1. Brain Care: The Neuroscience of Self Care
Esalen Institute May 8-10, 2015 Linda Graham, MFT

2. 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

3. 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

4. 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

5. 6 C’s of Coping Calm Compassion Clarity Connections to Resources
Competence
Courage

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. Evolutionary legacy Genetic templates Family of origin conditioning Norms-expectations of culture-society Who we are and how we cope…. …is not our fault.

17. Given neuroplasticity
And choices of self-directed neuroplasticity
Who we are and how we cope…
…is our responsibility
Paul Gilbert, PhD, The Compassionate Mind

18. 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

19. 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

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

21. 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

22. Between a stimulus and a response there is a space
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

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

24. 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.”

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

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

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. 6 C’s of Coping Calm Compassion Clarity Connections to Resources
Competence
Courage

34. Calm Manage disruptive emotions Tolerate distress
Down-regulate stress to return to baseline equilibrium

35. 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

36. 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

37. 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

38. 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

39. Courage Using signal anxiety as cue to: Try something new Take risks
Move resilience beyond personal self

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

41. 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

42. 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

43. 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

44. 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

45. 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

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

47. 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

48. 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

49. 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

50. 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)

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

52. 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)

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

54. Mindfulness and Compassion Activate Caregiving System
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

55. 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

56. 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

57. 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

58. 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

59. 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.

60. 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

61. Positive Emotions
Gratitude Awe Generosity Compassion Delight Serenity Love Curiosity Kindness Joy Trust

62. 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

63. 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

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

65. 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

66. 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

67. 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

68. Mindfulness Comes to West
Mindfulness: Focused attention on present moment experience without judgment or resistance. - Jon Kabat-Zinn

69. 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

70. 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

71. 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.

72. 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

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

74. 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.

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

76. 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.

77. 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.

78. 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.

79. 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.

80. 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

81. 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

82. 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

83. 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

84. 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

85. 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

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

87. 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

88. 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.

89. 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?

90. 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.

91. 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

92. 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”

93. 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

94. 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

95. 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

96. 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

97. 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

98. 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

99. Relational Intelligence
Reaching out and asking for help
Setting limits and boundaries
Negotiating change
Resolving conflicts
Repairing ruptures
Forgiveness

100. 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.

101. 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.

102. 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.

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

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

105. 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

106. 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.

107. 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

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

109. 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

110. 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

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

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

113. 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

114. 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)

115. 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

116. 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

117. 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

118. 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

119. 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

120. 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