E17. Norm Farb – Mindfulness, Interoception and Depression

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In this episode I speak with Norm Farb, Assistant Professor in the Department of Psychology at the University of Toronto, and Principal Investigator of the Regulatory and Affective Dynamics Lab. 

Dr. Farb studies the neuroscience of the self and emotion with a focus on how cognitive biases shape the emotional reactions that influence well-being, and how these biases and emotional reactions are affected by cognitive training practices such as mindfulness meditation.

He has led several influential studies on the mechanisms of mindfulness training and depression vulnerability, highlighting that resilience against depression stems more from the growth of mindfulness-related skills, such as interoceptive awareness, than the eradication of residual depressive symptoms. 

Show Notes

1:30 – How did Norm come to focus on the role of interoception in mindfulness, a practice so often described in cognitive terms  (such as quietening the mind). 

6:35 – On whether the interoceptive and default mode networks are anti-correlated

10:00 – Does mindfulness enhance your ability to perceive interoceptive signals from the body?

13:15 – How the experiential and narrative modes relate to depression 

24:50 – How do people relate to the signals from within their body in a way that supports their wellbeing?

32:00 – How does the interoceptive way of looking at mindfulness relate to the positive effects of mindfulness in healthy populations?

40:00 – Are there any cultural factors that might be shaping our balance between narrative and experiential modes?

46:00 – Is there research on interoception and intuition?

48:20 – What is coming up next for Norm?

53:10 – Advice for students

1:30 – How did Norm come to focus on the role of interoception in mindfulness, a practice so often described in cognitive terms  (such as quietening the mind). 

Norm started thinking that meditation would be a process of quieting the self, and expected to see reduced activity in the brain regions associated with self-referential thought (regions now identified as part of the default mode network). What he instead found, was greater activation in regions responsible for sensory processing. And so, following the data, he came to see that rather than quietening the self-related brain regions, meditation enhances the ability to access other modes of self-knowledge that aren’t about conceptual self-evaluation. This finding came to make good sense when Norm later started meditating himself, and realised that at least in the early stages, that meditation is a sensory awareness practice with the instructions centred on sensations and the body.

6:35 – On whether the interoceptive and default mode networks are anti-correlated

At least in young adults, there is an opponency between task-focused and default-mode networks. However, this may not be the case for everyone. More importantly, however, the interoceptive network is not a task-focused network in the conventional sense; it doesn’t use the same parts of the brain that we use to make judgements or manipulate information from the external world. 

10:00 – Does mindfulness enhance your ability to perceive interoceptive signals from the body?

No, mindfulness does not seem to make people ‘super sensors’, just as a concert pianist isn’t able to hear quieter sounds than other people. Instead, the concert pianist does more with, or gets more information, sounds. Similarly, mindfulness training seems support people become more in the habit of using information from the body.  In the brain, we see that mindfulness increases the integration of interoceptive signals into overall evaluative parts of the brain (e.g. the anterior insula), rather than enhancing activity directly in primary representers (i.e. posterior insula) of what’s happening in the body. And the connection between interoceptive and evaluative parts of the brain is strengthened.  

13:15 – How the experiential and narrative modes relate to depression 

While the first episode of depression usually relates to some adverse circumstances, people can fall into mental habits that make them vulnerable to future episodes of depression. Where this is true, recurrent depression can be seen as a product of an overly rigid negative set of interpretations that are applied to a variety of events in life. But in depression, people also tend to suppress new sensory processing once they become sad. The more people suppress signals from the body, the more likely they are to experience relapses into depression. 

So we see the opposite pattern activity from mindfulness: in depression there is a suppression of bodily signals and a dominance of conceptual-evaluative activity while in mindfulness there is greater integration of bodily signals relative to conceptual-evaluative judgements. From this perspective, mindfulness facilitates the opening to new (sensory) information that may serve to challenge the entrenched, negative mental patterns of depression. This opening to different information, contrasts with CBT where you challenge and restructure negative evaluations directly. 

