Linda Graham, MFT Brain Care as Self-Care: The Neuroscience of Well-Being Psychotherapy Networker Symposium Washington, D.C. March 17, 2016

Linda Graham, MFT Marriage and Family Therapist – 25 years Psychodynamic, Relational, Attachment, Trauma Mindful Self-Compassion Neuroscience Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being 2013 Books for a Better Life award 2014 Better Books for a Better World award

Emerging Philosophy of Self Care Macro – big tools, big practices Vacations, work out in gym, support group Micro – small tools, small practices Take a nap, stretch your body, self- compassion break

Compassion Fatigue Exhaustion Lack of job satisfaction Feeling powerless to effect change Despair

Brain Care The brain learns from experience Can choose to respond differently Regulate stress Rewire old patterns “Little and often” Create new habits, new coping strategies

Human Brain: Evolutionary Masterpiece 100 billion neurons Each neuron contains the entire human genome Neurons “fire” hundreds of time per second Neurons connect to 5,000-7,000 other neurons Trillions of synaptic connections As many connections in single cubic centimeter of brain tissue as stars in Milky Way galaxy

How to Replenish Human Brain Exercise-Movement Sleep - Rest Nutrition Laughter-Play Learn Something New Create with Your Hands Open Mind/Heart to Larger Perspective Hang Out with Healthy Brains

Exercise - Movement Macro cardio – BDNF Yoga, qi gong – move the energy Micro 3-minute better than nothing workout Move your body once every hour Sense and savor walk

Sleep - Rest Macro – 8 hours every night Housekeeping Reset nervous system Consolidate learning Sleep hygiene Micro Take mental breaks; switch the channel Take a nap Mini-meditate (10 breaths)

Take Mental Breaks Focus on something else (positive is good) Skillful distraction Talk to someone else (resonant is good) Relational regulation Move-walk somewhere else (nature is good) Moving the body resets the brain Every 90 minutes; avoid adrenal fatigue

Nutrition Macro Eat healthy! More protein, more water, less sugar, less carbs, less calories, less caffeine/alcohol Micro Savor (eat a raisin meditation) Eat one meal a day without doing anything else

Laughter-Play Macro Have a good time at family/friends dinner/celebration Schedule a play date Schedule a silly date Micro Watch a 4-minute Happify Daily video

Learn Something New Macro Speak a foreign language Play a musical instrument Juggle Play chess Micro Learn a new poem, quote, flower, bird each day

Create with Your Hands Knitting, woodworking, quilting Deep brain stimulation; meta-sensory cortex Flow state reduces stress Focus reduces worry, rumination Creativity evokes parallel psychological well- being

Open Heart/Mind to Larger Perspective Macro Spiritual practice Altruism-generosity Service – volunteer, career Micro Mindful Self-Compassion Mindfulness Self-Compassion Common Humanity

Hang Out with Healthy Brains Macro Participate in a conference, support group, book club, choir, cycling group Practice gratitude at family dinners Micro Read 10 pages of a good book, magazine article, blog post Send the link of the above to a friend Send a text or of gratitude, acknowledgement, appreciation to friend, co-worker

Brain Care is Self Care Choose one practice of brain care Practice every day for 30 days Reflect on difference in functioning, in resilience and well-being, in sense of self

Kindness is more important than wisdom, And the recognition of that is the beginning of wisdom. - Theodore Rubin Doing a kindness produces the single most reliable momentary increase in well-being of any exercise we have tested. - Martin Seligman

6 C’s of Coping Calm Compassion Clarity Connections to Resources Competence Courage

Calm Manage disruptive emotions Tolerate distress Down-regulate stress to return to baseline equilibrium

Compassion Being touched, moved by experience of pain and suffering Flow of kindness, tenderness, care and concern toward experiencer of pain and suffering Wise action to alleviate pain and suffering One cannot live with sighted eyes and feeling heart and not know the misery which affects the world. - Lorraine Hansberry Compassion is a verb. – Thich Nhat Hanh

Clarity Pause, become present Notice and name Step back, dis-entangle, reflect Shift perspectives; shift states Discern options Choose wisely – let go of unwholesome, cultivate wholesome

Connections to Resources Practices, Places, People Counter-balance brain’s negativity bias Strengthen inner secure base Access common humanity Increasing the social connections in our lives is probably the single easiest way to enhance our well-being. - Matthew Lieberman, UCLA Social: Why Our Brains are Wired to Connect

Competence Embodied sense, “Sure I can!” From previous competence, no matter how small Ownership Empowerment and mastery from changing old coping strategies, learning new ones Embodying, “I am somebody who CAN do this.” You can’t stop the waves, but you can learn to surf. - Jon Kabat-Zinn

Courage Using signal anxiety as cue to: Try something new Take risks Move resilience beyond personal self

Mastering the art of resilience does much more than restore you to who you once thought you were. Rather, you emerge from the experience transformed into a truer expression of who you were really meant to be. - Carol Orsborn

Keep Calm and Carry On Serenity is not freedom from the storm but peace amidst the storm. - author unknown

