Maine Psychological Association Annual Meeting 2012 Anne Uecker PhD Edmund N Ervin Pediatric Center MaineGeneral Medical Center • • • • • (1) (e.g., perceiving feelings and emotions without having to react to them); (2) (e.g., remaining present with sensations and feelings even when they are unpleasant or painful); (3) /(not on) automatic pilot, concentration/nondistraction (e.g., breaking or spilling things because of carelessness, not paying attention, or thinking of something else; (4) (e.g., easily putting beliefs, opinions, and expectations into words); (5) (e.g., criticizing oneself for having irrational or appropriate emotions). Goal: To attempt to SNAG you to consider to practice and promote mindfulness SNAG: A Daniel Siegel acronym for STIMULATE NEURONAL ACTIVATION AND GROWTH Mindfulness meditation carves new channels in the streambeds of the mind (Richardson and Begley, 2012). Interface of Cognition, Emotions and the Brain Self Directed Neuroplasticity Social Affective Neuroscience Contemplative Neuroscience (Jeffrey Schwartz) (Richard Davidson) (Richard Davidson) • Bold 9 year old children (those who had less behavioral inhibition, in the terminology of the experiment) had greater left than right activity in their prefrontal cortex, whereas the shy (more behaviorally inhibited) children had greater right than left activity. This was the first time the asymmetry was linked to anything that was not clearly an emotion: This time, leftright asymmetry was seen in conjunction with being bold or shy. Up to and greater than 52,000 hours Some of Richard Davidson’s early studies My Expertise Chart (to qualify my experience with regard to the present topic) 90 80 70 60 50 40 30 20 10 0 A view of the human brain SPACE VISION SCHEMATIC VIEW! 21 . . • Able to focus attention for a longer period of time • Less susceptible to distractions • Better Top-Down Control • Improved Body Awareness • Bottom-Up control (awareness of actual sensation) . Insight Meditation Society ---Barre, MA Studies: Mindfulness vs Relaxation (Does mindfulness complement multitasking) – Focused Attention: strengthens the ability to stay focused and ignore distracting information • 8 week program: Cohen , Darlene (2004). The one who is not busy: Connecting with Work in a Deeply Satisfying Way. – Open Monitoring: strengthens the ability to attend to a succession of stimuli without being drawn in by any one of them. • Relaxation: progressive tensing and relaxing, aided by relaxation imagery (Does mindfulness complement multitasking) • RESULTS___________________________________________ • Overall Time improved, but no effect of group group as compared to control and relaxation – • • • Meditation reduced task switching , whereas C and R groups decreased their time per activity. Expectation of benefit was greater in the relaxation group Task Memory improved in both the relaxation and meditation group as compared to R group (Positive and Negative Affect Scale) Greater Mindfulness as assessed with the Mindful Awareness Attention Scale (see end slide) – Fractional anisotropy: index for measuring white matter integrity. Higher FA value related to improved performance. • Axial Diffusivity: associated with axon morphological changes • Radial Diffusivity: implicates the character of the myelin. Studies: Mindfulness vs Relaxation Continuum of Time • Tang et al (series of studies 2010-2012) showed 4 wks of integrative bodymind training (11 total hours) enhanced FA in several brain areas involved in communication to and from the anterior cingulate, including the corpus callosum and superior corona radiata. • Also a two week, 5 hour group. • Also, a one week. • This series of studies has shown short term meditation to increase the ability to resolve conflict in a cognitive task, altered neural activity in the ACC, and improved connectivity of the ACC to other brain regions. (Brain regions do not act in isolation. Path analysis diagram with functional interactions) Open Monitoring • The quality of open, nonjudgmental awareness implies a balance, so you do not get stuck on an engaging stimulus but are, instead, open to all stimuli. • RESULTS: • CONCLUSIONS: Caudate Nucleus --and more rewards-• Brian Knutson, a neuroeconomist and an expert in the involvement of the pleasure center of the brain in motivating financial decisions, is now studying if similar brain areas are activated for altruistic reasons. Can extending compassion to another person look the same in the brain as anticipating something good for oneself? And who better to test than Tibetan monks, who have spent their lives pursuing a state of selfless nonattachment? • The “monk study” at Stanford is part of an emerging field of meditation science that has taken off in the last decade with advancements in brain image technology, and popular interest. Social Neuroscience • • • • • Body Awareness Intrapersonal Acceptance Empathy and Compassion toward others Attention Impulse Control Cortical Midline Structures --Self Development-- Social Neuroscience Circuit Nodes • Dorsolateral Prefrontal Cortex: motor planning, working memory, organization, and regulation • Anterior Cingulate: enables executive attention by detecting the presence of conflicts emerging from incoming streams of information processing • Ventromedial frontal cortex areas – cognitive control to inhibit prepotent responses, or engage in tasks where inhibition required, such as set switching or memory retrieval. – The middle prefrontal areas are essential for social communication as well as for self-observation. • Insula: internal bodily states, emotions, self awareness, social interactions • Temporoparietal: mediating the first person perspective of bodily states • Superior Temporal: in imitation not merely to passively register biological motion, but to actively represent visuomotor correspondence between one’s actions and others. • Amygdala: Emotions. Particularly sensitive to fear and negative emotions. Self Awareness The Insula • Ventromedial Frontal Cortex – Insula Body Awareness – Self Regulation Activations Insula – Brain Midline Area Activations • Another study by Lazar, Kerr, Wasserman, Gray, Greve, & Treadway (2005) revealed an increased thickness of two parts of the brain: (1) the middle prefrontal area, bilaterally, and (2) a related neural circuit, the insula, which was particularly thicker on the right side of the brain. The degree of thickness in these areas was correlated with length of time spent practicing mindfulness meditation. • An extensive review of many studies (Cahn & Polich, 2006) reveals a range of activations, especially in middle prefrontal areas (anterior cingulate), with mindfulness meditation. Interoception: Our Sixth Sense Insula interoceptive awareness, especially in subjective feelings associated with internal states. Associated with the limbic system. – Activation in imaging studies most likely to occur together with mPFC in self-referential tasks, esp as emotional self-relatedness increases. – Proposed to integrate a wealth of information, such as interoceptive sensations, which cumulate in a concept of awareness anteriorly. Insular Neuroplasticity – Heart rate • British researchers have found through neuroimaging that people who are more accurate in estimating their heart rate also have a larger insula; and, the larger the insula, the better the estimate. Interestingly, higher insula activation is associated with greater awareness not only of physical sensations but also of emotions. Narration: Left Shift Midline Structures Insula • But if ongoing narration, perhaps even without words in the form of a witnessing awareness or an internal observer, is truly a function of the , then there would be a on the (executive attention with active narrative observation) and perhaps also a (nonverbal selfreflection and meta-awareness in the medial prefrontal) and with viscera representation. and synthesize the findings of the left sided/approach shift that Davidson and colleagues have noted (Davidson et al., 2003) and Lazar’s middle prefrontal and right-sided insula findings (Lazar et al., 2005). From: Siegel, Daniel J. The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being . Hypotheses Insula and Default Mode Network (DMN) • Right fronto-insular cortex has been shown to play a critical role in switching between central-executive and default-mode network (which is the resting state network, most evident in states of daydreaming, mind wandering and projections into the past and future) • Successful meditators might be equipped with a better ability to switch on and off the DMN. Richard Davidson • A disorder of disrupted context • Individuals who fail to regulate their affective responses in a context-sensitive fashion may have a functional impairment of the hippocampus. • Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD (Shin et al, 2006) • Similar neurocircuitry in depression and schizophrenia. • Task specific increases in gray matter supposed to be related to improved functioning. • Increased gray matter generally presumed related to repeated activation of an area. • Insula, hippocampus, temporo-parietal junction, temporal gyrus, anterior and posterior cingulate cortex, cerebellum, middle prefrontal regions, orbitofrontal, amygdala, brainstem … – Quick functional changes, but also structural changes, for example shown by correlations between years of experience and a priori defined structures of interest. Holzel et al. 2009 Holzel et al. 2009 • Luders, Toga et al. 2009: Right Orbito-frontal (11, 12, 47) and Right Hippocampus. Both implicated in emotional regulation and response control. – May result in increased behavioral flexibility. – May possess the underlying neural correlates that allow disengagement from automatic thoughts. • Subject group were active meditators with an age range of 30-71 years. • A complicating factor is metabolism and other changes associated with age. Brain Biases in Meditation Research Neuroplasticity: Mindfulness folding pattern assumed to be under the influence of genetic control; degree of folding has been shown to continue to change in childhood and adolescence. Environmental factors may have a modulating impact. modifiable by experience, and affects information processing by regulating the