A beautiful example of how mindfulness can change the mind — Book excerpt from Mindsight

I’m currently reading three books in parallel, Mindsight, Buddha’s brain and The Buddha walks into a bar. All three books show how we can rewire our brain with practice although, from slightly different angles. That’s what makes it so interesting to read them at the same time. Yesterday I read a few chapters of Mindsight in which the author tells an anecdote about how one of his patients was able to overcome his aggression and depression through mindfulness meditation. It is the best accounts of the power of mindfulness I’ve read so far so I want to share it. You will learn how through practice, we can switch to an observer perspective in our brains — more specifically, the prefrontal cortex — so that we don’t get swiped away by our emotions as easily as before.


What shapes the currents of our sea inside? When we hit rough
waters, is there anything we can do to calm the storm? In this
chapter I will explore how we can use focused, conscious attention
first to sense, then to alter, the wild flow of energy and information
that can plague our lives. This focused attention permits us to use
awareness to create choice and change. This is the domain of the
integration of consciousness.
The term mood refers to the overall tone of our internal state. We
express this emotional baseline through our affect, the external
signals that reveal our feelings, and by way of our actions and
reactions. Simply sitting with Jonathon in my office, I could begin
to pick up his feelings of despair and depletion. As he readily
admitted, his down mood also included tearfulness, irritability,
difficulty sleeping, and decreased appetite. He also admitted that
his feelings of hopelessness and despair were sometimes
accompanied by suicidal thoughts, but I was able to determine that
he had made no attempts and had no plans, at least at the moment,
to hurt himself.
In a psychiatric textbook this cluster of symptoms would point to
a probable diagnosis of major depression, but as a clinician I
wanted to keep an open mind about other potentially relevant
issues. Jonathon’s family history included both drug addiction in an
uncle on his mother’s side and manic-depressive illness (also known
as bipolar disorder) in a grandfather on his father’s side. This made
me cautious about a premature diagnosis of only depression.
Because of the family history of drug abuse, Jonathon’s family
had already been screening him regularly for drug use. The tests
were consistently negative, and Jonathon himself asked, “Why
should I take things that would make me more up and down? They
just mess me up even more than I already am.” I was struck by his
insight, and I believed him.
The abrupt explosions that took him down the low road might
signal the irritability that is a hallmark of major depression,
especially in children. But they could also be a symptom of bipolar
illness, which often runs in families and can emerge in childhood
and adolescence. In its initial presentation, bipolarity can be
indistinguishable from what is called “unipolar” depression, in
which the mood disturbance moves in one direction only: toward
down, depressed states. In bipolar disorder, however, these
depressed states alternate with the “up” (or, more accurately,
“activated”) state of mania. Adults and adolescents with mania can
experience rapid thinking, an infuriating sense of self-importance and
power, decreased need for sleep, increased appetite (for both food
and sex), excessive spending, and irrational behaviors.
Making the distinction between unipolar and bipolar mood
disorders is crucial for proper treatment, so I often get a second
opinion from a colleague regarding this diagnosis. In Jonathon’s
case we also got a third. Both confirmed my concern that
Jonathon’s mood disturbance might be emerging bipolar disorder.
Described in brain terms, bipolar disorder is a condition
characterized by severe “dysregulation,” meaning difficulty in
maintaining equilibrium in the face of daily life. The sense one gets
as a clinician is that there is a problem with the coordination and
balance of the brain’s mood-regulating circuits. As you’ve seen in
the first Minding the Brain section, our subcortical regions influence
our emotional states, altering our moods, coloring our feelings, and
shaping our motivations and behaviors. The prefrontal cortex,
sitting atop the subcortical areas, regulates how we bring these
emotional states into equilibrium.
The regulatory circuits of the brain can malfunction for a number
of reasons, some of them related to genetics or the constitutional
(not learned) aspects of temperament. One current theory is that
people with bipolar disorder may have a structural difference in the
way their regulatory prefrontal circuits connect with the lower,
emotion-creating and mood-shaping limbic areas. This anatomical
difference, perhaps established by way of genetics, infection, or
exposure to neurotoxins, may lead to the unbridled firing of lower
limbic areas. When revved up, these subcortical circuits shape the
rapid thinking, heightened appetites, and overall driven quality of
the manic state. While mania may appear attractive and pleasurable
to an observer, and the person experiencing it may indeed enjoy
some periods of euphoria, he is also likely to have periods of
agitation, irritability, and restlessness that feel out of control and
desperate. And when the dysfunction in the subcortical circuits goes
in the opposite direction, thought slows down, mood becomes
depressed, the vital functions of sleep and appetite are disturbed,
and the person may withdraw almost entirely from social contact.
When impaired prefrontal regulation results in failure to bring
these two extremes of the emotional continuum into equilibrium,
both the manic and the depressive states can be experienced as
extremely distressing.
