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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 34  |  Issue : 4  |  Page : 313-322

Mind, mindfulness, and the social brain: Psychobiological understandings and implications


1 Department of Psychiatry, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey, USA
2 National Academy of Medical Sciences, New Delhi, India

Date of Web Publication19-Nov-2018

Correspondence Address:
Dr. Basant Pradhan
Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_80_18

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  Abstract 


Sociality in primates is determined by the social brain and is the outcome of an intricate and multi-dimensional relationship between the brain size, the richness as well as the selectivity of the neural networks and the behavioral complexities emanating from the bonded relationships that underpin the social coalitions. Accumulating data from the neuroimaging and cognitive neuroscience research reveal that the more intricate and extensive are these neural networks, the more powerful is the social experiences. Yoga and meditation practices are ancient and relatively inexpensive yet quite rich experiences with far-reaching health benefits. Their powerful effects are beginning to be understood in terms of their effects on neuroplasticity which is now known to occur in a wide variety of neural circuits with many different simultaneous mechanisms that involves the immensely active neurodynamic model of human brain which has by and large replaced the old static model and has been the major focus of recent research. In the last two decades or so, the major scientific advances have shown positive effects of Yoga and meditation on physical and emotional health including not only functional changes in brain hemodynamic or metabolism, etc. but also, permanent changes in brain structures as well. Embarking upon the psychobiological aspects of the social brain, of the group mind and that of Yoga and meditation, in this chapter we provide a synthesis of their psychobiological concomitants as well as socioclinical implications, both potential and factual, from a diverse array of subspecialties, for example, positive psychology, spirituality, neuroimaging and neurophysiology, cognitive neuroscience, and neuroimmunoendocrinology, etc. The purpose of doing so is to provide a synthesis for ensuing richer and multidisciplinary collaborations to understand this fascinating topic which may eventually lead to integrated management of the various maladies of the social brain deficits.

Keywords: Mindfulness, neural network, social brain, Yoga


How to cite this article:
Pradhan B, Gogineni RR, Sharma S. Mind, mindfulness, and the social brain: Psychobiological understandings and implications. Indian J Soc Psychiatry 2018;34:313-22

How to cite this URL:
Pradhan B, Gogineni RR, Sharma S. Mind, mindfulness, and the social brain: Psychobiological understandings and implications. Indian J Soc Psychiatry [serial online] 2018 [cited 2021 Dec 5];34:313-22. Available from: https://www.indjsp.org/text.asp?2018/34/4/313/245661




  Introduction Top


Human brains are wired for social interactions. Social doings of the past (both evolutionary and personal pasts) structure our brains. Sociality in primates is determined by the social brain. The concept of the “social brain” refers to a brain evolved in the selective pressures of living in the midst of social groups in which each person shows complex propensities to work in the various social settings such as during childhood relationships, and this social brain is continually shaped by these social experiences.[1] The brain seems to have been elaborately designed to mediate social functioning: almost every part of the brain is involved in social functioning which is altered in many neuropsychiatric conditions. Brain conducts on-going interpretations of the social situation and responds to these, it influences the environment and in turn, alters the inputs it receives. The social brain is truly a multi-disciplinary concept and does integrate the personal, social/interpersonal, and organ/cell biology. The social brain is the outcome of an intricate and multi-dimensional relationship between the brain size, the richness as well as the selectivity of the neural networks and the behavioral complexities that emanate from the bonded relationships that underpin these social coalitions. Thus, the social brain integrates personal, social, and organ-cell biology. Accumulating data from the cognitive neuroscience and neuroimaging research reveal that the more intricate and extensive are these neural networks, the more powerful are the social experiences. These neural networks are designed to buffer the individuals against the social stressors and are mediated, in humans at least, by mentalizing skills. It is important to note that, the earlier concept of the brain as a static entity has been replaced by the immensely active neurodynamic model of the human brain (i.e., the daily formation of new axons and dendrites forming synapses, and daily incorporation of newly minted neurons in new circuits of learning). With the enormous scientific advances resulting from structural as well as functional neuroimaging and from cognitive neuroscience, neurodynamic model of the human brain including the social brain has been the recent major focus of research. Similarly, work of many influential thinkers such as the Buddha and Patanjali of ancient India,[2] Freud[3] in early 20th century, as well as modern thinkers such as Beck[4] and Solms[5] reminds us time and again that the mind is a dynamic entity, that mind is not made up of static modules or boxes connected up by arrows. Instead, it comprises dynamic and fluid processes (e.g., Id, ego, and superego, etc.). Freud, for example, observed that the mind consisted of elements far more than consciousness; there was, pre-consciousness, a vast substructure, the workings of which had to be explored and understood before we would ever be able to make sense of the volitional brain. The enormous technological advances resulting from the advent of functional neuroimaging (functional magnetic resonance imaging (fMRI); positron emission tomography, (PET); and single-photon emission computed tomography (SPECT); functional near infra-red spectroscopy; optogenetic stimulation techniques)[6] made it possible to directly observe the neurodynamic processes under changing psychological conditions. Data from these demonstrate that we do now have neuroscientific methods that enable us to study the dynamic nature of the mind and brain and that the neural organization of the unconscious substructure can be studied in lot finer details. Each of these methods has its limitations, as all methods do, and there are undoubtedly many future advances to come, but the landscape of scientific inquiry in this domain has, certainly, radically changed, more so in the last two decades. These renewed insights are very applicable to understanding the neuroscientific basis of mind, of the meditative states and of the social brain.

