Transcript Catalyzing Brain Change:From Incremental Skills toQuantum

2015 Psychotherapy Networker Symposium
March 28, 2014
Washington, D.C.
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
www.lindagraham-mft.net
[email protected]
All the world is full of suffering.
It is also full of overcoming.
- Helen Keller
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
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.
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
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
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
 Evolutionary legacy
 Genetic templates
 Family of origin conditioning
 Who we are and how we cope…
…is not our fault
 Given neuroplasticity
 and choices of self-directed neuroplasticity
 Who we are and how we cope…
…is our responsibility
Mechanisms of Brain Change
 Conditioning
 New Conditioning
 Re-Conditioning
 De-Conditioning
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
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
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 selfworld, 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
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
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
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
New Conditioning
 Strengthen pre-frontal cortex
 Brain more resilient
 Brain more receptive
 We are more resilient
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
Re-conditioning
 Memory de-consolidation – re-consolidation
 “Light up” neural networks
 Juxtapose old negative with new positive
 Neurons fall apart, rewire
 New rewires old
Re-conditioning
 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
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
Modes of Processing
 Focused
 Tasks and details
 New conditioning and re-conditioning
 De-focused
 Default network
 Mental play space
 De-conditioning
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
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
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
Practices to Accelerate Brain Change
 Presence – primes receptivity of brain
 Intention/choice – activates plasticity
 Perseverance – creates and installs change
Mindfulness and Psychotherapy
 Even-hovering attention
 Unconditional positive regard
 Observing ego
 “What are you noticing now?”
 Catch the moment; make a choice
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
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
Incremental Learning to Quantum Leaps
 Antidote negativity bias; rewire defensive
patterns
 Install new, more resilient strategies
 New conditioning
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Use higher brain to rewire higher brain
DBT, MBCBT, ACT, positive psychology
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
Incremental Learning to Quantum Leaps
 Expand to creativity, flow, flourishing
 Embody, express authentic self
 Deconditioning
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Default network
Jungian, transpersonal, spiritual, visualizations,
imagery
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
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
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
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
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.
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
Neuroscience of empathy
 Dyadic regulation
 Social engagement system
 Vagal brake
 Fusiform gyrus regulates amygdala
 Restores equilibrium
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.
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.
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
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”
Create a Circle of Support
 Imagine several people who love and support
you, who are “on your side” – partners, close
friends, benefactors (therapists-mentorsteachers). 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
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
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?
Relational Intelligence
 Receiving/reaching out for help
 Setting limits and boundaries
 Negotiating change
 Repairing ruptures
 Forgiveness
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
Setting Limits and Boundaries
 Identify values that determine limit
 Create context of mindful empathy
 Assert limits/boundaries
 State consequences
 Enforce consequences
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
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
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
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
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
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
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
Compassion Practice
 Mindfulness
 Awareness of what’s happening
 (and our reaction to what’s happening)
 Self-Compassion
 Acceptance of what’s happening
 (and our reaction to what’s happening)
 Compassion – Common Humanity
 Wise effort in response to what’s happening
 (and our reactions to what’s happening)
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

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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
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
Take in the Good
 Notice: in the moment or in memory
 Enrich: the felt sense in the body
 Absorb: savor 10-20-30 seconds, install in long-
term memory
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
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
Love makes your soul crawl out of its hiding
place.
- Zora Neale Hurston
Love guards the heart from the abyss.
- Mozart
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
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
Reconditioning
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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
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
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
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
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.
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.
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.
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
De-conditioning - Quantum Learning
 Insights
 Epiphanies
 Revelations
 Aha!s
 Therapeutic break-throughs
Defocused mode
 Dreams
 Daydreams, reveries
 Stream of consciousness
 Imagination
 Guided visualization
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
Linda Graham, MFT
www.lindagraham-mft.net
[email protected]