The standard treatment for bipolar disorder is medication, which
has clear benefits for many patients. However, the side effects of the
medications used for bipolar disorder—called “mood-stabilizing
agents”—are much more significant than those of the
antidepressants used for unipolar depression. These risks present a
serious set of considerations for child psychiatrists, making us
hesitant to rush to the more long-term medications called for by a
bipolar diagnosis. Furthermore, if someone with undiagnosed
bipolar disorder presents first with depression and is given an
antidepressant medication, that clinical intervention can actually
trigger the onset of manic episodes. It may also make the individual
prone to an intense form of the disorder with rapid cycling between
mania and depression and sometimes the emergence of a “mixed
state” of both extremes at the same time.
Taking all of these concerns into account, I asked Jonathon’s
parents to come in with him and we discussed the issues openly,
including the role of medications in the treatment of serious
psychiatric disturbances. Many clinicians focus primarily on the
concept of “chemical imbalance,” and how various
neurotransmitters, such as serotonin or noradrenaline, take you
“up” or “down” as their levels rise or fall. However, I actually find
that a deeper discussion of emotional regulation in the brain gives
patients a larger view of the problem—and what we can do about
it. I introduced Jonathon and his family to the hand model of the
brain and described the prefrontal region’s crucial role. We didn’t
know why these circuits were not working optimally in Jonathon, I
told them. We just knew that his severe mental storms likely
correlated with such prefrontal dysfunction.
“What can be done to help those circuits work well?” Jonathon’s
mother asked astutely. One theory about depression, I said, is that
the brain’s ability to change in response to experience is shut down.
(In terms of our river of integration we can see this as rigidity.)
Antidepressants such as the familiar serotonin medications, the
selective serotonin reuptake inhibitors, or SSRIs, and mood
stabilizers such as lithium seem to help reignite neuroplasticity.
They help change the brain both by altering the way
neurotransmitters function and by enhancing the brain’s ability to
learn from experience—as in therapy. Medications and
psychotherapy combined often make an excellent treatment strategy
for major mood disorders. Even psychotherapy alone has been
shown to change the way the brain functions. In fact, I told them,
some recent findings have revealed that chronically relapsing
episodes of depression, like the ones that Jonathon might be
experiencing, may actually be prevented by a form of therapy based
on an ancient technique called “mindfulness.”

A MINDFUL APPROACH TO CHANGING THE MIND
At the time Jonathon came to me, I was in the midst of writing a
book that reviewed the existing neuroscience research on
mindfulness. Being mindful, having mindful awareness, is often
defined as a way of intentionally paying attention to the present
moment without being swept up by judgments. Practiced in the
East and the West, in ancient times and in modern societies,
mindful awareness techniques help people move toward well-being
by training the mind to focus on moment-to-moment experience.
People sometimes hear the word mindfulness and think “religion.”
But the reality is that focusing our attention in this way is a
biological process that promotes health—a form of brain hygiene—
not a religion. Various religions may encourage this health-
promoting practice, but learning the skill of mindful awareness is
simply a way of cultivating what we have defined as the integration
of consciousness.
As I’d told Jonathon and his parents, research had clearly
demonstrated that mindfulness-based therapy could help prevent
relapse in people with chronic depression. I had found no
comparable published research on using mindfulness for those with
bipolar disorder. However, I had reason to be cautiously optimistic.
Controlled studies had shown that mindfulness could be a potent
part of successful treatment for many conditions, including anxiety,
drug addiction (both treatment and relapse prevention), and
borderline personality disorder, whose hallmark is chronic
dysregulation.
In fact, one of the first studies to reveal that psychotherapy could
actually change the brain—a study of obsessive-compulsive disorder
done at UCLA—used mindfulness as a component of the treatment.
In addition, in our own pilot study at the Mindful Awareness
Research Center, also at UCLA, we found that mindfulness training
was highly effective for adults and teens who had trouble paying
attention at work or school.
Would Jonathon’s mood disorder respond to such an
intervention? The family’s cooperative stance, coupled with their
concerns about medication’s side effects, made me think it was
worth trying. I sought Jonathon’s and his parents’ informed consent,
keeping in mind his recent suicidal thoughts and the serious risks of
untreated depression, whether unipolar or bipolar. We elected to
do a trial of mindfulness training, agreeing that if it did not begin to
work within a few weeks’ time to reduce his suffering and stabilize
his mood, we would turn to the next phase of treatment, which
would probably include medication.

FOCUSING ATTENTION, CHANGING THE BRAIN
As I’d explained to Jonathon and his parents, the brain changes
physically in response to experience, and new mental skills can be
acquired with intentional effort, with focused awareness and
concentration. Experience activates neural firing, which in turn
leads to the production of proteins that enable new connections to
be made among neurons, in the process called neuroplasticity.
Neuroplasticity is possible throughout the lifespan, not just in
childhood. Besides focused attention, other factors that enhance
neuroplasticity include aerobic exercise, novelty, and emotional
arousal.