Yoga and meditation praxes are ancient and relatively inexpensive yet quite rich experiences with far-reaching health benefits. For several millennia, ancient Eastern contemplative practices are in use to expand consciousness, to connect to one's spiritual nature, as well as to maintain health and longevity. In the recent studies as well, the Yoga and meditation practices topped the list and accounted for 80% of the complementary health approaches (CHA). The prevalence of the CHA is constantly on the rise. For example, in the age group 65 and older, it has grown from 1.3% in 2002 to 2.2% in 2007, and more recently, 3.3% in 2012.[7] In another recent study by Johnson et al.[8] overall, 31% of the study sample (midlife and older US adults) had used CHA in the past year. Among users of CHA like this, 15% had used them for treatment only, 40% for wellness only, and 45% for combined wellness and treatment. Although we are still in the dark about the exact psychobiological aspects of the advanced subjective states of meditation, their powerful effects are beginning to be understood regarding their effects on neuroplasticity which is now known to occur in a wide variety of circuits throughout the brain with many different simultaneous mechanisms. Establishing focused attention (concentration, Sanskrit. dharana) followed by a state of detached observation of breath or any object during practice of meditation/mindfulness (Sanskrit. dhyana) and combining these two meditative states with the postures (Sanskrit: Asana) and movements of Yoga or Tai Chi, listening to the sounds and chants (Sanskrit. mantras), and engaging in group activities such as dancing to the rhythmic music etc., recruits a much wider neuro-circuitry and creates a much more profound experience which is in harmony not with one's inner self but also with the object world around it. In the last two decades or so, the major scientific advances have shown positive effects of Yoga and meditation on physical and emotional health including not only functional changes in brain hemodynamics or metabolism, etc. but also, permanent changes in brain structures as well. Other rather unexpected results of these practices include alterations in cellular DNA including decrease in telomerase activity and changes in immune factors, etc. Embarking on the psychobiological aspects of social brain, the group mind and that of Yoga and meditation, in this chapter we provide a synthesis of their psychobiological concomitants as well as socio-clinical implications, both potential and factual, from a diverse array of subspecialties, for example, positive psychology, spirituality, cognitive neuroscience, neurophysiology, psycho-neuro-immuno-endocrinology, etc. The purpose of doing so is to provide a synthesis for ensuing richer and multidisciplinary collaborations to understand this fascinating topic which may eventually lead to integrated management of the various maladies of the social brain deficits. We have tried to organize this chapter in the following sequence: Definitions and concepts related to the mind, mindfulness, mentalization, and the social brain; psychobiology of mindfulness; psychobiology of the social brain; overlap between the mindful brain and the social brain; the socio-clinical implications of the social brain with respect to psychiatric disorders, and conclusion and future directions.


  Definitions and Related Psychobiology Top


Mind is the creator of all our experiences

Conceptually mind falls into a rather subjective domain that consists of a bundle of five core domains: our thoughts, feelings, perceptions, memory, and will. Otherwise called as the five aggregates (Pali. khandas, Sanskrit. skandhas),[2] these five things are the five contents of the mind. Through these five contents, the mind creates a complete awareness of the objects in our experience. Just as we need a reflective surface to perceive the light, similarly we depend on these contents of the mind to perceive the mind and the experiences created by it. In the process of meditation, by using the mindful detachment and mindful awareness, the role of the meditator is to observe in detached manner the following: How these five aggregates of experience arise or originate in the field of awareness, how they co-create the experience in our awareness by their interdependent actions, and how these experiences change constantly, in an on-going manner to the point of their eventual dissipation in our field of awareness. The deep philosophies of the mindfulness traditions make us realize that each of these aggregates that constitute the experience is in a state of flux or constant change with respect to itself as well in relation to the other aggregates, i.e., these are impermanent or prone to change constantly, and hence, there is no reason to cling to them or to identify with them. The goal of the meditative praxes described by the early champions like the Buddha and Patanjali was to obtain a better idea (i.e., insight; Pali. vipassana) about how these five aggregates function in sequence and in relation to each other to co-create the human experience. This is the Buddha's profound theory of interdependence (Pali. paticcasamuppada; Sanskrit. pratityasamutpada) of the five aggregates which remind us again and again that we are all connected and that nothing exists in isolation, everything is part of a common flow so to speak. This age-old concept of interdependence provides a strong rationale for nurturing the basic human qualities such as mutual interdependence, empathy, and mentalizing ability, etc., the core features of the meditative-as well as of the social brains (described later).

