Nov/Dec 2007

feature article

Change your brain

BY BARRY BURNETT, M.D.

Someone you love wants you to change.
And that someone gives plenty of good reasons: the moods, perhaps; the worries; the words that hurt more than you meant. And you agree, at least privately. You’ve always wanted to live a calmer, more reasonable life. You could take a pill, but you’re not feeling sad or bad enough for that. Still, what if you could really change, become a whole new you? You’re not ten years old anymore—can you still do that?

If ‘you’ is your mind, and your mind lives in your brain, then it’s starting to look a lot like you can change. To look, in fact, like your brain can alter and develop at any age, and probably in the direction you need. Which is not to say it’s easy. But more on that later, after we check out what neuroscientists are discovering about growing a whole new you.

Imagine two storm fronts, converging. Coming together to form a real rainmaker, enough to saturate a parched and arid land. One front rolling in from the East, the very Far East, to bump into our own home front, Medical Science, with its inexorable development of finer and finer-tuned ways of looking at the brain.

For the Eastern action, we’ve got to thank a certain spiritual rock star, the Dalai Lama. Booted towards the West by the Chinese invasion of Tibet, he saw a chance for a greater synergy between his faith and the modern world, and made it happen. “I am interested in the extent to which the mind itself, and specific subtle thoughts, may have an influence upon the brain,"1. He started by helping Harvard researchers meet with Buddhist meditators—monks in caves, literally. Monks who initially thought that their job was to teach the scientists how to meditate, to discover the regions of the mind in the same way they did, from the outside in.

The researchers had something much more external planned: objective measurement. A goal that eventually took those inside-out meetings of inquiring minds, under the Dalai Lama’s influence, to studies and conferences up and down our own East (Coast) and at such semi-exotic sites as the University of Wisconsin’s Affective Neuroscience lab. But none of it would have happened without the courage to take the leap outside the meditator’s head into the cold hard world of radiation and radioisotopes and scans.

Because that home storm front of scientific Western thought was already cooking up its own new view of the matters of the mind. By the eighties, doctors could finally see, without a scalpel, into the tissues of a living brain.

The revolution in imaging technology started with CAT and then MRI scans, primarily used to see brain cancer and strokes in patients. Not only to diagnose them, but to watch how they did as their diseases progressed or, hopefully, quieted down. The assumption was that the adult brain was fixed and unchanging—wiring in place, job done—except for the damage that clots and blow-outs and crazed cell lines wrought. But before long, researchers found that wasn’t always true: new connections between the uninjured and injured side of the brain developed, and physical therapy could lead to a regrown, thicker cortex, the outermost layer of the brain.2 The scientists called it neuroplasticity, and when they looked, they found similar changes in the parietal areas of hard-studying medical students, in the cerebellar lobes of musicians working to improve their skills, and in... well, let’s not get ahead of ourselves.

The problem was, those snapshots of one moment in a brain’s life weren’t enough—to really understand what was going on, researchers needed to see what was happening over time, the ongoing processes of thinking, feeling, even relaxing. That neuroimaging need was first answered by PET scans, in which patients are injected with positron-irradiated sugar water: when active brain cells suck up the sugar, the liberated positrons shoot back out through the skull, where their trajectories are used to draw a living map, a map that changes as first one and then another active region of the brain lights up. Since then have come SPECT scans, Functional MRIs and more, all of which are being used today.

Medical research gravitates toward real world applications—okay, towards big pharm money—and the huge and expensive imaging machines were soon turned to the potentially lucrative mysteries of psychiatric diagnosis and treatment. The studies were small but there were a lot of them, from changes in brain-cell energy consumption, to blood supply, to actually showing, in living color, the ebb and flow of neurotransmitters like serotonin and GABA that can determine emotion and mood. What did they find? That many, but not all, psychological problems seem to have specific patterns of change in the brain, and that some drugs (like the famous Prozac, which boosts serotonin) appear to reverse them. Scans to develop drugs, scans to learn how best to treat. And, as the technology became more affordable for less-endowed investigators, scans to look at any brain activity you want.

Therapists, or at least the scientists interested in psychotherapy, were next to dive into the neuroimaging pool. The most striking study looked at cognitive-behavioral therapy for obsessive-compulsive disorder, and found that ten sessions not only worked, but changed the brain in almost exactly the same way that those serotonin drugs did. Similar studies of depression have shown equally potent changes in different areas, and demonstrated effects from other forms of psychotherapy.3 They’re still working on the differences, but it’s good to know that therapy can be as effective as drugs—and good to know that some drugs work in the same presumably positive, strengthening-not-weakening way as therapy.

However, your special someone isn’t that kind of concerned, and you’re not feeling all that bad: no obsessive thoughts taking over, nothing dark enough to pay for professional help. You just want to think and feel, well, better. And if you want to change your brain, it’s looking like meditation may be the way to go. Because this is where those two storms come together—Eastern and Western techniques, meditation and the ability to visualize mental processes, to look inside the brain.
The rain’s just beginning to fall, but a few striking findings are beginning to trickle out. The Harvard crowd looked at CAT scans of skilled Insight meditators, compared them to non-meditators, and found regions of increased cortical thickness—that is, more brain—in the meditators.4 Evidence of pure thought literally changing the shape of the brain. Next came Functional MRI scans of Yoga practitioners, finding that GABA levels spiked upwards during and after asana poses.5 It was the same mood-elevating increase seen with some antidepressants—a demonstrated change in brain chemistry that fit with those poser’s (sorry) general sense of increased well-being.

