Into the Impossible With Brian Keating - Fadel Zeidan on the neuroscience of mindfulness, and his research on pain, anxiety and psilocybin (#057)

Episode Date: July 15, 2020

  Producer Stuart Volkow interviews Dr. Fadel Zeidan, PhD, the Associate Director for Research at the UCSD Center for Mindfulness and Assistant Professor of Anesthesiology at UCSD. He and his laboratory have discovered the neural processes supporting mindfulness meditation and mindfulness-based pain relief. https://www.zeidanlab.com/ https://medschool.ucsd.edu/som/fmph/r… Recently, he and his team have demonstrated that mindfulness meditation is mechanistically distinct from and more effective than placebo, distraction, and relaxation. His research is currently funded by the National Center for Complementary and Integrative Health and has disseminated his findings through traditional media outreach (CNN ; NPR ; Time Magazine , CBS and others), Tedx and recently personally presented his work to His Holiness, the Dalai Lama in Mongolia. In his role at the UCSD Center for Mindfulness, Fadel will focus on expanding his research to focus on working with different patient populations and user-friendly approaches to promote the self-regulation of pain. Fadel is especially excited at examining ways to integrate mindfulness from the lab to the clinic and community. Dr. Fadel is also part of the The Psychedelics and Health Research Initiative (PHRI) at UC San Diego, under the auspices of the Clarke Center, that conducts novel basic and clinical research on the use of psychedelics for the treatment of pain and other health conditions. Learn more about your ad choices. Visit megaphone.fm/adchoices

Any sufficiently advanced technology is indistinguishable from magic. Welcome, everybody, to another episode of Into the Impossible. From the Arthur C. Clark Center for Human Imagination at the University of California, San Diego. I'm Stuart Volko. Today, we have the pleasure of talking with Fidel Zedan. He is the Associate Director for Research at the Center for Mindfulness in the Department of Family Medicine and Public Health at the UC San Diego School of Medicine. and he is a recently tenured associate professor in the Department of Anesthesiology.

I would like to welcome you to Into the Impossible. Thanks, Stuart. It's great to be here. Thanks for having me. Let's just start at the beginning and just get to know you a little bit. You're a fairly recent hire here at UCSD and you relocated from Winston, Seattle, North Carolina, from Wake Forest. Tell us a little bit about how you got here and your journey. Yeah, thanks. I'll try to make you brief.

So I've always been kind of interested in consciousness and psychology and human behavior. And, you know, when I was getting my bachelor's of science in North Carolina, I got a degree in psychology. And this was kind of in the midst of the kind of Ritalin over prescribing phenomenon that was happening. right and so every other kid i knew was all you know hopped up on on ridlin and adderall and um and so i was really interested from a health psychology perspective to appreciate more non-pharmacological ways for us to feel better right to kind of depend on ourselves so i was really into eastern philosophy and so on well getting a BS in psychology is kind of literally just that so i really couldn't do much with the psychology degree, except in Charlotte, North Carolina, they had this

educational program for educators where it was called lateral entry. So I didn't have an education degree, but I could, using my psychology degree, teach special education, which was something that was very interesting to me, and something I was very enthralled by. And so my students in elementary school, grades three through five, were very intelligent, but they had behavioral problems that impeded their learning. So these are kids that were suffering from the ramifications of emotional abuse, sexual abuse, severe anger management problems, predominal phases of schizophrenia and so on. And they were all hopped up on on psychotropic drugs. They were robots. They didn't really even have a personality. So I started teaching them mindfulness,

meditation in the morning and in the afternoon. And you're muted. I'm sorry. Let's Jim in there for one second. Why is that? Why is this so many of your students on these drugs and how did that happen? Is that a general? Is that prevalence?

It wasn't, yeah, it was in 2003 through five. You know, they, the drugs impeded what they called emotional meltdowns. And they were figuratively that. They were really dramatic. I mean, I was attacked by staplers. I had chairs thrown at me. I could tell you some really gross things as well. I won't.

I had a student that would, she never, she was, her mother used her in the most horrific ways for crack, cocaine. And she was malnourished. And she would give her lunch and she would save the food, her food in the back of her mouth. Because she didn't know when the next time she was going to have a meal. It's horrific. So the drugs kind of, I'm not going to say the word stabilized,

but allowed them to sit in their seats. Now, they weren't necessarily engaging anything cerebrally because they were zonked out. But it was just very disturbing for me. So I taught the mindfulness in the morning and the afternoon and I employed some of the academic disciplinary techniques my mother used on me. And, you know, they were very immature about the practice.

But as a function of time, we started to see some changes, especially when they had meltdowns. We would guide them through the practice that they had learned through a meltdown. And as a function of time, we started to see lower frequency and intensity of these meltdowns. By the end of the year, my classroom exhibited the highest growth in the state in academic performance. And by the end of the year, only one of them was still on psychotropic drugs. Now, I can't blame, I can't say this is mindfulness all, because we worked a lot with their parents and their foster parents and so on. It was multimodal, but they plucked me out of that school and they put me into another program and we replicated the effect and that's when I decided to go to graduate school to study mindfulness. So this was early on.

