On October 20, 2007, leading researchers in the fields of mood disorders and meditation discussed the promise-and limitations-of meditation for the prevention and treatment of major depression. Participating in a day-long symposium titled "Mindfulness, Compassion, and the Treatment of Depression" was His Holiness the Dalai Lama.
On October 20, 2007, leading researchers in the fields of mood disorders and meditation discussed the promise-and limitations-of meditation for the prevention and treatment of major depression. Participating in a day-long symposium titled "Mindfulness, Compassion, and the Treatment of Depression" was His Holiness the Dalai Lama. The event, which drew an audience of more than 3000, was cosponsored by Emory University in Atlanta and the Mind & Life Institute and was the 15th time that the Dalai Lama has met with Western scientists under the aegis of the Mind & Life Institute to engage in dialogue about points of intersection and divergence between Buddhist and scientific worldviews.
The conference focused on the role that meditation might play in promoting cognitive, emotional, and physiological states that are protective against depression. This issue was examined within the broader context of whether developing mindfulness and greater compassion through meditation training in adulthood might help individuals compensate for the depressogenic effects of adversity, trauma, and lack of nurturance early in life, all of which are primary environmental contributors to major depression.
During the conference, researchers presented data that suggested that mindfulness practices may help prevent the recurrence of major depression and that meditation practices specifically designed to promote compassionate cognitions and emotions toward others may have effects on the brain and body that are directly relevant to depression.
The Dalai Lama opened the conference by acknowledging the unique relationship that exists between Emory University and several leading institutions of higher education within the Tibetan exile community, a relationship that has culminated in the Dalai Lama joining the Emory faculty as a Distinguished Presidential Professor. He expressed his conviction that Western physical sciences and Buddhist traditions of studying the mind have much to offer each other in better understanding mind-body interactions relevant to health.
To set the stage for a discussion of the therapeutic potential of meditation, Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and chairman of the Emory department of psychiatry and behavioral sciences, and Helen S. Mayberg, MD, professor of psychiatry at Emory, provided the Dalai Lama with an overview of current scientific understandings of the risk factors for, and neurobiology of, major depression.
Dr Nemeroff recounted the tremendous cost in human suffering inflicted by depression and noted that people with major depression are more than twice as likely to die, not just of suicide, but of medical conditions such as cardiovascular disease. He reviewed data that showed that most of the risk for depression comes from environmental factors and highlighted the importance of a history of trauma, adversity, and/or lack of parental nurturance early in life, especially in individuals with vulnerability genes for depression. He showed evidence that individuals who were exposed to early adversity have lifelong biological changes relevant to depression, including hyperactivity of stress-response pathways and reductions in CNS oxytocin, a hormone known to contribute to social bonding.
Dr Mayberg reviewed recent findings regarding the neurobiology of depression, focusing on her team's work with deep brain stimulation (DBS) in the white matter surrounding the subgenual anterior cingulate cortex as a treatment for severe, treatment-resistant major depression.1 In addition to showing remarkable video footage of rapid and sustained mood improvements brought on by DBS, Dr Mayberg made the stronger point-with which the Dalai Lama very much agreed-that when depression reaches a certain degree of severity it may require biological interventions to normalize the brain to a degree sufficient to engage in behavioral strategies such as meditation.
Meditation and cognitive therapies
John Dunne, PhD, associate professor in the department of religion at Emory, served to bridge the more established scientific knowledge of depression with the still-nascent field of meditation research by highlighting intriguing similarities between cognitive-behavioral theories of depression and Buddhist understandings of the origin of emotional suffering. Dr Dunne noted that both disciplines recognize the important role played by negative cognitive schemas in the development of emotional suffering. These schemas are characterized by an excessive self-focus, an exaggerated and negative self-representation, and a tendency to hold to rigid interpretations of experience that confuse one's negative perceptions and emotions with actual external reality.
A central goal of Buddhist practice-which is relevant to depression-is to recognize that cognitive schemas are necessarily subjective and limited and are not the same thing as the larger reality they represent. Mirroring Dr Mayberg's earlier comment that the pain of severe depression makes it difficult for people to identify or empathize with others, Dr Dunne stressed that a Buddhist perspective would also acknowledge the importance of recognizing the depressive tendency to falsely place the self at the center of all events. It is in this context, he asserted, that meditation makes sense as an intervention for depression.
By cultivating mindfulness, he noted, meditation helps people recognize thoughts as thoughts. By enhancing compassion for others, meditation may offer an avenue for counteracting the negative self-focus that is common in depression.