Yoga versus meditation versus mindfulness

Meditation is inclusive of mindfulness (the mindful state of mind) itself and is fundamentally a cognitive-emotive process that involves learning to shift and focus the attention at one's will onto an object of choices, such as bodily feelings or emotional experience while disengaging from usual conditioned reactivity or elaborative processing.[9] The term Yoga is not only older than the term meditation but also is inclusive of it. Yoga, meditation, and mindfulness are three overarching circles inside the broad scheme of Yoga. In sage Patanjali's Eight-Limbed Yoga scheme (Ashtanga Yoga), meditation consists of its 6th and 7th steps (concentration/dharana and meditation proper/dhyan, respectively) which are practiced in sequence because, without a concentrated state of mind, a mindful state is difficult to attain.[2] Concepts in the broad rubric of Yoga include not only the mind and soul but also the body, as well as the various metaphysical and cosmological expositions of the universe as a whole, whereas meditation is mostly confined to the practitioner's mind, i.e., the various doings of the mind, the mutual relationship between the individual and with the mind and how the individual can establish control over the various doings of the mind so that eventually complete freedom (liberation, Sanskrit. moksh/nirvana, Pali, nibbana) can be attained. Thus, meditation is psychology. The term mindfulness correlates with the Buddhist Canonical term satipatthana (Pali. sati = attention, patthana = present right here),[10] the literal exposition of which informs us that meditation/mindfulness is a practice of attention to induce a state of detached observation of the mind and its various phenomena so that one can simply watch, monitor and appraise the doings of the mind in a detached way without reacting to them. A mindful state is created in the practitioner by cultivating a combination of two steps, (a) concentration (Sanskrit. dharana, the 6th step of the Eight Limbed Yoga) and (b) mindfulness proper (Sanskrit. dhyan, the 7th step of the Eight Limbed Yoga). This involves a systematic (and often sequential) process of developing the skill of bringing one's attention to whatever is happening in the present moment. Concentrative meditation, otherwise called the meditative absorption, serves as a prerequisite for mindfulness meditation and provides the directed attention/concentrative power to the mind for the subsequent mindfulness meditation (uniformly distributed attention in the field of awareness). On the other hand, mindfulness meditation involves cultivating a flexible attentional state that is grounded in the present moment; in this, one's role is simply as an observer of the arising and passing away of the various elements in one's experience (the five contents of mind, i.e., the thoughts, feelings, perceptions, memory, and will, as described above). In this, one does not judge the experiences and thoughts, nor do they try to figure things out and draw conclusions or change anything – the challenge during mindfulness is to simply register the mental events and observe them rather than elaborate on them. Unlike in concentration practice which needs focused and exclusive attention, the mindfulness practices, on the contrary, require moment-to-moment and all-inclusive attention to the changing objects of awareness and lead to examination of the subjective sense of “I” and its relationship with the other objects in one's awareness.[11] Clinical studies have documented both physical and mental health benefits of mindfulness in different patient categories as well as in healthy adults and children.[2],[12],[13],[14]