24:50 – How do people relate to the signals from within their body in a way that supports their wellbeing?

While depression relapse may be associated with the suppression of interoceptive signals following a negative cue induction, just paying more attention to interoceptive signals isn’t always associated with better outcomes. For example, interoceptive signals may be interpreted in a catastrophising manner in panic disorders. So it is a matter of relating to interoceptive signals differently, rather than just boosting them.

To start relating to interoceptive signals differently, people shouldn’t start by trying to focus on their body in the most unpleasant, triggering or patterned situations. Instead they should start small, in safe, pleasant situations and get in the habit of relating to your body differently. Once you are in the habit of relating to your body in an open, curious way, you can slowly progress to more unpleasant, triggering or patterned situations. 

32:00 – How does the interoceptive way of looking at mindfulness relate to the positive effects of mindfulness in healthy populations?

Mindfulness can lead to a greater feeling of agency and presence, both of which are thought to be related to interoceptive signals. Strengthening of concentration is also likely to be a mechanism of beneficial effects. 

Additionally, mindfulness can help us see the patterns in our thinking, feeling, and behaviour which we all have, but often become blind to. Seeing these habits better gives us the chance to evaluate them, and decide to change it if it doesn’t serve us. 

40:00 – Are there any cultural factors that might be shaping our balance between narrative and experiential modes?

Our education system is all about moving into the conceptual and elaborative way of relating to experience. The complexity of identity in our modern cosmopolitan world also demands ready intricate narratives about who we are. 

46:00 – Is there research on interoception and intuition?

It’s not a big area of research, but there is at least one study on the topic by Barnaby Dunn and colleagues; Listening to your heart. How interoception shapes emotion experience and intuitive decision making.

48:20 – What is coming up next for Norm?

Norm has been developing a lot of behavioural tasks that can be run online that can test aspects of contemplative training (for example, tasks that can measure how stable someone’s attention is) and how these aspects are applied (for example, people’s emotion regulation tendencies).

53:10 – Advice for students

Early on, there should be a decision made around whether you want your role to be someone who pushes the frontier vs. consolidate and clarify things that have already started to be discovered. Norm has always been somewhat of a maverick choosing things that are interested to him, rather than making choices that are safer in terms of leading to jobs.

If you are interested in being someone that pushes the frontier, it can be helpful to think about applying the principles leading scientists are using in other fields to your field of interest. 

Norm also recommends people look into Open Science. Especially in the contemplative science field, the rigour demanded by Open Science is a useful way to distinguish yourself. 

E16. Josef Parnas #2 – The Phenomenology of Schizophrenia

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Today we speak again with Professor Josef Parnas, Professor of Psychiatry at the University of Copenhagen and a co-founder and Senior Researcher at the Danish National Research Foundation: Center for Subjectivity Research.

For some 40 years, Professor Parnas has worked as a clinician and conducted research into the schizophrenia spectrum with an emphasis on the phenomenology of schizophrenia. In our first conversation we discussed the implications of taking the phenomenology of schizophrenia seriously, and covered topics such as importance of clinical experience, and adequacy of current systems to classify psychopathology.

But after the interview I realised that we didn’t really discuss the phenomenology of schizophrenia itself and felt that I had missed an opportunity to learn from someone with so much experience. So in this episode, I ask of a lot of basic questions to better understand what schizophrenia is and what life is like for those with it.

Show Notes

1:20 – On the prototypical case of schizophrenia. 

26:15 – On psychosis and it’s relationship to schizophrenia

32:10 – On psychosis in schizophrenia vs. psychosis in other conditions. 

38:00 – What catalyses psychotic episodes?

44:30 – Is psychosis itself adaptive?

49:00 – On the marked difference in quality of life outcomes between different cultures.

55:00 – On the link between Autism and Schizophrenia

1:20 – On the prototypical case of schizophrenia. 

