In this article comments on “The effects of gratitude expression on Neural Activity written by Kini Wong and a group of authors, it was published on March 1, 2016 in Neuroimage .
Interpretation of the findings
Gratitude correlates with activity in specific set of brain regions; and a simple gratitude writing intervention results in measurable in both gratefulness and neural sensitivity to gratitude over the course of weeks to months.
Specifically in this study significantly better mental health was reported by the participants involved in the gratitude interventions when compared with those in the expressive writing and therapy-as-usual. These improved outcomes lasted from about 4 weeks to 12 weeks. Additionally, when the gratitude writing was compared with expressive writing, a lower proportion of negative emotion words in subjects’ writing were indicative of better mental health.
This has strong implications for therapy and the practice of gratitude interventions. It appears when working with anxiety and depression a gratitude journal, modeling (positive words and behaviors) and the teaching of gratitude (positive words and behaviors) exercise can result in significant positive outcomes for clients and patients.
Conclusions
The effects of gratitude interventions in therapy are long lasting with long term effects on the brain which can be measured. There is both a difference in the measurement of gratitude from the measurement of empathy, theory of mind, and altruism and an overlap. The experience and expression of gratitude involves neural mechanisms associated with predicting the effects of one’s actions, mental arithmetic and calculations, and carrying out multiple tasks at once. Even brief expressions of gratitude show evidence of profound and lasting effects on neural activity and sensitivity, especially when considering the relationship of self to others.
Reference
Kini, P., Wong, J., McInnis, S., Gabana, N., & Brown, J. W. (2016). The effects of gratitude expression on neural activity. NeuroImage, 128, 1-10. doi: http://dx.doi.org.proxy1.calsouthern.edu/10.1016/j.neuroimage.2015.12.040
Even brief expressions of gratitude show evidence of profound and lasting effects on neural activity and sensitivity, especially when considering the relationship of self to others.
In this article, the author comments on the work of Dr. Sharprio and the implications it has in the therapeutic treatment of anxiety and fear. She defines meditation and contrasts it with mindfulness, and elaborates on incorporating mindfulness into the present medical model. Thus, she concludes with challenges individuals and practitioners to tackle anxiety and fears first using these treatment methods.
Mindfulness
Dr. Shaprio, a professor at Santa Clara University, a clinical psychologist is an internationally recognized expert on mindfulness (Shapiro, n.d.). She uses both current research in neuroscience and wisdom of ancient ways to illustrate her points. She makes it clear that perfection is not possible even though many of us spend much of our time trying to achieve this, and live in a continual state of self judgement. She articulates how each of us has great capacity to change and learn and how transformation is quite possible and within the reach of each individual no matter what the circumstances.
After years of studying how people transform, she found Mindfulness is one way people change (Shapiro, n.d.). She talked about her personal experience with spinal fusion, the pain, and her search for a way to cope and to live within her new body. This search led her across the world to learn Mindfulness from monks in Thailand at a meditation retreat. At first she struggled with being in the present moment as her mind keep wondering. She found the monks to be highly accepting and completely non-judgmental. They instructed her to feel her breath in and out of her nose. Our minds wander 47% of the time, so almost half of our lives we are missing, the moment right now as we wander somewhere else.
Feeling the breath, being present, recognizing our feet on the ground, softening our eyes, allows us to be present in the moment. Attempting to remove all personal judgement, judgement of others, and negative self-talk is central to the practice mindfulness. As in reality, many of us are practicing judgement (anxiety provoking behaviors), frustration and impatience and not mindfulness. Within her personal experience, a monk told her “what you practice grows stronger”. The neuroscience backs this up as repeated behaviors create more and more neural pathways which in turn shape our brain; repeated practice visibly increases synaptic connections (Carlson & Birkett, 2016).
A large part of mindfulness is training the brain to be right where you are. In response to this behavior, cortical thickening happens, new neurons grow and the brain becomes stronger (Shapiro, n.d.). Therefore, if you concentrate on judgement you are growing, strengthening judgement in your brain. Mindfulness is paying attention to ourselves and filling our thoughts with kindness and love. It is a welcoming of all parts of ourselves, a recognition that in every moment we are able to grow something good. Mindfulness is not just something you do when you meditate; it is a practice that is 24/7. Therefore the real question is what do you want to grow, strengthen or practice?