Social brain

Social brain forms the organ of our social interactions, the organ that makes meaning of our social environment, interpret it and responds to it, buffers our stress, and through its different channels, it helps with the process of healing/recovery. Whereas neuroscience has, up until recently, focused on the study of brains in isolation and study of neurons or networks of neurons, the new reality is that behavior arises from a network of different brain areas as well as different brains interacting. Primate societies are unusually complex compared to those of other animals. This is probably because primates have unusually large brains and also have high relative cortical volumes (i.e., the ratio between volumes of the cortex and the subcortical matter). Neuroanatomically, the social brain refers to those brain structures that subserve the various social processes (social cognition, social behavior, and social functioning), often in relatively domain-specific ways, for example, regions in the temporal lobe (fusiform gyrus) for processing faces, the temporoparietal junction and medial prefrontal cortex (MPFC) for representing other people's beliefs, and so forth.[15],[16],[17] Functionally, the social brain is closely linked with the other social phenomena, i.e., the social behavior, social cognition, and social functioning. Social behavior, the anchor for all these different levels of explanation, comprises the readily observable interactions between an individual and other people. Social cognition refers to the various psychological processes (both conscious and nonconscious) that underlie the social behavior. Social cognition includes any cognitive processing, perception, reasoning, memory, attention, motivation, and decision-making that underlies the social behavior. Social functioning is broader than social behavior and refers to the long-term, contextualized ability of an individual to interact with others (e.g., a person's behavior within a community over the past months). The social brain implements social cognition, which in turn causes social behavior, which in turn constitutes social functioning when integrated over time and context. The relationships between these different levels (social functioning, social behavior, social cognition, and social brain) are systemic rather than unidirectional. In addition, primate sociality involves a dual-process mechanism whereby the neuroendocrine system (mostly endorphin system and probably oxytocin as well) provides a psychopharmacological platform off which the social-cognitive and social-behavioral components are then built. Of note, endorphins play a central role in creating and servicing the social relationships.[18] The endorphin activation is triggered by social grooming:[19] The more frequently this is activated, the stronger the relationship. In contrast, the oxytocin system although helps with socialization (especially on affiliation) but appears to be insensitive to relationship quality or quantity. Furthermore, the oxytocin response habituates very quickly and in social interactions it does not allow individuals to influence the responses of the other individuals with whom they interact.[20]

Mentalization and the social brain in the context of the social phenomena

Primate sociality is based on bonded relationships that underpin coalitions. With the accumulating evidence on the social brain, one can no longer think of brains in isolation; rather it is conceptualized in terms of interacting domains and networks. The various social phenomena and related processes are governed by mentalization (or theory of mind), a core function of the social brain. Mentalization refers to our ability to read/infer the mental states of others. This important function is exclusive to the primates and engages many neural processes. There is a strong and positive correlation between the relative cortical volume of the brain and the social group size of the anthropoid primates. This is known as the social brain hypothesis[18] and is mediated, in humans at least, by the mentalizing skills. Neuropsychologically, all the social phenomena (i.e., social cognition, social behavior and social functioning, etc.) are associated with the size of the units within the theory of mind/mentalization network in the brain. The mentalizing system of the brain is probably in operation from around. 18 months of age, allowing implicit attribution of intentions and other mental states. Between the ages of 4 and 6 years, explicit mentalizing becomes possible.[21] Mentalization system has three components that form an important part of the social brain and are consistently activated during both implicit and explicit mentalizing tasks. These are the MPFC, the temporal poles and the posterior superior temporal sulcus (STS) which are also the locations rich in mirror neurons, the biological basis of empathy.[22] The MPFC distinguishes the mental state representations from the physical state representations, whereas the temporal poles might be involved in accessing the social knowledge in the form of the social scripts stored in the various areas of the brain. The STS region is probably the basis of our social perception and also detection of the social agency, i.e., it helps to distinguish between the human voice vs. environmental sounds, stories vs. nonsensical speech, moving faces vs. moving objects, etc.[23] It is important to note that the face- and object processing areas in the brain are necessary for developing social cognition and that these two aspects can develop independently of one another (i.e., the ability to process objects is not a prerequisite to process faces, and vice versa). Considerable overlap between the social brain areas and the meditative brain areas will be elaborated later.


  Psychobiological Effects of Yoga and Meditation/Mindfulness Top


Data on the evidence

In recent years, some systematic reviews have identified some overarching conceptual frameworks and neural networks that are useful for understanding how Yoga and meditation work. These neurobiological data on Yoga and meditation are quite rich and diverse as well and include the structural brain differences (MRI findings), change in neural activity during various meditative states (studied by functional MRI or fMRI findings) which range from resting-state brain changes to meditation-specific changes, changes in blood flow (studied by SPECT or changes in metabolism (studied by PET. The clinical effects of various Yogic and meditative practices have been found mainly on four aspects: (a) their effects on cardiovascular health, (b) on the stress response and immune system activity, (c) their neuroendocrine effects and (d) how they impact our pain perception.[24] More recently there are 18 studies supporting alterations in the expressions of genes with these practices.[25] These studies indicate that meditation practices are associated with a down-regulation of nuclear factor kappa B pathway which is the opposite of the effects of chronic stress on gene expression and suggests that MBI practices may lead to a reduced risk of inflammation-related diseases.