I started studying mindfulness in 99 and I went to get a master's degree in Cox Science philosophy around 2006, at which point I started my PhD program in health psychology. And there I really had the privilege of having mentors that gave me the ability and freedom to do what I wanted to do, which was study mindfulness. And at this time point, I was explicitly instructed by other professors to stay away from it, that it would be a career killer. So, and then I, you know, the advent of brain imaging started to, with the advent of brain imaging and it became much more accessible and more sophisticated and more user friendly, that's where really I started to be just, beyond impressed with what we can do to dive into the hallways of someone's mind. And I was also more particularly interested in how mindfulness worked and is it just a placebo. So a lot of my research is asking, is this just placebo-based type of research? Let's go to some definitions.

What is mindfulness and what's the difference between mindfulness and traditional types of meditation? That's a great question, Stuart. So you go from one lab to another lab, from one center to another center, and you're going to get a different definition of mindfulness. But of course, my laboratory's definition is the correct one. And we define mindfulness as non-reactive awareness to the sensory experience. And mindfulness itself can generally contain a number of different practices, but it's really cultivating the practice to be in the present moment without allowing,

allowing the emotions and feelings to kind of contaminate said moment. And if they do, that's okay to acknowledge them, let them go, and come back to the meditative object, which is usually a breath. So mindfulness practice is usually about stabilizing attention on a dynamic stimulus. This is why we study the breath. This is why people focus on the breath. And so what that does is it enhances the ability for someone to sustain attention. So you focus on the breath over and over and over.

This is really analogous to lifting a weight for bicep strength over and over and over. Now, when you do this, your mind's going to drift away. It's going to go to what you did yesterday, a conversation you had 20 years ago, what you're going to have, your future plans, what are you going to have for dinner and so on. Feelings too, pain, comfort, positive feelings. So the practitioner is taught to acknowledge those things and to let them go by bringing their attention back to the breath. So that secondary component is teaching the individual to self-regulate their emotions. Right.

Now, there's thousands of types of techniques of meditation. Mindfulness is distinct in the way that it is directly related to increasing attentional stability and emotion regulation. Other techniques are more mantra-based, where the repetition is eliciting a rhythm that starts to feel good, if you will. Some of these, a lot of the transcendental meditation techniques are using these. these mantras to elicit bliss. And some of these things are dogmatic in nature, right? They require a belief into the philosophy for them to be realized. I would say that mindfulness is inherently atheist.

Not that you are atheist, but it engages in the way that it's taught here, no spiritual, no religious emphasis. It's a mental training phenomenon. And that's something that we try to really hammer home in our research, especially if this is going to be clinically pragmatic. You really need to kind of get all the peripheral expectations of what folks think it is out of the way. So for instance, when I was working in North Carolina, there was a lot of Baptists and evangelicals. I mean, a lot, right? And so they thought, well, am I going to worship an idol?

You know, they see the Buddha sitting with a statue. you? Am I worshipping? I'm like, no, no, no, we're not getting. There's nothing religious or philosophical or spiritual about this. You're going to the gym for your mind. So that's the way we try to kind of present it to Westerners. Now, in California, it's a different ballgame, right? People are going to Spirit Rock.

They're going to Esselin. They're going to different meditation centers. And they want that spiritual component. And then that's a different game, isn't it? That's something that, um, is powerful in itself, but I try to stay away from that in the research context. Sorry, it's a bit verbose. That's okay because that answers a lot of my questions.

And that allows me to jump to your research. Before we get in specifically, because you're specializing in pain is one of your topics of research, just broadly speaking, and you mentioned brain mapping using various techniques, what does it do to your brain? And what have you found just in general using the techniques that you've had access to like fMRI and physiological monitoring? And is there a difference between what it does to your brain between meditation and mindfulness? Yeah, yeah, it's a great question. So mindfulness does a lot to your brain.

We are seeing that mindfulness is engaging multiple processes to increase well-being. And these improvements in well-being are correlated with profound, reproducible changes in the brain. The state of meditation will vary from expertise level, from a novice meditator to an adept expert meditator. So the novice meditator is going to be engaging more of their prefrontal cortex. So this is the front of the brain. It's kind of the newest.

update of our brain, kind of the iOS 20, if you will, from an evolutionary perspective. And then it kind of downregulates or inhibits, if you will, activation in old parts of the brain, like the amygdala, which is associated with kind of reflexive emotions that are integral to our survival, but also integral to developing some chronic conditions. And the thalamus, in the context of pain, the thalamus is a very old brain region that's kind of the gateway from the body to the brain. And so mindfulness kind of shuts down that gate a bit. And then the adept meditators, the more expert meditators,

they actually deactivate the prefrontal cortex through extensive training. And they have greater activation in the more sensory processing regions. So what's happening is in the early stages, folks are reappraising, they're engaging more reappraisal mechanisms. Focusing on the breath, I acknowledge a distracting thought. I'm not going to judge it. I'm going to come back to the breath. I'm reappraising.