Regulate Stress Macro Change conditions causing stress Job, boss, get family member into therapy Micro Work with brain to Manage disruptive emotions Tolerate distress Down-regulate stress

3 Motivational Systems Threat-protection cortisol Satisfaction-reward dopamine Soothing-comfort-caregiving oxytocin

Window of Tolerance SNS – explore, play, create, produce…. OR Fight-flight-freeze Baseline physiological equilibrium Calm and relaxed, engaged and alert WINDOW OF TOLERANCE Relational and resilient Equanimity PNS – inner peace, serenity…. OR Numb out, collapse

Hand on the Heart Touch – oxytocin – safety and trust Deep breathing – parasympathetic Breathing ease into heart center Brakes on survival responses Coherent heart rate Being loved and cherished Oxytocin – direct and immediate antidote to stress hormone cortisol; repairs damage from cortisol Pre-empt stress reponse

Touch Hand on heart, hand on cheek Head rubs, foot rubs, massage Massage back of neck Hold thumb as “inner child” Press thumb of one hand into palm of other hand Hugs – 20 second full bodied

Calm through the Body Hand on the heart; safe, warm touch Hugs Body scan Progressive muscle relaxation Rewire through movement Power posing

Rewiring through Movement Body inhabits posture of difficult emotion (40 seconds Body moves into opposite posture (40 seconds) Body returns to first posture (20 seconds) Body returns to second posture (20 seconds) Body finds posture in the middle (30 seconds Reflect on experience

Power Posing Amy Cuddy TED talk Before important meeting or interview: Stand tall and straight, like mountain pose in yoga Lift your arms in triumph or Place hands on hips (Wonder Woman)

Compassion Practice Mindfulness Awareness of what’s happening (and our reaction to what’s happening) Self-Compassion Acceptance of what’s happening (and our reaction to what’s happening) Compassion – Common Humanity Wise effort in response to what’s happening (and our reactions to what’s happening)

Mindfulness and Compassion Activate Caregiving System Mindfulness Focuses awareness on experience May I accept this moment, exactly as it is Self-Compassion Focuses kindness on experiencer May I accept myself exactly as I am in this moment Common Humanity I am not alone; I am not the only one Activates caregiving system Shift from reactivity and contraction to openness, engagement

Mindful Self-Compassion Shifts Brain Functioning Two of the most powerful agents of brain change known to science; both foster response flexibility In the present moment – restores equanimity Over time – creates new patterns of behavior Becomes way of being – natural, effortless

Benefits of Self-Compassion Increased motivation; efforts to learn and grow Less fear of failure; greater likelihood to try again Taking responsibility for mistakes; apologies and forgiveness More resilience in coping with life stressors Less depression, anxiety, stress, avoidance Healthier relationships; more support and, less control and/or aggression Increased social connectedness, life satisfaction, and happiness

Practices of Mindful Self-Compassion Affectionate Breathing Soles of the Feet Self-Compassion Break Caregiving: One for Me, One for You Caregiving with Equanimity

Affectionate Breathing Sit comfortably; breathe slowly and gently. Incline your awareness toward your breathing with tenderness and curiosity Let the body breathe itself; notice the natural nourishing and soothing of the body Feel the whole body breathe Allow the body to be gently rocked by the breath Savor the stillness and peace in the body

Soles of the Feet Stand up; feel soles of feet on the floor Rock back and forth, rock side to side Make little circles with your knees Walk slowly; notice changes in sensations Offer gratitude to your feet that support your entire body, all day long

Self-Compassion Break Notice moment of suffering Ouch! This hurts! This is painful. Soothing touch (hand on heart, cheek, hug) Kindness toward experiencer May I be kind to myself in this moment May I accept this moment exactly as it is May I accept myself in this moment exactly as I am May I give myself all the compassion I need to respond to this moment wisely

Caregiving Breathing in, “nourishing, nourishing” Breathing out, “soothing, soothing” In imagination, “nourishing for me, nourishing for you, soothing for me, soothing for you” “One for me, one for you” Practice breathing “one for me, one for you” when in conversation with someone

Caregiving with Equanimity Everyone is on his or her own life journey. I am not the cause of this person’s suffering, nor is it entirely within my power to make it go away, even if I wish I could. Moments like this are difficult to bear, Yet I may still try to help if I can.