Meditation Defined
It is confusing as the words mindfulness and meditation are often used interchangeably (Shapiro & Shapiro, 2017). Meditation is usually practiced for a specific amount of time during the day. There are a variety of ways one can practice meditation through yoga, meditative exercise, prayer, meditative music, chanting and so forth. Often mediation exercises have specific themes such as developing loving kindness, forgiveness, open heart meditation, compassion and clear mind meditations (aimed at developing a clear and focused mind). Meditation is the intentional stilling (quieting) and renewing of the mind at specific planned intervals. This takes us to a different level of thinking; it transcends our current state, and involves a kinder way of thinking. This process returns us to our “right mind”.
Integration of Mindfulness in the Medical Model
Mindfulness could be immensely helpful if it were integrated into the medical model. Often the mere act of receiving medical services increases an individual’s anxiety, blood pressure and fear. Breathing becomes shallower. The constant worry, stress and release of cortisol complicate the situation. These negative emotions interfere with healing and recovery (Karren, Smith, & Gordon, 2014).
For example, if one looks at heart disease (Karren et al., 2014) new studies show that free-floating hostility, anger, cynicism, (anxiety, worry and fear) suspiciousness and excessive self-involvement all wreak havoc on the body. These cause exaggerated stress responses as the body begins to produce massive amounts of hormones as it prepares to fight of flee. These behaviors cause microvascular drainage in the blood vessel walls. This allows cholesterol in the blood to seep into the wall and creates plaque. It also increases coronary artery spasms which further narrows the vessels supplying oxygen to the heart muscle. An increase in blood pressure increases the heart’s workload and oxygen requirements which further constrict the blood vessels and increases high blood pressure. Blood platelets become sticky and further obstruct the narrowing arteries, increasing the risk for heart disease. All of these bodily changes leads to oxygen imbalances in the heart and can result in a heart attack.
Reducing (Karren et al., 2014) free-floating hostility, anger, cynicism suspiciousness and excessive self-involvement can all be done through the practice of positive psychology exercises, mediation exercises and the practice of mindfulness behaviors. Practicing gratitude, increasing activities that produce “flow”, reflecting on positive emotional experiences and successes, practicing forgiveness and intentionally (mindfully ) increasing positive social interactions by being present in the moment all decrease the stress responses in the body and triggers the release oxytocin (the love hormone).
Creating a high level of positive emotion (Karren et al., 2014) throughout the day has a significant impact on all the psychological processes in the body. It increases serotonin function, personal level of control improves, self-esteem expands and high blood pressure is reduced. Oxygen levels increase and the heart’s work load decreases and pressure is removed from the blood vessels. Why are we not already teaching every patient these practices? The integration of these meditation and mindfulness ways of being into the medical model would result in a higher individual locus of control, and lessen the need for medical interventions.
Summary
In conclusion, this author believes that the significance of mind and body practices such as mediation and mindfulness working with the medical cannot be understated. The practice of mindfulness is vital to overall good health and well-being. Furthermore, it has the capacity to alter the damaging influences of constant worry, fear and anxiety upon the body. Mindfulness is an intentional awareness that occurs 24/7, in contract meditation is planned life affirming exercises that typically revolve around a positive theme (it can include spiritual thoughts and prayer). It is the opinion of this author that together, used regularly and practiced systematically these holistic and non medication approaches can have long lasting efficacy in the treatment of anxiety, worry and fear.
“Creating a high level of positive emotion throughout the day has a significant impact on all the psychological processes in the body. It increases serotonin function, personal level of control improves, self-esteem expands and high blood pressure is reduced.
Oxygen levels increase and the heart’s work load decreases and pressure is removed from the blood vessels, which in turn reduces or eliminates anxiety fears and worry”
– Dr. Diann Sanford, Psy.D, LPC
References
Carlson, N. R., & Birkett, M. A. (2016). Physiology of Behavior (12th ed.). New York, N.Y.: Pearson Education, Inc.
Compton, W. C., & Hoffman, E. (2013). Positive Psychology (2nd ed.). Belmont, CA: Wadsworth, Cengage Learning.
Karren, K. J., Smith, N. L., & Gordon, K. J. (2014). Mind Body Health (5th ed.). New York, NY: Pearson Education, Inc.
Shapiro, E., & Shapiro, D. (2017). Mindfulness & Meditation: What’s the Difference? Retrieved from https://medium.com/thrive-global/the-power-of-mindfulness-and-meditation-70fceeffa221
Shapiro, S. (n.d.). The Power of Mindfulness: What you Practice Grows Stronger. Retrieved from http://www.drshaunashapiro.com/articles-videos/
There has been increasingly widespread interest in the study of the variations of the beat to beat timing of the heart, known as heart rate variability (HRV). Fluctuations in heart rate have predictive importance (Kleiger, 2005), as they can be used to assess various pathological states or affirm wellness as heart rate responds dynamically to physiologic agitations umpired by the autonomic nervous system via efferent vagal and sympathetic nerve impulses. HRV can be used in clinical practice to help characterize a patient’s state in a real-time, non-invasive manner (Francesco et al., 2012). Hon and Lee first used it clinically in 1965 (Tayel & AlSaba, 2015), when they noticed that fetal distress was recognizable by changes in beat to beat variation of the fetal heart. They discovered that this heart rate variability change (Tayel & AlSaba, 2015) was present before there was a noticeable change in fetal heart rate (HR).
