Catalyzing Brain Change: From Incremental Skills to Quantum Learning 2015 Psychotherapy Networker Symposium March 28, 2014 Washington, D.C.

Linda Graham, MFT Marriage and Family Therapist – 25 years Psychodynamic, Attachment, Trauma, Mindfulness, 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 www.lindagraham-mft.net linda@lindagraham-mft.net

All the world is full of suffering. It is also full of overcoming All the world is full of suffering. It is also full of overcoming. - Helen Keller

Premise of Workshop Different neural activities underlie Different levels of client functioning, thus Different mechanisms of therapeutic change Four mechanisms of brain change to address Four levels of client functioning

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

Neuroscience of Brain Change Neuroscience technology is 20 years old Meditation improves attention and impulse control; shifts mood and perspective; promotes health Oxytocin can calm a panic attack in less than a minute Kindness and comfort, early on, protects against later stress, trauma, psychopathology

Parent comforting child

Neuroplasticity Greatest discovery of modern neuroscience 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 The brain changes itself - lifelong

Brain lit up

The brain is shaped by experience 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

Walking hand in hand

Evolutionary legacy Genetic templates Family of origin conditioning 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

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

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

Gullies on a hillside

Conditioning – Skills and Functions How brain learns from experience Encodes learning, behaviors, skills in neural circuitry Develop pre-frontal cortex Strengthen inner secure base, personal sense of self Therapeutic relationship = re-parenting

Attachment – Earliest Conditioning 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

Loving parent & child / parent and child ignoring each other / parent ignoring child

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

True Other to the True Self The roots of resilience are to be found in the felt sense of being held in the mind and heart of an empathic, attuned, and self-possessed other. - Diana Fosha, PhD To see and be seen: that is the question, and that is the answer. - Ken Benau, PhD

New Conditioning Choose new experiences Gratitude practice, listening skills, focusing attention, self-compassion, self-acceptance Create new learning, new memory Encode new wiring Install new pattern of response

New Conditioning Strengthen pre-frontal cortex Brain more resilient Brain more receptive We are more resilient

Cues to Practice - ANTS to PATS Identify habitual negative pattern of response Identify new, positive response to counter/replace Identify cue word or phrase to name negative and positive Criticism - Compassion Use cue to break automaticity and change the channel Repeat the practice as many times as necessary

Re-conditioning Memory de-consolidation – re-consolidation “Light up” neural networks Juxtapose old negative with new positive Neurons fall apart, rewire New rewires old

Pleasant thought bubble

Re-conditioning Evoke compassion for your self Resource with memory of someone’s compassion toward you Evoke compassion for your self Evoke memory of someone being critical of you (or inner critic) Hold awareness of criticizing moment and compassionate moment in dual awareness Drop the criticizing moment; rest in the compassionate moment

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

Modes of Processing Focused De-focused Tasks and details New conditioning and re-conditioning De-focused Default network Mental play space De-conditioning

De-Conditioning Default network De-focusing, loosens grip Creates mental play space Can open to worry, rumination Can open to plane of open possibilities Brain makes new links, associations New insights, new behaviors

Creative pondering

De-Conditioning Imagination Guided visualizations Guided meditations Reverie, daydreams Brain “plays,” makes own associations and links, connect dots in new ways Reflect on new insights

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

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

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

Incremental Learning to Quantum Leaps Stress/trauma; stuck in reactive patterns Restore calm, equilibrium, presence, acceptance Antidote negativity bias; rewire defensive patterns Install new, more resilient strategies Rewire shame Recover secure base of resilient self Expand to creativity, flow, flourishing Embody, express authentic self

Incremental Learning to Quantum Leaps Stress/trauma; stuck in reactive patterns Restore calm, equilibrium, presence, acceptance Conditioning Use integration of higher and lower brain Attachment conditioning (stabilize the brain) AEDP, IFS, CFT

Angry / Happy

Incremental Learning to Quantum Leaps Antidote negativity bias; rewire defensive patterns Install new, more resilient strategies New conditioning Use higher brain to rewire higher brain DBT, MBCBT, ACT, positive psychology

Distressed / Delighted

Incremental Learning to Quantum Leaps Rewire shame Recover secure base of resilient self Reconditioning Use higher brain to rewire lower brain Psychodynamic, Coherence therapy, sensorimotor, somatic experiencing, EMDR

Shame / Triumphant

Incremental Learning to Quantum Leaps Expand to creativity, flow, flourishing Embody, express authentic self Deconditioning Default network Jungian, transpersonal, spiritual, visualizations, imagery

Peaceful activity

Intelligences Somatic - body-based, rewire trauma Emotional - from survival responses to thriving Relational - heal heartache, access havens and resources, navigate peopled world Reflective – conscious awareness; catch the moment, make a choice

Conditioning Without intervention, what happens in brain all the time Therapeutic intervention Therapist as attachment, re-parenting figure Create conditions of safety and acceptance: Stabilize reactivity, foster receptivity Mature the pre-frontal cortex Dissolve defenses; re-open to learning

True Other to the True Self The roots of resilience are to be found in the felt sense of being held in the mind and heart of an empathic, attuned, and self-possessed other. - Diana Fosha, PhD To see and be seen: that is the questions, and that is the answer. - Ken Benau, PhD

Ah, the comfort, The inexpressible comfort Of feeling safe with a person. Having neither to weigh out thoughts Nor words, But pouring them all right out, just as they are, Chaff and grain together; Certain that a faithful hand Will take them and sift them; Keeping what is worth keeping and, With the breath of kindness, Blow the rest away. - Dinah Craik

People talking and looking peaceful

Deep Listening The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention….A loving silence often has far more power to heal and to connect than the most well-intentioned words. - Rachel Naomi Remen, M.D.

