Meditation (with Richard Davidson, PhD)

Dr. Richard Davidson is the William James and Vilas Professor of Psychology and Psychiatry at the University of Wisconsin–Madison and Founder & Director of the Center for Healthy Minds.  In this episode, he discusses the current state of research on mindfulness and meditation as mental health interventions.

00:00 Introduction
02:15 Focus areas in current research
04:37 Well-being as a universal intervention
06:21 Beyond mindfulness: other forms of meditation
07:24 Four pillars of well-being: awareness, connection, insight, and purpose
13:04 Healthy Minds Program and the impact of short daily meditation practices
17:05 Comparison of Mindfulness-Based Stress Reduction (MBSR) and the Healthy Minds Program, focusing on accessibility and time commitment
20:55 The potential for structural changes in the brain with meditation
26:24 Integrating mindfulness and meditation into clinical practice
28:06 Micro-supports for everyday well-being
33:27 Mindfulness and social connection
35:06 Future research directions, including the concept of a flourishing city

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Podcast producer: Jon Earle

Transcript

NOTE: Transcripts of our episodes are made available as soon as possible and may contain errors. Please check the corresponding audio before quoting in print.

DR. THEA GALLAGHER:
Welcome to NYU Langone Insights on Psychiatry, a clinician's guide to the latest psychiatric research. I'm Dr. Thea Gallagher. Each episode, I interview a leading psychiatric researcher about how their work is shaping clinical practice. Today, it's my pleasure to welcome Dr. Richard Davidson. Dr. Davidson is the founder and director of the Center for Healthy Minds at the University of Wisconsin-Madison. A pioneer in the study of mindfulness and meditation, Dr. Davidson takes us through his recent work on the science of human flourishing, including a mobile app that provides personalized mental-health supports. 

Dr. Davidson, thank you so much for being with us today.

DR. RICHARD DAVIDSON:
Thank you for having me. It's a pleasure.

DR. THEA GALLAGHER:
We're just going to jump right in. So where does the research currently stand on mindfulness meditation as a mental health intervention?

DR. RICHARD DAVIDSON:
I would say honestly, it stands at its relative infancy. It's only really quite recently that contemplative practices, including mindfulness, have been explored as possible, either adjuncts or treatments for individuals who are suffering from various kinds of psychiatric disorders. These traditions arose not to treat illness, but to promote awakening. And so it's really only in the most recent sliver of human history that these methods that have been around really for more than 2,500 years are first being applied to individuals with mental health issues. So we're still in the early stages. And I think that the media sometimes portrays it as more advanced than it is, but I think that's where we are right now.

DR. THEA GALLAGHER:
Yeah. I know you've had a number of studies in the last few years really looking at measuring and the mechanisms of what mindfulness and meditation are doing in the brain. Where are you currently focusing your research efforts?

DR. RICHARD DAVIDSON:
What we're most excited about right now, I should back up and just say that our center, the Center for Healthy Minds at the University of Wisconsin-Madison, is a large interdisciplinary research center. There are about 75 people working in the center. Just to give a sense of scale, there's a lot going on that ranges from basic research in a laboratory to applied work in real world settings. What I'm personally most excited about these days is the opportunity to scale well-being. I think most people would agree that the world can use a little bit more well-being, we're not flourishing as a species. There are all kinds of indicators that are raising red flags. For example, the Surgeon General of the United States issued a health advisory in April, last April, on loneliness as an urgent public health issue. Some people may be surprised to learn that loneliness is a greater risk factor for mortality than smoking 15 cigarettes a day and more than twofold risk factor for premature mortality than is obesity.

So these are characteristics that get under the skin, so to speak, affect our biology in ways that are deleterious to our health. And so there's an urgent need to scale well-being. We have the strong conviction that it's something that indeed can be done. We can use simple contemplative type practices. We can introduce them to large numbers of people. We can use mobile health technologies to do that, and we can also develop more effective measures of well-being so we can track the progress to see how these interventions are actually impacting individual's well-being and their mental health. So that's what I'm really passionate about and a lot of the work in our center is now focused on that.