Aerobic exercise seems to benefit not only our cardiovascular and
musculoskeletal systems, but our nervous system as well. We learn
more effectively when we are physically active. Novelty, or
exposing ourselves to new ideas and experiences, promotes the
growth of new connections among existing neurons and seems to
stimulate the growth of myelin, the fatty sheath that speeds nerve
transmissions. Novelty can even stimulate the growth of new
neurons—a finding that took a long time to win acceptance in the
scientific community.
Where we focus our attention channels our cognitive resources,
directly activating neural firing in associated areas of the brain. For
example, research has also shown that in animals rewarded for
noticing sounds, the brain’s auditory centers expanded greatly,
while in those rewarded for attending to sights, the visual areas
grew. The implication is that neuroplasticity is activated by
attention itself, not only by sensory input. Emotional arousal may
also be a factor in the activation that occurs when animals are
rewarded for noticing sounds or sights, and the same factor may be
involved in activating neuroplasticity when we participate in an
activity that is important or meaningful to us. But when we are not
engaged emotionally, the experience is less “memorable” and the
structure of the brain is less likely to change.
Other evidence of brain reshaping as a result of focusing comes
from brain scans of violinists. The scans show dramatic growth and
expansion in regions of the cortex that represent the left hand,
which must finger the strings precisely, often at very high speed.
Other studies have shown that the hippocampus, which is vital for
spatial memory, is enlarged in taxi drivers.

A MINDFUL BRAIN
The ability to focus the mind is what I wanted Jonathon to acquire
through mindfulness training. But what exactly does mindful
awareness training stimulate? And why would mindfulness, as
research has shown, help with such a wide variety of diffculties,
from mood to attention, addiction to personality disorders? Finally,
could mindfulness training help Jonathon with his serious problem
with dysregulation?
In summary, here is what modern clinical research, 2,500 years of
contemplative practice, recent neuroscience investigations, and my
own experience all suggest: Mindfulness is a form of mental activity
that trains the mind to become aware of awareness itself and to pay
attention to one’s own intention. As researchers have defined it,
mindfulness requires paying attention to the present moment from
a stance that is nonjudgmental and nonreactive. It teaches self-
observation; practitioners are able to describe with words the
internal seascape of the mind. At the heart of this process, I believe,
is a form of internal “tuning in” to oneself that enables people to
become “their own best friend.” And just as our attunement to our
children promotes a healthy, secure attachment, tuning in to the self
also promotes a foundation for resilience and flexibility.
The way that mindfulness seemed to overlap with the processes
of secure attachment and with the key functions of the prefrontal
region that I discussed in part 1 made a powerful impression on
me. It seemed that the act of attunement—internal in mindfulness,
or interpersonal in attachment—might lead to the healthy growth of
middle prefrontal fibers. Shortly after I had this realization, I read a
report of ongoing research that showed that the middle prefrontal
regions were indeed thicker in mindfulness practitioners.
So this is the hypothesis that led me to offer mindfulness training
to Jonathon: that the practice would help the parts of his brain that
regulate mood to grow and strengthen, stabilizing his mind and
enabling him to achieve emotional equilibrium and resilience. It is
not that I believed he had a history of an insecure attachment, but
rather that mindful awareness might directly stimulate the growth
of the cluster of neurons called the resonance circuits, which I
discussed in the third Minding the Brain segment. These neural
circuits, which include the middle prefrontal areas, enable us to
resonate with others and to regulate ourselves. It is here that we can
see the connection between attunement and regulation: internal and
interpersonal forms of attunement each lead to the growth of the
regulatory circuits of the brain. When we have attunement—either
interpersonally or internally—we become more balanced and
regulated. Helping Jonathon achieve this form of internal
attunement with mindfulness practice was our goal. This would
take focus, time, and careful monitoring to be sure his underlying
dysregulation did not worsen or endanger him or others.

THE ADOLESCENT BRAIN AND THE PREFRONTAL CORTEX
Jonathon was eager to find a way to ease his suffering. Normal
adolescence is hard enough: negotiating the changes in one’s body,
the emerging and sometimes overwhelming feelings of sexuality;
changes in self-identity and relationships; academic demands;
uncertainties about the future; and the stresses in family life in
anticipation of leaving home. The adolescent brain itself is in flux.
The prefrontal regions, including the middle areas, do not mature
fully until well into the mid-twenties. Not only is the brain exposed
to dramatic hormonal changes, but it undergoes genetically
programmed “neural pruning sprees”—the removal of neural
connections to hone down the various circuits, preserving those that
are used and discarding the unused, so that the brain becomes more
specialized and efficient. The normal remodeling of the brain is
intensified by stress, and it can unmask or create problems during
this vulnerable period. This makes the nine middle prefrontal
functions—from fear modulation to empathy and moral awareness
—somewhat unpredictable, so that emotional self-regulation can be
challenging for any teenager.
Jonathon’s mood dysregulation went well beyond normal
adolescent turmoil. Most adolescents do not get to the point of
suicidal thinking, or to a place where their unpredictable moods
create significant chaos in their lives. These eruptive and painful
periods had created self-doubt in Jonathon. He felt he could no
longer depend on his own mind, that his mind was betraying him.