Non-appraisal is what happens with more training. And that's remarkably consistent with the stance of the Pasina, or what we call choiceless awareness. So this is a transition. It's a natural transition in training where the breath focus kind of dissipates. And then the practitioner just watches non-judgmentally all thoughts, feelings, and emotions that arise in their consciousness. But they don't attach to the feeling order.

appraisal to it. And that requires the prefrontal cortex to kind of simmer down a little bit. Right. So the question is loaded in the sense is that it's relative to the type of, to the amount of experience that you have. So in the early stages, from the Buddhist context, we call it shamata. And then as you become more adept, you'd start to naturally transition into more of a vipasana or choiceless awareness stance, where you go from reappraisal to no appraisal. And as people practice these techniques, do these changes persist? Can you see differences in the neurobiology, neurophysiology? And how do you measure those?

Great question. So the answer could be a year-long course, but I'll try to give it to you in one minute. So, you know, there's this phenomenon in neuroscience called neuroplasticity. And neuroplasticity is the nature of our brain's ability to change as a function of a behavior or a practice. So if you're training in mindfulness, for instance, that you're going to have improvements in neural plasticity in brain regions that are associated with emotion regulation and cognitive control. And the same is true if you're always depressed or in living a sedentary lifestyle, the brain will also adapt to facilitate those negative behaviors. It goes both ways. Now, why would a bicep change as a function of physical training differently than the brain as a function of mental training?

So really, this is the use it or lose it principle. So we see changes in the brain from practicing mindfulness that are more stabilized as a function of training frequency. So we will do these techniques called resting state functional connectivity. So this is where an individual lays in a scanner and does nothing. and we will see different activations at rest, we call it at rest. There's different brain activation at rest. And one of the more unique findings that we're seeing is that the changes in the brain's default mode network are occurring. So this is the brain's self-referential, self-narrative, the mind-wondering network.

And so you're driving to the mountains, you get your whole family in your car, you're going 75 miles per hour, you're two hours in, but you are nowhere near that car. You were thinking about what you're going to do when you first get to your mountain house, whatever your mind has wandered. That default is being engaged and is largely being driven by activation in the medial prefrontal cortex and the posterior cingulate cortex. And this oscillating activation back and forth. Now, there's some data that shows that the longer we're in default or the stronger that we're in it, the less happy we are. Mindfulness practitioners, when they're just resting, have greater de-activity. activation of this mind wandering network, which is more reflective of them being in the present moment. So this is them not meditating.

And this is, let's say, if you're taking a longitudinal perspective of scanning someone before they practice in an intervention versus after, or getting age-matched folks to expert meditators, we will generally see a change in this mind-wandering network that's so intimately related to our well-being. You know, in the study of the neuroscience of imagination and creativity, we often talk about daydreaming and visualization and so forth. And I wonder if you have any thoughts about that default mode network, and is that important to creative states or states of imagination? And some of these meditation techniques, especially Tibetan Buddhist meditations, where you visualize deities or certain structures or yantras seem to come into play.

How is that related? Do you have any thoughts about that? Great. So I want to first just throw out the caveat about that. I don't explicitly know the relationship between imagination and visual arts and the default mode network. Having said that, it's probably been done. Default mode network is not necessarily a bad phenomenon.

It's a neuroprotective mechanism. So if we're 100% of our time fully engaged in a cognitive task, then the brain's not going to have the capacity to recover. So it's neuroprotective in the sense that it allows it to truly rest. It's more important to content of your default mode. So if someone's in chronic pain, the moment-to-moment experience is driven by their pain, including their mind wandering. Right. And if you're, you know, sailing through the islands of Greece and your mind wandering, you might be mind-wondering. and you might be mind wandering all these wonderful, beautiful things

that are engaging your consciousness as you go from one place to the other. So it's relative. So I want to throw that out there. I do think that daydreaming and wandering and this purported network are closely related. And you and I know that daydreaming has led to some incredible insights. So I can never say that that's a bad thing.

If the intention is to cultivate an idea through these practices of visualizations and daydreaming, then I would predict that default is more deactivated. You see, default deactivates when we have an intended practice or behavior. The second you drift away from that focus, that's when default kind of engages. So if you have the mental capacity to engage your mind and your visualizations and your daydreaming, if you will, for a proposed intention, then that would be a very positive thing, behaviorally and annually. And I would predict that if you have a practice that stabilize your mind, that you'll be able

to attain your intention with greater efficiency. But I haven't tested that, you see, so I have to be careful about what I say. Well, what you did choose to do in your career is you used pain as a way of researching this and delving deeper into the neurophysiology, neurobiology of it. We have a lot in common there because I also did my graduate work in pain and stress disease with some chronic pain clinical programs. And you have a very interesting way of testing how people respond to pain. So let's get into that a little bit.

