Brain Care is Self Care Kripalu Center for Yoga and Health May 15-17, 2015 Linda Graham, MFT

Linda Graham, MFT Marriage and Family Therapist – 25 years 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

Brain Care is Self Care Nourish and replenish brain; nourish and replenish self Choose new experiences; harness neuroplasticity Mechanisms of brain change: conditioning, new conditioning, re-conditioning, de- conditioning

Rewiring for Resilience and Well-Being Rewire brain out of stress-trauma-negativity- inner critic Recover resilience and resources – stability and flexibility Choose new experiences; harness neuroplasticity Move to thriving and flourishing

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

Kindness is more important than wisdom, And the recognition of that is the beginning of wisdom. - Theodore Rubin Share-listen-reflect stories of kindness received

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

How to Replenish Human Brain Exercise-Movement Sleep – Mental Breaks Nutrition Laughter-Play Learn Something New Hang Out with Healthy Brains

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

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

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

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

Neuroscience of Resilience 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

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

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

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 Paul Gilbert, PhD, The Compassionate Mind

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 Planning, decision making

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

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

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

How you respond to the issue…is the issue. - Frankie Perez

Shift from Self-Critical Voice to Self-Compassionate Voice Loving awareness of breathing Let a moment of discomfort arise; notice where you feel in the body Notice any critical self-talk; notice the words; notice the tone of voice Use critical voice as cue to practice: “May I be kind to myself in this moment; may I accept myself in this moment exactly as I am.”

The curious paradox is that when I accept myself just as I am, then I can change. - Carl Rogers

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

Re-conditioning 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

Modes of Processing 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

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 Practice – create new pathways, new more resilient habits of coping Perseverance – creates and installs change

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 Increasing the social connections in our lives is probably the single easiest way to enhance our well-being. - Matthew Lieberman, UCLA author of Wired to Connect

Competence 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

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

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 Deep breathing Positive Emotions Brakes on survival responses Restore coherent heart rate variability Oxytocin – safety and trust Relationships as resources

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 A single exposure to oxytocin can create a lifelong change in the brain. - Sue Carter, PhD

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

Calm through the Body Hand on the Heart Safe, soothing touch Body Scan Progressive Muscle Relaxation Soles of the Feet Rewiring through Movement Power Posing

Calm – Friendly Body Scan Awareness Breathing gently into tension Hello! and gratitude Release tension, reduce trauma

Progressive Muscle Relaxation Body cannot be tense and relaxed at the same time Tense for 7 seconds, relax for 15 Focused attention calms the mind

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

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)

Mindfulness and Compassion Awareness of what’s happening (and our reactions to what’s happening) Acceptance of what’s happening (and our reactions to what’s happening) Two most powerful agents of brain change known to science; both foster response flexibility Rewiring that is safe, efficient, effective

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)

Self-Compassion Threat-protection system Cortisol driven Pleasure-reward system Dopamine driven Caregiving-soothing-comfort system Oxytocin driven Paul Gilbert, The Compassionate Mind

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 Activates caregiving system Shift from reactivity and contraction to openness, engagement

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

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

Loving Kindness with Self-Compassion Sit comfortably, focus on gentle breathing, in and out Feel breath in entire body; let your body breathe you Breathe into areas of physical stress, discomfort Notice difficult emotions; incline awareness toward contraction or discomfort Self-compassion phrases: “May I be….” Your own phrases of kindness, tenderness, care Rest in stillness and peace in body

One for Me; One for You 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.

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 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

A hundred times every day, I remind myself that my inner and outer life depend on the labors of other people, and that I must exert myself in order to give in the same measure as I have received and am still receiving. - Albert Einstein

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 Repeat: 6 times a day; 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

Mindfulness Comes to West 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

Notice and Name Thoughts as thoughts Patterns of thoughts as patterns of thoughts Cascades of emotions as cascades of emotions States of mind as states of mind Belief systems and identities as… Mental contents, patterns of neural firing All mental patterns are optional

Notice Patterns of Reaction Imagine walking down the sidewalk, noticing someone you know walking on the other side of the street toward you Imagine you wave and call out “Hello!” There’s no response; notice your reaction. Now imagine the person notices you, waves and calls out “Hello!” Notice your reaction Reflect on the differences in your reactions.

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptive to change. - Charles Darwin

Mindfulness Catch the moment; make a choice - Janet Friedman Every moment has a choice; Every choice has an impact. - Julia Butterfly Hill

Breathing into Infinity Focus awareness on breathing, and on awareness of breathing, and on awareness Extend awareness to people near you; people you know; people in neighborhood, region, country, all over the planet Extend awareness to all creatures; to earth itself Extend awareness beyond planet; always remain aware of awareness.

Brahma Viharas Loving Kindness Compassion Sympathetic Joy Equanimity Send and receive wishes to and from your partner

Shifting Perspectives in Nature BELLY BOTANY Select a one square foot patch of earth. Observe patch from two feet away/above for two minutes. (light and shadow, movement and stillness, beauty and decay, life and death) Shift your view to the larger landscape, all the way to the horizon. Reflect on shift in perspective.

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

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, UCLA The moment we cease to hold one another, the sea engulfs us and the light goes out. - James Baldwin

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

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

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

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

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.

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?

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. 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”

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. - Brene Brown, PhD

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

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

Relational Intelligence Reaching out and asking for help 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.

Forgiveness is not an occasional act; It is a permanent attitude. -Martin Luther King, Jr.

Competence Bodily felt sense of “Sure I can!” Based on previous competence No matter what, no matter how small Ownership

Competence 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

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

Find the Gift in the Mistake 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

Courage It’s as wrong to deny the possible As it is to deny the problem. - Dennis Seleeby

Courage 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

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

How to Replenish Human Brain Exercise-Movement Sleep – Mental Breaks Nutrition Laughter-Play Learn Something New 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) Talk to someone else (resonant is good) Move-walk somewhere else (nature is good) 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 Read two minutes of jokes

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

Hang Out with Healthy Brains Macro Friendships, extra-curricular activities and clubs, athletics, choir 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