One interesting point about schizophrenia is that it can be difficult to date its onset. Although onset of flamboyant psychotic symptoms and diagnosis with schizophrenia typically occurs somewhere around the early 20s, and there is often a prior history of contact with psychological/psychiatric services and differences in behaviour and the person’s experience that occur well before diagnosis. These differences and difficulties are related to being a subject in the world. For example, even as a, say 11 or 13 year old, the person would often feel profoundly different and cut-off from others, even if they don’t display conspicuous behavioural differences. Interestingly people with schizophrenia may find it difficult to verbalise in what sense they are profoundly and fundamentally different. This feeling of a lack of naturalness in and attunement to the world is reflected in the person being perceived as peculiar or eccentric, and sometimes leads to a interest in metaphysical or philosophical issues. 

The onset of psychosis itself, is linked to an increasing sense of self-alienation. For example, the patient starts to experience their thoughts as being ‘at a distance from themselves’ and eventually as not belonging to themselves. This may lead to a sense of revelation that they are in contact with another dimension of reality that is not accessible to other people (and such a sense is often experienced by those with schizotypal traits without psychosis). Other schizophrenic symptoms such as the sense of have thoughts inserted into their head, and of one’s thoughts/actions being controlled (ie. passivity phenomena) is also related to this increasing sense of self-alienation. Delusions are also related to the growing sense of self-alienation, and are often developed while the person realises that something is happening, but doesn’t understand what is happening. 

For most patients, schizophrenia is a fluctuating condition (with or without medication). Only a minority of people deteriorate into a chronic debilitated state.  

26:15 – On psychosis and it’s relationship to schizophrenia

Psychosis is nearly impossible to define satisfactorily. People may have the auditory hallucinations characteristic of psychosis, but should not be considered psychotic if they recognise them as such and are able to function in the world. Only when such private experiences are taken to be the objective, shared world and are then acted upon is there a clear case of psychosis. And indeed, many people who are discharged as non-psychotic will continue to have unusual experiences but are able to separate their own experiences from those of the socially shared reality. 

32:10 – On psychosis in schizophrenia vs. psychosis in other conditions. 

The experience of psychosis itself is similar between its occurrence in schizophrenia and in other conditions. However, you might say that before psychosis, the experience of the person with schizophrenia is closer to the psychotic state than that of non-schizophrenic people. 

38:00 – What catalyses psychotic episodes?

Drug abuse can precipitate schizophrenia, but often there are questions about the direction of causality. Self-medication through dug abuse is common amongst people with schizophrenia. Additionally trauma, emotional deprivation (as was more common in the foster homes of past generations) or the loss of another person on whom the person is in some way dependent, is often a catalyst. 

44:30 – Is psychosis itself adaptive?

I asked this question after coming across this paper: https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00237/full

In contrast, Josef doesn’t consider there to be any real adaptiveness to psychosis itself. 

49:00 – On the marked difference in quality of life outcomes between different cultures.

Research almost 30 years ago by the WHO suggested that people in less developed countries had a better prognosis than people in more developed countries. However, such studies are extremely complicated. But the social environment is certainly important for life outcomes for those with schizophrenia. People with schizophrenia will do better in more tolerant social environment than a rigid and hostile one. So we could expect a more productivity-focused social environment to lead to worse outcomes for people with schizophrenia. 

55:00 – On the link between Autism and Schizophrenia

Josef does not think there is a link between the two conditions. This is not surprising given Josef’s emphasis on anomalous self-experiences – a recent paper has pointed to very different self-experiences in ASD and schizophrenia (https://academic.oup.com/schizophreniabulletin/article/46/1/121/5485220). He is also sceptical about the dramatic increase in prevalence of ASD in recent years, mentioning the work of Ian Hacking (for example, https://www.lrb.co.uk/the-paper/v28/n16/ian-hacking/making-up-people)

E15. Josef Parnas – Schizophrenia and Phenomenology

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Today we speak with Professor Josef Parnas, Professor of Psychiatry at the University of Copenhagen and a co-founder and Senior Researcher at the Danish National Research Foundation: Center for Subjectivity Research. Professor Parnas has been involved in research  into the schizophrenia spectrum for about 40 years, and by using a phenomenological approach, has come to focus on the anomalous self-experiences associated with the schizophrenia spectrum.

