Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net The Art and Science of Brain Care : Psychotherapy Networker Symposium Washington, D.C. March 26, 2015 Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net

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

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

Energetic vacation / napping

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 Hang Out with Healthy Brains

Exercise - Movement Macro Micro 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 Micro 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 Micro Eat healthy! Savor (eat a raisin meditation) 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 Micro 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 Micro 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 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 email of gratitude, acknowledgement, appreciation to friend, co-worker

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

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

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

Regulate Stress Macro Micro 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 Satisfaction-reward cortisol Satisfaction-reward dopamine Soothing-comfort-caregiving oxytocin

Frustration / Beaming with satisfaction / Comforted

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 Pre-empt stress reponse

Touch Hand on heart, hand on cheek Head rubs, foot rubs Massage back of neck Hugs – 20 second full bodied

Calm through the Body Hand on the heart Body scan Progressive muscle relaxation Soles of the feet Sense and savor walk

Barefeet in the sand

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

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

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)

Self-Compassion Kind, gentle attention to self when there is hurt, pain, shame, suffering Powerful and immediate antidote to self-criticism, self-loathing Practice not to feel better but because we feel bad Putting own oxygen mask on first when other people are not around Come into loving connected presence Compassion leads to calm leads to clarity; platform for wise action to alleviate suffering of others.

Compassion Research and Study Center for Investigating Healthy Minds (U. Wisconsin) http://www.investigatinghealthyminds.org Center for Mindful Self-Compassion (U.C. San Diego) www.centerformsc.org Kristin Neff: www.self-compassion.org Christopher Germer: www.mindfulselfcompassion.org Center for Compassion and Altruism Research and Education (CCARE - Stanford) http://ccare.stanford.edu Greater Good Science Center (U.C. Berkeley) www.greatergood.berkeley.edu Compassionate Mind Foundation (Paul Gilbert) www.compassionatemind.co.uk

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 Loving Kindness with Self-Compassion Self-Compassion Break One for Me, One for You Compassion 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

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

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 10-20-30 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 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

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

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

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

Connections Seeing Ourselves as Others See us Compassionate Friend Wished for Outcome

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.

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

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

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

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)

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 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

Parent comforting child

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

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

Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net The Art and Science of Brain Care : Psychotherapy Networker Symposium Washington, D.C. March 26, 2015 Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net