Negativity Bias – Left Shift Brain hard-wired to notice and remember negative and intense more than positive and subtle; how we survive as individuals and as a species Leads to tendency to avoid experience Positive emotions activate “left shift,” brain is more open to approaching experience, learning, and action

Positive Emotions - Benefits Less stress, anxiety, depression, loneliness More friendships, social support, collaboration Shift in perspectives, more optimism More creativity, productivity Better health, better sleep Live on average 7-9 years longer Resilience is direct outcome

Practices of Positive Emotions Gratitude Take in the Good Circle of Support Positivity Portfolio

Gratitude 2-minute free write Gratitude journal Gratitude buddy Carry love and appreciation in your wallet

Take in the Good Notice: in the moment or in memory Enrich: Felt sense in the body Absorb: savor seconds, install in long- term memory

Circle of Support Call to mind people who have been supportive of you; who have “had your back” Currently, in the past, in imagination Imagine them gathered around you, or behind you, lending you their faith in you, and their strengths in coping Imagine your circle of support present with you as you face difficult people or situations

Positivity Portfolio Ask 10 friends to send cards or s expressing appreciation of you Assemble phrases on piece of paper Tape to bathroom mirror or computer monitor, carry in wallet or purse Read phrases 3 times a day for 30 days Savor and appreciate

Clarity - Mindfulness Focused attention on present moment experience without judgment or resistance. - Jon Kabat-Zinn

Mindfulness Pause, become present Notice and name Step back, dis-entangle, reflect Catch the moment; make a choice Shift perspectives; shift states Discern options Choose wisely – let go of unwholesome, cultivate wholesome

Mindfulness and Psychotherapy Even-hovering attention Unconditional positive regard Observing ego “What are you noticing now?” Catch the moment; make a choice

Notice and Name Increasingly complex objects of awareness: Sensations as sensations Emotions as emotions Cascades of emotions as cascades Thoughts as thoughts Patterns of thoughts as patterns States of mind as states of mind Identities, belief systems and identities as Mental contents, patterns of neural firing Awareness itself- a vast sky that clouds and storms pass through

Noticing Patterns of Reactions Imagine walking down the street Notice someone you know walking toward you Wave “hello!” There’s no response. Notice your response to the lack of response The person notices you and waves “hello!” Notice your response to the response Notice any differences in your responses

Autobiography in Five Short Chapters – Portia Nelson I I walk down the street. There is a deep hole in the sidewalk I fall in. I am lost…I am helpless It isn’t my fault. It takes me forever to find a way out.

II I walk down the same street. There is a deep hole in the sidewalk. I pretend I don’t see it. I fall in again. I can’t believe I’m in the same place But, it isn’t my fault. It still takes a long time to get out.

III I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in…it’s a habit My eyes are open, I know where I am. It is my fault. I get out immediately.

IV I walk down the same street There is a deep hole in the sidewalk. I walk around it. V I walk down another street. -Portia Nelson

Linda Graham, MFT Rewiring the Brain to Enhance Attachment Psychotherapy Networker Symposium Washington, D.C. March 18, 2016

Connections to Resources This is what our brains are wired for: reaching out to and interacting with others. These are design features, not flaws. These social adaptations are central to making us the most successful species on earth. - Matthew Lieberman, PhD Social: Why Our Brains Are Wired To Connect

Connections Increasing the social connections in our lives is probably the single easiest way to enhance our well-being. - Matthew Lieberman Friendships, marriage, support groups, book clubs, church choirs, cycling groups

Compassionate Friend Sit comfortably; hand on heart for loving awareness Imagine safe place Imagine warm, compassionate figure – Compassionate Friend Sit-walk-talk with compassionate friend Discuss difficulties; listen for exactly what you need to hear from compassionate friend Receive object of remembrance from friend Reflect-savor intuitive wisdom

Competence, Mastery, Efficacy You can’t stop the waves, But you can learn to surf. -Jon Kabat-Zinn

Post-Traumatic Growth 75% Americans will experience potentially traumatizing event at least once in lifetime 8% will develop PTSD More than 50% will fully recover, finding meaning, deepening sense of self, stronger ties to community and common humanity

Post-Traumatic Growth - I Acceptance of reality Support from family/friends; belief in recovery Community of “the tribe” with same trauma Find positive moments in midst of catastrophe Allow the struggle Be flexible

Post-Traumatic Growth - II Pro-actively re-enter the world Positive re-framing; find positive meaning in negative event Communicate about trauma; sharing, journaling Helping others Value the process, not the outcome Appreciate new life because of catastrophe

Coherent Narrative This is what happened; these were the consequences. These were the resources and coping strategies I used. These were the positive meanings I found and the lessons I learned. This is how I re-entered the world and helped others. This is what I now appreciate because of the event.

Courage It’s as wrong to deny the possible As it is to deny the problem. - Dennis Seleeby A ship is safe in harbor, but that’s not what ships are for. - Grace Hopper Yes, risk-taking is inherently failure-prone. Otherwise, it would be called sure thing-taking - Tim McMahon

Do One Scary Thing a Day Venture into New or Unknown Somatic marker of “Uh, oh” Dopamine disrupted Cross threshold into new Satisfaction, mastery Dopamine restored

Resilience, Creativity, Flow and Flourishing I am no longer afraid of storms, for I am learning to sail my ship. - Louisa May Alcott

There is a natural and inviolable tendency in things to bloom into whatever they truly are in the core of their being. All we have to do is align ourselves with what wants to happen naturally and put in the effort that is our part in helping it happen. - David Richo

Linda Graham, MFT Brain Care as Self-Care: The Neuroscience of Well-Being Psychotherapy Networker Symposium Washington, D.C. March 17, 2016