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Context  Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective  To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants  Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).Main Outcome Measures  Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.Results  Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ = −6.8; 95% CI, −4.8 to −8.8; depersonalization, 8.4 to 5.9; Δ = −2.5; 95% CI, −1.4 to −3.6; and personal accomplishment, 40.2 to 42.6; Δ = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ = −4.1; 95% CI, −1.8 to −6.4); total mood disturbance (33.2 to 16.1; Δ = −17.1; 95% CI, −11 to −23.2), and personality (conscientiousness, 6.5 to 6.8; Δ = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = −0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = −0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).Conclusions  Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

Ten-month-old infants viewed videotape segments of an actress spontaneously generating a happy or sad facial expression. Brain activity was recorded from the left and right frontal and parietal scalp regions. In two studies, infants showed greater activation of the left frontal than of the right frontal area in response to the happy segments. Parietal asymmetry failed to discriminate between the conditions. Differential lateralization of the hemispheres for affective processes seems to be established by 10 months of age.
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The authors examined the hypothesis that rhesus monkeys with extreme right frontal electroencephalographic activity would have higher cortisol levels and would be more fearful compared with monkeys with extreme left frontal activity. The authors first showed that individual differences in asymmetric frontal electrical activity are a stable characteristic. Next, the authors demonstrated that relative right asymmetric frontal activity and cortisol levels are correlated in animals 1 year of age. Additionally, extreme right frontal animals had elevated cortisol concentrations and more intense defensive responses. At 3 years of age, extreme right frontal animals continued to have elevated cortisol concentrations. These findings demonstrate important relations among extreme asymmetric frontal electrical activity, cortisol levels, and trait-like fear-related behaviors in young rhesus monkeys.
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Research on the neural substrates of emotion has found evidence for cortical asymmetries for aspects of emotion. A recent article by Nicholls et al. has used a new imaging method to interrogate facial movement in 3D to assess possible asymmetrical action during expressions of happiness and sadness. Greater left-sided movement, particularly during expressions of sadness was observed. These findings have implications for understanding hemispheric differences in emotion and lend support to the notion that aspects of emotion processing might be differentially localized in the two hemispheres.
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<p>In the past two decades, the familiar experience of attention - the emphasis on a particular mental activity so that it "fills the mind" - has been subjected to much scientific inquiry. David LaBerge now provides a systematic view of the attention process as it occurs in everyday perception, thinking, and action. Drawing from a variety of research methods and findings from cognitive psychology, neurobiology, and computer science, he presents a masterful synthesis of what is understood about attentional processing. LaBerge explores how we are able to restrict the input of extraneous and confusing information, or prepare to process a future stimulus, in order to take effective action. As well as describing the pathways in the cortex presumed to be involved in attentional processing, he examines the hypothesis that two subcortical structures, the superior colliculus and the thalamus, contain circuit mechanisms that embody an algorithm of attention. In addition, he takes us through various ways of posing the problem, from an information-processing description of how attention works to a consideration of some of the cognitive and behavioral consequences of the brain's computations, such as desiring, judging, imaging, and remembering. Attentional Processing is a highly sophisticated integration of contributions from several fields of neuroscience. It brings together the latest efforts to solve the puzzle of attention: how it works, how it is modulated, what its benefits are, and how it is expressed in the brain.</p>

Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. Among these various practices, there are two styles that are commonly studied. One style, focused attention meditation, entails the voluntary focusing of attention on a chosen object. The other style, open monitoring meditation, involves nonreactive monitoring of the content of experience from moment to moment. The potential regulatory functions of these practices on attention and emotion processes could have a long-term impact on the brain and behavior.