Listening and working things out

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

Neuroscience of empathy Dyadic regulation Social engagement system Vagal brake Fusiform gyrus regulates amygdala Restores equilibrium

See Yourself as Others See You 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.

The Guest House - Rumi This being human is a guest-house. Every morning a new arrival. A joy, a depression, a meanness, Some momentary awareness come As an unexpected visitor. Welcome and entertain them all! Even if they’re a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably.

He may be clearing you out for some new delight He may be clearing you out for some new delight. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond. - Rumi

Welcome Them All Wiser Self welcomes to the “party” characters that embody positive and negative parts of the self with curiosity and acceptance of the message or gift of each part and honors each part of the “inner committee”

Create a Circle of Support Imagine several people who love and support you, who are “on your side” – partners, close friends, benefactors (therapists-mentors-teachers). Spiritual figures and pets work, too. Imagine your circle of support surrounding you, or in support behind you, as you venture into the unknown or difficult

Positivity Portfolio Ask 10 friends to send cards or e-mails 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

Wiser Self Imagine yourself five years from now: wise, compassionate, good, strong, alive and vibrant Ask this Wiser Self: how did you become like this? What did you have to overcome or let go of to become like this? What one word of advice do you have for me? Inhabit this Wiser Self briefly; what does it feel like to become your Wiser Self?

Relational Intelligence Receiving/reaching out for help Setting limits and boundaries Negotiating change Repairing ruptures Forgiveness

Receiving-Reaching Out for Help Identifying conditioned patterns Avoiding/rejecting; clinging Practicing the opposite pattern Asking/receiving; activating/experimenting Allowing the new pattern to settle in Self-compassion when new practice is difficult; evokes shame

Someone helping another person

Setting Limits and Boundaries Identify values that determine limit Create context of mindful empathy Assert limits/boundaries State consequences Enforce consequences

Negotiating Change Speaker requests dialogue Speaker/listener create conditions to be heard Speaker states topic sentence Speaker uses “I” statements; focuses on own perceptions, reactions, needs Listener reflects back; no interruptions, questions, defenses, explanations, judgments, criticisms

Negotiationg Change, part 2 Listener summarizes; speaker corrects Speaker identifies 3 behavior he/she can do to meet identified need and 3 behaviors partner can do to meet identified need; positive, measurable, within time frame Each chooses one behavior to do in time frame Each acknowledges the other when behavior is done

Repairing Ruptures Acknowledge existence of rupture; desire to repair Each states own experience, hurts, needs Each listens to and empathizes with experience, hurts, needs of other Each takes responsibility for their actions and acknowledges impact Each asks and offers forgiveness

Forgiveness

Forgiveness Forgiving ourselves Asking others for forgiveness Forgiving others for harm, hurt, betrayal, abandonment out of fear, anger, hurt, confusion in thought, word, or deed knowingly or unknowingly

New Conditioning Use cues to break automaticity Create new thoughts, affirmations Use cues to practice new behaviors Shift from negative to positive emotions Create new habits, new ways of being

Neuroscience is Revolutionizing Our Thinking about Feelings Negative Emotions – Up Side of Your Dark Side Signal – pay attention, this is important! Motivator of action Positive Emotions – left shift; antidotes negativity; opens up possibilities

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

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

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

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

Take in the Good Notice: in the moment or in memory Enrich: the felt sense in the body Absorb: savor 10-20-30 seconds, install in long-term memory

Emotional Intelligence Perceiving, identifying, managing one’s own emotional landscape with openness and curiosity Regulating negative emotions Cultivating positive emotions Maintaining emotional vitality and equilibrium Recognizing others’ emotions, empathizing with emotional causes of behaviors Responding to one’s own and others’ emotions skillfully and compassionately

Reconditioning of Shame that 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. - Brene Brown, PhD

Bowed in shame

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

Hopeful

Just that action of paying attention to ourselves, that I care enough about myself, that I am worthy enough to pay attention to, starts to unlock some of those deep beliefs of unworthiness at a deeper level in the brain. - Elisha Goldstein

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

Reconditioning Anchor in present moment awareness Resource with acceptance and goodness Start with small negative memory “Light up the networks” Evoke positive memory that contradicts or disconfirms Simultaneous dual awareness (or toggle) Refresh and strengthen positive Let go of negative Rest in, savor positive Reflect on shifts in perspective

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

Intelligence of Integrated Self 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

Creativity, Flow, Flourishing Enjoyment appears at the boundary between boredom and anxiety, when the challenges are just balanced with the person’s capacity to act. The best moments usually occur when a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile. Optimal experience is thus something that we can make happen. For each person there are thousands of opportunities, challenges to expand ourselves. - Mihaly Csikszentmihalyi

Creativity

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 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 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

De-conditioning - Quantum Learning Insights Epiphanies Revelations Aha!s Therapeutic break-throughs

Defocused mode Dreams Daydreams, reveries Stream of consciousness Imagination Guided visualization

I am larger than I thought. I did not know I held so much goodness I am larger than I thought. I did not know I held so much goodness. - Walt Whitman Love teaches me I am everything. Wisdom teaches me I am nothing. Between the two, my life flows. - Sri Nisargadatta

Meditation

Catalyze Brain Change: From Incremental Skills to Quantum Learning Linda Graham, MFT www.lindagraham-mft.net linda@lindagraham-mft.net