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Dan Siegel - Mindfulness, Psychotherapy and the Brain


[I'm updating this posting. Look at the end of this thread, if you've been here before.] 
UCLA Professor Daniel J. Siegel, M.D., recently published a book entitled, The Mindful Brain, which primarily examines the impact of mindfulness practice upon brain structure and function. In my opinion it is the most important book about this subject that was published in 2007.

Below there is a brief essay that summarizes some of Dan Siegel's ideas about mindfulness, psychotherapy and the brain. (His new book is much broader in scope.)

An Interpersonal Neurobiology Approach to Psychotherapy:
Awareness, Mirror Neurons, and Neural Plasticity in the Development of Well-Being

Daniel J. Siegel, M.D.


In this article the principles of an interdisciplinary approach to psychotherapy called “interpersonal neurobiology” will be summarized with an emphasis on neuroscience findings regarding the mirror neuron system and neural plasticity. Interpersonal neurobiology is a “consilient” approach that examines independent fields of knowing to find the common principles that emerge to paint a picture of the “larger whole” of human experience and development. Interpersonal neurobiology attempts to extract the wisdom from over a dozen different disciplines of science to weave a picture of human experience and the process of change across the lifespan.

The perspective of “interpersonal neurobiology” is to build a model within which the objective domains of science and the subjective domains of human knowing can find a common home. An interpersonal neurobiology approach to psychotherapy draws on the basic framework of this interdisciplinary view in exploring the ways in which one individual can help others alleviate suffering and move toward well-being. The central idea of interpersonal neurobiology is to offer a definition of the mind and of mental well-being that can be used by a wide range of professionals concerned with human development.

The Mind:

   A Definition – The mind can be defined as an embodied process that regulates the flow of energy and information. Regulation is at the heart of mental life, and helping others with this regulatory balance is central to understanding how the mind can change. The brain has self-regulatory circuits that may directly contribute to enhancing how the mind regulates the flow of its two elements, energy and information. 
   Mind Emergence – The mind emerges in the transaction of at least neurobiological and interpersonal processes. Energy and information can flow within one brain, or between brains. Naturally other features of our world, nature and our technological environment, can also impact on how the mind emerges. Within psychotherapy, we can see that relationships with another person profoundly shape the flow of energy and information between two people, and within each person. 
   Mind Development – The mind develops across the lifespan as the genetically programmed maturation of the nervous system is shaped by ongoing experience. We now know that about one third of our genome directly shapes the connections within our brains. Though genes are extremely important in development, we also know that experience shapes our neural connections as well. When neurons become active they have the potential to stimulate the growth of new connections among each other. With one hundred billion neurons and an average of ten thousand synaptic connections linking one neuron to others, we have trillions of connections within our brains. These synaptic linkages are created by both genes and by experience. Nature needs nurture. Experience shapes new connections among neurons by how genes are activated, proteins produced, and interconnections established within our spider-web like neural system. 
   Mental Well-Being – An interpersonal neurobiology view of well-being states that the complex, non-linear system of the mind achieves states of self-organization by balancing the two opposing processes of differentiation and linkage. When separated areas of the brain are allowed to specialize in their function and then to become linked together, the system is said to be integrated. Integration brings with it a special state of functioning of the whole which has the acronym of FACES: Flexible, Adaptive, Coherent, Energized, and Stable. This coherent flow is bounded on one side by chaos and on the other by rigidity. In this manner we can envision a flow or river of well-being, with the two banks being chaos on the one side, rigidity on the other. One way of viewing the symptoms of the Diagnostic and Statistical Manual for psychiatric diagnoses is as manifestations of rigidity or of chaos. This flow of well being can be seen to reveal the correlations among an empathic relationship, a coherent mind, and an integrated brain as three points on a triangle depicting well-being.

Promoting Well-Being

What does an interpersonal neurobiology approach to psychotherapy offer as a framework for considering how therapy works and how to work in therapy? Therapeutic experiences that move an individual toward well-being promote integration. Deviations from this integrated flow are revealed as rigidity and/or chaos and result in symptomatic conditions that may be experienced as inflexible, maladaptive, incoherent, deflated and unstable. To achieve the goal of promoting integration it has been helpful to delineate at least nine domains of integration that can remain in the therapist’s mind within the process of psychotherapy. Besides briefly outlining these domains, this article will focus specifically on the nature of interpersonal integration highlighting recent contributions from the studies of the mirror neuron system and neural plasticity. A fuller description of the clinical implications of these domains within psychotherapy can be found in other publications.

Domains of Integration

1. Integration of Consciousness

The mind flows as energy and information are channeled through the process of attention. The nomenclature of science refers to the presence of three general mechanisms of attention: exogenous, endogenous, and executive. Exogenous attention is a form of attentional focus driven by the immediacy of an often external stimulus, such as a loud sound. A more sustained, self-generated form is called endogenous attention in which the individual chooses to focus attention on a particular stimulus. With executive attention one can create a flexible response not governed by the external world or by a singular focus of attention. The integration of consciousness involves the development of executive forms of attention that are associated with the larger capacities for self-regulation, such as the balancing of emotion, improved stress response, and enhanced social skills. Self-awareness has its roots within the central regulatory systems of the brain and thus may play an important role in various forms of psychotherapy and in various psychiatric disorders. In many ways, how we have developed the capacity to have a receptive, flexible form of awareness enables us to have freedom to focus our attention in ways that are most helpful to us and to those around us.