It seemed to me that becoming “his own best friend” was exactly
what Jonathon needed. If we could help him grow the integrative
fibers of his middle prefrontal cortex, he might be able to achieve
more of the FACES flow I discussed in chapter 4, so that he could
find a more harmonious path between the banks of rigidity and
chaos. Integration of consciousness might help stabilize his mind.
I explained all of this to Jonathon, and reminded him that with
regular exercise, a good diet, and sleep, he could set the foundation
for promoting neuroplasticity. Jonathon and I made a verbal
agreement that he would follow this “prescription” for health. It’s
amazing how often these basics of brain health are ignored. Exercise
is an underrated treatment—and now we know that aerobics not
only releases the endorphins that can combat a down mood but
also promotes the growth of the brain. Eating regularly and well,
balancing the various food groups, and avoiding excessive sugar and
stimulants can help to reduce mood swings. And sleep, though in
short supply and difficult at times to initiate for Jonathon, is a
healer that can be approached in a systematic way. Sleep hygiene
includes setting up a calming routine before bed. Minimizing
caffeine or other stimulants once evening approaches, if not before;
shutting of digital stimulation an hour or two before sleeping; and
quiet activities such as taking a bath, listening to soothing music, or
reading a book can all help the body as well as the mind to settle.
With these brain hygiene basics in our contract, we could move into
our specific efforts to promote integration.
Now it was time to use the focus of Jonathon’s mind to change
his brain. We began a series of skill-training sessions to help him
develop mindful awareness. The idea was that the techniques I
taught him would create a temporary state of brain activation each
time they were repeated. Induced regularly, these temporary states
would become long-term, enduring traits. With practice, a mindful
state becomes a mindful trait.

THE WHEEL OF AWARENESS: RIM, SPOKES, AND HUB
This is the basic diagram I drew for Jonathon to help him visualize how we
can focus our attention.
A picture in my own mind helped me make sense of the techniques
I’m about to describe to you. I call it the mind’s “wheel of
awareness.” I drew it for Jonathon as we started our work together.
Picture a bicycle wheel, with the hub at the center, and spokes
radiating to the outer rim. The rim represents anything we can pay
attention to, such as our thoughts and feelings, or our perceptions of
the outside world, or the sensations from the body. The hub represents the inner place of the mind from which we become aware. The spokes represent how we direct our attention to a particular part of the rim. Our awareness resides in the hub and we
focus on the various objects of our attention as points on the rim.
The hub can be seen as a visual metaphor for our prefrontal cortex.
To experience this directly, let’s turn to the first exercise I offered to
Jonathon.

A MINDFUL AWARENESS EXERCISE: FOCUSING ON THE BREATH
Over thousands of years of human history, from East to West,
virtually all cultures have developed some form of practice that
harnesses the power of mindfulness to cultivate well-being. These
include body-and energy-centered practices such as yoga, tai chi,
and qigong; devotional practices such as centering prayer or
chanting; and various forms of sitting and walking meditation that
were first introduced into the West by Buddhist practitioners.
I elected to teach Jonathon a practice called “insight meditation,”
both because I had learned it myself from experienced teachers and
because it had the most research backing up its potential to help
develop the brain. Other techniques might have been just as
reasonable a starting point, but I felt most comfortable with this
one.
Here is a transcript of the meditation exercise that I teach my
patients and students. Feel free to read through this, and then try it
out if you’re in a comfortable place that will allow you to dive into
the sea inside.
It’s helpful to be able to become aware of your own mind. That can be a
very useful awareness to have. Yet not much happens in school or in our
family life that lets us come to know ourselves. So we are going to spend a
couple of minutes now doing just that.
Let yourself get settled. It’s good to sit with your back straight if you
can, feet planted flat on the floor, legs uncrossed. If you need to lie flat on
the floor that’s okay, too. And with your eyes open at first, just try this.
Try letting your attention go to the center of the room. And now just
notice your attention as you let it go to the far wall. And now follow your
attention as it comes back to the middle of the room and then bring it up
close as if you were holding a book at reading distance. Notice how your
attention can go to very different places.
Now let your attention go inward. You might let your eyes close at this
point. Get a sense inside yourself of your body in space where you’re
sitting in the room. And now let yourself just become aware of the sounds
around you. That sense of sound can fill your awareness. (Pause for some
moments.)
Let your awareness now find the breath wherever you feel it most
prominently—whether it’s at the level of your nostrils, the air going in and
out, or the level of your chest as it goes up and down, or the level of your
abdomen going inward and outward. Perhaps you’ll even just notice your
whole body breathing. Wherever it comes naturally, just let your
awareness ride the wave of your in-breath, and then your out-breath.
(Pause.)
When you come to notice, as often happens, that your mind may have
wandered and become lost in a thought or a memory, a feeling, a worry,
when you notice that, just take note of it and gently, lovingly, return your
awareness toward the breath—wherever you feel it—and follow that wave
of the in-breath, and the out-breath. (Pause.)
As you follow your breath, I’m going to tell you an ancient story that’s
been passed through the generations.