Your specific research and the results you've gotten. First let's talk about the experimental model that you use, which is the subject of a lot of media attention because it's pretty dramatic. Yeah. Well, we're not sadistic at any way, but we do explicitly and experimentally induce pain in our laboratory. Pain is a wonderful phenomenon to study consciousness,

and that's really why I got into studying pain because it's an event-related experience that we can isolate using brain imaging techniques in real time. I mean, it's, it's, I could turn it on, you could say, ouch, and then I could turn it off. So pain is constructed and modulated by a constellation of interactions from the sensory to the cognitive to the affective dimensions, which are analogous to our moment-to-moment consciousness experience. Then I had some experiences in the clinic, right, where I saw actual suffering. And that was really motivating as well. I mean, more so, I think, just to find a way to get folks to alleviate their own suffering.

we use a device, a couple of devices that elicit noxious heat, and we'll stimulate the arm and or the leg. So we'll put the probe under the leg while we scan their brains or collect blood or do some kind of pharmacologic antagonism. We do all kinds of stuff to understand how these techniques work. And then after the heat stimulus, which is in the frankly noxious range, but it doesn't cause tissue damage or burns. It's controllable. I mean, you'll have variability and the pain responses, but it's controllable. And they could always lift their leg up and quit, you know, and still get paid. We pay very well.

So I should purpose it that way. We pay well. So they'll sit there and then we'll get a pain rating from zero to 10, zero not painful, 10 most imaginable using like a scale and algometer. The more red you see, the more in pain you're in. So we call this psychophysics, right? It's something that's completely personal in, you can't see it.

So we need to use validated quantitative sensory testing procedures to get a reliable psychophysical measurement of one's own experience. So just to drill down that just a tiny bit. So psychophysical, so the stimulus you're providing is objective. You know the temperature and know the area. And the reaction, people have this subjective index of how painful it is. right? So you you sort of correlate the two. Absolutely.

And so some folks won't even, to this noxious stimulus, a couple of folks will give me a rating of zero. They'll even laugh through it. Like, you're kidding me? This is nothing. Other folks will say, 10, worst pain imagine. Well, I'm thinking worse than fingernails being pulled. Like, I mean, I don't want to get, you know, too visual here.

But worse pain imaginable? And they are 100% sure. it. So we will get variability. And the reason we use the same not just stimulus temperatures, we won't want to introduce variability within the cortex as a function of the stimulus. We let the variability come from the subjective report because brain scans are really expensive. So I really need to make sure I see a pain signal in the brain or a no susceptible signal in the brain. So you're scanning them while they're undergoing this stimulus? Exactly. Exactly. And then we use other techniques as well that are more related to different chronic pain conditions. But for the most part,

we use the same methodology from one study to the other so we could generalize across studies. And then we'll scan their brains during this painful heat and we'll see a reliable neural signal. I mean, we could see this distributed network of brain regions that are responding to this painful stimulus. And then we'll compare that to a placebo, to mindfulness technique, to different other pain, postulated pain therapies, and we contrast the two, behaviorally and neurologly. This is not that complicated. It's pretty simple, actually. So what it does, it gives you a model, and it gives you repeatability is also very key.

We talk about this in this show quite a bit with other scientists of falsifiability, repeatability, the scientific method. And it seems like one of the features of your work is it's very repeatable. And you're getting lasting results, which is, I guess, why you're teaching this to medical staff and anesthesiologists. Absolutely. And we, because of the rigor and the methods, we not only have reproducible methodologies that translate across studies, our results are largely reproducible. we normally see the same results across studies. And I think it's because of quite frankly my training and my postdoctoral mentorship where it was really a hard-nosed fellowship where I really got to learn why it was so important

to use these types of methods, the way that we use them. You got to take the buy. So are you able to help folks that reduce the amount of pain relieving drugs, you know, the narcotic drugs, et cetera? who have chronic pain problems? Great question. Stuart, we're collecting those data right now. We have a five-year NIH National Institutes of Health-funded project. So I'm blinded to those findings right now.

I can tell you in the healthy participants, we're using this noxious heat paradigm, we see dramatic reductions in pain. And from the pilot data, the smaller projects that I ran before getting these data, we saw about an 85% reduction in chronic low back pain. other groups are studying chronic pain as well using mindfulness techniques and they're seeing dramatic reductions in pain as well. So in the context of the medical field, a greater than 30% or greater clinical improvement is considered clinically significant.

And we do see that repeatedly for mindfulness. I would say that mindfulness is one of the most promising techniques for pain. The jury is still kind of out on depression, although it works for depression, but we're getting mixed signals from different studies and post-traumatic stress. There's all these other health outcomes that mindfulness, it's kind of a mixed bag or at the stage of the game with what it does. But for pain, I'm very confident. And I got very lucky that I studied pain and mindfulness.

That mindfulness really bona fidely works for pain. But I don't know if folks out there are watching and listening know how big a problem in our society chronic pain really is. And of course, we know about the opioid addiction problem, which is on the heels of that. Statistics are quite astounding. So any clinical benefits you have are quite significant. Absolutely.

Yeah. I mean, we have in our country, and these are 2012 figures, 100 million Americans that suffer from chronic pain, 1.5 billion worldwide, costs our country alone $635 billion a year. I mean, that's probably a different story as a function of our health care system. And, yeah, we have an opiate epidemic. There's an over 400% increase in opiate misuse and addiction.

