Brain Training
For Britton, it’s not enough to know that MBSR and Mindfulness Based Cognitive Therapy (or MBCT, which is used to prevent relapse of depression) work. She wants to know how they work. That’s the question driving Dismantling Mindfulness, her five-year, three-arm, NIH-funded study to determine how, exactly, mindfulness helps ease depression (her specialty) and anxiety.
“MBSR and MBCT are like drug cocktails. They have many different kinds of practices and components in them, they have very different goals and very different neurological correlates,” Britton says. “It’s really hard to know what the active ingredient is. So basically what we’re doing is taking out one [practice]at a time and doing eight weeks of that and comparing that to the cocktail.”
After filling out a two-hour online questionnaire, study participants undergo a five-hour neuropsychological assessment in Britton’s lab to measure the strength or weakness of their prefrontal cortex, or PFC, the part of the brain largely responsible for short-term memory, focus, and will power. A weak PFC makes us emotionally reactive, while a strong one enables us to control our impulses and regulate our emotions.
“I call mindfulness meditation ‘cognitive remediation.’ I think of it as physical therapy,” Britton says. “The PFC tends to be weak in a wide range of psychiatric conditions—addictions, ADD, eating disorders, schizophrenia, pretty much anything that’s characterized by high levels of negative emotions, which is most of them, and poor emotion regulation, which would even include mania. Those are all characterized by poor prefrontal control over the limbic system. You can rehabilitate the PFC through attention training—of which one kind is mindfulness.”
The participants then embark on an eight-week treatment program of one weekly three-hour class in one of three meditation practices—what Britton calls “systematic strength training” for the PFC; this approach will enable the investigators to compare the clinical efficacy of each practice, as well as each practice’s separate neuropsychological mechanisms. The goal is to determine which practices are best or worst suited for which types of individuals, and why. Ultimately Britton envisions an empirically based set of guidelines for meditation, as there would be for any medication.
Lost in Translation
In 2006-2007, when Britton was doing her clinical psychology internship at Brown, two meditators from a retreat center in western Massachusetts were hospitalized at Butler Hospital for meditation-induced psychosis. “Two in one year seemed like more than a coincidence, so I started asking around if these kinds of things happen at other retreat centers,” recalls Britton, who also completed her postdoctoral fellowship, in mood disorders treatment research, at Brown. “I found that every place I asked has a file drawer full of these kinds of hospitalizations and other stories.”
Around this time, Britton bought a rambling Victorian house near Brown’s campus, and the place became a locus for Brown students who were committed meditators and who found dorm life less than conducive to a contemplative practice. She named her home Cheetah House, which plays on citta, Sanskrit for consciousness.
Word about Cheetah House spread, and soon Britton was getting phone calls and emails from people whose meditative practice had left them in varying states of distress. Some were so impaired they couldn’t work; some were emotionally volatile or dissociated.
She wasn’t at all surprised.
According to Britton, many of the adverse effects these people described are found in the Buddhist texts; some are an integral part of the experience of meditating— and, in the traditional Buddhist context, signs of progress. The problem, she says, is that in most cases mindfulness meditation is being taught and practiced by people who lack a deep knowledge of its Buddhist foundation.
“In Buddhism one of the key insights into the nature of reality … is to see that there is no inherent self. Seeing into the emptiness of self is supposed to have a beneficial effect,” she says. “But not having ownership over your body, or thinking, ‘Where am I? I don’t seem to be located anywhere’—that isn’t liberating to everybody. Some people find it to be really disturbing.”
One well-known meditation teacher calls this insight “Enlightenment’s Evil Twin.” In clinical psychiatry, it’s called depersonalization, for which the DSMIV’s diagnostic criteria include “persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body” causing “clinically significant distress or impairment.”
“It’s considered a very difficult psychological disorder, and it’s really hard to treat, and it has a high suicide rate,” Britton says.
Britton, who is certified in both MBSR and MBCT, is critical of the “romanticized orientalist projections” modern Western practitioners bring to mindfulness, but she is more concerned about teachers who are not equipped to treat adverse effects when they come up. Clifford Saron, PhD, a neuroscientist at the Center for Mind and Brain at the University of California, Davis, and lead researcher of the Shamatha Project, a large-scale study of the effects of meditation, concurs. At many retreat centers, he says, the intake process is not nearly as stringent as it should be, and people who are at risk of adverse effects are accepted when they shouldn’t be. “Training of teachers doesn’t include the sophistication required to identify terrain that needs professional support,” he says, noting that at Spirit Rock, the renowned meditation center north of San Francisco founded by Jack Kornfield and others in 1987, “almost all the teachers went out and got PhDs in clinical psychology.”