DR. THEA GALLAGHER:
Yeah. And it sounds like you want to focus this work not only on clinically depressed populations or clinically anxious populations, but also "healthy populations." Is that what I'm getting as well? That this kind of well-being is something that everybody can benefit from?

DR. RICHARD DAVIDSON:
Absolutely. We think of it as very much as a universal intervention. We also think that if people are honest with themselves, we're all suffering. We don't need to earn a formal diagnosis. I think that suffering is unfortunately so prevalent. And so we also hold the view that decreasing or even eliminating symptoms of psychiatric illness like symptoms of anxiety or symptoms of depression is not equivalent to flourishing. And so strategies to treat these problems are important, but they don't go far enough. Every human being has the capacity to flourish, and flourishing is something more than simply not being depressed or not being anxious.

DR. THEA GALLAGHER:
And do you envision, and I know a lot of clinicians, psychiatrists, psychologists, therapists do use mindfulness and meditation as a standard tool in their clinician toolkit. And in a lot of ways, even mindfulness can be almost a blanket over the work that a clinician is doing. But do you see this being a really important part of the therapeutic relationship and a really important part of therapy moving forward?

DR. RICHARD DAVIDSON:
I think it can be, yes. And I would also call attention to the importance of framing this more broadly than mindfulness. Mindfulness is one of several really important elements that are essential for human flourishing, but it's not the only one. And I think unfortunately, a lot of the work in the West, in the incorporation of meditation methods into therapy and other psychiatric interventions has excessively focused on mindfulness. And I think, so we need to broaden it. There are hundreds of forms of meditation. Mindfulness is just one form. And other forms may really be important for human flourishing. We know they are.

DR. THEA GALLAGHER:
Can you give some examples of some other forms that you're referring to?

DR. RICHARD DAVIDSON:
Sure. So I think at this point it's helpful to introduce our framework for understanding the plasticity of well-being or flourishing. We published this framework in 2020. The framework holds that there are four key pillars of well-being, each of which has specific neural correlates and biological correlates, and each of which is really essential in human flourishing.

The first pillar we call awareness. Awareness is where mindfulness would be. It would include the capacity for self-awareness. It would also include the capacity for meta-awareness. And meta-awareness is the quality of knowing what our minds are doing. And to some listeners, that may sound a little strange. Don't we all know what our minds are doing? But I wonder how many listeners have had the experience of reading a book where they're reading each word on a page and they may read one page, they may read a second page, and after a few minutes, they have absolutely no idea what they've just read. Their mind is lost. That's a good example of not knowing what our mind is doing. But the moment we recognize it is a moment of meta-awareness. It's a moment of awakening. And it turns out that could be trained. And there are some people walking around who are meta aware all the time. And meditation is something that can really help with that.

So the second pillar of well-being we call connection. Connection is about qualities that are important for healthy social relationships, qualities like gratitude, appreciation, kindness, compassion. And there are specific practices that are designed to cultivate these qualities. We know that humans come into the world with a preference for kindness and cooperation compared to selfishness and aggression, for example. But in order for these preferences to really become robust qualities, they need to be nurtured. And there is a long tradition of practices that are designed to nurture these.

The third pillar we call insight and Insight is about a curiosity-driven self-knowledge. And it's really knowledge about the self, that is all of us have this entity that we construct in our minds called ourself. It's a narrative, it's a set of beliefs and a set of expectations about ourselves. We know that there are some people on the far end of a continuum who have very negative self-beliefs and very negative or low expectations of themselves. And of course, that's a prescription for depression. One of the insights from the contemplative traditions is that what's most important for well-being initially is not so much changing the narrative, but it's changing our relationship to the narrative so that we're not hijacked by the narrative. We can actually see the narrative for what it is, which is a bunch of thoughts. It's not who we are, it's not our essence. It's really this construction. And when we're able to see it that way, it provides some leverage and we can be less hijacked by this narrative.

