Linda Graham, MFT Bouncing Back: The Neuroscience of Resilience and Well-Being Esalen December 11-13, 2015

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

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

Resilience and Well-Being Hardiness Grit, will to survive Determination, perseverance, endurance, follow-through Coping Face and deal with disappointments, difficulties, disasters Navigate life’s twists and turns, unexpected and disruptive Reduce stress and trauma, recover baseline equilibrium Bounce back from adversity, from truly awful Flexibility Shift perspectives, open to possibilities, create options Find meaning and purpose; move into thriving and flourishing

Response Flexibility 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

Response Flexibility Between a stimulus and 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

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

Response Flexibility How you respond to the issue…is the issue. - Frankie Perez, Momentous Institute

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

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

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

Intelligences Somatic:Body-based equilibrium Emotional: managing one’s own emotions and empathizing with others’; compassion Relational: connect, heal heartache, access resources, navigate peopled world Reflective: conscious awareness, mindfulness

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

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

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

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

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

Modern Neuroscience How neural structures/circuits develop How brain processes information; communicates within itself How brain learns/installs patterns of coping How brain rewires its memory patterns

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.

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

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. - Paul Gilbert, The Compassionate Mind

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

Pre-Frontal Cortex Center of executive functioning Evolved most recently; matures the latest Development kindled in relationship 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 CEO of resilience

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 Without intervention, is what the brain does Conditioning is neutral, wires positive and negative

New Conditioning Choose new experiences Focused attention, compassionate listening, gratitude practice Create new thoughts, new experience of self Create new learning, new memory Encode new wiring Install new pattern of response, new habits, new ways of being

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.”

Re-conditioning Memory de-consolidation – re-consolidation “Light up” neural networks Juxtapose old negative with new positive Neurons fall apart, rewire 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 Attention Tasks and details Deliberate, guided change New conditioning and re-conditioning De-focused Attention Default network Mental play space – random change De-conditioning

De-Conditioning Default network De-focusing, loosens grip of attention Creates mental play space, free association Can drop into worry, rumination Can drop into plane of open possibilities Brain makes new links, associations New insights, aha!s new behaviors

De-Conditioning Reverie, daydreams Imagination Guided visualizations Guided meditations 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 – creates new pathways, new more resilient habits of coping Perseverance – “little and often” installs change

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

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

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 Affectionate Breathing Hand on the Heart Safe, soothing touch Body Scan Progressive Muscle Relaxation Soles of the Feet Rewiring through Movement Power Posing Mindful Self-Compassion

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 dy_language_shapes_who_you_are 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)

Self-Compassion 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

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

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 In the present moment – restores equanimity Over time – creates new patterns of behavior Becomes way of being – natural, effortless

Hand Gestures of Self-Compassion Fists closed Palms open, facing upward Palms extended and forward Palms placed over heart

Self-Compassion Break Notice moment of suffering, or inquire: “Is there any suffering here?” Ouch! This hurts! This is painful. Soothing touch (hand on heart, cheek, hug) Common humanity: I’m not alone; I’m not the only one 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

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 GratitudeAweGenerosity CompassionDelight Serenity Love Curiosity Kindness Joy Trust

Negativity Bias - Positive Emotions 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 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

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: the felt sense in the body Absorb: savor seconds, felt sense in body 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

Connections to Resources Practices Yoga, tai chi, meditation, prayer Places Sacred places; safe places People Resonant Social

Relationships Lead to Resilience and Well-Being Social “Pancake” - broad Resonant “Cathedral” - deep

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

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

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

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 Parenting is attuned, empathic, responsive, comforting, soothing, helpful Attachment develops safety and trust, and inner secure base Stable and flexible focus and functioning Open to learning inner secure base provides buffer against stress, trauma, and psychopathology

Insecure-Avoidant Parenting is indifferent, neglectful, or critical, rejecting Attachment is avoidant of people and emotions, withdrawn, compulsively self-reliant Stable, but not flexible Focus on self or world, not others or emotions Rigid, defensive, not open to learning Neural cement

Insecure-Anxious Parenting is inconsistent, unpredictable Attachment is clingy, needy, compulsive caregiving Flexible, but not stable Focus on other, not on self-world, Less able to retain learning Neural swamp

Disorganized Parenting is frightening or abusive, or parent is “checked out,” not “there” Attachment is paralysis, fright without solution Lack of focus Moments of dissociation Compartmentalization of trauma

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

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”

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

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

While vulnerability is the birthplace of many of the fulfilling experiences we long for – love, belonging, joy, creativity, and trust, to name a few – the process of regaining our emotional footing in the midst of struggle is where our courage is tested and our values forged. Rising strong after a fall is how we cultivate wholeheartedness in our lives; it’s the process that teaches us the most about who we are. - Brene Brown, Rising Strong

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 uploads/2013/12/Relational-Intelligence.pdf

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 Monitor and modify Shift perspectives; shift states Discern options Choose wisely – let go of unwholesome, cultivate wholesome

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

Shift Happens Shit happens Shift happens, too Shift can happen in this moment Shift can happen in any moment That’s the shift

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

Mindfulness Dissolves the Stuff of “Self” Quantum physics investigates matter Matter is more space than stuff Mindfulness investigates “I” Self is not static or fixed; is ever-changing, ever-unfolding True Self is flow of beingness

Breathing into Infinity Anchor awareness in your breathing, and in the awareness that lets you know you’re breathing Expand awareness to include people near you, other people you know; people you don’t know in this town, region, country, all over the planet – all breathing, and the awareness that lets you know Expand awareness to include animals, plants, birds, fish. The earth itself: land, air, ocean – all breathing, and the awareness that holds it all Return to awareness of your breathing, in this moment and place, and of your awareness

Then it was as if I suddenly saw the secret beauty of their hearts, the depths of their hearts where neither sin nor desire nor self- knowledge can reach, the core of their reality, the person that each one is in the eyes of the Divine. If only they could all see themselves as they really are. If only we could see each other that way all the time. There would be no more war, nor more hatred, no more cruelty, no more greed. …I suppose the big problem would be that we would fall down and worship each other. - Thomas Merton

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

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

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 Acceptance of reality; create the new narrative Support from family; belief in recovery Community of “the tribe” Positive re-framing; positive meaning of negative event Helping others Appreciate new life because of catastrophe

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

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.

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

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 Be afraid not…or be a frayed knot. – Bev Stevens

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

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

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 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

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

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 Friendships, book clubs, bowling league, 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

Linda Graham, MFT Bouncing Back: The Neuroscience of Resilience and Well-Being Esalen December 11-13, 2015