And it's directly related to chronic pain. So our own Centers for Disease Control have proposed new prescribing guidelines for pain. And the number one recommendation guideline is to use non-opiate pain therapies. And through our work, we were able to discover, well, let me back up, the number one pain modulatory pathway engages the body's endogenous opiate system. When you stub your toe, your body releases a cascade of endogenous opiates to attenuate that. Other than endocanamoid receptors, opiate receptors are the second most concentrated highest frequency receptors in the brain and body. we were primed for opiate addiction. We were talking about placebo, distraction, hypnosis, acupuncture,

prayer, you name it. All these techniques use the body's opiate system to reduce pain. Well, across three separate studies, we were able to discover that mindfulness does not actually use the system. It is non-opiadurgic. So, which is wonderful if you consider that if you are addicted to opiates, you would have to meditate like the Dalai Lama to build up and cultivate enough opiates to over.

override the tolerance that you've built. But since it's not using opiates to reduce pain, it's circumventing that pathway. It's going, it's utilizing a secondary, undiscovered pathway at this point of the game to alleviate pain. So it's, these findings are really quite, what's the word, appropriate for chronic pain as well as opiate addiction. So moving on a little bit from the discussion of your research and pain, the center of, also teaches folks how to use these techniques to control stress and improve performance. So I'm very interested in that and as other benefits to this. Maybe you can talk a little bit about how your research relates to that and some of the

programs that you have. Yeah, I can't tell you how lucky I am to be here at UC San Diego. It's a dream come true in so many levels. And one of the most attractive aspects of moving here was, that we have one of the best centers for mindfulness. It's a UCSD-based center for mindfulness, and it's been around for well over 13, 14 years, I believe. And we train folks on over a dozen different mindfulness standardized programs

from mindfulness-based stress reduction, from mindfulness performance enhancement for athletes and health. There is mindful self-compassion, compassion, compassion cultivation therapy, mindfulness resilience development for leaders, for businesses, for physicians. We have mindfulness-based relapse prevention for opiate addiction. There's all types of standardized programs that are tailored to optimize benefits for a whole host of health outcomes. And our teachers are all certified.

They're all incredible. and there's an whole army of them. What we also do is we provide the certification for aspiring teachers as well. So we train the trainers as well at our center. And so when I came here, you know, I had to train all the meditation teachers in North Carolina, which wasn't a bad thing. We had some awesome teachers in Carolina. But here, I just show up, and there's an entire dozens of teachers that are just so ready to go to get into the research field.

So that's made my life a lot easier. It's helped standardize the approach as well in the way that we use in what we use to test. So MBSR versus mindfulness-based stress reduction versus mindfulness-based relapse prevention. What are the similarities? What are the differences, right? So our Center for Mindfulness is really, and we have a new executive director, Doug Zodonis, who has a really, used to be a chair of psychiatry at UMass, University of Massachusetts, and has always, as a long rich history of integrating mindfulness into his research as well as

his department. So we are now fully focused and devoted to expanding our research enterprise within the context of the center. And we've got a lot of cool things happening. And remarkably, this wasn't happening when I was recruited here, but we now also have a new T.D.T. Denny Sanford Institute for Empathy and Compassion, who is led by Dr. Bill Mowgli, and we have, you know, collaborations with the Dalai Lama's office and a bunch of researchers here. And compassion and empathy training is directly related to mindfulness as well, right? So we're really in this beautiful place right now, and I feel like we're poised to be the kind of center for contemplative science exploration at UCSD in light of our new Center for Mindfulness,

the way that our new Center for Mindfulness is set up, the new Institute for Empathy and Compassion, and all the incredible researchers and colleagues that we have in our immediate environment. That's fantastic. Aren't you pumped? I mean, I knew it was vast, but that's even bigger than I thought and more vast. We're just getting started. That's the great thing. Well, one of the things that I noticed, of course, now I wanted to talk a little bit about

the pandemic times and the COVID. the increased stresses. People are under the problems, you know, the courses that you're offering in the classes, there are many workshops. You're doing a lot of things online. I can barely keep up with how many events and things that you offer. But how has this affected people?

And what is the benefit? I mean, are there certain things that you can do to mitigate that? And maybe you can just tell us a little bit about some of the, the online things the center is doing. Absolutely, Stuart. I'm glad you brought that up. And we can maybe post the website later, but we are every day now

providing free, live, recorded mindfulness training by our teachers on a vast variety of different techniques. And they're recorded so that if you miss it, you can come back and catch it. But if you attend live, you can have inquiry with the teachers afterwards.

And we are, we have a ton of people joining us on a daily basis, hundreds. And I think that people have the time to sit, A, and B, we are really in a, this has never happened before, at least not in the context of 2020, right, when information is presented to you like that. So everyone's stressed. We're anxious. We don't have an ending in sight per se.