Enhancing this receptive awareness in the present moment is sometimes called “mindful awareness.” Mindfulness is defined as paying attention, in the present moment, on purpose, without grasping onto judgments. Mindful awareness has the quality of receptivity to whatever arises within the mind’s eye, moment to moment. Recent studies of mindful awareness practices reveal that it can result in profound improvements in a range of physiological, mental, and interpersonal domains of our lives. Cardiac, endocrine, and immune functions are improved with mindful practices. Empathy, compassion, and interpersonal sensitivity seem to be improved. People who come to develop the capacity to pay attention in the present moment without grasping on to their inevitable judgments also develop a deeper sense of well-being and what can be considered a form of mental coherence.

Within psychotherapy the focus of attention on various domains of mental, somatic, and interpersonal life can create the neural firing patterns in the brain that enables new synaptic connections to be established. Neural plasticity, the change in neural connectivity induced by experience, may be the fundamental way in which psychotherapy alters the brain. Based on the modification and growth of synapses and the potential differentiation of neural stem cells into fully integrated neurons, neural plasticity reveals how the brain’s interconnectedness can change throughout the lifespan. Consciousness may play a direct role in harnessing neural plasticity by altering previously automatic modes of neural firing and enabling new patterns of neural activation to occur.

The basic steps linking consciousness with neural plasticity are as follows: Where attention goes, neural firing occurs. And where neurons fire, new connections can be made. In this manner, learning a new way to pay attention within the integration of consciousness enables an open receptive mind within therapy to catalyze the integration of new combinations of previously isolated segments of our mental reality.

2. Vertical Integration

Taking the perspective of the vertical plane of our somatic architecture, we can envision the anatomically and functionally differentiated elements of our bodies to extend from our head to our toes. Vertical integration directly links these elements within awareness so that new connections can be established. We know that the mind is embodied, built in part from its roots in somatic reality, but often seduced to live in the land of the purely non-physical world we can isolate as “mental.” Linking the basic somatic regulatory functions of the brainstem with the limbic circuits’ generation of affective states, motivational drives, attachment, and appraisal of meaning and laying down of memory is a first layer of vertical integration.

Above the limbic circuitry emerged the neocortex, or “outer bark” of our evolving brains. The cortex, unlike the brainstem, is quite underdeveloped at birth and is shaped by both genetics and especially by experiences out in the world. In general, the posterior regions of the cortex are specialized for perception of the physical world (our first five senses) and the body itself is registered in the more forward aspects of this posterior region. In the frontal lobe of the cortex we have our motor and pre-motor planning areas that enable us to carry out behaviors. The forward most part of this frontal lobe is the prefrontal cortex. The side part of this area, known as the dorsolateral prefrontal region, is considered an essential circuit for working memory that enables us to pay attention to something in the here-and-now. Toward the middle of the prefrontal cortex, just behind the forehead area, are several regions that are sometimes thought to be the “higher part” of the limbic circuitry and a core aspect of the social circuits of the brain: the orbital frontal area behind the eyes, the medial prefrontal cortex behind the forehead, and the anterior cingulate just behind it. These more midline structures, along with a region called the insular cortex, serve important functions in linking body, affective state, and thought. For the purpose of this discussion of the beneficial effects of psychotherapy, we’ll refer to these midline structures as the “middle prefrontal cortex” as they generally work as a team with each other.

A review of the anatomy of the middle prefrontal cortex reveals that it has a major integrative function, linking body-proper, brainstem, limbic circuits, and cortex to each other. In this manner these middle prefrontal circuits may carry out what we are labeling as vertical integration. What does this term really mean? This idea means that fibers literally physically connect the input of somatic and vertically distributed neural structures with one another. A wide array of independent studies in basic brain research reveals that these middle prefrontal areas are crucial for generating nine aspects of life: 1. Body regulation: Balance of the sympathetic (accelerator) and parasympathetic (brakes) branches of the autonomic nervous system. 2. Attuned communication: Enables us to tune into others’ states and link minds. 3. Emotional balance: Permits the lower limbic regions to become aroused enough so life has meaning, but not too aroused that we become flooded. 4. Response flexibility: The opposite of a “knee-jerk” reaction, this capacity enables us to pause before acting and inhibit impulses giving us enough time to reflect on our various options for response. 5. Empathy: Considering the mental perspective of another person. 6. Insight: Self-knowing awareness, the gateway to our autobiographical narratives and self-understanding. 7. Fear extinction: GABA (an inhibitory neurotransmitter) fibers project down to the amygdala and enable fearful responses to be calmed. 8. Intuition: Being aware of the input of our body, especially information from the neural networks surrounding intestines (a “gut feeling”) and our heart (“heartfelt feelings”) enables us to be open to the wisdom of our non-conceptual selves. 9. Morality. The capacity to think of the larger good, and to act on these pro-social ideas, even when alone, appears to depend on an intact middle prefrontal region.

By focusing awareness on the input from the body, our affective states, and our range of thoughts and ideas, the first steps toward vertical integration can be encouraged by the therapist. With a receptive mind, it may be that this vertical integration naturally occurs. But for many individuals coming to therapy, having the intention to pay attention to the body’s signals is a purposeful act that can transform a disconnected way of living into a richer, more integrated way of living.

It is relevant to note that these nine middle prefrontal functions can be seen to emerge not only with mindful awareness practices, but at least the first seven are also associated with the outcome of secure attachment between child and caregiver. This finding may suggest that experiences of “mental attunement” – interpersonal in the case of attachment or internal in the practice of mindful awareness – may be at the heart of developing an integrated brain and well-being. Healthy self-regulation, through relationships and self-reflective observation, may depend on the development of the integrated circuits of these prefrontal regions.

