Calm Yourself! with Dr. Sara Lazar

Pain and fear are inevitable, especially these days, but we can retrain our brains to reduce suffering. Dr. Sara Lazar, Assistant Professor in Psychology at Harvard Medical School, reveals how just eight weeks of mindful meditation can visibly change parts of the brain to be less reactive to pain. Plus… how meditation apps put the power of mindfulness right in your hand.

Phil Stieg: Hello, today, I have with me Dr. Sara Lazar. She is a scientist in the Department of Psychiatry at the Massachusetts General Hospital and Harvard Medical School. She studies the beneficial effects of mindfulness training and its positive impact on controlling fear and pain. She will describe how her personal life experiences led to this line of research and its benefits. Sara, thank you for being with me and welcome.

Sara Lazar: Thanks for having me.

Phil Stieg: So let’s start off with the what — what are we talking about line. What is mindfulness and what does it do?

Sara Lazar: So mindfulness is really simple and just paying attention in the present moment. In this non judging open and accepting way. So anyone can do it any time. Mindfulness meditation is just practicing it continuously for 40 minutes. And you might think, well, OK, what’s the difference? Well, think of it sort of like, you know, playing soccer, right?  Anyone can get a kick a ball, right. It’s simple. It’s no big deal. But in order to make that amazing goal,  you need to practice, practice, practice. And so the idea is that we practice for 40 minutes every day so that we can be mindful throughout the day during the game of life, so that, you know, when we’re driving, you know, in the horrible morning commute traffic or just dealing with the morning commute  , dealing with the deadlines and dealing with the difficult people in our lives, we can remain calm and centered and mindful at all times, not just, you know, while we’re sitting and practicing.

Phil Stieg: So how is that different than meditation and yoga?

Sara Lazar: Mindfulness is a form of meditation. So the idea would be that so often when people think meditation, they think mantra. Right.  And so there’s no mantra here what people like to usually focus on breathing sensations or sounds. And so the idea would be you just become mindfully aware of breathing sensations. So how do you know you’re breathing? You know, what’s the actual sensation of your ribcage? You know, expanding, contracting your belly, rising and falling. You know, the air passing through your nostrils says all you’re doing. So you just pay attention to that for 40 minutes. And that’s the meditation.

Phil Stieg: For a person just starting doing this and they want to think about their heart rate,  to focus their mind, what does it do for them? What are they going to notice physiologically, emotionally or in their day-to-day life?

Sara Lazar: It varies tremendously from person to person. So let’s say them back. The steps of during meditation, there’s going to be a bit of a trap.  A lot of people say, oh, I can’t get my mind to stop. And, you know, I’m just I’m restless and I just I can’t do this some people. Right. And that’s OK, because everyone, even  really advanced meditators have days where their mind is restless, and they can’t do it and and and end.  So it really does take practice.  But with practice, what happens is that people say  they start to be calmer and less reactive.  You start to actually be more aware of what’s going on around you during the day. So if you take on these eight-week programs, one of the practices they say is, you know, when you’re outside walking, can you just be aware of walking? So what are the sensations of your feet on the ground? What’s the sensation of the sunlight on your face? You know, what’s a temperature? What’s the wind? Rather than thinking about whatever’s in your mind, just focus on the sensory experience. And so initially, you have to put some effort into this. But with practice, it starts just happening naturally and just really just take in nature for a few minutes and just let go of all the stuff that we worry about.  People also report better memory,  increases in sustained attention, increases in creativity. It really has really wide-ranging effects.

Phil Stieg: When I started training to do mindfulness. I couldn’t get my mind to stop…

Sara Lazar: Yeah,

Phil Stieg: …for obvious reasons. And so what my instructor made me do is lay down.

Sara Lazar: Mm.

Phil Stieg: I lay down and eventually I fell asleep, which she said was OK, you know, it’s kind of progress of letting things go. So  , even for those individuals that have a hard time letting go, you know, I just want to hold it out that there is hope for you.

Sara Lazar: Uh huh.

Phil Stieg: And then the other thing that you said is 40 minutes.  I don’t have forty minutes. I personally think that if I can do, you know, ten to 20 in the morning and if I can get it in, in the evening, I’m feeling pretty good about it. Is that your sense as well?

