By Deborah Zelinsky, O.D.
“For many brain injury survivors, mindfulness is an essential practice that helps regulate their mental health, mood changes, and memory.”
That comment – from the Headway Company, which works with affordable mental health services – suggests why mindfulness meditation has undergone scientific scrutiny as a technique to bring relief to patients struggling with the physical and psychiatric symptoms of traumatic brain injury. Those symptoms often include cognitive and memory difficulties, headaches, posture and balance abnormalities, lack of focus, depression, anxiety, and even post-traumatic stress disorder (PTSD).
Indeed, scientists reporting in a 2020 issue of Applied Psychology: Health and Well-Being (https://doi.org/10.1111/aphw.12244) say their meta-analysis of 20 previous studies indicates a combination of yoga, meditation, and mindfulness offers “significant improvement of overall symptoms” across all measured outcomes in patients with mild traumatic brain injury. Other investigators, writing in a 2021 edition of BMC Psychology (10.1186/s40359-021-00628-0), conclude mindfulness “supports the self-management of health after neurological injury/impairment…[by] encouraging adaptive approach-based coping and acceptance” of one’s health status and impairments. They refer to mindfulness as a “stress-buffering strategy which can reduce the psychological distress, depression, pain, and worry associated with living with chronic illness.”
But what exactly is mindfulness? Nationally noted meditation instructor James Baraz simply calls it a condition of “being aware of what is happening right now without wishing it were different; enjoying the pleasant without holding on when it changes (which it will); [and] being with the unpleasant without fearing it will always be this way (which it won’t).” Some experts refer to it as a method which can promote positive changes in an injured brain. Authors of a report in the Journal of Neuroscience (10.1523/JNEUROSCI.5791-10.2011) reference investigators who consider mindful meditation as either “focused attention, promoting a sense of detachment from ongoing affective states and enhancing cognitive control” or as a “moment-to-moment non-evaluative awareness of ‘whatever arises.’”
In a blog posted in a 2021 edition of Psychology Today (www.psychologytoday.com/us/blog/designs-strong-minds/202105/did-i-already-do), cognitive restructuring specialist Donalee Markus PhD, president of Designs for Strong Minds in Highland Park, Illinois, refers to mindfulness as a “state of being ‘present in the moment’ and controlling the inner dialog that prompts one’s thoughts to wander. We all have that voice in our head [as we move through our day] telling us, ‘You should not have said that. Why didn’t you say it…?’ or ‘First, I need to get coffee, then go to the dry cleaners, and maybe after that…’ People often subconsciously use these types of metacognitive conversations to criticize themselves, sometimes harshly. At the very least, they use their internal conversation to evaluate behavior and actions.
“Whether we are aware of it or not, we all have a voice or voices inside our head that help monitor behavior and how we interact with the world. Often this is the first thing brain injury patients lose, because it is at such a prominent level of thinking,” Dr. Markus explains in her Psychology Today blog. “If any so-called metacognitive dialog remains, most often it is negative—Why can’t I do this? What’s wrong with me?”
For those who suffer head injuries or develop other chronic illnesses, that same “inner voice” torments, adding to patients’ stress and anxiety by asking and re-asking the same questions in their minds, “Will I ever recover from my injuries? Why did it happen? Will I ever be normal again?” Internal dialogue can take a person “out of the moment” and draw him or her to places, events, and times in the foggy past or into an anxious future that may never happen. Mindfulness returns a patient to the present.
Dr. Markus and Designs for Strong Minds apply mindfulness techniques to enhance a patient’s cognitive ability to think, judge, plan, and organize through use of pictures and puzzles that are “hierarchically organized into specific areas – much like the brain is organized.”
The Mind-Eye Institute uses another form of mindfulness, one modifying a patient’s perception by shifting eye posture and altering sensory integration. Patients with brain injuries or neurological disorders are often unaware of their environment, and unable to maintain attention on a target. These patients often develop compensatory postures and have poor balance. In neurologically compromised patients, these shifts influence the mental map of surroundings. Using individualized optometric interventions to selectively activate the retina (which is an extension of brain tissue), the Mind-Eye Team can modify brain activity.
Both the Mind-Eye Institute and Designs for Strong Minds agree that the “brain is plastic and modifiable at any age and can be rehabilitated after injury or disruption from disease.” Mindfulness is one tool to help accomplish that in positive ways.
Scientists concur.A review published in a 2020 edition of the journal Consciousness and Cognition (https://doi.org/10.1016/j.concog.2020.102991) indicates studies of mindfulness and meditation demonstrate “mindfulness induction improves cognitive performance in tasks involving complex higher-order functions.” An earlier study in Psychiatry Research: Neuroimaging (10.1016/j.pscychresns.2010.08.006) documents mindfulness meditation as producing “changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.”
Authors of research in a 2017 issue of Frontiers in Immunology (10.3389/fimmu.2017.00670) report “pro-inflammatory genes get downregulated” when practicing mindfulness and other mind-body interventions. In effect, they indicate mindfulness meditation can reduce the effects of stress and anxiety by actually reversing the expression of specific genes. Reducing the impact of stress is an important step in recovery from brain injury. Meanwhile, the writers of the Journal of Neuroscience report mentioned earlier in this article indicate mindfulness meditation can have “dramatic pain-relieving effects.”
We are all different. Each of us processes our world in unique ways. Designs for Strong Minds and the Mind-Eye Institute referred patients to each other for the past 30 years, depending on whether a patient requires cognitive restructuring, a rebuilding of visual processing skills and perception, or both.
When people visualize, they think about the future. Planning takes people from today – the present – to tomorrow. Mindfulness is rooted in our todays and exemplifies the work of self-empowerment authors Napoleon Hill and David Imonitie who exhorted readers to “conceive it, believe it, and achieve it.” The “brain” glasses prescribed by the Mind-Eye Institute and the puzzles used by Designs for Strong Minds are highly individualized, based on each patient’s interests and the specific ways each one thinks, plans, learns, and reacts to situations. This kind of individualization helps patients reconnect with their world.
Deborah Zelinsky, O.D., is a Chicago optometrist who founded the Mind-Eye Connection, now known as the Mind-Eye Institute. She is a clinician and brain researcher with a mission of building better brains by changing the concept of eye examinations into brain evaluations. For the past three decades, her research has been dedicated to interactions between the eyes and ears, bringing 21st-century research into optometry, thus bridging the gap between neuroscience and eye care.