The mind is like the ocean. And deep in the ocean, beneath the surface,
it’s calm and clear. And no matter what the surface conditions are like,
whether it’s smooth or choppy or even a full-strength gale up there, deep
in the ocean it’s tranquil and serene. From the depth of the ocean you can
look toward the surface and simply notice the activity there, just as from
the depth of the mind you can look upward toward the waves, the brain
waves at the surface of your mind, all that activity of mind—the thoughts,
feelings, sensations, and memories. Enjoy this opportunity to just observe
those activities at the surface of your mind.
At times it may be helpful to let your attention go back to the breath,
and follow the breath to reground yourself in the tranquil place at the
deepest depth of the mind. From this place it’s possible to become aware
of the activities of the mind without being swept away by them, to discern
that those are not the totality of who you are; that you are more than just
your thoughts, more than your feelings. You can have those thoughts and
feelings and also be able to just notice them with the wisdom that they are
not your identity. They are simply one part of your mind’s experience. For
some, naming the type of mental activity, like “feeling” or “thinking,”
“remembering” or “worrying,” can help allow these activities of the mind
to be noted as events that come and go. Let them gently float away and out
of awareness. (Pause.)
I’ll share one more image with you during this inward time. Perhaps
you’ll find it helpful and want to use it as well. Picture your mind as a
wheel of awareness. Imagine a bicycle wheel where there is an outer rim
and spokes that connect that rim to an inner hub. In this mind’s wheel of
awareness, anything that can come into our awareness is one of the
infinite points on the rim. One sector of the rim might include what we
become aware of through our five senses of touch, taste, smell, hearing,
and sight, those senses that bring the outside world into our mind.
Another sector of the rim is our inward sense of the body, the sensations
in our limbs and our facial muscles, the feelings in the organs of our
torso: our lungs, our heart, our intestines. All of the body brings its
wisdom up into our mind, and this bodily sense, this sixth sense, if you
will, is another of the elements to which we can bring our awareness.
Other points on the rim are what the mind creates directly, such as
thoughts and feelings, memories and perceptions, hopes and dreams. This
segment of the rim of our mind is also available to our awareness. And
this capacity to see the mind itself—our own mind as well as the minds of
others—is what we might call our seventh sense. As we come to sense our
connections with others, we perceive our relationships with the larger
world, which perhaps constitutes yet another capacity, an eighth relational
sense.
Now notice that we have a choice about where we send our attention.
We can choose which point on the rim to visit. We may choose to pay
attention to one of the five senses, or perhaps the feeling in our belly, and
send a spoke there. Or we may choose to pay attention to a memory, and
send a spoke to that area of the rim where input from our seventh sense is
located. All of these spokes emanate from the depth of our mind, which is
the hub of the wheel of awareness. And as we focus on the breath, we will
find that the hub grows more spacious. As the hub expands, we develop
the capacity to be receptive to whatever arises from the rim. We can give
ourselves over to the spaciousness, to the luminous quality of the hub. It
can receive any aspect of our experience, just as it is. Without
preconceived ideas or judgments, this mindful awareness, this receptive
attention, brings us into a tranquil place where we can be aware of and
know all elements of our experience.
Like the calm depths of the sea inside, the hub of our wheel of
awareness is a place of tranquillity, of safety, of openness and curiosity. It
is from this safe and open place that we can explore the nature of the
mind with equanimity, energy, and concentration. This hub of our mind is
always available to us, right now. And it’s from this hub that we enter a
compassionate state of connection to ourselves, and feel compassion for
others.
Let’s focus on our breath for a few more moments, together, opening the
spacious hub of our minds to the beauty and wonder of what is. (Pause.)
When you are ready you can take a more voluntary and perhaps deeper
breath if you wish and get ready to gently let your eyes open, and we’ll
continue our dialogue together.
How was that? Some people have a tough time diving in; others
feel at ease with the experience. If the breath doesn’t work for you
after a few sessions, you may want to find another form of mindful
focus. Yoga or tai chi or walking meditation might be a more
comfortable place for you to begin.
Just a few minutes a day of this or another basic mindful-
awareness practice can make a big difference in people’s lives. A
number of my patients have reported feeling less anxiety, a deeper
sense of clarity, safety, and security, and an improved sense of well-
being. I hoped Jonathon would respond the same way.
Fortunately, Jonathon took to this exercise well and became
committed to doing a mindfulness-of-the-breath meditation daily,
initially for about five or ten minutes at a time. When his mind
wandered from an awareness of his breath, he’d simply note this
distraction and gently return his attention to his breathing.
The renowned psychologist William James once said, “The
faculty of voluntarily bringing back a wandering attention, over and
over again, is the very root of judgment, character, and will… . An
education which should improve this faculty would be the
education par excellence.” Though James also said, “It is easier to
define this ideal than to give practical directions for bringing it
about,” we actually do know how to refocus a wandering attention
again and again—to use mindfulness practice to educate the mind
itself. I truly did feel like a teacher for Jonathon, offering him an
education in his own mind developed from 2,500 years of
contemplative practice.