Other rather unexpected results of these practices include alterations in cellular DNA including increase in the telomerase enzyme activity; Telomers are the protective caps on the ends of chromosomes and telomerase is the enzyme which helps to rebuild these caps so that our DNA does not get lost that much during cell division. Telomerase activity slows down the biological aging: Thus, higher is the telomerase activity, longer is the life span. In a highly controlled residential study on meditation and telomerase activity,[26] A total of 102 healthy women nonmeditators were recruited to live at a resort for 6 days and were randomized to either meditation retreat group or relaxing on-site group. Both groups were compared with regular meditators with respect to telomerase activity, and aging-related biomarkers (i.e., markers for regulation of stress response, immune function, and amyloid beta (Aβ) metabolism). Regular meditators in this study showed a post-intervention trend toward increased telomerase activity and higher Aβ42/Aβ40 ratio compared with the nonmeditators. The Aβ42/Aβ40 ratio was observed to be higher in regular meditators at baseline and did increase post-intervention in the novice meditator group as well. A growing number of human studies[26] suggest that a low plasma. Aβ42/Aβ40 ratio is a risk factor for major depression, dementia and higher mortality. Another recent systematic review quite comprehensive analyzed the effects of mindfulness meditation on immune parameters by analyzing 20 randomized clinical trials.[27] Three studies in this analysis found decreased nuclear factor-kB and no strong evidence for changes in interleukin inflammatory markers (interleukin-6) or Tumor necrosis factor-alpha (TNF-α), but some evidence for a decrease in the C-reactive protein and increases in telomerase activity.

Mechanisms involved in the beneficial clinical effects of Yoga and meditation

A systematic review by Meister and Becker[28] that involved 441 articles (of which five were included) found out three biological mechanisms in subjects with depression (vagal control, heart rate variability (HRV), brain-derived neurotrophic factor (BDNF), cortisol). This review found that decreased rumination and increased mindfulness was associated with the effect of yoga on treatment outcome. In addition, preliminary studies suggest that alterations in cortisol, BDNF, and heart rate variability (HRV) may play a role in how yoga exerts its clinical effect.

The potential underlying mechanisms for the general effects of Yoga and meditation include enhanced vagal activity (noted in at least four studies, primarily resulting in an increase in HRV (vagal activity) and a reduction in the low frequency/high frequency ratio suggesting greater vagal activity or parasympathetic control) and changes in brain wave activity (Yoga group showed increased alpha, beta and theta Electroencephalography (EEG) band powers and a reduction in delta band power suggesting enhanced memory and concentration and synchronization of brain activity).[24] Other mechanisms include differential regulation of brain cortico-steroids, immuno-endocrinological changes such as reduction in TNF-alfa levels or enhancements in nerve growth factors or alterations in the levels of NFk-B as well.[25] The effects of Yoga and meditation on the sympathetic nervous system and hypothalamo-pituitary-adrenal axis with a measurable reduction in cortisol levels is the most common view in people with depression and anxiety while others have posited an increase in brain-derived neurotrophic factor.[24] On the other hand, in people with schizophrenia, an increase in oxytocin levels was observed in post-Yoga therapy, and thereby the related vagal nerve stimulation is postulated as a mechanism.[29]

Yogic breathing (Sanskrit. pranayama) deserves a mention here. Pranayama induces intermittent hypoxia which has been postulated to cause health benefits because of its antioxidant and anti-senescence effects. The two components of pranayama that are studied more are the bhastrika pranayama and kumbhaka pranayama. Bhastrika is a combination of kapalabhatiand ujjayi breathing and causes hyperventilation and thus hypocapnia, whereas kumbhaka pranayama involves deliberate retention of breath and thus causes hypercapnia. Bhastrika pranayama and kumbhaka pranayama have been known to produce different cerebral hemodynamic changes which are almost opposite to each other.[30] A balanced combination of hypercapnia and hypoxia leads to increased (H+) concentration, which activates voltage-gated potassium (K+) channels. The resultant hyperpolarization of endothelial cells has been postulated to reduce intracellular calcium, leading to cerebrovascular relaxation and vasodilatation. Other proposed mechanisms of these types of breathing include the release of vasoactive agents such as nitric oxide and prostaglandins in response to the velocity-induced shear stress and adenosine-induced vasodilation.

Thus, Yoga and meditation interventions represent potentially powerful tools for generating new knowledge of mind-body interactions. By consolidating the findings of diverse arrays of studies, this field of contemplative neuroscience is coming to a consensus not only about the neurobiological effects of the various mind-body practices but also shedding more light on their potential applications in health and illnesses.[31] However, the emerging challenges in Yoga-meditation research include a need for large studies using randomized controlled and dual-blind designs with active control groups and an increased focus on measuring mechanisms of action as well as outcomes.