Mental attunement may depend on a quality of openness to living in the moment that may be essential for the therapist’s own stance and serve as a strategic goal for the process of therapy itself. Of note from the neuroscience literature are preliminary studies suggest that mindful meditation practice, as one example of a receptive mental state, may actually lead to enhanced growth of the middle prefrontal regions as well as preserved neural tissue in these regions with aging.

3. Bilateral Integration

The nervous system of vertebrates is asymmetric with left being different from right in animals from zebra fish to lizards, toads, chickens, pigeons, apes, and us. With more complexity comes more adaptability. Cortical function and structure are driven by the lower asymmetries of the limbic and brainstem areas and various forms of research have revealed that the right and left cortex perceive and create reality in quite distinct ways. In this brief overview these differences will be highlighted to illustrate the importance of bilateral integration.

The right hemisphere develops first after birth, its activity and synaptogenesis more robust during the first two to three years of life. After that period, there are a series of cyclical waves of left, then right, and then left sided dominance in growth and activity. In general the right and left sides of the brain have the following characteristics that have been supported by a range of scientific and clinical investigations.

The right mode of processing: A. Holistic – things are perceived in the whole of their essence. B. Visuospatial – the right side works well with seeing a picture and is not proficient at decoding the meaning of words. C. Non-verbal – eye contact, facial expression, tone of voice, posture, gestures, and timing and intensity of response are the non-verbal components of communication that the right mode both sends and perceives from others. D. A wide range of functions, including the stress response, an integrated map of the whole body, raw, spontaneous emotion, autobiographical memory, a dominance for the non-verbal aspects of empathy. The right mode has no problem with ambiguity and is sometimes called “analogic” meaning it perceives a wide spectrum of meaning, not just a digital restricted definition of something.

The left mode of processing: A. Linear – the left loves this sentence, one word following the next. B. Logical – specifically syllogistic reasoning in which the left looks for cause-effect relationships in the world. C. Linguistic – these words are the left’s love. D. Literal – the left takes things seriously. In addition, the left is sometimes considerer the “digital” side, with on-off, yes-no, right-wrong patterns of thinking.

One proposed manifestation of impaired left-right integration can be that the drive of the left hemisphere to tell stories, to explain in a linear fashion using words, would be compromised if the story were about the self. Given the repeated finding of autobiographical memory being primarily mediated within the right hemisphere, what would a life-story be like if the narrating left hemisphere could not easily access the non-verbal autobiographical details of the right side of the brain? Before we turn to such narrative incoherence, let’s first look at the integration of memory.

4. Integration of Memory

Memory can be defined as the way in which a past experience alters the probability of how the mind functions in the future. Memory shapes how we experience the present and how we anticipate the future, readying us in the present moment for what comes next based on what we’ve experienced in the past. This broad view enables us to examine the findings of two aspects of memory and explore how their integration can promote well-being. Segregation of these memory functions, in contrast, may be seen as one aspect the source of mental suffering.

Experience creates the activation or “firing” of neurons. This neuronal activation can in turn lead to alterations in the connections among neurons, the basis of neural plasticity. Throughout our lives we embed experience into memory via a first layer of processing called “implicit” or “non-declarative” memory. Before one and a half years of age, this early implicit layer of memory is the only form available to the growing infant. But even beyond that early age, we continue to create implicit memories but they are then often selectively integrated into the next layer of processing called “explicit” or “declarative” forms of memory.

Implicit memory involves the perceptual, emotional, and behavioral neural responses activated during an experience. It is likely that our bodily sensations are also a form of implicit memory, but these have not been formally studied in research paradigms. Mental models, or generalizations of repeated experiences called “schema,” are also a form of implicit memory. The brain also readies itself to respond in a fashion called “priming” in which past experiences shape the way we prepare for the future.

Implicit memory encoding does not require focal, conscious attention. A second crucial feature of implicit memory is that when we do retrieve an element of implicit memory into awareness we do not have the internal sensation that something is being accessed from a memory of the past. We just have the perceptual, emotional, somatosensory, or behavioral response without knowing that these are activations related to something we’ve experienced before.

The second layering of memory is called explicit and involves the two forms of factual (or “semantic”) memory and episodic (or memory for an episode of an experience in the past). Episodic memory has a sense of the self and of time. Both semantic and episodic memory appear to require focal attention for their encoding and when they are retrieved from storage into present awareness they do have the internal sensation that something is being activated from the past. The hippocampus may serve an important role in memory integration as it functions as an “implicit memory puzzle piece assembler” that clusters the basic building blocks of the various elements of implicit memory together into framed pictures of semantic and episodic memory. These framed pictures of explicit memory can then be further integrated into autobiographical memory, a function that may involve rapid eye movement sleep as our dreams integrate our past experiences, our daytime events, and our emotional themes of our lives.

One proposal about trauma’s effects on memory is that it may transiently block the integrative function of the hippocampus in memory integration. With massive stress hormone secretion or amygdala discharge in response to an overwhelming event, the hippocampus may be temporarily shut-down. In addition to this direct effect of trauma of hippocampal function, some people may attempt to adapt to trauma by dividing their conscious attention, placing it only on non-traumatic elements of the environment at that time. The resultant neural configuration of blocked hippocampal processing, when reactivated, can present itself as free-floating, unassembled elements of perception, bodily sensation, emotion, and behavioral response without the internal sense that something is coming from the past. Beliefs and altered states of mind may also enter consciousness as the implicit mental models and priming become activated in response to environmental or internal triggers resembling components of the original experience. This “implicit-only” form or memory can be one explanation for the flashbacks and symptomatic profile of Post Traumatic Stress Disorder.