Sara Lazar: Definitely, yes. There have been studies where people were there, told us to do 10, 15, 20 minutes and there’s definitely there’s benefits.  So if you go to a meditation center they are going to tell you 40 minutes. But in the clinical setting, it’s usually say five, ten minutes. And there’s some apps and the apps often have 10, 15, 20 minute guided meditations. So definitely you can definitely benefit from the shorter periods.

Phil Stieg: So I found it interesting, which will lead us into some of the research, that you’re doing is how you actually got into mindfulness. Can you describe that to us, please?

Sara Lazar: Yeah. So back in grad school, a friend and I decided to run the Boston Marathon.

Phil Stieg: (laugh)

Sara Lazar: Yeah, but we ramped up too quickly and it destroyed my knee and  my lower back. So I went to see a physical therapist and they said, stop running and just stretch. Right. And so as I was leaving the physical therapists office, I happened to notice an ad for a vigorous yoga class that, you know, promised to promote, you know, cardiovascular fitness and strength and flexibility. So I thought, great, this will be a way I can just stretch but stay in shape and still run the marathon.  And this is back 25 years ago now. And that, you know, back then, yoga, meditation, you know, we’re equivalent to tinfoil hats and, you know, crystals and whatnot. I went to this purely as a form of physical t    herapy. Right. I had zero interest whatsoever in yoga, meditation, Eastern philosophy, any of that. But the amazing thing was after two or three classes, I started noticing I was more relaxed and I was interacting with people in a whole new way. And it was really profound to me.  And so I decided when I finished my PhD to switch. I’ve been doing this research ever since and I did not run the marathon. Everyone was asking me that. It’s like, no, I never did run the marathon. Stuck with yoga.

Phil Stieg: So that kind of gets into the things that you’re really focusing on, the sense of how mindfulness can play a role in the management of pain.

Sara Lazar: There’s two components to pain. One component of pain is the actual physical sensations. So the burning, stabbing, tingling, that sensation of it.  The second component is the emotional reaction to it. I don’t like it. Make it stop. Why me? Right. And what’s really interesting is that those are in two completely separate parts of the brain and they’re unrelated. So you could take one hundred people and apply the exact same physical thing to them, you know, so a shock or, you know, you hitting them or cutting them or something like that.  And all of them, on a scale of one to ten, report the intensity of the physical sensation, probably about the same. But in terms of the emotional component of it, it would be all over the place. Right.  Because there’s just no correlation between the intensity and the emotional reaction to it.  Because some people are very, you know, stoic or just, you know, very not reactive. Other people are even the tiniest little, you know, bump and they’re, you know, in tears.  And so we did two studies, one, the pain, one of fear conditioning. And so the first one was with the pain. And what we saw was that the meditators, when they were meditating, the actual sensory cortex that is actually experiencing it, increased while they were being mindful of the pain compared to just being in a normal state. But they’re “I  don’t like it. Make it stop”  went down and that part of the brain also went down.  And so this gets back to, OK, well, what is mindfulness? Mindfulness is paying attention to the present moment sensory experience in this non-judging way. And that’s exactly what they were doing. They’re paying attention to the pain in this non judging open way.  We’re going to  encounter pain, physical pain in our life. We cannot stop it, but we can change our reaction to it. And that’s what’s really, really important.

Phil Stieg: I think you said that with mindfulness, you were able to reduce the perception of pain by, what? Twenty two   in the anxiety related to the pain by, what? Twenty nine percent. 

Sara Lazar: Right. So actually it was just the the, the, the reaction to the pain, the actual pain and the sensory cortex did not change. It actually went up. Right. And also the reports of the pain, you know, did not change. So at first pass, it might look like stoicism, but then when you talk to them and then you sort of understand what the mindfulness is about. You understand. No, it’s it’s about   being open to it. Right. And so that’s why they’re saying, OK, yeah, I’m getting shocked, but it’s OK. It’s not bothering me.

Phil Stieg: So just tell us about what you were doing to induce pain. I think people need to understand.

Sara Lazar: Oh, sorry. Yeah. So it was a very just a very mild electric shock, sort of similar to like the hand buzzers, like where you you shake some hands and buzzes you. So is about about that intensity of pain of a mild electric shock while they’re in the MRI scanner. But they didn’t know what I was going to come. So they’re just lying there and all of a sudden they get shocked and they knew what’s going to happen, but they didn’t know exactly what is going to happen.