velocity and synchrony of impulse conduction between distant cortical regions. Gyrification Luders et al 2012 • Mean curvature across thousands of vertices on individual surface models • 50 meditators-50 controls • Age range 24 – 71 years • Years of Meditation practice 4 – 46 years (19.8 years + 11.4) Duration Meditation Minutes in a Week 160 140 120 100 80 60 40 20 0 1 6 11 16 21 26 31 Meditators 1 - 49 36 41 46 The Unique Brain Anatomy of Meditation Practioners: Alterations in Cortical Gyrification Luders, Kurth, Mayer, Toga, Narr and Gaser, 2012. Mindfulness and Development Children through …. Susan Kaiser-Greenland Some recent PubMed Abstracts (for independent review by audience) • ADHD: Grey matter thickness was measured in 18 meditators and 18 controls. Subjective reports of attentional absorption were modestly higher in meditators and across the entire sample correlated positively with cortical thickness in several regions corresponding to cingulo-fronto-parietal attention networks. Within these regions the meditation group had greater cortical thickness which was positively related to the extent of prior training. Evidence suggesting that meditative practice activates these cortical are as, improves attention and may ameliorate symptoms of ADHD by targeting vulnerable brain regions is discussed. Grant et al (2012). Cortical thickness, mental absorption and meditative practice: possible implications for disorders of attention. Biological Psychiatry. • Cognitive Abilities: Mindfulness meditation practices (MMPs) are a subgroup of meditation practices which are receiving growing attention. The present paper reviews current evidence about the effects of MMPs on objective measures of cognitive functions. Five databases were searched. Twenty three studies providing measures of attention, memory, executive functions and further miscellaneous measures of cognition were included. Fifteen were controlled or randomized controlled studies and 8 were case-control studies. Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions. However, many of the included studies show methodological limitations and negative results have been reported as well, plausibly reflecting differences in study design, study duration and patients' populations. Accordingly, even though findings here reviewed provided preliminary evidence suggesting that MMPs could enhance cognitive functions, available evidence should be considered with caution and further high quality studies investigating more standardized mindfulness meditation programs are needed. Chisea et al (2011) Doe s mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin Psychol Rev. Some recent PubMed Abstracts (for independent review by audience) • Aging: Brain regions associated with attention, interoception and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula. Between-group differences in prefrontal cortical thickness were most pronounced in older participants, suggesting that meditation might offset age-related cortical thinning. Lazar et al. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport. • PTSD: DESIGN: Posttraumatic stress disorder (PTSD) symptoms, depression, functional • • status, behavioral activation, experiential avoidance, and mindfulness were assessed at baseline, and 2 and 6 months after enrollment. RESULTS: At 6 months, there were significant improvements in PTSD symptoms (standardized effect size, d = -0.64, p< 0.001); depression (d = -0.70, p<0.001); behavioral activation (d = 0.62, p<0.001); mental component summary score of the Short Form-8 (d = 0.72, p<0.001); acceptance (d = 0.67, p<0.001); and mindfulness (d = 0.78, p<0.001), and 47.7% of veterans had clinically significant improvements in PTSD symptoms. CONCLUSIONS: MBSR shows promise as an intervention for PTSD and warrants further study in randomized controlled trials. J Clin Psychol. 2012 Some recent PubMed Abstracts (for independent review by audience) Depression: Major depressive disorder (MDD) is currently ranked the third leading cause of disability in the world. Treatment-Resistant Depression (TRD) causes the majority of MDD's disability. Strikingly, 50% of individuals with MDD will fail to remit with two adequate trials of antidepressant medications, thus qualifying as treatment resistant. Current pharmacological and psychotherapeutic treatment strategies for TRD are limited in effectiveness so new interventions are needed. Mindfulness-Based Cognitive Therapy (MBCT) is a new psychotherapeutic treatment with established efficacy in preventing relapse of depression for individuals in complete remission. MBCT is a group-based, 8-week intervention that uses mindfulness meditation as its core therapeutic technique. It teaches people to have a different relationship to depressive thoughts and feelings. Strategies are focused on decreasing rumination, enhancing self-compassion, increasing acceptance and decreasing avoidance. This modified version of MCBT, which includes the use of metaphor and adaptations of the original intervention will be discussed through the clinical case of a woman with long-standing TRD. A brief review of the current MBCT