Psychotherapy Networker 2014 Symposium March 20, 2014 Washington, D.C.

Linda Graham, MFT Bouncing Back: Rewiring Your Brain For Maximum Resilience and Well-Being

I arise in the morning Torn between the desire To save the world And a desire to savor the world. This makes it hard to plan the day. - E.B. White

Self Care: Antidote to Compassion Fatigue Overwhelm of care for others Self-care drops off the radar Clinicians are vehicles for concern and care Self-care: replenish and resource self Energy and bandwidth to care for others

Neuroscience of Self-Care Neuroscience technology is 20 years old Meditation shifts mood and perspective; impacts immune system and gene expression Oxytocin can calm a panic attack in less than a minute Kindness and comfort, early on, protects against later stress, trauma, psychopathology

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

The field of neuroscience is so new, we must be comfortable not only venturing into the unknown but into error. - Richard Mendius, M.D.

Neuroplasticity Growing new neurons Strengthening synaptic connections Myelinating pathways – faster processing Creating and altering brain structure and circuitry Organizing and re-organizing functions of brain structures

Conditioning Experience causes neurons to fire Repeated experiences, repeated neural firings Neurons that fire together wire together Strengthen synaptic connections Connections stabilize into neural pathways Conditioning is neutral, wires positive and negative

The brain is shaped by experience. And because we have a choice about what experiences we want to use to shape our brain, we have a responsibility to choose the experiences that will shape the brain toward the wise and the wholesome. - Richard J. Davidson, PhD

Evolutionary legacy Genetic templates Family of origin conditioning Norms-expectations of culture-society Who we are and how we cope…. …is not our fault.

Given neuroplasticity And choices of self-directed neuroplasticity Who we are and how we cope… …is our responsibility

Between a stimulus and a response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. The last of human freedoms is to choose one’s attitude in any given set of circumstances. - Viktor Frankl, Austrian psychiatrist, survivor of Auschwitz

7 R’s of Self-Care Replenish Recognize Regulate Reflect Resource Re-Frame Re-Wire

Resilience Deal with challenges and crises Bounce back from adversity Recover our balance and equilibrium Find refuges and maximize resources Cope skillfully, flexibly, adaptively Shift perspectives, open to possibilities, create options, find meaning and purpose

Replenish Sleep Nutrition Movement-Exercise Laughter Hanging Out with Healthy Brains

Sleep Housekeeping Reset nervous system Consolidate learning Take mental breaks

How to Sleep Well Stick to a sleep schedule Pay attention to what you eat and drink Create a bedtime ritual Get comfortable Limit daytime naps Include physical activity in your daily routine Manage stress

Take Mental Breaks Focus on something else (positive is good) Talk to someone else (resonant is good) Move-walk somewhere else (nature is good) Avoid adrenal fatigue

Nutrition Less Caffeine Less Sugar More Protein

Movement - Exercise Oxygen – brain is 2% of body weight, uses 20% of body’s oxygen Endorphins – feel good hormones, brighten the mind Brain-Derived Neurotrophic Factor (BDNF) - grow new brain cells, will migrate to where needed

Laughter Increases oxygen and blood flow, reduces risk of heart disease and stroke Releases endorphins – body’s natural pain killer Reduces stress hormone cortisol, lowers blood pressure Triggers catecholamines, heightens alertness in brain Releases tension in body, balances nervous system

Laughter Promotes work productivity Reduces stress Promotes creativity and problem-solving Reduces mistakes, increases efficiency Promotes group cohesion Promotes learning (through play) Eases loss, grief, trauma

How to Promote Laughter Humor A person without a sense of humor is like a wagon without springs – jolted by every pebble in the road. - Henry Ward Beecher Play Play, in short, prepares the brain to handle the unexpected. – Lee Alan Dugatkin Playful resonance Laughter is the closest distance between two people. – Victor Borge

Hanging Out with Healthy Brains Brain is social organ; matures and learns best in interactions with other brains Social engagement regulates nervous system Resonant interactions prime the brain’s neuroplasticity; promotes learning and growth

Recognize Mindfulness: Focused attention on present moment experience without judgment or resistance. - Jon Kabat-Zinn Attention and allowing Awareness and acceptance

Mindful Self-Compassion Awareness of what’s happening (and our reaction to what’s happening) Acceptance of what’s happening (and acceptance of our reaction) Brain stays plastic, open to learning

Self-Compassion Break Notice-recognize: this is a moment of suffering Ouch! This hurts! This is hard! Pause, breathe, hand on heart or cheek Oh sweetheart! Self-empathy Of course this is painful, and I’m not the only one; I’m not alone Drop into calm; hold moment with awareness; breathe in compassion and care May I be free of suffering and the causes of suffering Share experience with resonant other

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

Oxytocin Hormone of safety and trust, bonding and belonging, calm and connect Brain’s direct and immediate antidote to stress hormone cortisol Can pre-empt stress response altogether

Hand on the Heart Touch Deep breathing Positive Emotions Brakes on survival responses Oxytocin – safety and trust Relationships as resources

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

Reflect Mindfulness and Psychotherapy Even-hovering attention Unconditional positive regard Observing ego “What are you noticing now?”