Providing evidence for these assertions, Zindel V. Segal, PhD, who is the Morgan Firestone Chair in Psychotherapy in the department of psychiatry and psychology at the University of Toronto and a central figure in the development of mindfulness-based cognitive therapy (MBCT), showed research from his group demonstrating that if episodes of sadness trigger excessive self-focus in patients with a history of major depression the risk of a depressive relapse significantly increases.2 Conversely, functional MRI data indicate that the practice of mindfulness meditation activates patterns of neural activity that reflect a diminished focus on self and an increased awareness of the current state of the body,3 which may provide a neural basis for the therapeutic benefits that have been observed when mindfulness training is added to more conventional cognitive-behavioral psychotherapy. Dr Segalconcluded his talk by noting that practices used in MBCT prioritize the cultivation of nonjudgmental awareness and that while these activities can be conceived of as acts of compassion toward the self, they do not include practices that explicitly seek to generate compassionate emotions toward the self or others.
At this point, the discussion shifted from mindfulness-based practices to the neural effects and therapeutic potential of meditation practices designed to actively generate compassion through the use of cognitive exercises, visualization, and techniques that seek to activate empathic emotions for the self and others. Richard J. Davidson, PhD, Vilas Professor of Psychology and Psychiatry at the University of Wisconsin, Madison, and a seminal figure in the field of meditation and compassion research, highlighted the fact that depressed individuals tend to have abnormal neural responses to positive social interactions and that this provides a scientific justification for exploring compassion training in the context of mood disorders.
That compassion practice may have beneficial effects on brain circuits relevant to social cognition and emotional regulation was supported by data from Dr Davidson's group that advanced Tibetan Buddhist meditators show profound alterations in brain regions linked to empathy when they practice compassion techniques. Davidson also reported findings from his research group that showed that even short-term compassion training in novices can affect activity in relevant neural circuitry and can enhance altruistic behavior.
The final 2 presentations of the conference described an ongoing study of compassion meditation in college students attending Emory University. Geshe Lobsang Negi, PhD, senior lecturer in the department of religion at Emory University and spiritual director of the Drepung Loseling Institute in Atlanta, provided His Holiness and the audience with an explanation of the central components of compassion meditation based on the lojong tradition of Tibetan Buddhism before discussing some of the challenges he faced in secularizing and adapting these practices for use in a 6-week training program for college freshmen. He emphasized that lojong-based practices differ from more frequently studied mindfulness techniques in being discursive, cognitive strategies that encourage practitioners to challenge their everyday assumptions about relationships with others.
The author of this article (Charles L. Raison, MD) provided a rationale for compassion meditation as a potential strategy to protect individuals against depression by noting that positive social connectivity has been shown in many studies to reduce stress system reactivity and to be associated with reduced inflammatory tone in the body.4,5 In contrast, conditions that increase inflammatory activity, such as psychosocial stress and medical illness, greatly increase the risk of depression.6,7 Moreover, individuals with depression respond to stress with dysregulation of the autonomic nervous system and increased inflammatory signaling. Based on these data, Drs Negi and Raison hypothesized that by teaching individuals to perceive their social connections in a more positive light, compassion meditation might be especially effective at reducing the types of deleterious physiological responses to stress that have been associated with depression and a number of medical illnesses for which depression is a risk factor. Dr Raison presented data from the first phase of the Emory study that supported this hypothesis.
The conference concluded with a wide-ranging discussion between the Dalai Lama and the presenters regarding challenges and opportunities facing the field of meditation research. Issues discussed included how best to assess the effect of meditation practice time on outcomes, how to identify which individuals would be most likely to benefit from meditation training, how to identify whether a given individual would be especially likely to benefit from a particular practice, and whether meditation is likely to be of more benefit for depression as a treatment or a preventive strategy.
Mayberg HS, Lozano AM, Voon V, et al. Deep brain stimulation for treatment-resistant depression.
Segal ZV, Kennedy S, Gemar M, et al. Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.
Arch Gen Psychiatry.
Farb NA, Segal ZV, Mayberg H, et al. Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference.
Soc Cogn Affect Neurosci.
Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes.
J Behav Med.
Loucks EB, Berkman LF, Gruenewald TL, Seeman TE. Relation of social integration to inflammatory marker concentrations in men and women 70 to 79 years.
Am J Cardiol.
Kendler KS, Karkowski LM, Prescott CA. Causal relationship between stressful life events and the onset of major depression.
Am J Psychiatry.
Evans DL, Charney DS, Lewis L, et al. Mood disorders in the medically ill: scientific review and recommendations.