  Neuro-dynamics of Yoga/Meditation: The Meditative brain and its Overlap with the Social Brain Areas Top


Although Yoga and meditation practices involve many major areas of the brain, the main players in it are the Lateral prefrontal cortex (LPFC), the MPFC, the anterior cingulate cortex, the amygdala and the insular cortex (mostly the right insula).[32],[33]

Prefrontal cortex

The LPFC is the Assessment Center of the brain in the sense that it allows us to look at things from a more rational, logical, and balanced perspective. It does it so by modulating our emotional responses, overriding the automatic behaviors/habits and decreasing our brain's tendency to take things personally. MPFC is rightly called as the Me Center or the Self-Referencing Center of the brain because it is deeply involved in building one's notion of self and also plays an important role in self-reflection and empathy. It also engages us in social interactions and helps in inferring other people's state of mind (theory of mind or mentalizing ability). The MPFC has two parts. The first part is the ventromedial MPFC (VMPFC) which is involved in processing information related to us and people that we view as similar to us and often activated when we take things too personally, and hence called as the “unhelpful part' of the MPFC. The second part is the dorsomedial Prefrontal Cortex (DMPFC) which is involved in processing information related to people we perceive as being dissimilar from us and is involved in feeling empathy, especially for people who we perceive of as not being like us and also helps in maintaining social connections. Hence, this part is called as the ‘helpful part’ of MPFC. In our daily life, the LPFC (the Assessment Center) acts like a brake for the unhelpful parts of the MPFC (i.e., the VMPFC or the Me Center).

The insula and the amygdala

The insula is the part of the brain that is involved in experiencing the “gut-level” feelings by monitoring one's bodily sensations and also helping guide how strongly we will respond to what we sense in our bodies (i.e., are these sensations dangerous or benign?). Insula, especially the right one is also heavily involved in experiencing empathy. Amygdala is the alarm system (otherwise called the fear center) of the brain, and is responsible for many of our initial emotional responses and reactions, including the “fright-fight-or-flight” response, seen more in anxiety disorders including Posttraumatic stress disorder (PTSD) or social anxiety disorder.

In an unmeditative brain, the Assessment Center's (LPFC) connection to the Me Center (MPFC) is relatively weak, and the connections within the Me Center and between the Me Center and the bodily sensation/fear centers of the brain (insula and amygdala respectively) are strong. Thus, without meditation practice, we tend to become over-indulgent, and we take things too personally and whenever we feel anxious, scared or have a sensation in our body (e.g., a tingling, pain, itching, etc.), we are far more likely to assume that there is a problem (related to us or our safety). Also, we often get stuck in repeating loops of thoughts about our life, mistakes we made, how people feel about us, our bodies (e.g., “I've had this pain before, does this mean something serious is going on?), and so on. On the contrary, regular meditation practice changes the brain as mentioned below:

  1. It strengthens the Assessment Center's (LPFC) connection to the Me Center. As mentioned before, the Assessment Center acts like a ‘brake’ for the unhelpful parts of the Me Center (VMPFC)
  2. It strengthens the connections between the helpful parts of the Me Center (i.e. DMPFC), and the bodily sensation (interoception) center (i.e., insula that is involved in empathy). This healthy connection enhances our capacity to understand where another person's views are coming from, especially those who we cannot intuitively understand because we think or perceive things differently from them (i.e., dissimilar others). This increased connection explains why meditation enhances empathy– it helps us use the part of the brain that infers other people's states of mind, their motivations, desires, etc., while simultaneously activating the part of the brain involved in the experience of empathy (insula). The result is that we become able to put ourselves other person's shoes, thereby increasing our ability to feel more empathy and compassion for others
  3. It also strengthens the Assessment Center itself so that it works at a higher capacity and modulates better the excessive activity of the VMPFC (i.e., the unhelpful part of the Me Center that takes things too personally) and enhance the activity of the DMPFC (the part involved in empathy and theory of mind etc.). This would lead us to take in all the relevant information, to discard erroneous data (that the Me Center might want to focus on exclusively) and to view whatever is happening from a more balanced perspective– essentially decreasing the overthinking, ruminations and worries that the Me Center is famous for promulgating. This, along with the already strengthened Assessment Center, makes us more readily able to take these sensations as they are (Pali. tathata, Eng. suchness, a central concept in Mahayana Buddhism that leads to radical acceptance of things without getting stuck in them). This decreases our strong reactions so that we can watch the unpleasant sensations/emotions such as pain/fear simply rise and fall without we becoming too much ensnared in a story about what it might mean. These are the psychobiological mechanisms that explain how regular meditation practice reduces our anxiety and suffering.