And finally, the last pillar of wellbeing is purpose. Purpose is about identifying our sense of direction in life. It's about clarifying our values. It's not so much about finding something more purposeful to do, but how can we find meaning and purpose in that which we are already doing, including the pedestrian activities of daily living. Can taking out the garbage be deeply connected to your sense of purpose? And of course it could be, it just requires a little bit of reframing. And again, there are simple meditation practices designed to do this.

So unfortunately in the West, most people equate meditation with mindfulness. The Dalai Lama, for example, doesn't do mindfulness meditation. That's really not the kind of practice that he typically does. There are just these rich practices that are part of these traditions that have received much less attention in the West, but are really critical for promoting human flourishing. I often use the metaphor of, if you just focus on mindfulness, it would be like going to the gym and just working out on your upper body. It'd be good for your upper body, but if that's all you're doing, after a while it's going to actually lead to some imbalance

DR. THEA GALLAGHER:
Mm-hmm. From your research, do you feel like, is there a certain amount of time to be spent in meditation that makes these pillars more reinforced or practiced or real? I'm thinking meditation versus living your life. Is there a sense of how much time should be spent in meditation practices?

DR. RICHARD DAVIDSON:
Yeah, it's a very important question. I should say that we have developed a curriculum called the Healthy Minds Program that incorporates each of these four pillars of well-being, and we've put it into a mobile app called the Healthy Minds Program and it's totally free. It's freely available wherever you get apps. The New York Times Wirecutter named it as one of the three best meditation apps for 2023. It's produced by a nonprofit organization that I founded that's affiliated with our university center called Healthy Minds Innovations.

We've done research, and it turns out that people don't need to do a lot to begin to see real benefits. If you practice even as short as four to five minutes a day and you can sprinkle this throughout your day, just doing one minute here, two minutes there, over the course of 30 days, that actually, from randomized controlled trials that we've done and published, show huge benefit in reducing symptoms of anxiety and depression and promoting well-being.

One of the ways I often talk about this is to remind listeners that when human beings first evolved on this planet, none of us were brushing our teeth. And today, virtually everyone on the planet brushes their teeth. It's something we do for our personal physical hygiene. The data show that if we spent even as short a time as we do brushing our teeth, nourishing our mind, this world would really be a different place.

DR. THEA GALLAGHER:
Wow. Mm-hmm. Well, that's very promising and exciting and also very accessible. Some of the other episodes we've had are talking about research that's really exciting, but we're not going to see being able to be utilized for another 10 years likely, or it's going to take time. So it must make this work exciting for you as well to see benefits, to see something that's also relatively accessible to all.

DR. RICHARD DAVIDSON:
Yes, absolutely. And that's why we made the crazy decision to release our app completely freely to remove any kind of financial barrier so that it is as widely accessible as possible.

DR. THEA GALLAGHER:
Yeah. Do you have any sense of what's happening in the brain during meditation that makes it so powerful in such a small dose?

DR. RICHARD DAVIDSON:
Well, we have some inklings. And first, we can't use the word meditation as if it refers to one thing. As we were discussing earlier, there are many different forms of meditation. And it turns out different forms of meditation do different things to the brain. That's quite well established by now. So mindfulness meditation is very different from meditation on compassion. And in turn, both of those are very different from meditation that's focused on insight. So different forms of meditation do different things. Broadly speaking, we can say that meditation is influencing major networks in the brain, particularly the default network, the salience network, and the central executive network. Those are three networks in the brain that consistently are affected by different forms of meditation in different ways depending upon the nature of the practice.

DR. THEA GALLAGHER:
And then would you also say that... Can you explain also how this differs maybe from MBSR or mindfulness-based stress reduction, which is a more formal program, if I'm not mistaken?

DR. RICHARD DAVIDSON:
Yeah. I mean MBSR or mindfulness-based stress reduction is... I mean, it's a great program that we have studied extensively in our own lab. It's a program first developed by John Kabat-Zinn at the University of Massachusetts Medical School. It's a program that I have an enormous amount of respect for. It's taught at most academic medical centers in the US and Europe as well as other places in the world too. And it's an eight-week program that's very accessible.