The key to memory integration is the neural reality that focal attention allows the puzzle pieces of implicit memory to enter the spotlight of attention and then be assembled into the framed pictures of semantic and self-memories. With such reflective focus, what was once a memory configuration capable of intrusion on a person’s life can move into a form of knowing that involves both deep thoughts and deep sensations of the reality of the past.

5. Narrative Integration

As we continue to grow throughout the first five years of life, explicit autobiographical recollection becomes even further integrated into narrative memory which involves the detection and creation of thematic elements of our lives. The brain appears to be able to have a narrative function that can detect themes of our life story and to draw heavily on prefrontal functions as they continue to integrate neural maps that form the underlying architecture of our episodic and autobiographical memory systems. With narrative reflection, one can choose, with consciousness, to detect and then possibly change old maladaptive patterns.

In the attachment research world, it is coherent narratives, stories that deeply make sense of our lives, which are the most robust predictor of how children will attach to us. This finding suggests that parents who have made sense of their lives, as revealed in their coherent life narratives, will be those that somehow offer their children patterns of communication that promote well-being. In brief, we can summarize the exploration of this finding by suggesting that it is the parents’ neural integration that helps them create a coherent narrative, and helps them be receptive to their child’s own mind and communicative signals. Such a pattern may reflect the central role of inter- and intrapersonal mental attunement in the development of well-being.

6. State Integration

As the brain becomes activated in the moment, it coalesces its firing patterns into clusters of activation we can call a “state of mind.” These repeated and enduring states of activation of the brain can help define what we see as our personality, our patterns of perception and emotional and behavioral responses that help us denote who we are. We can embrace the differentiated states of mind and their drive to satisfy different needs for familiarity and comfort, novelty and challenge, connection and love, mastery and exploration. State integration refers to the way we embrace and nurture these different states and their defining needs across time. Late adolescence is thought to be a time of resolution of these conflictual states, with mental well-being emerging when such state integration is done well and mental turmoil present when resolution is not achieved. Finding balance in the integration of states enables us to find our needs satisfied and to create meaning in the pursuit of those various dimensions of our lives.

7. Temporal Integration

As we move from our earliest years and our prefrontal cortices begin to develop our capacity for reflection on the nature of time begins to emerge. First available as a form of mental time travel that enables an early form of self-knowing awareness, this reflective capacity to link past, present, and future soon reveals itself in an awareness of the finite nature of our time on this planet. We learn that people’s lives are often limited to a century or so, and that the experience of death is an inevitable part of each of our lives. Temporal integration directly confronts this organizational role of time, and our transient lives, in helping us consider the deep questions of purpose in life.

8. Interpersonal Integration and the Mirror Neuron System

Our brain is the social organ of the body. The structure of our neural architecture reveals how we need connections to other people in order to feel in balance and to develop well. As we’ve seen in the function of the middle prefrontal regions, the brain integrates input from other people with the process of regulating the body, balancing emotional states, and the creation of self-awareness. This visceral, social, and self integration suggests that our minds are woven from the integration of aspects of reality that on the surface appear to be quite disparate. How could bodily, interpersonal and mental go together? To explore this dimension, let’s use the example of mirror neurons to highlight the integration of these domains of reality.

Discovered in the mid-nineteen nineties, the mirror neuron system reveals how the brain is capable of integrating perceptual learning with motor action to create internal representations of intentional states in others. Initial studies in monkeys revealed that if a monkey sees someone pick up an object, his own motor system will become primed to imitate that same action. In humans, the mirror neuron system is much more complex and emerging studies reveal that many ways in which our internal, one-to-one, and larger social experiences may be shaped by the integrative nature of this system.

For example, the mirror neuron system is thought to be an essential aspect of the neural basis for empathy. By perceiving the expressions of another individual, the brain is able to create within its own body an internal state that is thought to “resonate” with that of the other person. Resonance involves a change in physiologic, affective, and intentional states within the observer that are determined by the perception of the respective states of activation within the person being observed. One-to-one attuned communication may find its sense of coherence within such resonating internal states. In addition, the behavior of larger groups, such as families and social gatherings may reveal this shared state of internal functioning.

The clinical implications of this work are profound and help therapists to understand not only the inherently social nature of the brain but that their own bodily shifts may serve as the gateway toward empathic insights into the state of another person. Mediated via the insula, perceptions of another’s affective expressions may alter our own somatic and limbic states and then be examined through a prefrontal process of interoception, interpretation, and attribution to another’s states.31 Being open to our own bodily states as therapists is a crucial step in establishing the interpersonal attunement and understanding that is at the heart of interpersonal integration. The term “countertransference” can be used to refer to this important way in which our own non-verbal shifts in brain state may offer us a direct glimpse into the internal world of our patients.

The mirror neuron system offers us a new vista into the neural basis of not only imitation, social behavior and empathy, but also the interpersonal experiences that may promote a state of well-being. Mirror neurons reveal the fundamental integration within the brain of the perceptual and motor systems with limbic and somatic regulatory functions. The mirror neuron system also illuminates the profoundly social nature of our brains. This social basis of neural function may offer new pathways for us to understand how psychotherapy leads to the process of change. When two minds feel connected, when they become integrated, the state of firing of each individual can be proposed to become more coherent. Literally this may mean that the corresponding activations between the body-proper, limbic areas and even cortical representations of intentional states between two individuals enter a state of “resonance” in which he matches the profiles of the other. The impairment of such shared states has been proposed to be a characteristic of forms of psychopathology, including schizophrenia. Recent studies in individual with autism spectrum disorder reveal impairment in the capacity to perceive emotional expressions in others that is associated with markedly diminished mirror neuron activation. With impaired mirror neuron system functioning, the social brain is unable to share in the rapid social interactions that depend on a shared set of neural profiles that create an embedded matrix of both social behavior and non-verbal understanding of the meaning of social interactions.