  Maladies of the Social Brain (Autism, Sociopathy, Aggression, Social Anxiety, etc.) and Clinical Implications in the Context of Social Psychiatry Top


The interdependence of mental health and social life cannot be emphasized enough. Stable and supportive social life is crucial for healthy human development and well-being. Altered social functioning over time results in changes in brain and cognition, and vice versa. Symptoms of the physical and psychiatric disorders express them in the social contexts and do possess interactional meanings with relational repercussions which greatly relates to the processes of social adaptation and healing/recovery. Concepts of the social brain provide the ‘language’ for discussing the illness with the patient. A social brain focus allows clinicians to formulate etiological hypotheses as stories of interactions rather than too much focus on just ‘chemical imbalances’ which is a rather vague and unduly reductionistic approach in treating mental illnesses. Social brain concept provides a coherent story of the illness, tells us about what “image” the patient uses for the illness experience and provides the context to facilitate the discussion between doctor and patient, to trust in and commit to a treatment plan, to establish a shared understanding of the problem and why a particular treatment is proposed.[34] The social role can lead to molecular changes and vice versa, and this provides rationale for pharmacological and psychotherapeutic treatment. Psychotherapy affects social brain via verbal and non-verbal engagements and also alters input from the individual or family or other social networks. More specifically, the formation of a trusting therapeutic alliance via social interactions is a great facilitator of therapeutic success that is independent of the specifics of a particular intervention. A good doctor-patient relationship can enhance or undermine even the most ‘biological’ treatment.[35]

Neuropsychiatric disorders (e.g., frontal lobe damage, amygdalar lesions, autism, and Williams Syndrome, etc.) affect some aspects of the social cognition, social behaviour, and social functioning which could be disproportionately impaired compared to the non-social behavior or the intellectual functioning. Unlike neurological disorders, which often feature more precise neuroanatomical structure-function relationships, neuroanatomical descriptions of psychiatric disorders are not that precise. Some of these disorders emphasize the importance of early development in social cognition, perhaps more than in other cognitive domains and show that social abilities are partial independent of our general intellectual functioning (e.g., in autism spectrum disorder (ASD).

Social brain in autism spectrum disorder versus in Williams syndrome

Studies on ASD inform us that the abnormal social cognition and social behavior inherent in this condition result from the abnormal brain connectivity between the different components of the social brain rather than everywhere in the brain.[36],[37],[38] In contrast, Williams syndrome a genetic and developmental disorder caused by a discrete deletion of a set of approximately 26–28 contiguous genes from the chromosome seven, presents in some respects the social phenotypic opposite to that of autism. For example, compared to the individuals with ASD, they are hyper-social, they tend to approach strangers, and they spend more time looking at social stimuli in the various social scenarios.

Social brain in social aggression

Research shows that social/interpersonal aggression, defined as aggression toward a fellow species member as opposed to prey, is closely associated with the brain's memory region, especially the CA2 region of the hippocampus.[39] One such condition is the intermittent explosive disorder (IED) which involves sudden episodes of severe unpremeditated anger outbursts which can even result in violence and property destruction. Neuroimaging studies in IED reveal problems with the orbital/medial prefrontal cortex which is an important component of the social brain.[40] In addition, many individuals with IED have EEG abnormalities (spikes in temporal areas) as well[41] which probably explains why they, more often than not, report partial amnesia to events around the sever aggressive outbursts and interestingly, and why they respond at least in part, to treatment with anticonvulsant medications like sodium valproate. These findings imply that CA2 could be a therapeutic target to treat abnormal aggression associated with neuropsychiatric conditions which hopefully can be possible in the near future by targeted approaches like the repetitive transcranial magnetic stimulation (rTMS) or by optogenetic stimulation-based approaches.[6]

Social brain in schizophrenia

In a schizophrenia cohort (5 in the test group and 5 in the control group), Russell et al.[42] showed less activation in the mentalization areas of the brain, especially in the left middle/inferior frontal gyrus and insula than the comparison subjects. This frontal under-activation in schizophrenia is in line with functional and structural findings indicating a frontal dysfunction in this patient population which is similar to the left inferior frontal focus shown in patients with autism as well which led authors to conclude that the left frontal under-activation in schizophrenia during mental state attribution is a socio-emotional neurocognitive deficit.

Social brain in severe personality disorders

Neuroimaging studies systematically examining the social brain in severe personality disorders such as anti-social-, narcissistic- and schizoid personality disorders are lacking and definitely remains in the scopes of future research.


