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Psychotherapy Networker 2014 Symposium March 20, 2014 Washington, D.C. Slide 2 Linda Graham, MFT www.lindagraham-mft.net lindagraham2@earthlink.net Bouncing Back: Rewiring Your Brain For Maximum Resilience and Well-Being Slide 3 I arise in the morning Torn between the desire To save the world And a desire to savor the world. This makes it hard to plan the day. - E.B. White Slide 4 Self Care: Antidote to Compassion Fatigue Overwhelm of care for others Self-care drops off the radar Clinicians are vehicles for concern and care Self-care: replenish and resource self Energy and bandwidth to care for others Slide 5 Neuroscience of Self-Care 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 Slide 6 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 Slide 7 The field of neuroscience is so new, we must be comfortable not only venturing into the unknown but into error. - Richard Mendius, M.D. Slide 8 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 Slide 9 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 Slide 10 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 Slide 11 Evolutionary legacy Genetic templates Family of origin conditioning Norms-expectations of culture-society Who we are and how we cope. is not our fault. Slide 12 Given neuroplasticity And choices of self-directed neuroplasticity Who we are and how we cope is our responsibility Slide 13 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 ones attitude in any given set of circumstances. - Viktor Frankl, Austrian psychiatrist, survivor of Auschwitz Slide 14 7 Rs of Self-Care Replenish Recognize Regulate Reflect Resource Re-Frame Re-Wire Slide 15 Resilience Deal with challenges and crises Bounce back from adversity Recover our balance and equilibrium Find refuges and maximize resources Cope skillfully, flexibly, adaptively Shift perspectives, open to possibilities, create options, find meaning and purpose Slide 16 Replenish Sleep Nutrition Movement-Exercise Laughter Hanging Out with Healthy Brains Slide 17 Sleep Housekeeping Reset nervous system Consolidate learning Take mental breaks Slide 18 How to Sleep Well Stick to a sleep schedule Pay attention to what you eat and drink Create a bedtime ritual Get comfortable Limit daytime naps Include physical activity in your daily routine Manage stress Slide 19 Take Mental Breaks Focus on something else (positive is good) Talk to someone else (resonant is good) Move-walk somewhere else (nature is good) Avoid adrenal fatigue Slide 20 Nutrition Less Caffeine Less Sugar More Protein Slide 21 Movement - Exercise Oxygen brain is 2% of body weight, uses 20% of bodys oxygen Endorphins feel good hormones, brighten the mind Brain-Derived Neurotrophic Factor (BDNF) - grow new brain cells, will migrate to where needed Slide 22 Laughter Increases oxygen and blood flow, reduces risk of heart disease and stroke Releases endorphins bodys natural pain killer Reduces stress hormone cortisol, lowers blood pressure Triggers catecholamines, heightens alertness in brain Releases tension in body, balances nervous system Slide 23 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 Slide 24 How to Promote Laughter Humor A person without a sense of humor is like a wagon without springs jolted by every pebble in the road. - Henry Ward Beecher Play Play, in short, prepares the brain to handle the unexpected. Lee Alan Dugatkin Playful resonance Laughter is the closest distance between two people. Victor Borge Slide 25 Hanging Out with Healthy Brains Brain is social organ; matures and learns best in interactions with other brains Social engagement regulates nervous system Resonant interactions prime the brains neuroplasticity; promotes learning and growth Slide 26 Recognize Mindfulness: Focused attention on present moment experience without judgment or resistance. - Jon Kabat-Zinn Attention and allowing Awareness and acceptance Slide 27 Mindful Self-Compassion Awareness of whats happening (and our reaction to whats happening) Acceptance of whats happening (and acceptance of our reaction) Brain stays plastic, open to learning Slide 28 Self-Compassion Break Notice-recognize: this is a moment of suffering Ouch! This hurts! This is hard! Pause, breathe, hand on heart or cheek Oh sweetheart! Self-empathy Of course this is painful, and Im not the only one; Im not alone Drop into calm; hold moment with awareness; breathe in compassion and care May I be free of suffering and the causes of suffering Share experience with resonant other Slide 29 Regulate: Keep Calm and Carry On Serenity is not freedom from the storm but peace amidst the storm. - author unknown Slide 30 Oxytocin Hormone of safety and trust, bonding and belonging, calm and connect Brains direct and immediate antidote to stress