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

2. 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

3. 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

5. 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

6. 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.

7. 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

8. Parent comforting child

9. 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

10. Brain lit up

11. 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

12. Walking hand in hand

13. Evolutionary legacy
Genetic templates
Family of origin conditioning
Who we are and how we cope…
…is not our fault

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

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

16. 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

17. Gullies on a hillside

18. 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

19. 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

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

21. 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

23. 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

25. 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

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

28. 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

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

30. Pleasant thought bubble

31. 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

32. 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

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

34. 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

35. Creative pondering

36. 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

37. 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

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

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

40. 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

41. 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

42. Angry / Happy

43. 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

44. Distressed / Delighted

45. 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

46. Shame / Triumphant

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

48. Peaceful activity

49. 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

50. 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

51. 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

53. 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

54. People talking and looking peaceful

55. 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.

56. Listening and working things out

57. 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

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

59. 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.

60. 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.

61. 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

62. 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”

63. 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

64. 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

65. 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?

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

67. 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

68. Someone helping another person

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

70. 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

71. 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

72. 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

73. Forgiveness

74. 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

75. 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

76. 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

77. 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

78. 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)

79. 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

80. 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

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

82. 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

84. 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

85. Bowed in shame

86. 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

87. Hopeful

88. 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

89. 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

90. 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

91. 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

92. 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

93. 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

94. Creativity

95. 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.

96. 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.

97. 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.

98. 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

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

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

102. 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

103. Meditation

104. Catalyze Brain Change: From Incremental Skills to Quantum Learning
Linda Graham, MFT