  Directions for Future Research: Despite the Promising Data, Many Questions Still Remain Unanswered Top


A widely recognized disparity in modern neuropsychiatry is the wealth of new insights into the pathophysiology of psychiatric disorders derived from basic neuroscience research on the one hand, and the lack of successful translations into effective treatments on the other hand. This disappointing situation is partly rooted in the biological complexity of psychiatric conditions, but arguably also in some conceptual limitations. As outlined above, clarification of the interacting genetic, neural, and environmental mechanisms through integrative approaches offers opportunities for therapy, and possibly prevention. To this effect, several candidate gene variants have indeed been found to enhance the beneficial effects of a positive early environment, suggesting potential resilience mechanisms.[22] Although many structures and networks participate in social behavior, future research into the social dysfunctions of psychiatric disorders can be more meaningful by shifting the focus on the core set of brain structures that constitute the “social brain” and their connectivity which may provide a good base to explore answers to many unanswered questions on social brain. Careful design and contrast of tasks to isolate social processing, and establishing links across the levels of social brain, cognition, behavior, and functioning will help to keep social neuroscience domain-specific to some extent and hopefully in future will result in interventions for the various psychiatric maladies of the social brain that we touched upon in this chapter.

An important aspect in this regard is the development of the social brain therapeutics using the focused brain stimulation methods (e.g., rTMS) or disorder-specific Yoga-mindfulness methods for the maladies of the social brain. Among all the Eastern spiritual practices (e.g., Yoga, meditation, Qi Gong, Tai Chi, mindfulness, or Zen, etc.), there need to be therapy models which are optimally customized and targeted for their use in disorder-specific ways. For example, the first author of this article has developed a PTSD specific Yoga and mindfulness-based cognitive therapy approach called TIMBER (an acronym for Trauma Interventions using Mindfulness-Based Extinction and Reconsolidation of trauma memories).[43] Our recently published studies[14],[44] in subjects with chronic and refractory PTSD, many of whom had co-morbid depression and social anxiety disorder as well, show that the efficacy of TIMBER psychotherapy augmented with a single infusion of ketamine (0.5 mg/kg body weight dose), a glutamate antagonist, can produce remission rates as high as 90% in acute phase/3-month trials and around 70% remission in a 2-year follow-up. One of these studies[43] also shows that the serum levels of D-serine, a brain glutamate modulator which is implied in formation and maintenance of trauma memories via long-term potentiation (LTP) mechanisms in the neurons, can serve as a biological marker for this enhanced and much needed therapeutic response for this chronic and often difficult to treat condition. In this study, TIMBER psychotherapy alone produced a significant reduction in the 40-min post-infusion D-serine plasma concentrations relative to the basal concentrations, which is a further indication that Yoga and mindfulness interventions used in TIMBER produce changes in the basic brain chemistry. Thus, Yoga and mindfulness interventions have tremendous potential for their utility in psychiatry including in treating the maladies of the social brain; however, they need rigorous and ongoing evaluations to produce generalizable, level-1 empirical evidence. Some important questions at this time that still need answers are mentioned below:

  1. What are the neurobiological mechanisms that can explain the different effects of the Hatha yoga exercises as compared to that of any other physical exercise or progressive muscle relaxation?
  2. Can (or should) we differentiate between the beneficial effects of the various Eastern spiritual practices which, as mentioned earlier, are quite heterogeneous?
  3. Yoga and meditation interventions are complex and multimodal. It is important to determine which specific components of these complex interventions are more useful than physical exercise-based Hatha yoga for what specific psychiatric conditions. Is there a differential efficacy among the various types of Yoga and meditation therapy? For example, Hatha Yoga versus Mantra Yoga versus Kundalini Yoga versus Kriya Yoga versus Tibetan meditation (Vajrayana) versus Zen meditation, etc.?
  4. What are the various possible adverse effects due to yoga therapy? And what are the specific adverse effects due to the distinct components of yoga therapy such as asanas, loosening exercises, purificatory/preparatory practices, breathing exercises, meditative practices, etc.? Finally, we want to state that the Yoga and meditation present to us a very rich interactions and merger between many interfaces ranging from philosophy, spirituality, religion, and humanity at one end, and cognitive neuroscience, neuro-imaging, and genetics at the other end. What scientific and philosophical tools do we have to use to understand these often hard-to-operationalize interdisciplinary borderlands?



  Conclusions Top


The disturbed functionality of the neural circuits involving the social brain promotes symptoms of mental illness and is linked to the effects of social environmental and genetic risk factors for mental health, which converge on these networks. The existing evidence, although preliminary in nature, supports a causal role for the social environment in risk, resilience and manifest illness, implying that everyday social interactions are both actor and stage for mental illness. New translational research strategies are needed to delineate the neural outcomes of the complex underlying gene-environment interactions. The in-depth understanding of these mechanisms holds the prospect of novel strategies for pharmacology, psychotherapy and social policy that target and converge on the identified neural circuits. A renewed focus on social neuroscience, therefore, has much to offer for scientists, patients and therapists alike. Hopefully, this quickly expanding field that has so far provided many exciting data pertaining to this will be able to provide meaningful answers in distant future if not too soon.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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