hormone cortisol Can pre-empt stress response altogether Slide 31 Hand on the Heart Touch Deep breathing Positive Emotions Brakes on survival responses Oxytocin safety and trust Relationships as resources Slide 32 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 Slide 33 Reflect Mindfulness and Psychotherapy Even-hovering attention Unconditional positive regard Observing ego What are you noticing now? Slide 34 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 Slide 35 Resource Practices Places People Slide 36 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 Slide 37 Positive Emotions GratitudeAweGenerosity CompassionDelight Serenity Love Curiosity Kindness Joy Trust Slide 38 Positive Emotions Help us feel and function better Put the brakes on negativity Antidote survival responses Foster the left shift, open to experience Better coping with stress and trauma Possibilities, creativity, productivity Cooperation and collaboration Flexibility and resilience Slide 39 Kindness is more important than wisdom, And the recognition of that is the beginning of wisdom. - Theodore Rubin Slide 40 Neuroscience of Sharing Positive Emotions Social engagement system Dyadic regulation Vagal brake Fusiform gyrus regulates amygdala Emotional communication is 93% non-verbal Restores equilibrium Slide 41 Gratitude 2-minute free write Gratitude journal Gratitude buddy Carry love and appreciation in your wallet Slide 42 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 Slide 43 Take in the Good Notice: in the moment or in memory Enrich: the intensity, duration, novelty, personal relevance, multi-modality Absorb: savor 10-20-30 seconds, felt sense in body Slide 44 Places as Resources Nature as refuge re-Source Nature is our biology, our being We can create and notice shifts in perspective Slide 45 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 Slide 46 Attachment Styles 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 Slide 47 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 Slide 48 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 Slide 49 I have learned that people will forget what you said and people will forget what you did, but people will never forget how you made them feel. - Maya Angelou Slide 50 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 Slide 51 The roots of resilience are to be found in the felt sense of being held in the heart and mind of an empathic, attuned, and self-possessed other. - Diana Fosha, PhD Slide 52 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 cant use shame to change ourselves or others. Slide 53 Love makes your soul crawl out of its hiding place. - Zora Neale Hurston Love guards the heart from the abyss. - Mozart Slide 54 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. Slide 55 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 Slide 56 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 Slide 57 Relational Intelligence Setting limits and boundaries Negotiating change Resolving conflicts Repairing ruptures Forgiveness Slide 58 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. Slide 59 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. Slide 60 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. Slide 61 Re-frame Regrettable Moment Teachable Moment Whats Right with this Wrong? Whats the Lesson? Whats the Cue to Act Differently? Find the Gift in the Mistake Slide 62 Coherent Narrative This is what happened. This is what I did. This has been the cost. This is what Ive learned. This is what I would do differently going forward Slide 63 Mechanisms of Brain Change Conditioning New Conditioning Re-Conditioning De-Conditioning Slide 64 New Conditioning Choose new experiences Positive emotions, resonant relationships, self- compassion, self-acceptance Create new learning, new memory Encode new wiring Install new pattern of response Slide 65 Re-conditioning Light up neural networks Juxtapose old negative with new positive De-consolidation - re-consolidation New rewires old Slide 66 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 Slide 67 De-Conditioning De-focusing Loosens grip Creates mental play space Plane of open possibilities New insights, new behaviors Slide 68 Brahma Viharas Loving Kindness Compassion Sympathetic Joy Equanimity Slide 69 Modes of Processing Focused Tasks and details Self-referential New conditioning and re-conditioning De-focused Default network Fertile neural background noise De-conditioning Slide 70 Practices to Accelerate Brain Change Presence primes receptivity of brain Intention/choice activates plasticity Perseverance creates and installs change Slide 71 I am no longer afraid of storms, For I am learning how to sail my ship. - Louisa May Alcott Slide 72 Linda Graham, MFT www.lindagraham-mft.net lindagraham2@earthlink.net