And so folks are finding ways to self-regulate. And they're finding that mindfulness practices are quite efficacious. We are collecting data on the COVID-19 during the COVID-19 intervention. So before and after each one of these practices that are facilitated live, we collect data. We have IRB approval, ethics approval from UCSD to do this work. It takes about a few minutes. And actually, I just presented some data this morning. Let's see if I can.

It'll pull up in a second. But I can tell you that actually, I can pull it up right here, that we have seen now, we have run 176 people have completed the surveys. A lot of people are coming back. But this is just from the first time they come. Okay? We have a 53% reduction in stress. a 49% reduction in anxiety, a 31% increase in social connectedness, and a 34% reduction in depression.

This is just one shot. And it's self-selected. It's not randomized. We're not using the highest level. And by the way, I have never presented these like publicly before, but you asked, right? And so we actually have data on this. We're collecting data on this. And this is in light of pandemic, right?

In light of COVID-19, stress, anxiety, depression, and so on. I think that just generally slowing down the breath and focusing on it can really elicit a lot of benefit. Having listening to other people experiencing the same anxiety and stress is also therapeutic. And having a teacher that can read your nonverbals that can potentially address your needs in real time, even in the Zoom. This is all Zoom facilitated, mind you. It can be quite profound. We need each other now, especially when meeting each other means being away from each other physically. But we have this privilege that we get to enjoy the technologies that are afforded to us in 2020,

where, you know, I can sit here on Zoom and hang out with my buddies all over the world that I'm able to catch up with. I mean, this was happening in 1918, right? It's just a completely different ballgame, right? There's pros and cons, of course. So I digress, Stewart. So we are training folks daily. We have daily practices. This is sponsored by the Center for Mindfulness and the Institute of Empathy and Compassion at UCSD.

And Bill Mobley and Doug and I and the rest of our team really thought, hey, we need to do something about this. People are, you know, really nervous. And so how can we calm them to get them to kind of be patient, be present? is there there's a lot and some of our recent guests uh for example tiffany schlaine has a book called 246 and um other folks that we've interviewed talk about the unique stresses of depending on the technology so much and how that impacts the way that you're wired especially of course social media which is causing a lot of conflict and a lot of tension in our society.

You know, what do you think about that? I mean, what's the, you know, you just mentioned there's an upside to it, which is a very good thing to focus on. How do you balance the dependence on technology and how it impacts your neurobiology? It's a great question. I mean, social media is really an addictive phenomenon. I mean, quite literally, it is addictive. We get addiction-related neurophysiology that relates to the craving of checking your Facebook,

your Instagrams and your Twitter and whatnot, right? And a lot of the things that we read on there are quite emotionally aggravating. I have a tendency to delete people. I don't, no, I shouldn't, but I do. I can't help it. There's some things I see that I just don't. And so one way I have done it balance is just to get off of those, those emotional, I am not feeling better after I get off Facebook.

And in fact, there's some nice papers that have come out that show that folks are actually more depressed as a frequency of their social media use. Right. And so it's up, it's the, it comes back to intention, doesn't it, Stuart? Like, what is your intention for getting on Facebook versus what's your intention for sitting with our Center for Mindfulness teachers versus? is having a Zoom conversation, right? What's the intention here?

And I think if folks are mindful or more aware of the emotions and feelings that arise as a function of technological innovation, as well as being a little bit more open about what their intention is for getting on there, then we can maybe kind of assuage the negative effect. But I don't have an answer in that light. All I know is that it's really, in that sense, It's not good for you at all, is it? It's causing a lot of problems, a lot of stress.

So let me get into what you do and how your daily, what's your daily routine and daily practice. How do you use this in your daily life? Right. Well, I wake up and I have a cup of coffee and I hug my kid and I go for a long run. I do mindful running and I run about, you know, six to nine miles a day. And I try to just be present with my, music and my running pace,

etc. Just what do you mean by mindful running? Ah, so mindful running is simply being aware of the biomechanics of your stride, the contact of the foot making with the pavement, the motion of running,

the rhythm of running. If you're in the present moment of that, practice, your breath, right? Then that's mindful running. You're simply aware of the process. So yoga is mindfulness, right? You would agree with that.

Yoga practice is mindfulness practice. Well, yoga is just shifting the attention from the breath, which you can do as well with yoga, which you definitely do again with yoga, onto the muscle tension, the stretches, the feelings that arise from the body. Well, why couldn't you do that with running? It's the same thing. You know, there might be a little bit more distractions. I have to avoid more people that are not wearing masks or, you know, get out of the way

of, you know, a little kid or something. But generally speaking, if I can get into that zone and focus on my breathing, focus on my biomechanics, the posture, the feelings of the pavement and my feet, and so on. And that's all mindfulness is just awareness of yourself and your sensory environment, right? So you're just aware of it. And so there's some mental training that's also being integrated with the physical component. So that's how I start my day and then I'll decompress when I do my stretch afterwards with a podcast, some, some Dharma talk or some guided meditation practice where I'll do my stretches with focus on the breath.

and then, you know, I clean up and get to work, which is an awesome commute now, but, you know. So, and throughout the day, there will be opportunities for mindful pauses, right? So I might not be such an avid practitioner where I have a formalized sitting practice, although I try to sometimes here and there, but I always try to be mindful, try to be aware of my feelings and my emotions before they kind of get out of hand, right? We have a lot of emotions and feelings that are reflexive. Right. And with mental practice, we can kind of slow that reflex down where you can separate the judgment slash evaluation from that sensory event. That event is not me.