Phil Stieg: And you didn’t have any trouble getting any subjects to do that for you?

Sara Lazar: Yeah, we pay them (laugh)

Interstitial – This Is Your Brain: The Guided Tour

Phil Stieg: What areas of the brain benefit from mindfulness and what kind of changes you see?

Sara Lazar: There are these eight week clinical programs that are completely secular.  You learn how to do mindfulness and you’re told to go home and practice it every day for 40 minutes.  We scan people before and after one is eight week programs, and we also compared their brains to people who are scanning weeks apart but who didn’t do anything in between. And what we found is that from pre to posts, compared to the people scanned eight weeks apart, that there five major brain changes. The most interesting one was the amygdala. And so the amygdala is often referred to as the fight-or-flight part of the brain. So it’s involved in emotion regulation. It regulates cortisol and some of the other stress hormones.  And what we found is that decreases in stress correlated with decreases in amygdalasize. And this is really cool because in animal studies, you see the exact opposite.  So that was really cool. . And then there was three regions that worked together, which are the hippocampus, the posterior cingulate and the temporal parietal junction.  And so and it’s interesting that those three regions together contribute to something called the Default Mode Network. And so you have heard about this. It’s the you know, when you’re walking on the street, nothing about anything in particular or lying in the scanner, not thinking about anything particular. This is the network that comes up and is the idea is that this is a network that’s thinking about me and sort of what am I doing today and what happened to me yesterday and what I had to do tomorrow. Right. This is the network. It’s been shown that this network gets turned off when you meditate.  And so what we think is happening is that and also about the connections between these networks sorry, the connections between these nodes of this network get stronger. So we think what’s happening is that this change in structure reflects increased connectivity between these three regions and also the turning off of it. So they’re getting stronger and they’re better able to turn it off while you’re meditating. And so therefore you’re not thinking about yesterday and tomorrow and all the other things, and you’re able to just quiet your mind and focus on the present moment.

Phil Stieg: It’s a little bit like when you’re using your cell phone and you look at your connection to the Internet and you’ve got one band with mindfulness, you can increase that consistently to five bands, right?

Sara Lazar: Exactly.

Phil Stieg: And basically, you’re just improving the connectivity between different regions of the brain that that allow you to function more effectively. And your specific questions were in relation to pain and the fear response related to that. Correct?

Sara Lazar: Right. Well, that’s the first study where we’re looking at structure that was actually just stress. So people are going through the stress reduction program. The pain study was with long term meditators. And then we also did a study with fear conditioning, which again, was eight weeks before and after.   Right. So what is fear conditioning? So good old Pavlov, you know, the dogs, see the food, hear the bell. They learn to salivate when they hear the bell.  What fear conditioning is, is so the same stimuli we used with the pains that there’s a mild electric shock and we paired it with different colored lights. So we do that and then we just show them the lights and they don’t get shocked, and then we bring them back the next day and we say, OK, how well do you remember that, you know that you’re going to get shocked. You’re not going to get shocked. And what we see is with the meditators is that they remember correctly…. More than compared to the exercise group, right. And so it’s really clear that this memory, the memory of being shocked and then not being shocked, you know, that was better preserved in the mindfulness practitioners compared to the exercise stress reduction.  Again, that’s the whole reason for practicing. Right.  We practice so that when we encounter pain and stress and, you know, life, we can better bring up the mindfulness. 

Phil Stieg: So is there an age dependence of this, do you know? I mean, if old people pick it up, is it going to be as beneficial if I picked it up when I was 22

Sara Lazar: We don’t know that.  We’re actually just finishing up a study now with people 65 to 80 and they definitely benefit. And so, I mean, I can’t tell you that it’s as beneficial as if you did it in your teens. But you they definitely benefited.

Phil Stieg: Is mindfulness also useful with children? 

Sara Lazar: Yeah, there’s been several studies now with young children, both, you know, high school students, but also even, you know, grade school students, I think like second and third grade and showing that, yeah, it’s definitely beneficial, you know, and they like it and they really they really enjoy it typically, again, in just five or ten minutes, sometimes it’s yoga instead of meditation. Some teachers are now incorporating it, especially like right after recess when the kids are all running around.  Sort of a nice way to sort of transition, you know, from recess into the classroom and sort of gets them into the present moment and then they can focus.