In this conversation we discuss how we should think about schizophrenia, phenomenology and the importance of clinical experience, and systems to classify psychopathology.

Show Notes

0:00 – On Josef’s background.

3:25 – Josef’s overview of what we know about schizophrenia.

10:30 – Contrasting the core of schizophrenia from the symptoms.

21:45 – On the compatibility of predictive Bayesian computation accounts and phenomenological accounts of schizophrenia.

26:10 – Are schizotypal traits adaptive?

33:25 – On the disorder of self in schizophrenia.

35:45 – On the scale that Josef published to measure anomalous self experiences: the Examination of Anomalous Self Experience.

36:50 – Does Josef find the research on meditation or psychedelics interesting, given his interest in alterations of self-experience?

38:20 – Why Josef is not hopeful that dimensional classification systems for psychopathology?

50:15 – Alternatives for students or researcher who do not have the option of gaining direct experience with schizophrenic populations.

52:00 – On what historical European psychiatry has to offer contemporary psychiatry.

0:00 – On Josef’s background.

Josef was trained as a medical doctor at the University of Copenhagen, and then completed his internship at a hospital running important studies that showed that schizophrenia has an important genetic basis. He has worked simultaneously in clinical and research capacities throughout his career.

He arrived at his interest in phenomenology because of his interest in psychopathology. The phenomenological perspective was the most mature account of psychopathology, and was very much mainstream until DSM-3.

3:25 – Josef’s overview of what we know about schizophrenia.

Thinks that schizophrenia is not well represented by the current medical model, which emphasises chronic psychotic symptoms, such as hallucinations and delusions. This is likely due to the desire of recent DSM efforts for reliability of diagnoses. The core features of the schizophrenia spectrum, which include distortion of subjective life and disorders or expressivity, are relatively neglected perhaps because they tend to require clinical experience to reliably identify.

Schizophrenia is more than just the chronic condition identified by the DSM. One piece of evidence that suggests schizophrenia is a spectrum rather than just the severe diagnosable condition is that only a minority of patients with diagnosable schizophrenia experience a deteriorating chronic course, many experience a remitting course and a significant proportion (20-25%) of those that would qualify for a diagnosis are never treated or seek medical help at all. Then there are milder parts of the spectrum that wouldn’t qualify for a schizophrenia diagnosis, which again, do not typically seek psychiatric help. Also, there are links between vulnerability to schizophrenia and creativity.

10:30 – Contrasting the core of schizophrenia from the symptoms.

There is something qualitative about the symptoms of schizophrenia. A schizophrenic delusion or hallucination is easily distinguished by the experienced clinician from the delusions or hallucinations symptomatic of other conditions. Josef considers the nature of these symptoms to be reflective of differences in the subjective experience, which he considers the core of schizophrenia colouring the manifest symptoms. Said differently, it is not the case that the symptoms in schizophrenia are not simply occurring to a person that otherwise experiences life as a neurotypical person does. The differences occur right down to a fundamental level of the person’s subjective experience, and these differences pre-date and may give rise to the more obvious clinical symptoms.

Josef tells a story of a client of his that was surprised to learn that most people experience thoughts as their own, as opposed to existing in some sort or collective space as experienced by the client.

Therefore, to understand schizophrenia, we need to be thinking in terms that are pervasive and fundamental, rather than modular.

21:45 – On the compatibility of predictive Bayesian computation accounts and phenomenological accounts of schizophrenia.

Intuitively, Josef is attracted to such accounts.

26:10 – Are schizotypal traits adaptive?