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

Resource Practices Places People

Positive Emotions-Behaviors 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 GratitudeAweGenerosity CompassionDelight Serenity Love Curiosity Kindness Joy Trust

Positive Emotions Help us feel and function better Put the brakes on negativity Antidote survival responses Foster the left shift, open to experience Better coping with stress and trauma Possibilities, creativity, productivity Cooperation and collaboration Flexibility and resilience

Kindness is more important than wisdom, And the recognition of that is the beginning of wisdom. - Theodore Rubin

Neuroscience of Sharing Positive Emotions Social engagement system Dyadic regulation Vagal brake Fusiform gyrus regulates amygdala Emotional communication is 93% non-verbal Restores equilibrium

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

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

Take in the Good Notice: in the moment or in memory Enrich: the intensity, duration, novelty, personal relevance, multi-modality Absorb: savor seconds, felt sense in body

Places as Resources Nature as refuge – re-Source Nature is our biology, our being We can create and notice shifts in perspective

People as Resources At times our own light goes out and is rekindled by the spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us. - Albert Schweitzer

Attachment Styles Secure –safety and trust, stable and flexible focus and functioning, open to learning, inner secure base provides buffer against stress, trauma Insecure-avoidant – stable, not flexible, focus on self-world, not on other or emotions, rigid, defensive, not open to learning, neural cement Insecure-anxious – flexible, not stable, focus on other, not on self-world, less able to retain learning, neural swamp Disorganized – lack of focus, moments of dissociation, compartmentalization of trauma

Pre-Frontal Cortex Executive center of higher brain Evolved most recently – makes us human Development kindled in relationships Matures the latest – 25 years of age Evolutionary masterpiece CEO of resilience

Functions of Pre-Frontal Cortex Regulate body and nervous system Quell fear response of amygdala Manage emotions Attunement – felt sense of feelings Empathy – making sense of expereince Insight and self-knowing Response flexibility

I have learned that people will forget what you said and people will forget what you did, but people will never forget how you made them feel. - Maya Angelou

Resonance Circuit Resonance – vibe, emotional contagion Attunement – felt sense, explicit, non-verbal Empathy – verbal, cognitive, coherent narrative Compassion – concern, caring, help Acceptance – pre-requisite for resilience and lasting change

The roots of resilience are to be found in the felt sense of being held in the heart and mind of an empathic, attuned, and self-possessed other. - Diana Fosha, PhD

Shame De-Rails Resilience Shame is the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging. Shame erodes the part of ourselves that believes we are capable of change. We cannot change and grow when we are in shame, and we can’t use shame to change ourselves or others.

Love makes your soul crawl out of its hiding place. - Zora Neale Hurston Love guards the heart from the abyss. - Mozart

Seeing Ourselves as Others See Us Imagine sitting across from someone who loves you unconditionally Imagine switching places with them; see yourself as they see you; feel why they love you and delight in you; take in the good Imagine being yourself again; taking in the love and affection coming to you; savor and absorb.

Reconditioning Memory de-consolidation – re-consolidation “Light up” neural networks of problematic memory Cause neural networks to fall apart temporarily and instantly rewire by: Juxtaposing positive memory that directly contradicts or disconfirms; Focused attention on juxtaposition of both memories held in simultaneous dual awareness Causes the falling apart and the rewiring

Wished for Outcome Evoke memory of what did happen Imagine new behaviors, new players, new resolution Hold new outcome in awareness, strengthening and refreshing Notice shift in perspective of experience, of self

Relational Intelligence Setting limits and boundaries Negotiating change Resolving conflicts Repairing ruptures Forgiveness

Forgiveness - I For the many ways that I have hurt and harmed myself, that I have betrayed or abandoned myself, out of fear, pain, and confusion, through action or inaction, in thought, word or deed, knowingly or unknowingly… I extend a full and heartfelt forgiveness. I forgive myself. I forgive myself.

Forgiveness - II For the ways that I have hurt and harmed you, have betrayed or abandoned you, caused you suffering, knowingly or unknowingly, out of my pain, fear, anger, and confusion… I ask for your forgiveness, I ask for your forgiveness.

Forgiveness - III For the many ways that others have hurt, wounded, or harmed me, out of fear, pain, confusion, and anger… I have carried this pain in my heart long enough. To the extent that I am ready, I offer you forgiveness. To those who have caused me harm, I offer my forgiveness, I forgive you.

Re-frame Regrettable Moment – Teachable Moment What’s Right with this Wrong? What’s the Lesson? What’s the Cue to Act Differently? Find the Gift in the Mistake

Coherent Narrative This is what happened. This is what I did. This has been the cost. This is what I’ve learned. This is what I would do differently going forward

Mechanisms of Brain Change Conditioning New Conditioning Re-Conditioning De-Conditioning

New Conditioning Choose new experiences Positive emotions, resonant relationships, self- compassion, self-acceptance Create new learning, new memory Encode new wiring Install new pattern of response

Re-conditioning “Light up” neural networks Juxtapose old negative with new positive De-consolidation - re-consolidation New rewires old

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

De-Conditioning De-focusing Loosens grip Creates mental play space Plane of open possibilities New insights, new behaviors

Brahma Viharas Loving Kindness Compassion Sympathetic Joy Equanimity

Modes of Processing Focused Tasks and details Self-referential New conditioning and re-conditioning De-focused Default network Fertile neural background noise De-conditioning

Practices to Accelerate Brain Change Presence – primes receptivity of brain Intention/choice – activates plasticity Perseverance – creates and installs change

I am no longer afraid of storms, For I am learning how to sail my ship. - Louisa May Alcott

Linda Graham, MFT