Thirty-two participants were tested for both resting electroencephalography (EEG) and neuropsychological function. Eight one-minute trials of resting EEG were recorded from 14 channels referenced to linked ears, which was rederived to an average reference. Neuropsychological tasks included Verbal Fluency, the Tower of London, and Corsi's Recurring Blocks. Asymmetries in EEG alpha activity were correlated with performance on these tasks. Similar patterns were obtained for delta and theta bands. Factor analyses of resting EEG asymmetries over particular regions suggested that asymmetries over anterior scalp regions may be partly independent from those over posterior scalp regions. These results support the notions that resting EEG asymmetries are specified by multiple mechanisms along the rostral/caudal plane, and that these asymmetries predict task performance in a manner consistent with lesion and neuroimaging studies.
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<p>Drawing its main source of inspiration from a naturalized interpretation of Husserlian phenomenology, On Becoming Aware: A Pragmatics of Experiencing attempts to examine closely the nature of experience and how we may become aware of our own mental life. The authors also focus on how this project fits into the larger context of cognitive science, psychology, neurosciences, and philosophy. Additional partners in the effort to better understand experience are the contemplative systems of the world's spiritual or wisdom traditions, including particularly that of Buddhism. The book includes three separate glossaries of technical terms in phenomenology, the cognitive sciences, and Tibetan Buddhism. The book On Becoming Aware seeks a disciplined and practical approach to exploring human experience. While much of the book draws its inspiration from the phenomenological theories of Husserl, other approaches to the direct study of experience are also explored in depth. One of these approaches is embodied by the world's spiritual or wisdom or contemplative traditions such as Sufism, Buddhism, the Philokalia tradition, and others. Collectively, these traditions have come upon a variety of their own insights and methods for understanding experience, or, to use words from the phenomenological tradition, has developed its own ways of phenomenological reduction Amongst the various wisdom traditions, the authors focus mainly on Buddhism. The authors give an introduction to Buddhist theory and history, followed by an in-depth discussion of the Buddhist contemplative practices of mindfulness, śamatha, vipaśyanā, tonglen (gtong len), lojong (blo sbyong), dzokchen (rdzogs chen), and mahāmudrā. The authors then relate this discussion to themes from philosophy and phenomenology explored earlier in the book, paricularly Husserl's concept of épochè. (Zach Rowinski 2005-01-17) Publisher's description: This book searches for the sources and means for a disciplined practical approach to exploring human experience. The spirit of this book is pragmatic and relies on a Husserlian phenomenology primarily understood as a method of exploring our experience. The authors do not aim at a neo-Kantian a priori ‘new theory’ of experience but instead they describe a concrete activity: how we examine what we live through, how we become aware of our own mental life. The range of experiences of which we can become aware is vast: all the normal dimensions of human life (perception, motion, memory, imagination, speech, everyday social interactions), cognitive events that can be precisely defined as tasks in laboratory experiments (e.g., a protocol for visual attention), but also manifestations of mental life more fraught with meaning (dreaming, intense emotions, social tensions, altered states of consciousness). The central assertion in this work is that this immanent ability is habitually ignored or at best practiced unsystematically, that is to say, blindly. Exploring human experience amounts to developing and cultivating this basic ability through specific training. Only a hands-on, non-dogmatic approach can lead to progress, and that is what animates this book.</p>

Many of us go through our daily lives on autopilot, not fully aware of our conscious experiences. In a discussion moderated by Steve Paulson, executive producer and host of To the Best of Our Knowledge, neuroscientists Richard Davidson and Amishi Jha and clinical mindfulness expert Jon Kabat-Zinn explore the role of consciousness in mental and physical health, how we can train our minds to be more flexible and adaptable, and cutting-edge neuroscience findings about the transformation of consciousness through mindfulness and contemplative practice. The following is an edited transcript of the discussion that occurred February 6, 2013, 7:00-8:15 PM, at the New York Academy of Sciences in New York City.

Many of us go through our daily lives on autopilot, not fully aware of our conscious experiences. In a discussion moderated by Steve Paulson, executive producer and host of To the Best of Our Knowledge, neuroscientists Richard Davidson and Amishi Jha and clinical mindfulness expert Jon Kabat-Zinn explore the role of consciousness in mental and physical health, how we can train our minds to be more flexible and adaptable, and cutting-edge neuroscience findings about the transformation of consciousness through mindfulness and contemplative practice. The following is an edited transcript of the discussion that occurred February 6, 2013, 7:00-8:15 PM, at the New York Academy of Sciences in New York City.
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<p>A key early fifteenth-century Tibetan historical work that includes all the main schools of Tibetan Buddhism as they existed up to the fifteenth-century, but mainly focused on the Kagyü (bka' brgyud) schools. (BJN)</p>