People with schizotypal traits often don’t share the naturalness with which neurotypical people relate to the world. And if you don’t take the obvious for granted, this may facilitate a curiousity about the world and lead to greater creativity. And indeed, there is a documented link between schizophrenia (and relatives of those with schizophrenia) and creativity.

Here is a link to the study Josef mentioned on the prevalence of schizophrenia in the relatives of university scientists.

Robert Sapolsky’s lecture on schizophrenia: https://www.robertsapolskyrocks.com/schizophrenia.html

Josef’s translation of Hans Gruhle’s 1929 work, ‘The schizophrenic basic mood (self-disorder)’.

33:25 – On the disorder of self in schizophrenia.

Josef thinks that the disorders of self-experience in schizophrenia, are coming to be increasingly recognised. In fact, disorders of self-experience will be mentioned in the new ICD-11.

35:45 – On the scale that Josef published to measure anomalous self experiences: the Examination of Anomalous Self Experience.

The above link contains not only the measure itself, but also courses on the measure. There is also a self-report version, recently published the Inventory of Psychotic-Like Anomalous Self-Experiences.

36:50 – Does Josef find the research on meditation or psychedelics interesting, given his interest in alterations of self-experience?

Josef published a paper on the relation of mystical states and schizophrenia, but doesn’t follow the meditation or psychedelics fields closely.

38:20 – Why Josef is not hopeful that dimensional classification systems for psychopathology?

Clinicians say that they only need ~25 diagnostic categories, not the ~400 in DSM-5. The reliance on well defined diagnostic criteria (in the DSM and ICD) and the discarding of phenotypic/prototypic descriptions, has resulted in an unending proliferation of diagnoses. Josef is also sceptical that a dimensional approach will be adopted by clinicians – “clinicians like categories”.

Instead, Josef thinks the best solution might be to have different classification systems depending on the context/purpose.

50:15 – Alternatives for students or researcher who do not have the option of gaining direct experience with schizophrenic populations.

Josef recommends a number of books to gain insight into the phenomenology of schizophrenia, including;

Madness & Modernism by Louis Sass

The Center Cannot Hold by Elyn Saks

The Psychiatric Interview for Differential Diagnosis

52:00 – On what historical European psychiatry has to offer contemporary psychiatry.

All European psychiatry was somewhat phenomenological until the domination of psychiatry by American research, following DSM-3. But there has been a recent revival of phenomenology. For example, Oxford University Press has recently published The Oxford Handbook of Phenomenological Psychopathology and Cambridge University Press has recently published The Maudsley Reader in Phenomenological Psychiatry.

E13. Vince Polito – Microdosing

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Today I speak with Dr. Vince Polito (@vincepsy), Research Fellow in the Department of Cognitive Science at Macquarie University. Vince works on developing better measures of self representation and investigating how this capacity is altered in different contexts, clinical conditions and states of consciousness.

Vince and I discuss microdosing, which refers to regularly taking very small doses of psychedelic substances. Earlier this year, Vince published one of the most rigorous studies conducted on microdosing to date.

This is an interesting topic because of its link to the promising therapeutic psychedelic studies currently being undertaken, the positive reports of microdosing in the media, and the lack of empirical research into the practice. We discuss these preliminary investigations and the outlook for this field.

Show Notes

1:10 – On Vince’s research background

7:20 – How Vince came to be interested in microdosing

13:30 – On the methodology and findings of Vince’s microsdosing paper.

22:00 – On the plausibility and continuity of microdosing effects with higher dose psychedelics

25:30 – On how to square the reported benefits of microdosing with the fact that the therapeutic effect of psychedelics are related to the intensity of experience (eg. Griffiths et al., 2017).

31:50 – What do altered states of consciousness, more broadly, have to offer cognitive science?

36:50 – Advice to students interested in similar areas.

39:10 – On meditation as an altered state of consciousness.

43:00 – What’s coming up for Vince in terms of research.