In the process of psychotherapy involving a range of individuals with intact mirror neuron systems, shared states with the therapist may be an essential component of the therapeutic process. As two individuals share the closely resonant reverberating interactions that their mirror neuron systems make possible, what before may have been unbearable states of affective and bodily activation within the patient may now become tolerable with conscious awareness. Being empathic with patients may be more than just something that helps them “feel better” – it may create a new state of neural activation with a coherence in the moment that improves the capacity for self-regulation. What is at first a form of interpersonal integration in the sharing of affective and cognitive states now evolves into a form of internal integration in the patient. With the entry of previously warded-off states of being in conscious awareness, the patient can now learn to develop enhanced self-regulatory capacities that before were beyond their skill set. It may be that as interpersonal attunement initiates a new form of awareness that makes intrapersonal attunement possible, new self-regulatory capacities become available.

If the mirror neuron system were to be focused on one’s own states of mind, we can propose that a form of internal attunement would allow for new and more adaptive forms of self-regulation to develop. The practice of focusing attention in the present moment on one’s own intentions and somatic states, such as the breath, have been a mainstay of mindful awareness practices over thousands of years. The recent findings that such practices are associated with enhanced physiological, psychological and interpersonal functioning may fit into the larger framework that integrated states correlate with well-being. A “Mirror Neuron-Mindfulness Hypothesis” can be offered that proposes that the focusing of one’s non-judgmental attention on the internal state of intention, affect, thought and bodily function may be one way in which the brain focuses inward to promote well-being. As the therapist attempts to achieve such an open, receptive state of awareness toward both internal state changes and for interpersonal signals sent by the patient, the patient’s own mind may be offered the important social experiences to create a similar state. In this way the mirror neuron system may serve a powerful role as the neural basis of mental attunement within and between both patient and therapist.

Studies of attachment reveal that the parent’s openness to a child’s signals and the coherence of the parent’s own narrative are important predictors of a child’s development of secure attachment. Such factors seem to promote a form of resiliency in the child which helps self-regulation unfold as the child matures. Psychotherapy may naturally harness these developmental origins of well-being in creating a resonant state in which the therapist is sensitive to the patient’s signals and also has made sense of his or her own life. Being open to the many layers of our experience, often involving the non-verbal world of sensation and affect in addition to our verbal understanding is an important stance for the therapist to create toward the internal and interpersonal worlds. Within this framework, the state of brain activation in the therapist serves as a vital source of resonance that can profoundly alter the ways in which the patient’s brain is activated in the moment-to-moment experiences within therapy. Such interactive experiences allow the patient to “feel felt” and understood by the therapist, and they also may establish new neural net firing patterns that can lead to neural plastic changes. Ultimately lasting effects of psychotherapy must harness such experiences that promote the growth of new synaptic connections so that more adaptive capacities for self-regulation and well-being can be established.

9. Transpirational Integration

As individuals move forward in achieving new levels of integration across the eight domains described above, clinical experience reveals a fascinating finding in which people begin to feel a different sense of connection to both themselves and the world beyond their previously skin-defined sense of self. The term “transpiration” denotes how new states of being seem to emerge as a vital sense of life is breathed across each of the domains of integration. One feeling that many patients have articulated is a sense that they are connected to a larger whole, beyond their immediate lives, than the previous sense of isolation they may have been feeling from others, and even from themselves. It may be that our highly evolved mirror neuron systems reveal the fundamental ways in which we are neurally constructed to feel connected to each other. Because neural plasticity appears to enable the brain to change throughout the lifespan, it may be that psychotherapy for individuals at any age can allow for interpersonal experiences to open the door to change.

Our work as psychotherapists is to dedicate our lives to help alleviate suffering in individuals, couples, and families, and also to be a part of a larger effort to bring integration and healing into the many layers of our interconnections with each other. When we examine the deep layers of our neural selves we come to glimpse not only the roots of our mental and social lives, but the essential reality of our selves as part of an integrated whole across the span of life.

John Francis Ca... – October 15, 2007 – 3:36am

from The Mindful Brain, by UCLA Prof. Daniel J. Siegel, M.D. (Dr. Dan), pp. 159-62. 

Fear drives us to shine a focused beam of light onto what we think we must know, to keep us safe, to give us a sense of truth, of keeping the world the way we think it should be. We have words and ideas that frame and form the field of awareness that dull our senses, shaping what we think we know, in thoughts, about what can be known. But the real truth is that those “cognitive contraptions” help structure a neural attempt to make sense of a complex world, only to then entrap us in the very structures that we have created.

As we grow, we run through our lives with those spotlights of attention that selectively focus on only what we need to be doing. Without the night’s mind vision of being, we lose sight of the real and big picture. We lose the essence of being, the core of being present. Presence is the bare awareness of the receptive spaciousness of our mind. Beneath the layers of adaptation to survive in the world, remains a powerful mind vision that enables us to be receptive to whatever is. It is this presence that mindfulness recreates. This is a re-creation because children early on have this receptivity, this playfulness of being. Recreation, in its deepest sense, is a re-creation of a playful state of presence.

When we feel presence in others we feel the spaciousness of our being received by them. And when we reside in presence in ourselves, others and indeed the whole world are welcome into our being.