Patients with cardiovascular issues experience alterations in HRV (Tayel & AlSaba, 2015), therefore many researchers have concentrated on studying the characteristics of HRV that assist in predicting long term risk of deadly ventricular arrhythmias. HRV is also affected by growing older, gender and circadian rhythm (Sammito & Bockelmann, 2016). HRV increases at night and decreases significantly during the early morning hours (Sammito & Bockelmann, 2016). Aging has been linked to a decrease in efferent vagal tone, reduced beta-adrenergic responsiveness, and the regression of HRV (Tayel & AlSaba, 2015). Likewise, regular physical activity has been shown to improve HRV, thus improving vagal tone, and in turn slowing down the aging process (Eftekhari, Soleimani, & Mani, 2013).
HRV is widely used as a measure of the Autonomic Nervous System’s (ANS) status (Viljoen & Claassen, 2017). The plasticity of HRV is deemed to be a marker of psychological and physical well-being, and a predictor of both morbidity and mortality (Viljoen & Claassen, 2017). HRV is influenced by many physiological factors and diseases, and awareness of these are central to the analysis and assessment of HRV in both scientific studies and in clinical practice (Sammito & Bockelmann, 2016). At rest, the heart rate fluctuates cyclically. High frequency (HF) cyclic fluctuations are modulated by ventilation, changes in vagal outflow while slower fluctuations happen due to thermoregulation or baroreflexes (Kleiger, 2005).
Individuals have internal control systems that act in response to both internal and external stimuli, these systems maintain homeostasis (Francesco et al., 2012), consequently the human heart rate is not regular and varies in time, however this heart rate variability (HRV) is not random (Francesco et al., 2012). Circadian changes, the difference between night and day mark the greatest variations in heart rate, which are regulated by complex neurohormonal rhythms (Kleiger, 2005), exercise and emotions have serious effects on heart rate variability as well.
Biological systems are complex, they are built from a dynamic web of interconnected feedback loops (Francesco et al., 2012). These sophisticated networks are marked by interdependence, redundancy and multiple reactions of a myriad of organizational structures (Francesco et al., 2012). A decrease in HRV indicates a decrease in mortality, and a host of other diseases and illnesses go hand in hand with this decrease in HRV (Sammito & Bockelmann, 2016), similarly, an increase in HRV marks overall improved mortality, health, and functioning (Sammito & Bockelmann, 2016).
Measurement
Short term HRV measurements were used in the 1970s as a marker of diabetic autonomic neuropathy (Tayel & AlSaba, 2015), from there it was found that patients with hypertension exhibited growing low-frequency power (LFP) and reduced circadian patterns. HRV has been comprehensively explored as a reliable tool to predict the risk of sudden death by cardiac arrest (Tayel & AlSaba, 2015). HRV was found to be influenced by many psychological, physiological, biological and environmental factors (Ginsburg, 2016), and was found to be sensitive and reactive to acute stress, as it marks both dynamic and accumulative load (Eftekhari, et al., 2013).
HRV is the measurement and analysis of the beat to beat (R-R) intervals or (NN) the gap in heart beats between two normal peaks (Sammito & Bockelmann, 2016). Progress in the development of technology has decreased the costs of recording, while analysis has increased the use of these instruments in clinical settings (Sammito & Bockelmann, 2016). There are two ways in which heart rate variability (HRV) is commonly assessed (Kleiger, 2005); it can be measured under controlled laboratory conditions or it can be determined from 24-hour ECG recordings made while subjects go about their regular activities. In short-term laboratory studies, researchers often viewed standard five-minute segments of heartbeat variability (Kleiger, 2005), consisting of two peaks during this time, called the interval power spectra. There would be a high frequency (HF) peak between 0.15 and 0.40 Hz and a low frequency (LF) peak between 0.04 and 0.15 Hz (Kleiger, 2005).