I wouldn't call it any more or less formal than our Healthy Minds Program. Our Healthy Minds program is also a formal program. It just is a lot less time intensive because we're really trying to meet people where they are. Most people cannot comply with the assignment in MBSR to practice 45 minutes a day for six days a week. If you ask people six months after they take an MBSR course, "How many of you are practicing 45 minutes a day, six days a week?" I think the percentage is very close to zero. So our interest is in getting people on a path where they can do something regularly every day. And for that reason, the bar is much lower.

DR. THEA GALLAGHER:
But you also think the bar being lower, but the effects are, would you say longer lasting? Or it's just maybe more sustainable because of the... I think time is the four-letter word in our society. So is there part of that that the reduction of the time commitment might have more longevity for, again, a formal program but less time intensive?

DR. RICHARD DAVIDSON:
Yeah, those are great questions. And really, the most honest answer is we don't know.

DR. THEA GALLAGHER:
Right. Mm-hmm.

DR. RICHARD DAVIDSON:
Because they've never been directly pitted against one another, so to speak, in a randomized controlled trial with long-term follow up. And in order to really scientifically address the question you're asking, that would be required. And that's never been done. It would be interesting to do at some point. I think both programs have their place and their value. Someone may start with our Healthy Minds program and do four to five minutes a day and find that they want more and that it's really resonating with them. And at that point, they may go to a mindfulness-based stress reduction course and really get a lot out of it. So I think that they can work in a very synergistic and complementary way.

DR. THEA GALLAGHER:
Yeah. And building on the research, it looks like in 2022, you co-authored this paper that said that you didn't find structural changes in the brain in subjects who had completed the 8-week course of MBSR. So what conclusions do you draw from this about maybe MBSR's effectiveness? Or I don't know if you feel like it applies also to Healthy Minds? What do you make of this idea that maybe there aren't structural changes happening?

DR. RICHARD DAVIDSON:
Yeah, so first of all, thank you for asking that question and referring to that article. That was, I think, an important article, it appeared in a high-profile journal. I think that it is a useful corrective to some of the hype, particularly in the popular media, about structural changes in the brain with short amounts of meditation. I don't think the Healthy Minds program over the course of two months would structurally change the brain either. So it's not that MBSR is "worse" or better. I don't think any meditation practice that is at these early stages with just a total of, in the case of MBSR, it's roughly 30 hours over the course of eight weeks. The data show that it's not enough to structurally change the brain.

On the other hand, we do know that longer-term practice does change the brain. So there's no doubt that there could be structural changes in the brain. It just is going to require more practice. And so we don't know what the parameters are that lead to structural changes. I also suspect that there are big individual differences in this. And also the nature of the structural changes matters. So what we are looking at in the 2022 paper that you are mentioning are volume changes and cortical thickness changes. There are other kinds of structural changes. For example, changes in the integrity of the white matter. We have data that we've published showing that MBSR does change white matter in eight weeks. And so it really depends on which structural changes you're talking about.

DR. THEA GALLAGHER:
And I guess my question is, if people are identifying a benefit, like in say a self-report measure, or they're saying that they find that their life is maybe more manageable or they feel more positive symptoms or more positivity and they feel better, do there have to be structural changes for it to be beneficial, I guess?

DR. RICHARD DAVIDSON:
No, I don't think there does have to be structural changes. And that's a really critical question. We know that MBSR produces functional changes in the brain. We know that even really short amounts of practice produce functional changes in the brain way shorter than MBSR. And so the benefits that people are reporting likely have to do with functional changes in the brain. And those functional changes are really important and they underlie the immediate benefits that people are reporting. So the structural changes I think are important for the effects to endure over a longer period of time, but they're not necessary for the immediate benefit that people experience.

DR. THEA GALLAGHER:
Which I think sounds almost hopeful that you can do something and maybe it will take time to change things structurally, but you can still experience benefits pretty quickly in a short timeframe.

DR. RICHARD DAVIDSON:
Absolutely. I agree.