...[W]e imagine a sense of danger and then we create our conceptual constructs to save us, our personal identities to define and confine us, so that we’ll know and be able to predict, to control the outcome of this wild journey we call life.

Letting go of such top-down influences is the art of mindful awareness. The receptivity of presence permits us to unleash the shackles that automatically enslave us. The fear, so often unspoken, is that without that structure we’ll lose our minds, go insane, fall prey to attackers, and die.

Words are the cognitive contraptions we use to work our way through the world of uncertainty. Words can free us: as symbols they are essential to distance us from experience enough to compare and contrast and reveal patterns in a complex universe. Seeing those patterns with ideas framed in our mind also enables us to communicate those insights to others. In these ways words are a wonderful gateway to understanding and sharing.

Yet words can also entrap us. If we do not recognize the limitations of their boundaries, if we see them as real, their top-down influences on our lives can be devastating. We can come to believe that “intelligence” is something we are either born with, or not. We can think that “we” are good and “they” are bad. We can even feel that “I” is something so real and important that “you” don’t matter. In each of these ways, our linguistics lock us in, trap our minds, cloud our vision. But poets have found a way to use words to free our minds, to clear our vision, to create mindfulness in the moment. The art of the poet is to bring presence into our lives. With poetry we sense the world in a new light….

Hearing poetry feels integrative. The science of language and the brain reveals that while the left hemisphere specializes in linguistic language, the right takes a dominant role in words with ambiguous meaning. Also, the imagery evoked by poetry seems to more directly activate the primary visuospatial processes of our brains, also a specialty of the right hemisphere. In these ways, a poet may be artfully inducing an integrated state that melts away the simple secondary enslavements that everyday top-down usage of words can become.

…[I]nviting people to focus on their breath for a few minutes enabled them to have deeper appreciation for the impact of poetry (citation). The mindful state, even if just a hint of it is created by a few moments of silent breath awareness or poetry reflection, seems to create a receptive presence of mind. By “presence” I mean quite specifically the state of receptive awareness of our open minds to whatever arises as it arises. Presence is an invitation to experience directly.

In the presence mindful awareness reveals, top-down constraints that filter, distort, limit, and restrict sensation are minimized. I want to say that they are eliminated, but perception, as we have discussed, is never “the thing as it is.” There is no immaculate perception. But it seems that mindful awareness does permit us to get as close as we can to clear vision, that there is some kind of “ground of being” or some grounded receptive state, some spaciousness of the mind, that is as free from top-down filter constraints as is humanly possible.

Poetry may dissolve those secondary influences because the words of poems do not “stand for something else.” Poems have words, and as linguistic packets they must be symbols of something other than the squiggly lines or vibrations of sound waves of which they are made. But I sense that what is meant by this proclamation is that as words they are as direct as can be.

Just as presence is as “pure” a form of receptivity as the mind can muster, the words of poetry have that same bottom-line essence to them. In an intimately integrative way, poems transform our minds with direct experience. To be open to experiencing the message we need to be in at least a state of intentionality to receive. But poems can also activate a state of receptive mindful awareness. I believe that they do this by directly stimulating the four streams of awareness that flow into our river of consciousness to crate a mindful presence. Poems evoke a sensory immediacy that is at the ground of mindful awareness. Poems enable us to observe with clarity as they show, but do not tell. The imagery and sensations of poetry seem to put old conceptualizations on hold – and can even burst our cognitive conceptions at their roots as they create new conceptual frameworks of experience. And poems give birth to a new way of knowing.

 The Mindful Brain, pp. 166-8:

Researchers in Italy were studying the premotor area of a monkey’s cortex. When the monkey ate a peanut, a single neuron being monitored with an implanted electrode fired off (Gallese, Fadiga, Fossi, & Rizzolatti, 1996).

Fine, that is what they were studying, so it wasn’t a big surprise. What happened next has changed the course of our neural insight into the mind. When the monkey watched someone else eat a peanut, that same motor neuron fired off! This implies that the motor neuron in the front of the brain was connected to the perceptual areas in the back of the brain, in this case the visual system. At a minimum this is an example of sensorimotor integration, an interesting but not startling finding. The exciting finding was that this integrated system only becomes active when the motion being observed is goal-directed. If you wave you hands in front of the monkey there will be no activation of mirror neurons. The mirror properties imply that the carrying out or the perceiving of an intentional act, a goal-directed behavior, activates this set of circuits: Monkey see, monkey do.

As these mirror properties were discovered in humans by Marco Iacoboni and others, including the original researchers, Rizzolatti and Gallese, it became clear the the human brain creates representations of others’ minds (Gallese, 2003; Iacoboni, in press; Koski et al., 2001; Iacoboni, Woods et al., 1999; Rizzolatti & Craighero, 2004; Rizzolatti, Fogassi, & Gallese, 2001). At a neural level, we embed in our brains not just what we physically see, but the mental intention we imagine is going on in someone else’s mind. This is big news: Mirror neurons demonstrate the profoundly social nature of our brains.

Marco Iacoboni and I work together at the Center for Culture, Brain, and Development, at UCLA (; see Appendix I). There we provide a research and educational program for undergraduate, graduate, and postdoctoral students in interdisciplinary thinking and investigation. Mirror properties of the nervous system provide an important window into examining the nature of culture and how shared ritual behaviors within our families, schools, and communities enable us to resonate with each others’ internal states, including intentions.

Iacobini carried these ideas further into the realm of empathy. He and his colleagues were able to demonstrate (see Carr, Iacoboni, Dubeau, Maziotta, & Lenzi, 2003) that the mirror neuron system, located in various cortical regions such as the frontal and parietal lobes, and relating directly to the superior temporal area, would not only be able to represent intentional states of others, but could mediate the basic mechanisms of emotional resonance so fundamental to relationships.