1:10 – On Vince’s research background

Vince’s work has included studying cognitive processes involved in self-representation (how we make sense of the world and where our bodies are in the world) and sense of agency (the feeling of intending things to happen in the world). In studying how sense of agency can be disrupted, Vince has looked at hypnosis, flow states and passivity phenomena in schizophrenia.

7:20 – How Vince came to be interested in microdosing

Vince has also done studies on belief formation – both how delusional beliefs come to be held and how beliefs spread through groups of people. Microdosing was an interesting topic from a belief formation perspective due to a combination extremely positive media coverage, the costs involved and virtually no empirical research. And so, apart from the effects of microdosing itself, Vince’s study investigated the impact of prior beliefs on reported effects.

13:30 – On the methodology and findings of Vince’s microsdosing paper.

Given the barriers to studies involving actual microdose administration, Vince thought that the most rigorous way to proceed would be to find people who were already microdosing and track their experience systematically.

The first part of the study tracked the immediate effects of microdosing through daily ratings of connectedness, contemplation, creativity, focus, happiness, productiveness, and wellbeing. Results suggested a broad positive impact on dosing days, but no residual positive impact on the following days.

The second part of the study looked at the longer term effects. At baseline and again after 6 weeks of microdosing, participants completed a battery of questionnaires assessing effects that are often talked about in connection with microdosing as well as with high dose psychedelics, including mental health, attention, wellbeing, mindfulness, mystical experience, personality, absorption, creativity and agency. Depression, stress and mind-wandering decreased, while absorption and neuroticism increased.

The third part of the study involved comparing expected effects to reported effects. People did have very positive expectations, but it didn’t seem like the observed effects were driven by expectations. For example, creativity was the trait that people most expected to increase yet this was not found in the actual results.

22:00 – On the plausibility and continuity of microdosing effects with higher dose psychedelics

Yes, broadly the findings are consistent. However, the finding of higher neuroticism seems inconsistent with higher dose research and the finding of unchanged creativity seems inconsistent with other studies of microdosing.

25:30 – On how to square the reported benefits of microdosing with the fact that the therapeutic effect of psychedelics are related to the intensity of experience (eg. Griffiths et al., 2017).

Firstly, despite some instructions that microdosing should be imperceptible, microdosing is generally accompanied by noticeable changes in cognitive functioning. Still, these effects are orders of magnitude lower than those reported on high doses of psychedelics, which Vince likens to a positive version of trauma. Because of this, it is difficult to square the reported benefits of microdosing with how we conceive of the therapeutic mechanisms of high doses of psychedelics. Presumably the effects of microdosing result from a more direct pharmacological effect, perhaps relating primarily to effects on the default mode network.

31:50 – What do altered states of consciousness, more broadly, have to offer cognitive science?

We are so bound to our normal waking consciousness, that altered states of consciousness offer an important tool to separating out the dimensions that are part of normal waking consciousness. This is basically a neuropsychological approach. Meditation and virtual reality are other related technologies of consciousness.

36:50 – Advice to students interested in similar areas.

Some good advice might be not try to build a career around psychedelics of altered states of consciousness, but to find a topic that is important and respectable, then use altered states as a case study of how your topic might be effected. This is what Vince has done with sense of agency.

39:10 – On meditation as an altered state of consciousness.

I propose to Vince that the best way to consider meditation might be not necessarily as an altered state of consciousness, but as an attentional practice that can give rise to altered state of consciousness. Vince agrees and reaffirms the legitimacy of deep states of meditation as altered states of consciousness.

43:00 – What’s coming up for Vince in terms of research.

Vince will be working on better measures of self-representation – measures that capture sense of agency, embodiment and presence. He doesn’t have immediate plans for follow-up psychedelic research, but stay posted.

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Episode References

Robin Carhart-Harris and Karl Friston’s recent (2019) paper proposing a relaxing of prior beliefs within a hierarchical predictive coding framework as a model of how psychedelics have their effects. “REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics“.