<p>Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches, such as yoga, TaiChi, Body-Oriented Psychotherapy, Body Awareness Therapy, mindfulness based therapies/meditation, Feldenkrais, Alexander Method, Breath Therapy and others with reported benefits for a variety of health conditions. To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus groups. The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness. For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness. The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as dialectic of body and self described by some philosophers as being experienced in distinct developmental levels.</p>
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The brain and the cardiovascular system influence each other during the processing of emotion. The study of the interactions of these systems during emotion regulation has been limited in human functional neuroimaging, despite its potential importance for physical health. We have previously reported that mental expertise in cultivation of compassion alters the activation of circuits linked with empathy and theory of mind in response to emotional stimuli. Guided by the finding that heart rate increases more during blocks of compassion meditation than neutral states, especially for experts, we examined the interaction between state (compassion vs. neutral) and group (novice, expert) on the relation between heart rate and BOLD signal during presentation of emotional sounds presented during each state. Our findings revealed that BOLD signal in the right middle insula showed a significant association with heart rate (HR) across state and group. This association was stronger in the left middle/posterior insula when experts were compared to novices. The positive coupling of HR and BOLD was higher within the compassion state than within the neutral state in the dorsal anterior cingulate cortex for both groups, underlining the role of this region in the modulation of bodily arousal states. This state effect was stronger for experts than novices in somatosensory cortices and the right inferior parietal lobule (group by state interaction). These data confirm that compassion enhances the emotional and somatosensory brain representations of others' emotions, and that this effect is modulated by expertise. Future studies are needed to further investigate the impact of compassion training on these circuits.
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BACKGROUND: The frontal lobe has been crucially involved in the neurobiology of major depression, but inconsistencies among studies exist, in part due to a failure of considering modulatory variables such as symptom severity, comorbidity with anxiety, and distinct subtypes, as codeterminants for patterns of brain activation in depression. METHODS: Resting electroencephalogram was recorded in 38 unmedicated subjects with major depressive disorder and 18 normal comparison subjects, and analyzed with a tomographic source localization method that computes the cortical three-dimensional distribution of current density for standard electroencephalogram frequency bands. Symptom severity and anxiety were measured via self-report and melancholic features via clinical interview. RESULTS: Depressed subjects showed more excitatory (beta3, 21.5-30.0 Hz) activity in the right superior and inferior frontal lobe (Brodmann's area 9/10/11) than comparison subjects. In melancholic subjects, this effect was particularly pronounced for severe depression, and right frontal activity correlated positively with anxiety. Depressed subjects showed posterior cingulate and precuneus hypoactivity. CONCLUSIONS: While confirming prior results implicating right frontal and posterior cingulate regions, this study highlights the importance of depression severity, anxiety, and melancholic features in patterns of brain activity accompanying depression.
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Fragile X syndrome (FXS) is the most commonly known genetic disorder associated with autism spectrum disorder (ASD). Overlapping features in these populations include gaze aversion, communication deficits, and social withdrawal. Although the association between FXS and ASD has been well documented at the behavioral level, the underlying neural mechanisms associated with the social/emotional deficits in these groups remain unclear. We collected functional brain images and eye-gaze fixations from 9 individuals with FXS and 14 individuals with idiopathic ASD, as well as 15 typically developing (TD) individuals, while they performed a facial-emotion discrimination task. The FXS group showed a similar yet less aberrant pattern of gaze fixations compared with the ASD group. The FXS group also showed fusiform gyrus (FG) hypoactivation compared with the TD control group. Activation in FG was strongly and positively associated with average eye fixation and negatively associated with ASD characteristics in the FXS group. The FXS group displayed significantly greater activation than both the TD control and ASD groups in the left hippocampus (HIPP), left superior temporal gyrus (STG), right insula (INS), and left postcentral gyrus (PCG). These group differences in brain activation are important as they suggest unique underlying face-processing neural circuitry in FXS versus idiopathic ASD, largely supporting the hypothesis that ASD characteristics in FXS and idiopathic ASD reflect partially divergent impairments at the neural level, at least in FXS individuals without a co-morbid diagnosis of ASD.
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The experience of aversion is shaped by multiple physiological and psychological factors including one's expectations. Recent work has shown that expectancy manipulation can alter perceptions of aversive events and concomitant brain activation. Accruing evidence indicates a primary role of altered expectancies in the placebo effect. Here, we probed the mechanism by which expectation attenuates sensory taste transmission by examining how brain areas activated by misleading information during an expectancy period modulate insula and amygdala activation to a highly aversive bitter taste. In a rapid event-related fMRI design, we showed that activations in the rostral anterior cingulate cortex (rACC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex to a misleading cue that the taste would be mildly aversive predicted decreases in insula and amygdala activation to the highly aversive taste. OFC and rACC activation to the misleading cue were also associated with less aversive ratings of that taste. Additional analyses revealed consistent results demonstrating functional connectivity among the OFC, rACC, and insula. Altering expectancies of upcoming aversive events are shown here to depend on robust functional associations among brain regions implicated in prior work on the placebo effect.
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