These outer cortical processes of perception and representation of intentions become linked to the more central limbic/emotional processing and bodily state shifts by way of the insula. The insula serves as an information highway responding to mirror neuron activations by engaging bodily and limbic firings to match what the individual perceives in another person. The insula links mirror neuron activation in perception to the alteration in bodily and emotional states that we call emotional contagion in science, or emotional resonance in plain language. Resonance, as we have said, is the functional outcome of attunement that allows us to feel felt by another person.

We use our first five senses to take in the signals from another person. Then the mirror neuron system perceives these “intentional states,” and by way of the insula alters limbic and bodily states to match those we are seeing in the other person. This is attunement and it creates emotional resonance. The mirror neuron system interacts directly with the insula and other regions, such as the superior temporal cortex, to create what we are calling a “resonance circuit” (see Figure 8.1 and Appendix III, Resonance Circuits). Mirror neurons link perception and motor action directly and interact intimately with these related areas to create a functional circuit that can create behavioral imitation, affective and somatic resonance, and the attunement of intentional states. The input of these processes directly influences the middle prefrontal areas, which are thus also included as part of the resonance circuitry.

Empathy draws on these bodily and limbic shifts in a process called “interoception” in which we perceive inward – using what we’ve called our “sixth sense,” so that we come to sense what we ourselves are feeling in our own body. As we use the prefrontal cortex to carry out interoception by way of the input back-up-ward from the insula (relaying data from our limbic and our bodily areas), we can then be in a position to carry out the hypothesized functions of interpreting our state shifts and then attributing these to others. Interoception, interpretation, and attribution are the proposed steps of empathy carried out by the prefrontal region is this “insula-hypothesis” model of Iacoboni and colleagues (Carr et al., 2003).

As Iacoboni and I were presenting the clinical implications of this view to over 500 mental health practitioners in San Francisco (Iacoboni & Siegel, 2004), the audience was eager to understand not only the science, but what could be done with this information in clinical terms. At the very least, these discoveries confirmed a clinician’s intuition that relationships are fundamental in a person’s life and well-being. But these findings also verified the importance for each of us to be attuned to our own internal states in order to attune to others. Here is where mindfulness, empathy, and interoception seem to overlap. Each may reinforce the other.

The discovery of mirror neurons also revealed the ways that our brains are able to create representations of other people’s minds. This is a crucial view of how we are linked to each other on the mental plane of reality – our seventh sense, mindsight.

Empathy requires that we reflect on our internal states. The mirror neuron system and related regions’ creation of emotional resonance shifts the limbic and bodily states so that the prefrontal region can reflect on those changes and create compassionate (feeling with another) an empathic (understanding another) responses. When we sense that resonance, when we become aware of being attuned, there may be the eighth sense we have been discussing in which we feel the state of our relational resonance. In this way, the resonance circuitry involves all eight senses and participates in creating a coherent state of mind.

John Francis Ca... – November 4, 2007 – 5:33pm

I have been appreciating the articles on the brain functions and editing/filtering that you have been doing for us. I don't always have time to read them, and I usually do get around to reading them all... I rarely feel as though I have time to respond to them in an appropriately thoughtful manner... Thanks

sh – November 5, 2007 – 7:22am

 Hi John

I just became a member and am writing my Bachelor about Daniel Siegel's ideas about interpersonal connections and how they affect neural integration and well-being. I would like to know where you got the article you have posted above so that I can refer to it in my paper. could you let me know please? That would be great!


Sibéal Hill

sibealhill – February 27, 2008 – 5:01am

Sorry for the tardy reply. I spent last month at Esalen, and wasn't paying much attention to internet traffic. I found the essay someplace on the web, but that was a while ago, and now I'm clueless.

You might want to contact Dr. Dan yourself. There is contact info on the web page for the Center for Culture, Brain & Development, You probably ought to be in touch with them anyway.

By the way, I saw Siegel at both Spirit Rock Meditation Center and Esalen last month. He and Gordon Wheeler are friends. He's also friends with Jack Kornfield, and he does a lot of work with Spirit Rock teachers.

I look forward to seeing your further contributions to iThou!

John Francis Ca... – March 9, 2008 – 4:10pm

Missed seeing you here. x

AnjelaM – March 9, 2008 – 6:22pm

Such good information, John.

I especially like "Presence is the bare awareness of the receptive spaciousness of our mind. Beneath the layers of adaptation to survive in the world, remains a powerful mind vision that enables us to be receptive to whatever is. It is this presence that mindfulness recreates. This is a re-creation because children early on have this receptivity, this playfulness of being. Recreation, in its deepest sense, is a re-creation of a playful state of presence. "

That statement also reminds me of the work that underlies somatic neuromuscular therapies such as Trager and Feldenkrais, that take one back to one's pre-armored pre-traumatized state.

Thanks for adding the link to this blog to your more recent blog page. 

Happy trails, D.

Scarlet Rose – August 12, 2008 – 11:39am

meant to put  my comment after another posting.....

AnjelaM – August 13, 2008 – 9:22am

This update is intended to increase awareness of Dr. Dan Siegel’s new book entitled: Mindsight: The New Science of Personal Transformation.

What I find frustrating is that I know the book is sitting in boxes on a loading dock someplace, but it won’t be released until December 1st. By then I could have bought one copy, read it twice, then bought a couple more to give to friends. Oh well... All this will change, and some day we’ll be able to get the books that we want on our Kindle (which by then will cost $20) as soon as they are written! 