Phil Stieg: In our spine center, a lot of patients come in with low back pain.

Sara Lazar: Yeah.

Phil Stieg: And they don’t have a surgical or an injectable lesion that they would benefit from. So we send them for cognitive behavioral therapy and that has been shown to be beneficial.  They feel the pain. They just develop an alternate way of thinking about it. What’s going on there? What are they doing?

Sara Lazar: You know, definitely that’s part of it. So and definitely mindfulness is great for pain.  But it’s not just thinking about the pain is experiencing the pain differently, because, again, oftentimes when people have chronic pain, you automatically start to tense up around it. Right?  And you hold that part of your body differently. And, you know, this is part of the fear. It’s like, “oh, if I move this way, I’m going to feel more pain”. Right? And so you go you don’t go out and do things because “oh it’s going to cause me more pain” . And so there’s oh, again, this is the fear of pain, and that’s really what the mindfulness is. It’s like, OK, well, can you be OK even if you’re feeling pain?  

Phil Stieg: Is it when you quantified it, when you quantified it in your papers, is, is that, is that that awareness of it that gets reduced around 30 percent.

Sara Lazar: The actual experience of pain does not go down. I mean, they report like a little bit, but that’s actually not significant. It’s just the suffering is that I don’t like it make it stuff. That’s what goes down. And then there’s been other studies with chronic pain patients. And what they show is that it’s really it’s the fear of pain and it’s called pain catastrophizing.  Also, a lot of times what people say is, you know, at the beginning, it’s like I am my pain, you know, this my, my, my painful knee. And at the end, it’s like, no, there’s me. And then there’s  this pain and the pain is not part of me. I am separate from my pain. So what’s really important distinction.

Phil Stieg: With that distinction, am I able to continue on with my daily life and do the things that I want to do?

Sara Lazar: Yes. And that’s the idea.  Part of it is because, you know, you tend to clench up if you’re in pain.  And so if you relax, you actually experience less pain because you’re not all tensed up. And so if you learn to just relax around it and completely changes the experience of the pain.

Phil Stieg: So where are you going with this? What’s the next – what’s going to win you the Nobel Prize?.

Sara Lazar: (laugh) Well, we’ll see. So we just finished the study with the healthy aging. And so we’re hoping to do more of that, you know, and to ask that question that you asked. You know, is there an optimum age?  How old can people be and still benefit from this practice? Can we get people who in the 90s, can they still benefit from this practice? You know, what other benefits are there? Also trying to really dig more down into what’s actually happening, the brain. We now know where the brain is changing. So now I’m trying to dig deeper into saying, OK, so what exactly is happening in that part of the brain?

Phil Stieg: Looking back on your career, which is we’ll say, not even half over, what was your biggest surprise?

Sara Lazar: What was my biggest surprise? I’m. I guess, yeah, the first time the brains seen the brains change in just eight weeks, I mean, I kind of thought so because what happened was I saw a paper about juggling and they show that the brain changed after three months of juggling.  I was like, wow. You know, could that really happen with meditation, too? Mm hmm. And lo and behold, it did. And so so that I think, you know, so I knew the brain was changing, but I didn’t know if I could actually detect it in just eight weeks.

Phil Stieg: Yeah, yeah. I mean, I find the whole concept of plasticity in the brain to be absolutely amazing. I mean, I’m a little bit older than you when we started. Well, you know, we were taught that you were born with what you had and you better make the best of it. Now we’re learning and you’re proving with your studies that the brain can adapt to different environments and you can train it. And that’s what’s most the most important part in my mind of your message is, you know, it’s like a healthy heart – There’s the healthy brain and there’s things you can do for it.

Sara Lazar: Yeah, definitely. Definitely.

Phil Stieg:  Dr. Sara Lazar, you’ve given all of us hope in managing the anxiety related to fear or you’ve given us hope and you’ve given us hope in dealing with the anxiety related to pain. A little bit of an understanding of how that really works in our brain. I really want to tell you thank you so much for taking the time to be with us today.

Sara Lazar: Thanks for having me.