But with some of these reflexive emotional reactions, we start to think that that feeling and emotion is inherently myself. But it's not. It's just an interpretation that can be easily assuaged. Easily is a strong word. we'll give folks the resources that you have and the center provides so people can get started and there's a lot of apps out there as well that are popularized and advertised. What do you think of those? Well, I don't know.

I don't know. I'm a little, I don't know. I guess I haven't explored enough apps to give a definitive answer, but I think apps can be useful if you know how to use them appropriately. For me, I'm a purist in the sense that sitting in silence and focusing on the breath, you know, when you and I talked about this, right, we have a recipe to make an omelet. Now make a perfect omelet. You know the recipe. Well, mindfulness is just that. It's a recipe.

You focus on the breath non-judgmentally. There's a couple of other things that you can do to make your practice a little bit more dynamic. But it's just got to practice. So I don't know if I necessarily need those different didactics. And a lot of the way the Westerners teach is super verbose. There's not enough times in silence. It's just kind of the spoken word type of phenomenon. And I don't love that per se.

Now, do apps help people? Sure. If that's how you're getting your sit, do it. But, you know, with Zoom and FaceTime and all week and in recordings, You can actually, on YouTube or whatnot, we can actually have a real-time, real-life facilitated integrate with you, which I think will get a lot better.

There's a lot of redundancy that could arise from an app. And that redundancy can lead to mind wandering and some other types of distractions that can really reduce the efficacy of it. Further, there's issues with posture, right? So a teacher can look at your posture and then guide you in a certain way based on what you're telling she or he,

but with your non-verbals, right? Apps can't do that. So while I find them to be lucrative in many ways for folks and to be efficacious in promoting well-being, I have not seen any data out there that shows that an app-based recording can provide improvements in well-being above and beyond an active control. That doesn't mean it doesn't exist. It just means that I am not so well-versed to be able to cite one for you.

Now, there are e-delivery interventions that are highly efficacious. So you can have the teacher sit with you in front of your phone, computer, whatever, and you will get a benefit that resembles live facilitation. So I think, Stuart, it really comes down to the individual. If he or she has the discipline to follow an app and it works for them, then who am I to say it's not working? Of course. I hear this all the time.

that people are finding the apps to be efficacious. But let me give you an example. The Headspace has an app, right? The Headspace is the most popular one. And so we developed a technique in our laboratory called sham mindfulness meditation. So this is where to make people think they're practicing mindfulness when they're not. They're taking, they're first told that they're doing mindfulness

and they sit with a straight posture, eyes closed, and every couple of minutes they're told to take a deep breath as we sit here in mindfulness meditation. All aspects of the genuine intervention are matched, except the explicit instructions to focus on the changing sensations of the breath non-reactively. Well, Headspace, kudos to them, tested Andy, who is their teacher's intervention, I don't know how many weeks it is, to X amount of weeks of sham mindfulness meditation. They actually used our technique, and Andy recorded it too.

Both techniques significantly were efficacious, but there was no differences between the two techniques. So Andy's real meditation versus Andy's sham mindfulness meditation, there were no differences. So that's what I mean. Is it mindfulness that's doing the good stuff, the health promotion, or is it the belief that you're meditating? Is it just breathing? It's probably all the above, right? But for us to really get an appreciation of what the good stuff about mindfulness is, the mechanisms of mindfulness, we really need to do more placebo-type controlled interventions.

I mean, all new therapies, drugs have to go through multiple phases of placebo-controlled trials before they're deemed safe and efficacious. Well, I would argue that meditation research is just as or more susceptible to these nonspecific effects. So I'd like to see the field get a little bit more rigorous. And there's a lot of people doing a lot of good work for sure. But it would be nice for us to use the same type of rigor and standards that we employ in modern medicine that we do for contemplative medicine. On that note, you've got a couple of interesting research projects that are imminent. Some of them are getting into the realm of some pharmacological interventions. Do you want to talk a little bit about that?

Sure. You're interested in it? Sure. So, again, this is just another benefactor of being at a place like UCSD where it's so open here. I mean, there's so many talented and bright people. And if you can present an idea, no matter how far-fetched it is, people will listen if they say, hey, is it going to work? Do you think it's going to work? So a couple of years ago, Roma Chandraen, who's a famous psychologist here at UCSD, he does a lot of work with phantom limb pain and mirror box therapy. Well, there was an individual who works in your center, Stuart, that is an amputee that took a very large dose of psilocy.

cybin, which is the active ingredient in so-called magic mushrooms. It's a hallucinogen. And this individual was in just incredible amounts of pain from their missing limb. Phantom limb pain is when the individual feels pain because they think the body, the organism thinks that the limb is still there, right? And there's a disconnect between the visual and the sensory input and the actual health nature of the subject. In other words, it's an overreaction of the system to say, hey, help, help, you're missing a limb. Well, the subject took a very large dose under the supervision and got tested under the supervision of Ramshandran and found that this dose of magic mushrooms completely removed Phantom Limpain. And that, by the way, for our listeners, is Albert Lynn, who's affiliated here as part of this study you're talking about.