literature and future directions for the treatment of TRD are discussed. Eisendrath S, et al. 2011. Adapting Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression: A Clinical Case Study. Cogn Behav Pract. Anxiety. While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615-623).METHOD: Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment.RESULTS: Eleven subjects (six female and five male) with a mean age of 49 (range=36-72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment.CONCLUSION: MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD. Evans et al 2008. Mindfulness-based cognitive therapy for generalized anxiety disorder. J Anxiety Disord. • • Mindfulness Based Individual Therapy for OCD and Anxiety The OCD Center of Los Angeles offers therapy for the treatment of OCD and related anxiety based conditions, with a strong emphasis on Mindfulness Based Cognitive Behavioral Therapy (MBCBT). Among the conditions we treat are: • • • • • • • • • • • • • OCD • Pure Obsessional OCD (Pure O) • Perinatal / Postpartum OCD • Child / Adolescent OCD • Body Dysmorphic Disorder (BDD) • Hypochondria / Health Anxiety • Phobias • Panic Disorder • Social Anxiety / Social Phobia • Trichotillomania • Dermatillomania / Compulsive Skin Picking • Olfactory Reference Syndrome • Also a good information resource: http://www.ocdla.com/mindfulness-cbt-ocd-anxiety.html • OCD: Jeffrey Schwartz. Coined the term “Self Directed Neuroplasticity.” – The Mind and the Brain: Neuroplasticity and the Power of Mental Force – Brain Lock: Free Yourself from Obsessive-Compulsive Disorder – You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life Some recent PubMed Abstracts (for independent review by audience) • • Pain Sensitivity: Meditators had significantly lower pain sensitivity than controls. Assessed across all subjects, lower pain sensitivity was associated with thicker cortex in affective, pain-related brain regions including the anterior cingulate cortex, bilateral parahippocampal gyrus and anterior insula. Comparing groups, meditators were found to have thicker cortex in the dorsal anterior cingulate and bilaterally in secondary somatosensory cortex. Grant JA, et al. (2010) Cortical thickness and pain sensitivity in zen meditators. Emotion Substance Abuse: Relapse Prevention. Surfing the Urge. Internet Resource: http://www.mindfulness.org.au/URGE%20SURFING.htm. Useful Web Sites • Mindful Awareness Research Center at UCLA (http://www.marc.ucla.edu) • Inner Kids: http://www.susankaisergreenland.com/innerkids.html • UCSD Center for Mindfulness: http://ucsdcfm.wordpress.com/tag/inner-kids/ (many additonal websites at location) • Mind and Life Institute: http://www.mindandlife.org/ • www.mindfulschools.org Some References • • • Chan, B.R. and Polich, J. (2006). Meditation States and Traits: EEG, ERP and Neuroimaging Studies. Psychological Bulletin. Davidson, R.J. (2012). The Emotional Life of the Brain. How Its Unique Patterns Affect the Way You Think, Feel, and Live—and How You Can Change Them. Hudson Street Press. Davidson, R.J. and McEwen, B. (2012). Social influences on neuroplasticity: Stress and interventions to promote well-being. Nature Neuroscience. Holzel, B. et al (2008). Investigation of mindfulness meditation practitioners with voxel-based morphometry. Social Cognitive and Affective Neuroscience. S Holzel, B. et al (2010). Mindfulness practice leads to increases in regional gray matter density. Psychiatry Research: Neuroimaging. Holzel, B. et al (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience. Holzel, B. et al (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science. Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Lazar et al. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport. Levy, D.M. et al (2012). The Effects of Mindfulness Meditation Training on Multitasking in a High Stress Environment. Graphics Interface.. Luders, E et al. (2009). The underlying anatomical correlates Luders, E et al. (2012). The unique brain anatomy of meditation practitioners: alterations in cortical gyrification. Frontiers in Human Neuroscience. Pfeiffer, J. & Peake, S.J. (2012). Self-development: Integrating cognitive, socioemotional, and neuroimaging perspectives. Developmental Cognitive Neuroscience Sedlmeir, P. et al (2012). The Psychological Effects of Meditation: A Metaanalysis. Psychological Bulletin. Shin, L.M.et al. (2006). Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD. An. NY Acad Sci Siegel, D.J. (2007). The MindfulBrain: Reflection and Attunement in the Cultivation of Well-Being. Siegel, Daniel J. (2007-04-17). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being . Norton. Kindle Edition. Slagter, H.A. et al .., Davidson, R.J. (2009). Theta Phase Synchrony and Conscious Phase Perception: Impact of Intensive Mental Training. Journal of Cognitive Neuroscience. Tang,Y-Y. et al. (2012). Mechanisms of White Matter Change. Proceedings of the National Academy of Science. • You Tube: • • • Hanson, R.The Neurology of Awakening. http://www.youtube.com/watch?v=mK_ngFJWx-g Siegel, D.J. Hand Model of the Brain. http://www.youtube.com/watch?v=gm9CIJ74Oxw Davidson, RJ. Tranform your Mind, Change your Brain. http://www.youtube.com/watch?v=7tRdDqXgsJ0 • • • • • • • • • • • • • • • • Mindful Attention Awareness Scale (Brown and Ryan (2003); referenced in Levy et al 2012 [available on the internet]) Day-to-Day Experiences Instructions: Below is a collection of statements about your everyday experience. Using the 1-6 scale below, please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather than what you think your experience should be. Please treat each item separately from every other item. 1 2 3 4 5 6 (Almost Always; Very Frequently; Somewhat Frequently; Somewhat Infrequently; Very Infrequently; Almost Never) I could be experiencing some emotion and not be conscious of it until some time later. 1 2 3 4 5 6 I break or spill things because of carelessness, not paying attention, or thinking of something else. 1 2 3 4 5 6 I find it difficult to stay focused on what’s happening in the present. 1 2 3 4 5 6 I tend to walk quickly to get where I’m going without paying attention to what I experience along the way. 1 2 3 4 5 6 I tend not to notice feelings of physical tension or discomfort until they really grab my attention. 1 2 3 4 5 6 I forget a person’s name almost as soon as I’ve been told it for the first time. 1 2 3 4 5 6 It seems I am “running on automatic,” without much awareness of what I’m doing. 1 2 3 4 5 6 I rush through activities without being really attentive to them. 1 2 3 4 5 6 I get so focused on the goal I want to achieve that I lose touch with what I’m doing right now to get there. 1 2 3 4 5 6 I do jobs or tasks automatically, without being aware of what I'm doing. 1 2 3 4 5 6 I find myself listening to someone with one ear, doing something else at the same time. 1 2 3 4 5 6 I drive places on ‘automatic pilot’ and then wonder why I went there. 1 2 3 4 5 6 I find myself preoccupied with the future or the past. 1 2 3 4 5 6 I find myself doing things without paying attention. 1 2 3 4 5 6 I snack without being aware that I’m eating. 1 2 3 4 5 6 Five Facet Mindfulness Questionnaire http://www.utwente.nl/gw/pgt/mw/klooster/FFMQ_ENG.pdf 1- never or very rarely; 2 - rarely; 3 – sometimes true; 4 – often true; 5 – very often or always true. 1. When I’m walking, I deliberately notice the sensations of my body moving. 2. I’m good at finding words to describe my feelings. 3. I criticize myself for having irrational or inappropriate emotions. 4. I perceive my feelings and emotions without having to react to them. 5. When I do things, my mind wanders off and I’m easily distracted. 6. When I take a shower or bath, I stay alert to the sensations of water on my body. 7. I can easily put my beliefs, opinions, and expectations into words. 8. I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or otherwise distracted. 9. I watch my feelings without getting lost in them. 10. I tell myself I shouldn’t be feeling the way I’m feeling. 11. I notice how foods and drinks affect my thoughts, bodily sensations, and emotions. 12. It’s hard for me to find the words to describe what I’m thinking. 13. I am easily distracted. 14. I believe some of my thoughts are abnormal or bad and I shouldn’t think that way. 15. I pay attention to sensations, such as the wind in my hair or sun on my face. 16. I have trouble thinking of the right words to express how I feel about things 17. I make judgments about whether my thoughts are good or bad. 18. I find it difficult to stay focused on what’s happening in the present. 19. When I have distressing thoughts or images, I “step back” and am aware of the thought or image without getting taken over by it. 20. I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing. 21. In difficult situations, I can pause without immediately reacting. 22. When I have a sensation in my body, it’s difficult for me to describe it because I can’t find the right words. 23. It seems I am “running on automatic” without much awareness of what I’m doing. 24.. When I have distressing thoughts or images, I feel calm soon after. 25. I tell myself that I shouldn’t be thinking the way I’m thinking. 26. I notice the smells and aromas of things. 27. Even when I’m feeling terribly upset, I can find a way to put it into words. 28. I rush through activities without being really attentive to them. 29. When I have distressing thoughts or images I am able just to notice them without reacting. 30. I think some of my emotions are bad or inappropriate and I shouldn’t feel them. 31. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light and shadow. 32. My natural tendency is to put my experiences into words. 33. When I have distressing thoughts or images, I just notice them and let them go. 34. I do jobs or tasks automatically without being aware of what I’m doing. 35. When I have distressing thoughts or images, I judge myself as good or bad, depending what the thought/image is about. 36. I pay attention to how my emotions affect my thoughts and behavior. 37. I can usually describe how I feel at the moment in considerable detail. 38. I find myself doing things without paying attention. 39. I disapprove of myself when I have irrational ideas.