DR. THEA GALLAGHER:
It sounds like you're really passionate about mindfulness and meditation and these pillars you're talking about. I think sometimes for clinicians, it's something that is, like you said earlier, maybe an adjunctive that they're adding to the work that they're doing. Would you recommend that more clinicians maybe lead with mindfulness and meditation practices or have that be not just integrated or an adjunctive, but really a core part of the treatment that they're doing with every individual?

DR. RICHARD DAVIDSON:
Yeah, another really wonderful question. It's complicated. I think that first of all, if they're going to do that, I think they need to have their own practice. You can't teach this stuff if you don't do it yourself. It needs to come from an authentic embodied place, because a lot of the teaching is really almost through social learning, through it's kind of an osmotic process, if you will. And it is through an embodied demeanor that the clinician can impart to her or his client or patient the nature of these qualities. So that's the first thing. And I would strongly encourage all clinicians to have a meditation practice. I think it's a great benefit. And in fact, to me, it's almost inconceivable to be a mental health provider if you don't have a practice.

If I were in charge of training curricula, I would have this be a mandatory piece of training because I think it is so essential. So if they do have that practice, then yes, I think that it would be a great thing to include on a regular basis not just as an adjunct, but as a more formal component of the methods that they use. There's a growing evidence base for the efficacy of these kinds of methods, specifically with patients who are suffering from various kinds of psychiatric illnesses.

DR. THEA GALLAGHER:
Yeah. And in a lot of the work that I do with exposure and response prevention for OCD, if you don't have OCD, it's kind of hard to have an exposure practice in your life, even though I try to put myself in some situations that would activate me. So I kind of get a sense of what that might be like for my patients. But I think this is a really great way also that we can kind of relate and build that connection of humanity with our patients that we can all benefit from mindfulness and various meditation practices.

DR. RICHARD DAVIDSON:
Yeah, I agree. And I think it's so important. And I think, again, going back to our earlier discussion, I think if we're all honest with ourselves, all of us are suffering in one way or another. We all can benefit from a greater sense of well-being and flourishing.

DR. THEA GALLAGHER:
I know you're working to develop these algorithms that are delivering these micro supports. Can you tell us a little bit more about this project?

DR. RICHARD DAVIDSON:
Yeah, so this is really a further extension of some of the issues that we are discussing earlier about the accessibility of these practices. There are surveys that have been done of people who are just asked if they are engaging in any specific practice to cultivate their own wellbeing, broadly defined, whether it's meditation, yoga, or many different things that people might do to benefit their own well-being. Pretty consistently, in surveys done, at least in Western countries, what you find is that there's not more than around 15 percent of the population that's actively doing something to cultivate their own well-being. Eight-five percent are not. And of those 85 percent, a large fraction don't even have the recognition that well-being is something that can actually be improved or be learned.

People like me often find themselves in front of the already converted, so to speak, people who already drank the Kool-Aid. But frankly, I'm much more interested these days in spending time with the other 85 percent. And that's why we're working with people like police and firefighters and employees who were at call centers and stuff like that. These are people who might never have heard of these kinds of practices. We are exploring ways in which we could be of some benefit. And this is where microsupports come in.

An example of a microsupport are... It's really a very short practice that can be seamlessly integrated with your everyday life. And by short, I mean one minute or less. And so an example of this is, this an example of some research we did during COVID with public school teachers in the United States where we invited them to reflect on their purpose in becoming a teacher for one minute before they start the day. Spend one minute reflecting on your purpose. And it turned out that a very large fraction of teachers reported that this was an elixir for their soul.

DR. THEA GALLAGHER:
Wow.

DR. RICHARD DAVIDSON:
That they got completely disconnected from their sense of purpose. And this simple invitation for one minute was really powerful in helping them navigate the challenges that they're facing. And we do this several times a day. We sprinkle it in. Another example of a microsupport is before an important meeting with a group of colleagues or coworkers, spend one minute reflecting on something positive that each of these individuals has done over the last month. Just reflect on something positive that they've done. It's amazing how one minute doing that can change the entire tenor of a meeting. These are examples of microsupports. So you don't have to meditate, you just have to be willing to engage with these microsupports. You don't have to sit in any special posture. You don't have to be in any special place. You can do this as you're navigating your everyday life.