Here is a Google video of Dan Siegel, courtesy of Monika Broeker, who started the Google program and has since become a private practitioner in the Bay Area.


Here are some notes that will help you review the video. 

Here is a link to the August 10th newsletter from Upaya (aka Joan Halifax) memorializing a program with Dan Siegel.


John Francis Ca... – August 22, 2009 – 12:11pm

Dan Siegel’s brand new book entitied, Mindsight: The New Science of Personal Transformation, is one of the very best books about psychotherapy I have read. In this book Siegel explains his new approach to psychotherapy which combines meditation, attachment theory, neuroscience, along with many of the humanistic techniques we are all familiar with. He uses numerous case studies to illustrate the method he uses. His extensive background as a physician, practicing psychotherapist, and professor of clinical psychiatry supports the clarity and simplicity of his rhetoric. Here is an excerpt:

The Adult Attachment Interview 

The research instrument that measures how we have “made sense” of our lives is called the Adult Attachment Interview, or AAI. If I were to give you a version of the AAI, I would ask you a series of questions paraphrased like these. What was your childhood like? What was your relationship like with each parent – and were there other people with whom you were close as a child? Whom were you closest to and why? I’d ask you to give me several words that described your early relationship with each parent or caregiver, and then I’d ask for a few memories that illustrated each of those words. The questions go on: What was it like when you were separated, upset, threatened, or fearful? Did you experience loss as a child – and if so, what was that like for you and for your family? How did your relationships change over time? Why do you think your care-givers behaved as they did? When you think back on all these questions, how do you think your earliest experiences have impacted your development as an adult? And if you have children I’d ask you these questions: How do you think these experiences have affected you parenting? What do you wish for you child in the future? And finally, when your child is twenty-five, what do you hope he or she will say are the most important things he or she learned from you? That’s essentially it.

Answering this set of open-ended questions is like diving deeply into areas of untapped memory. When I was doing research with the AAI, many subjects told me that the interview was the most helpful therapy session they’d ever had. As a therapist I found this especially amazing, because the research protocols required that I be as neutral as humanly possible. Nevertheless, something about these question repeatedly prompted new discoveries even in individuals who’d had years of therapy.

If I had administered the AAI to you in a research setting, your responses would have been recorded and then transcribed. The transcription would then have been carefully analyzed by a researcher trained to code the results. We would be watching for how you presented the material, noting if the details of memory corresponded to the generalizations you offered, keeping track of the unfolding of your story to see if it made sense and held together logically, and observing the patterns of response such as insisting you did not recall the past or getting confused between past and present. The transcription would also be assessed for how you monitored what you were saying as you went along, and how you took me into account as you spoke – did you try to make sure that I understood what you were saying? In this way, the “narrative analysis” becomes as much an evaluation of interpersonal communication as it is a study of your own internal process.

The AAI evaluation accepts that memory is fallible. As you’ve seen, memory is not a photocopy machine, and it’s highly suggestible, readily conforming to others’ expectations – and to our own. Even at our most honest moments we say things we think others expect to hear, and we say them in ways that make us appear as we want to appear. For these reasons the analysis does not presume the accuracy of the facts as stated. Instead it focuses on the coherence of the story.

This analysis of the responses to the AAI questions reveals the “adult state of mind with respect to attachment” that turned out to be so powerfully predictive of parenting behavior and of how the children of these adults responded in the Infant Strange Situation. Later studies also revealed that a child’s attachment behavior in childhood predicted the type of narrative he of she developed as an adult. I’ll be exploring these link in the remainder of the chapter....

pp. 173-4

My one argument with this book is that the neuroscience explanations are overly simplified. I attribute this to an effort to make the book more accessible to a wider audience. However, I found myself tantalized and disappointed by the lack of depth in passages like this one:

The overactive circuits of OCD involve the same areas of our middle prefrontal cortex that alert us when we’ve made a mistake. In ordinary circumstances, such as my experience with Pablo’s antibiotic, a prefrontal area activates the nearby anterior cingulated cortex to create a sense of anxiety. As I discussed in chapter 7, the ACC connects emotion and bodily function, so the anxiety affects our heart and intestines, giving us an internal sense of dread, which in turn motivates us to find the mistake and correct it.

In OCD, another area deeper in the brain, called the caudate nucleus, is also highly active. The caudate helps us “shift gears” so that we can change the direction of our thoughts or course of action, which is essential to fixing a mistake. But if this prefrontal-caudate link get stuck in the “on” position, it can created a loop of never-ending worry and agitation. (Strep infection are believed to trigger OCD because they irritate the caudate.) This out-of-control circuit, in turn, can activate the deep alarm system of the brainstem. The brainstem survival reflexes, coupled with the emotion of fear, feed back to the cortical areas, motivating us to search for danger – whether or not it is truly there.

pp. 249-50

Of course, some readers might find this passage troublesome because of its complexity. If so, don’t worry. This is as heavy as the neuroscience gets. Everything is explained at a level of detail and clarity that beginners to the field of brain science can readily understand.

John Francis Ca... – January 26, 2010 – 9:49am

Thanks again for filtering and sharing this information... I don't get as much time to read the days as I once did, so I appreciate the "abridged" editions you share. 



sh – January 29, 2010 – 8:10am

 Thank you for giving me the opportunity to exercise (or even exorcise) my brain!  When I read your posts, I think.

The opportunity to think, and/or to wonder, and/or to learn, is something that I welcome very much right now.   It is so very boring for me in this little tiny town in which I presently live.


Plays well with others

zen puppy – January 31, 2010 – 2:54pm