AWARENESS TRAINING AND STABILIZING THE MIND
As a part of his school’s film club, Jonathon had been creating short
documentaries exploring various parts of town with his parents’
camcorder. He brought one of these projects in to show me early in
our work together, and I was impressed by the creative ways he
used camera angles to capture the mood and textures of this city in
which both of us had been born and raised. His eyes sparkled with
pride when he saw how much I enjoyed his creation. I told
Jonathon about the metaphor of a camera on a tripod that I
introduced in chapter 2. The lens of this camera is our ability to
perceive the mind. Without a tripod to keep the lens steady, the
mind can jump around like an amateur movie made with a
handheld camera. Jonathon got it immediately—the blurry, bumpy
film was like the feeling of being lost in his mood swings. Jonathon
also liked the image of the ocean in the meditation exercise. He
could identify with being a cork bobbing up and down on the
surface of an agitated sea. But whichever metaphor of the mind
works for you—wheel-and-hub, camera, sea—the sense is the same.
There is a place deep within us that is observant, objective, and
open. This is the receptive hub of the mind, the tranquil depth of
the mental sea. From this place Jonathon could use the power of
reflective awareness to alter the way his brain functioned and
ultimately to change the structure of his brain.
Let’s look at this process using the three legs of the mindsight
tripod: observation, objectivity, and openness.

OBSERVATION
Jonathon first needed simply to become aware of his awareness, to
observe how he focused his attention. As he discovered when he
tried to focus on his breath, he would get distracted repeatedly and
become lost in his thoughts, feelings, and memories. This is not
doing the meditation “wrong.” The point of the exercise is to notice
these distractions—and then to refocus on the target (the breath),
over and over again. Exercising attention is like developing a
muscle: We bend our arm and then straighten it—flexing and
relaxing our biceps, focusing and refocusing our attention when it
wanders. This practice would not only develop Jonathon’s ability to
be aware of his awareness, but it would strengthen his attention to
his intention—in this case, to focus on the breath. This monitoring
of awareness and intention is at the heart of all mindfulness
practices, from yoga to insight meditation, whether the focus is on
posture and movement, the breath, a candle flame, or any of the
myriad other targets found in the world’s cultures. Bit by bit,
Jonathon would build this mindfulness skill of “aim and sustain”
and stabilize his mindsight lens.
In addition to his mindfulness exercise, Jonathon agreed to keep
a journal of his daily activities, noting his shifts in mood, his
mindful practice (or not), and his aerobic exercise. This was another
opportunity to develop his capacity to observe his internal and
external experiences and to reflect on the workings of his mind.
Recording his experience with mindfulness quickly revealed his
lack of confidence in his mind. Nearly everyone who tries
meditation discovers that thoughts and feelings keep interrupting
our attempts at focus, even after years of practice. But intense
feelings of frustration would flood Jonathon at such times, and he
would write in his journal about how out of control this made him
feel. He shared some entries with me where his self-disparagement
bordered on not wanting to go on living. But there were glimmers
of something else in the journal, as well: “My father told me to stop
playing my music so loud and I blew up. He’s so mean and doesn’t
know how to get of my back… . But tonight I could see my
explosion at him like from a watchtower, sitting watching it fume,
and it felt bad and I couldn’t stop it.” The next day, he said, he had
calmed down, but he still felt that his mind had “betrayed” him
again. “Only this time, I could see it instead of just being lost in it.”
The observational distance that allows us to watch our own
mental activity is an important first step toward regulating and
stabilizing the mind. Jonathon was beginning to learn that he could
“sit” in his prefrontal cortex and not get swept up by the brain
waves crashing in on him from other neural regions. It was an
important place to start.

OBJECTIVITY
If you’re new to awareness training or meditation, you may find it
helpful to compare it to what happens when you learn to play a
musical instrument. Initially you focus on the characteristics of the
instrument—the strings, the keys, the mouthpiece. Then you
practice basic skills such as playing scales or strumming chords,
focusing on one note at a time. This intentional and repeated
practice is building a new capacity—it actually strengthens the parts
of the brain that are required for this new behavior.
Awareness training is a skill-building practice in which the
musical instrument is your mind. The aim-and-sustain skill
developed during observation enables you to hold your attention
steady, to stabilize the mind. The next step is to distinguish the
quality of awareness from the object of attention.
We began this phase of Jonathon’s awareness training with what
is called a “body scan.” During this practice, Jonathon would lie
down on the floor and focus his awareness on whatever body part I
mentioned. We would systematically move from his toes to his
nose, pausing for him to take in the sensations of each region.
When his attention strayed, his job was simply to gently note the
distraction, let it go, and refocus—just as he’d done with the breath.
What this immersion in body sensation was doing was directing his
attention to a new area on the rim of his wheel of awareness.
Sitting at the hub of the wheel, he could focus on the various
sensations from his body, locating areas of tension or relaxation,
and noting mental distractions while moving at will within this
sixth-sense sector of the rim.