DR. THEA GALLAGHER:
Yeah. And in some of my work with burnout and workplace wellness, I get some pushback sometimes about these kinds of interventions. Like, how can this solve the bigger problem maybe of feeling overworked and under supported or how also can it help with all of the global crises that are ongoing. What's your take on micro interventions being powerful, but then maybe some of these larger systemic issues? How do they interact or relate?

DR. RICHARD DAVIDSON:
Yeah, so I think that's super important and it's really important to recognize that there are these systemic injustices and they do affect our wellbeing. It's not either/or. So that's the primary answer. It's not either/or. It's got to be both. Because if you are totally burned out, you will have your vitality sacked and you won't be an effective social change agent. We need people who are operating on all cylinders in order to change the systemic injustices that we're all facing. And so it's got to be both. And so framing it as either/or is really I think the wrong kind of framing.

DR. THEA GALLAGHER:
And it seems like you think there's a correlation between mindfulness and meditation and ultimately feeling more whole and having maybe more energy to engage in larger change. And specifically, I know that you feel passionately about prosociality. And so even though a lot of these practices seem pretty individual, how do you hope they translate into greater social connection?

DR. RICHARD DAVIDSON:
Yeah. So again, really important. The role of social connection is huge. It is one of our four key pillars of wellbeing. We know it's intimately connected to wellbeing and flourishing. One of the convictions that we have, and there's data to support this, is that nurturing connection will help in real social connection. And engaging in social connection, meaningful social relationships will in turn help nurture these qualities. It's bidirectional. And so I think that this is something that really is important and the data speak to the value of these practices in nurturing real social connection that can combat loneliness.

DR. THEA GALLAGHER:
Yeah. And just the image in my mind that we use a lot like, you kind of can't pour from an empty cup. So almost being able to, the more you can nurture the aspects of your humanity that seem to lead to flourishing and thriving, they can then lead to community engagement, whether that's in your familial community or a larger work community or even a global community.

DR. RICHARD DAVIDSON:
Right.

DR. THEA GALLAGHER:
In my final question, where do you hope to see the research go in the future? What are you hoping for? What do you hope to see in the next five to 10 years with the work that you're doing?

DR. RICHARD DAVIDSON:
Well, there are a few things. One is we, I think, will have much better measures of wellbeing that we can track on a more granular basis. This can provide us with important information to provide micro-supports in the moment, in a context-appropriate way that can really be of great benefit. I also see the possibility of massive scaling. One of the dreams I have is of a flourishing city where we can work with a city with a number of key sectors simultaneously. For example, healthcare, education, first responders, communities of faith, city government, and the workplace. We've worked with all of those sectors individually, but we've never worked with all those sectors simultaneously. And if we can bring this to a mid-sized city, for example, we can look at distal outcomes that really matter that we think are mediated by well-being. So what would an example of a distal outcome be? A distal outcome might be crime rate in the city, suicide rate, life expectancy, healthcare costs. All of those are targets that we actually believe can be moved when a sufficiently large fraction of the population is nourishing their mind in addition to brushing their teeth.

DR. THEA GALLAGHER:
Yeah. And it's such inspiring and exciting work that is accessible to all, which I think it's pretty rare in the work many psychiatrists are doing. So thank you so much for sharing this work with us and you've not only shared it on this podcast, but with your Healthy Minds app that everybody can download and utilize. And so thank you so much Dr. Davidson for all of this great information.

DR. RICHARD DAVIDSON:
Thank you so much. Pleasure to be with you.

DR. THEA GALLAGHER:
Thanks so much for that conversation, Dr. Davidson. If you enjoyed this episode, be sure to rate and subscribe to NYU Langone insights on Psychiatry on your podcast app. For the Department of Psychiatry at NYU Langone, I'm Dr. Thea Gallagher. See you next time.