Brain Care is Self-Care

1. Brain Care is Self-Care Psychotherapy Networker 2014 Symposium March 20, 2014 Washington, D.C.

2. Brain Care is Self-Care Linda Graham, MFT www.lindagraham-mft.net lindagraham2@earthlink.net Bouncing Back: Rewiring Your Brain For Maximum Resilience and Well-Being

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

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

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

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

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.

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

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

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

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.

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

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 one’s attitude in any given set of circumstances. - Viktor Frankl, Austrian psychiatrist, survivor of Auschwitz

14. 7 R’s of Self-Care • Replenish • Recognize • Regulate • Reflect • Resource • Re-Frame • Re-Wire

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

16. Replenish • Sleep • Nutrition • Movement-Exercise • Laughter • Hanging Out with Healthy Brains

17. Sleep • Housekeeping • Reset nervous system • Consolidate learning • Take mental breaks

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

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

20. Nutrition • Less Caffeine • Less Sugar • More Protein

21. Movement - Exercise • Oxygen – brain is 2% of body weight, uses 20% of body’s oxygen • Endorphins – feel good hormones, brighten the mind • Brain-Derived Neurotrophic Factor (BDNF) - grow new brain cells, will migrate to where needed

22. 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

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

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

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 brain’s neuroplasticity; promotes learning and growth

26. Recognize Mindfulness: Focused attention on present moment experience without judgment or resistance. - Jon Kabat-Zinn Attention and allowing Awareness and acceptance

27. Mindful Self-Compassion • Awareness of what’s happening • (and our reaction to what’s happening) • Acceptance of what’s happening • (and acceptance of our reaction) • Brain stays plastic, open to learning

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 I’m not the only one; I’m 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

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

30. 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

31. Hand on the Heart • Touch • Deep breathing • Positive Emotions • Brakes on survival responses • Oxytocin – safety and trust • Relationships as resources

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

33. Reflect Mindfulness and Psychotherapy • Even-hovering attention • Unconditional positive regard • Observing ego • “What are you noticing now?”

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

35. Resource • Practices • Places • People

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

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

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

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

40. Neuroscience of Sharing Positive Emotions • Social engagement system • Dyadic regulation • Vagal brake • Fusiformgyrus regulates amygdala • Emotional communication is 93% non-verbal • Restores equilibrium

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

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

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

44. Places as Resources • Nature as refuge – re-Source • Nature is our biology, our being • We can create and notice shifts in perspective

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

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

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

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

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

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