Next I taught Jonathon a walking meditation: twenty slow paces
across the room with the focus of attention on the soles of his feet
or lower legs. Same approach: When he noticed that his mind had
pulled his attention away from the target, he simply refocused.
These practices continued to build the aim-and-sustain function of
observation, but they also were an entrée into objectivity: The focal
point of attention changed with each practice, but the sensation of
awareness remained the same. Awareness itself was becoming an
expanded presence in his internal world.
Here is an entry Jonathon shared with me from his journal
around this time: “Amazing realization: I can feel this change—my
thoughts and feelings come up, sometimes big, sometimes bad—but
they used to feel like who I was and now they’re becoming more
like an experience I’m having, not who I am, they don’t define who
I am.” Another entry described an incident when he was upset with
his brother. “I just got really mad … but then took myself outside
for a walk. I was in the yard, and in the back of my head I could
almost feel this split, something like a part of me that could see,
and a part that could get lost in the feeling. It was really weird. I
watched my breath, but I’m not sure that did much. Sometime later,
I just seemed to calm down. It was as if I didn’t take my own
feelings so seriously.”
During his home practice Jonathon was alternating among
breath-awareness, body-scan, and walking meditation. But now his
initial sense of frustration returned in a new form. He reported one
day that he would get a huge “headache,” a kind of “voice” that
kept telling him what he ought to feel, what he should be doing,
that he was doing his meditation all wrong, that he was no good.
All of these judgments were activities of his mind, I said, and I
reassured him that he was certainly not alone—many of us have a
judging voice that critiques our progress. But the next step in his
growth would require him to stop being a slave to that voice. I felt
this was a challenge that Jonathon was now ready to confront.

OPENNESS
Observation had enabled Jonathon to focus on the nature of
intention and attention, the driving forces of mental life. Objectivity
permitted him to distinguish awareness from mental activity, to
further free his identity from the storms of his mental sea. But now
that stormy rim activity was creeping back into his hub, in the form
of the “shoulds” of expectations. These are the prisons of life.
Trying to change how we actually feel by ordering ourselves to do
so is a strategy that goes nowhere, fast. Open awareness is about
accepting what is and not being swept up by those judging
activities.
Does this seem ironic? Jonathon comes to me to try to change,
and now I am encouraging him to accept himself as he is. But here
is the distinction: Our effort to combat our actual experience creates
internal tension, a kind of self-inflicted distress. But rather than
march into our inner world and say “No—don’t do that!” we can
embrace what is and notice what happens. Amazingly, time after
time people discover that letting things be also allows them to
change. We can approach our inner world with openness and
acceptance rather than with judgments and preconceptions.
Consider this: If a friend came to you with some difficulties, you’d
probably listen to her first, invite her to bring up whatever came to
mind, and offer her an open heart and a shoulder she could lean
on. This is what openness entails—attuning to what is, being kind
and supportive to ourselves, letting our state be receptive rather
than reactive.
Jonathon, however, had not yet learned to be kind to himself.
He’d be focusing on his breath, for example, and if he got distracted
by some memory of last weekend, some concern about schoolwork,
or thoughts about a fight with a friend, then he’d get a “sense” in
his head that he was “not meditating right” and that he was “not a
good meditator.” I suggested to Jonathon that these harsh self-
criticisms were just another mental activity for him to notice. They
were judging thoughts, I told him, and when they came up he could
try simply labeling them—“judging … judging …”—and then bring
his attention away from them and back to his breath. Jonathon
decided he preferred using the label “doubting, doubting” to
remind himself of the undermining nature of these distracting
thoughts.
The quality of openness is the third tripod leg stabilizing our
mindsight lens. It means that instead of being swept up by shoulds,
we come to accept ourselves and our experiences. But to get to this
place of inner attunement, of internal acceptance, we must first
become aware of when we are our own prison wardens.

A STABILIZED MIND
Jonathon noticed the changes that were emerging. He would go for
a run or ride a bike during stormy times, trying to find some way
out of the mood that seemed to take him over. These rhythmic
physical activities helped him to calm his body, to get grounded in
his awareness, and to bring himself back into balance. As the weeks
unfolded, Jonathon described a new experience. He began to sense
his raging thoughts and intense emotional storms with more clarity,
seeing them but somehow not becoming swept up by them. What
surprised him, and thrilled his parents, was that he seemed to find a
new way to actually calm the storms.
This is what Jonathon wrote in a journal entry one night: “I had a
fight with my Mom this afternoon and I went to my room before
dinner. I thought of killing myself. There it is again. This will never
get better. Just when I think things are changing, they stay the same.
I was late coming home from school and she just laid into me, she
was SO angry. … I sat in my bed and just thought—what’s the
point. But then the feeling of being absolutely helpless seemed to
float in my head, like a raft or a boat, some kind of log or
something. But instead of the usual feeling of being on that boat,
floating away, I was somewhere else. I could see that the raft was
just a feeling, just the feeling of me not being able to DO anything
to get out of this. And what was really weird was that once I let the
boat just be there, kind of in my head but separate from ‘me,’ not
being on it, it didn’t make me feel so bad. Then when I looked at it
straight on, like just some kind of helplessness, it just disappeared.”