Yeah, Albert's just such a great guy. And he's also like National Geographic Explorer of the Year and a professor. a dad and just a super nice guy, big fan of Albert on and off the field. And so Albert basically eradicated this undeniable pain almost permanently. And we have a couple of doctors, physicians here that are also working with folks that are taking psilocybin for their phantom limb pain. And they're seeing the same results, eradication of their chronic pain. We don't see this in the field anywhere where one therapeutic dose of a natural product, may I add,

can remove pain. So we are working with our new psychedelic health research initiative at ECSD. We have a website for that as well to study how natural products like psilocybin and cannabis can impact behavioral and mural and physiological responses to pain. We're eventually going to also move to other health domains such as anxiety, depression, to see, to kind of just get an appreciation of how this works, how these natural products work. Maybe we could isolate said mechanisms and then try to apply them to other therapies to, you know, to improve well-being. So the doctors are really excited because, hey, we've never really seen anything work this way, a one-time therapeutic that can, you know, produce long-lasting health and pain improvements.

So we are, my, my lab is moving a little bit into this direction and, uh, we can't wait to get started. There's a lot of, a lot of loopholes you have to jump through, be able to do this work. What's your hypothesis on how a single dose rewires the brain so profoundly? How does it do that? I think it does it similarly to mindfulness meditation. You see, mindfulness restarts the moment to moment experience. I'm sorry, restarts the mental set in a moment. moment to moment way. So focusing on the breath, starting over, focusing and get distracted, start over, come back to the breath, start over, come to the breath, right? Well, I think what's happening with Solzivan, and we have some insight from some of the existing

brain imaging data, is that Sol Simon is also eliciting a restart button, but the button is much bigger. So then mindfulness. So mindfulness is something that requires training and you do it over and over and over to restart the organism. Something I think is happening with psilocybin that restarts the organism that stops the disconnect between the perception and the experience, the perception of a missing limb and the experience of phantom limb pain with such a dose. It's like we know that serotonin is going to be involved, but the exact neural processes supporting this are unknown.

So the hypothesis is that the prefrontal cortex is going to be somehow involved that restarting neurophysiological pain processing one way or another. I'm really excited. I have no idea how it's going to work, if it's going to work at all. But it will be controlled, too, so that's good.

That, by the way, is being run by the Arthur C. Clark Center for Human Imagination, and that's a good way to come to the end of our time, and we'll be very interested to see how that goes. It's almost like rebooting, right, or a lot of soft, a lot of bad software metaphors come through. Yeah, I'm good for that. So just in closing, first of all,

I want to really thank you for your time. A lot of really great information. What would you recommend as a first step for our listeners and viewers who want to get into this further? I imagine the meditation is getting into the meditation. I would say go on to the UCSD Center for Mindfulness website. We have tons of free guided interventions and practices.

Start with a five, ten minute one. Just start five, ten minutes and just be more aware of yourself non-reactively. And the practice will lead you to do that. And then try to be mindful the rest of the day. The next day, come back, add another minute or two if you feel like it. attend some of our live sessions. That way, some of the questions that will arise, you can have them immediately addressed by a certified teacher.

Or you can email them too. They're totally available. I mean, we are full on open to helping people right now. So this is a unique opportunity to get formalized training for free, live free training through our center. And if you don't have the time, of course, then try a guided practice that's recorded. There's tons of free resources out there.

just be careful that sometimes people call different meditative practices, mindfulness when in fact it's not. It's a very hot term right now, so they just put that tag on there. But if you're going through our center, it's going to be pretty legit. Thank you so much, Fidel, for your time and for the amazing resources that are available. And I'm looking forward to having another one of these when you start your next cohort of research and when we get back to some kind of in-person workshops. Very much.

Thank you so much for your. time and inviting me. Stuart, it's been great to get to know you and looking forward to collaborating more. Any sufficiently advanced technology is indistinguishable from magic. If you enjoyed this episode of Into the Impossible, please subscribe, comment, share, rate, and review. For a chance to win a free copy of our most recent guest's newest book, send a screenshot of your review to info at imagine.ucsd.edu. We appreciate hearing from you and are always open to your suggestions for future episodes. For more information, go to imagination.ucsd.edu.

Find us on Twitter at ImagineUCSD. Watch us on YouTube, listen on iTunes. Into the Impossible is a production of the Arthur C. Clark Center for Human Imagination in the Division of Physical Sciences at the University of California, San Diego. Eric Viri, Director, Brian Keating, co-director, Patrick Coleman, Associate Director, produced by Stuart Volko.