folks are looking into these clinical areas research areas they're interested in Tibetan Buddhism they're interested in you personally where can we find you where can we track you down and see what kind of work you're doing a kind of researcher going oh well I just started well of being a website so they can go to that and it's www integrated mind science is all one word dot org integrated mind science org is great wonderful and you'll have some of your publications some of your write philosophy actually I'll put yes great well we will we will go there and look for that so again thank you so much for being a guest on our show today our headfirst listeners I'm sure or having their minds blown by just a few of the very wise and subtle things you said so it's very much a treat nice to see you and folks take care this has been another episode of head first with dr. Hill our guest today was dr. Lobsang Rapp gay so take care of those brains and we'll talk to you soon thank you [Music]
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