In the session that day, Jonathon and I spoke about how this
experience of the “boat” let him see that in fact he did not have to
just float aimlessly on that feeling of despair. He had learned that
he could do something to prevent being ambushed by his feelings.
Jonathon also learned that just observing his own inner world with
acceptance had a strong soothing effect on his distress. He told me
that he began to notice he could soften the violence of his thoughts
and feelings by looking directly at them and not running from
them. Understanding that he could actually reverse the flow of his
feelings and thoughts gave him wonderfully positive feedback about
his own abilities. In many ways, Jonathon’s experiences echoed the
research finding that people with mindful awareness training have
a shift in their brains toward an “approach state” that allows them
to move toward rather than away from challenging situations. This
is the brain signature of resilience.
Later on Jonathon wrote, “I know this sounds lame, but my view
of life is changed now. What before I thought was my identity I
now realize is just an experience. And being folled with big feelings
is just some way my brain gives me experiences but they don’t have
to say who I am.”
I was moved by his discoveries, and in awe of his ability to
articulate such deep insights. Now we had to see how he could
refine this newly enriched monitoring ability to begin to alter the
way energy and information were flowing in his internal world—to
stop his mind from being flooded with those “big feelings” in the
first place. Having already learned how to use self-observational
skills to see his internal storms, he was now ready to learn
techniques that would enable him to do something about them. I
next taught Jonathon basic relaxation skills, inviting him to imagine
a peaceful place from his memory or imagination that he could
evoke at times of distress. We practiced this imagery in the safety of
the office and combined it with the grounding feeling he’d get by
just noticing his body in the chair or sensing his breath. These
relaxation and internal imagery techniques would provide him with
some readily accessible ways of calming himself. Over time,
Jonathon learned to ward of an impending “low-road” meltdown
by noticing his change in bodily state—his pounding heart, churning
belly, tense fists—and then the very act of noticing would soothe
him. Jonathon was experiencing the power of a stabilized
awareness of the mind to achieve mental equilibrium.
In our sessions as the months unfolded, Jonathon became more
and more confident of his ability to look inward and then to change
what was going on. In his journal he wrote, “I am beginning to see
how my own way of paying attention to my feelings changes what
they do to me. They used to explode and last for hours. Now after a
few minutes, I can see how they can crash around and then, as I
don’t take them so personally, they just melt away. It’s strange but
I’m starting to believe in myself, maybe for the first time.”
Change required the ability to accept what was there and have
the strength to let it be, until his mind became stable again. He and
I both knew how hard this road had been for him. The storms of his
life had been a huge challenge, but they also provided the
motivation for him to find a way to create a harbor of safety in his
own mind.
What had changed for Jonathon? We don’t have the brain scans
to say for sure from a neural point of view—but what I picture is
that over these hardworking months of twice-weekly sessions and
essentially daily awareness practice and aerobic exercise, Jonathon
was growing his middle prefrontal integrative fibers. His new way
of focusing his attention, of integrating his consciousness, would
have been made possible by his middle prefrontal areas expanding
their connections and beginning to grow the GABA inhibitory fibers
that could calm his subcortical storms. The “GABA-goo” could then
soothe his irritable limbic amygdala so that it didn’t recruit his
brainstem areas into the fight-flight-freeze routine that had been
driving Jonathon mad. He was also likely moving more toward a
“left-shift” brain state of approach. With this new integration
Jonathon was learning how to coordinate and balance the firing of
his brain in new and more adaptive ways. He could now “sit” in the
sanctuary of his newfound awareness without being swept up by
the mental activities that used to overwhelm him. This mental
training was more than just a way to alleviate his roller-coaster
symptoms—it was a way for Jonathon to become more resilient,
and more himself. “I’m feeling almost like a di?erent person—like
I’m stronger now. I don’t want to say this too much to jinx it, but I
feel really good—really clear.”
By six months into our work together, most of Jonathon’s
symptoms of emotional turmoil appeared to have dissipated. Sitting
with him in the room had a different feeling: He seemed more at
ease, clear, and lighthearted. He seemed more comfortable in his
own skin. “I just don’t take all those feelings and thoughts so
seriously—and they don’t take me on such a wild ride anymore!”
We continued to work on his practice and solidified his newfound
skills. On our last visit, after a year of therapy, Jonathon stood up
to shake my hand and I saw again that sparkle in his eyes that had
so often been hidden behind a mask of anguish and fear. Now his
gaze was clear, his face at ease, and his handshake confident and
strong. He must have grown at least three inches since he first
stepped into my office, what felt like ages ago.
After high school, Jonathon moved on to attend college out of
town. It’s now years later, and I recently ran into Jonathon’s parents
at a neighborhood store. They told me that he is “doing great” and
has not had a recurrence of his roller-coaster mind. He’s studying
film, and psychology.


Also published on Medium.