Studies of Buddhist meditation have also been coming out of the University of Wisconsin, documenting increased activity in brain areas associated with happiness, empathy, and the control of emotional states. Much of the work has looked at the most central of brain functions: how well that gray matter pays attention. One group of beginners showed a marked improvement after a three-month training program, and, according to Professor Richard Davidson, "A significant increase in activation in left pre-frontal regions of their brain... associated with a reduction in the amount of anxiety that they reported.”6 Another study compared more-skilled to less-skilled meditators, and found, to quote him again, that: “Attention can be trained, and in a way that is not fundamentally different than how physical exercise changes the body.”7 And that part about it not being easy? Learning to pay attention can be a bit of work, but the scans of the most-skilled monks demonstrated an ease that came with time, “...that they were able to concentrate in an effortless way.”

Effortless? Not exactly, at least at the beginning, whether your focus of attention is a set of asanas, the coming and going of your breath, or a single word, perception or thought. And while there is that rush of well-being that seems to be part of the deal, a compensating boon to bring you back the next time, no physiologic change—except the obvious, decomposition—comes without metabolic work. On some level, change has got to take effort, as hard as building up those pecs. Say you’re working on your memory, trying to beef it up before you get old. The scans aren’t in to prove that one, but if it does help, it’s the mental sweat that’ll get your neurons to make all those extra connections, the ones you’re hoping will be a cushion if things start to fall apart. You’ve learned checkers? Then master chess. Like those musicians, bulking up their cerebelli with years of practice, or the medical students, beating their way through those dense neuroimaging texts.

So you start meditating, and stick with it. And you do change, slowly, over time, and get your new version of ‘you’. Not just an older version—we all get that—but hopefully a better one, both calmer and more attentive, with a plastic, moldable brain that keeps growing through the decades. Maybe there’s even an extra payoff, something beyond the elevated serotonin and GABA levels, when you seem to connect to something... further. That’s another topic—neurotheology—and it’s also beyond the scope of this brief review. Prayer, for instance, can be viewed as another form of meditation, and at least one study of prayer has demonstrated neurological change as well. There’s no earthly reason why a bigger, better brain should be more capable of reaching out that way, but meditation seems to bring the two together. Thought to matter and then, perhaps, to spirit: East meets West again, at the next level. Who knows when we’ll be able to image that?

Barry Burnett, MD, is a local physician and writer. For a few chapters of his fictional look at the perils of imaging on the brain, visit thrillingromance.com.

Check out these related articles and books, for a readable way in to these often-complex studies:
Yoga and Gaba: http://www.sciencedaily.com/releases/2007/05/070521145516.htm

Skilled meditators and attention:
http://www.news.wisc.edu/13890

Meditation to train attention:
http://www.sciencedaily.com/releases/2007/05/070507202029.htm
http://www.sciencenews.org/articles/20070512/fob2.asp

Meditation and Increased Cortical Thickness:
http://www.nytimes.com/2005/11/22/health/22effe.html?ex=1189569600&en=21a20cf43822314f&ei=5070

Psychotherapy and the Brain:
http://www.intracarehospital.com/pages/psychotherapy.pdf

Begley - how thinking can change the brain
http://www.dalailama.com/news.112.htm
or
http://psyphz.psych.wisc.edu/web/News/wsj_1-19-07_begley.html

Sara Lazar—Massachusetts General Hospital—Meditation experience is associated with increased cortical thickness.

Linden—How psychotherapy changes the brain—Molecular psychology— (dense to the point of near-unreadability, but its all in there)

Sharon Begley—Train Your Mind, Change Your Brain—(WSJ article version at http://psyphz.psych.wisc.edu/web/News/wsj_1-19-07_begley.html)—readable book about the dalai Lama and Harvard’s investigators.

The brain that Changes Itself, by Norman Doidge—patient tales of neuroplasticity and recovery

Mind altering experiences that literally change your brain--
It you’re hurting, consider pharmacotherapy: reliable, easy, but plan to keep on taking it. See your friendly local prescriber. And forget the tranquillizers, sedatives, opiates and street drugs—they’ll rearrange your brain, but only so you want more. Combining with psychotherapy absolutely works wonders.

Psychotherapy: Hard, but it works—especially Cognitive Behavioral Therapy (CBT). Eight or ten sessions and your gray matter could be sporting a few permanent new curves.

Meditation: Clear, long-term changes, though you’ve probably got to keep on doing it. On the other hand, it feels good, and seems to make everybody else feel good, too. More for the cranky and dissatisfied than the troubled. Yoga, mindfulness, TM; they all seem to work. Try a few and decide which fits best.

For a cutting-edge passage through the brain, check out the White Matter Atlas at www.DTIatlas.org. Not that many can understand what these tiny jewel-like images mean—I can’t—but they sure look cool.