1. 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

3. 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

4. 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

5. Energetic vacation / napping

6. Compassion Fatigue Exhaustion Lack of job satisfaction
Feeling powerless to effect change
Despair

8. 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

11. 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

12. How to Replenish Human Brain
Exercise-Movement
Sleep - Rest
Nutrition
Laughter-Play
Learn Something New
Hang Out with Healthy Brains

13. 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

15. 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)

17. 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

19. 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

21. 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

23. 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

25. 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 of gratitude, acknowledgement, appreciation to friend, co-worker

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

28. 6 C’s of Coping Calm Compassion Clarity Connections to Resources
Competence
Courage

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

31. 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

32. 3 Motivational Systems Threat-protection Satisfaction-reward
cortisol
Satisfaction-reward
dopamine
Soothing-comfort-caregiving
oxytocin

33. Frustration / Beaming with satisfaction / Comforted

34. 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

36. 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

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

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

40. Barefeet in the sand

41. 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

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

45. 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)

46. 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.

47. Compassion Research and Study
Center for Investigating Healthy Minds (U. Wisconsin)
Center for Mindful Self-Compassion (U.C. San Diego)
Kristin Neff:
Christopher Germer:
Center for Compassion and Altruism Research and Education (CCARE - Stanford)
Greater Good Science Center (U.C. Berkeley)
Compassionate Mind Foundation (Paul Gilbert)

48. 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

49. Practices of Mindful Self-Compassion
Affectionate Breathing
Loving Kindness with Self-Compassion
Self-Compassion Break
One for Me, One for You
Compassion with Equanimity

50. 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

51. 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

52. 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

53. 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

54. 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.

56. 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

58. 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

59. Practices of Positive Emotions
Gratitude
Take in the Good
Circle of Support
Positivity Portfolio

60. Gratitude 2-minute free write Gratitude journal Gratitude buddy
Carry love and appreciation in your wallet

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

62. 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

63. 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. Clarity - Mindfulness Focused attention on present moment experience
without judgment or resistance.
- Jon Kabat-Zinn

67. 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

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

69. 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.

70. 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.

71. 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.

72. 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

73. 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

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

76. 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.

77. 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

78. 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

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

80. 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)

82. 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.

83. 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

84. 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

85. 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

86. Parent comforting child

87. Resilience, Creativity, Flow and Flourishing
I am no longer afraid of storms, for I am learning to sail my ship.
- Louisa May Alcott

89. 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

90. 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

91. 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