HRV and Clinical Implications
Studies have used measures of HRV to assist researchers in the exploration of mental disorders and responses to stress (Muaremi, et al., 2013). The classification of results from high and low-stress groups after presenting stress provoking stimulus to subjects, such as controlled workloads and time pressures, produced findings that accurately discriminated subjects under stress from subjects not under stress with 90% accuracy (Muaremi et al., 2013). Baroreflexes and sympathetic and parasympathetic efferent nerve traffic modulate the low-frequency power (Kleiger, 2005), it is this low-frequency power that seems to implicate the presence of depression, anxiety, and ADHD. Moreover, bipolar patients have been identified and characterized by HRV analysis through information obtained after wearing a sensorized t-shirt (Muaremi et al., 2013).
Biomarkers are alternative measures for studying disease and illness states, they identify problematic areas of physiological responses (Young & Benton, 2018). There has been increasing research regarding the use of HRV as a biomarker device. This increase in use is due to the fact that HRV indicates the complex interaction of the heart with a multitude of body systems, expressly the brain (Blase, Van, Cluitmans, & Vermetten, 2016). Individuals suffering from anxiety disorders, panic attacks, posttraumatic stress disorders, depressions along with other illness such as epilepsy, anorexia, and borderline personality disorders all have been shown to have lower HRV (Sammito & Bockelmann, 2016). Currently, HRV training is often used in conjunction with heart rate variability biofeedback, termed HRVB (Blase, et al., 2016) and other interventions (Young & Benton, 2018).
Application
Chronic stress increases the risk of neuropsychiatric, cardiovascular and endocrine disorders (Pereira, Campos & Sousa, 2017). The practice of HRVB is the antidote. The susceptibility to chronic stress varies among individuals and changes across the lifespan. Chronic stress can be modulated through distinct molecular mechanisms. The autonomic nervous system is a determinant of stress resilience, manipulating it through biofeedback is useful to promote resilience (Pereira, et al., 2017). Daily practice of biofeedback sessions increases the amplitude of heart rate oscillations that improve emotional well-being (Mather & Thayer, 2018),thus it modulates chronic stress.
Blood flow timing enhances functional connectivity in brain networks associated with emotional regulation, slows oscillations in heart rate and has the capacity to strengthen brain network dynamics (Mather & Thayer, 2018). Heart rate variability biofeedback (HRVB), is a non-invasive treatment in which patients are expected to self-regulate a physiological dysregulated vagal nerve (Blase et al., 2016). Researchers have found that the prefrontal regulatory regions are particularly responsive to these changes in heart rate oscillations (Mather & Thayer, 2018); this signifies the possibility that all mental illnesses that impact emotions, the brain, and specifically the pre-frontal cortex as being most responsive to the use of HRV.
This is revealed in the psychological, biological, immunological, and physiological responses as assessed in our body’s biomarkers, such as in heart rate variability. Thus, with proper holistic interventions, the biomarker, heart rate variability can be improved (Young & Benton, 2018), and in turn, the symptoms of depression, anxiety, and ADHD reduced.
“Psychological, biological, immunological, and physiological responses as assessed in our body’s biomarkers, such as in heart rate variability. Thus, with proper holistic interventions, the biomarker, heart rate variability can be improved), and in turn, the symptoms of depression, anxiety, and ADHD reduced. ”
– Dr. Diann Sanford, Psy.D, LPC
References
Bateman, A., & Fonagy, P. (2008, May 5). 8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as usual 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. The American Journal Of Psychiatry, 165, 631-638. http://dx.doi.org/dx.doi.org/10.1176/appi.ajp.2007.07040636
Beauchanine, T. P., Gatzke-Kopp, L., Neuhaus, E., Chipman, J., Reid, M. J., & Webster-Stratton, C. (2013). Sympathetic and parasympathetic linked cardiac function and prediction of externalizing behavior, emotion regulation, and prosocial behavior among preschoolers treated for ADHD. Journal of Consulting and Clinical Psychology, 81(3), 481-493. http://dx.doi.org/10.1037/a0032302
Blase, K., Van, D. A., Cluitmans, P., & Vermetten, E. (2016). Efficacy of HRV-biofeedback as an additional treatment of depression and PTSD. Tijdschr Psychiatr, 58(4), 292-300. Retrieved from https://europepmc.org/search?query=JOURNAL:“Tijdschr+Psychiatr”&page=1
Deadman, P. (2018). The transformative power of deep, slow breathing. Journal of Chinese Medicine, 116, 56-62. Retrieved from https://www.journalofchinesemedicine.com/the-transformative-power-of-deep-slow-breathing.html
Eftekhari, G., Soleimani, S. A., & Mani, A. (2013). Heart rate variability, vagal activity and the pulse of inflammation. The association for the Publication of the Journal of Internal Medicine, 490-491. http://dx.doi.org/10.1111/joim.12046
Francesco, B., Grazia, B. M., Emanuele, G., Valentina, F., Sara, C., Chiara, F., … Francesco, F. (2012). Linear and nonlinear heart rate variability indexes in clinical practice. Computational and Mathematical Methods in Medicine, 2012. http://dx.doi.org/10.1155/2012/219080
Kleiger, R. E. (2005, ). Heart Rate Variability: Measurement and Clinical Utility. The annuals of Noninvasive Electrocardiology ( A.N.E.), 10(1), 88-101. http://dx.doi.org/10.111/j.1542-474x.2005.10101
Mather, M., & Thayer, J. F. (2018). How heart rate variability affects emotion regulation brain networks. ScienceDirect, 19, 98-104. http://dx.doi.org/10.1016/j.cobeha.2017.12.017
Muaremi, A., Arnich, B., & Troster, G. (2013). Towards Measuring Stress with Smartphones and Wearable Devices During Workday and Sleep. BioNanoSci, 3, 172-183. http://dx.doi.org/10.1007/s12668-013-0089-2
Pereira, V. H., Campos, I., & Sousa, N. (2017). The role of autonomic nervous system in susceptibility and resilence to stress. ScienceDirect, 14, 102-107. http://dx.doi.org/10.1016/j.cobeha.2017.01.003
Sammito, S., & Bockelmann, I. (2016). Factors Influencing Heart Rate Variability. International Cardiovascuclar Forum, 6(), 18-22. http://dx.doi.org/10.17987/icfj.v6i0.242
Tayel, M. B., & AlSaba, E. I. (2015). Poincare’ Plot for Heart Rate Variability. International Journal of Biomedical and Biological Engineering, 9(9), 708-711. http://dx.doi.org/10.5281/zenodo.1109321
Viljoen, M., & Claassen, N. (2017). Allostatic load and heart rate variability as health risk indicators. African Health Sciences, 17, 428-435. http://dx.doi.org/10.4314/ahs.v17i2.17
Young, H. A., & Benton, D. (2018). Heart -rate variability: a biomarker to study the influence of nutrition on physiological and psychological health? Behavioral Pharmacology, 29, 140-151. http://dx.doi.org/10.1097/FBP.0000000000000383
It doesn’t take a whole new routine to instill a dose of happiness into your day—but it does take a little self awareness.
1. Be grateful for the good & the bad.
Research shows, grateful people are happy people. It’s also important to understand that happiness is not the absence of negative feelings. Gratitude is a focus on the present and appreciation for what we have now, rather than wanting more. Embracing gratitude, as a state of mind, can have a positive affect on all aspects of life including our happiness and overall satisfaction.
Up your mood by taking a moment daily to think of your world with gratitude. Start a gratitude journal or take a walk in nature paying attention to all the gifts around us. Think of a person that helps you on a daily or weekly basis – a spouse, parent, friend, pet, teacher, cleaner, or babysitter.
Quiz: How grateful are you? Take the Gratitude Quiz published by the Greater Good Science Center at UC Berkeley.
2. Flex your creativity muscles.
Do you have a passion or hobby? It doesn’t have to be a formal activity, simply engaging in creative thinking can enhance well-being by enhancing cognitive flexibility and problem-solving abilities. A recent study out of New Zealand, published in The Journal of Positive Psychology explains that creative activities can trigger an “upward spiral” of well-being.
“Practicing an art — no matter how well or badly — is a way to make your soul grow. So do it.” – Kurt Vonnegut.
Make some space in your day to create, even if it’s just for the sake of it. Try exploring unique textures or even natural and recycled materials to make something for your home or a friend. Looking for some tips on how to add more creativity into your daily life? Read this list of 101 creative habits to explore.
3. Get connected, Stay connected.
Being apart of something larger than yourself can help bring perspective as well as a sense of belonging. Scientific evidence strongly suggests that feeling like you belong and generally feel close to other people is a core psychological need; essential to feeling satisfied with your life. The pleasures of social life register in our brains much the same way physical pleasure does.
So take the time to nurture a friendship that is important to you. Make an extra effort to show you care, send a card, make a plan to have lunch, or give them a call and really listen to what they say. Smile and say hello to a stranger. Tell a story when someone asks how your day is going. Notice how you feel when you share something with someone new.
Struggling and need support? Join a support group and talk to others that can relate. Find your tribe: support.therapytribe.com – a free online support community brought to you by TherapyTribe.
Tip: Check out the wellness tracker. It’s a simple but powerful tool designed to help you remember the promises you make to yourself. As you complete wellness activities your tree will blossom, and so will you!
