1. Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net The Neuroscience of Resilience Kaiser Permanente Physician Wellness Happiness: Evidence Based Research October 17, 2015

2. 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 linda@lindagraham-mft.net www.lindagraham-mft.net

3. Resilience Hardiness Grit, will to survive Determination, perseverance, endurance, follow-through Coping Face and deal with challenges and crises Navigate life’s twists and turns, unexpected and disruptive Bounce back from adversity, from truly awful Flexibility Responsiveness; able to shift gears: perspectives, views, behaviors You can’t stop the waves, but you can learn to surf. - Jon Kabat-Zinn

4. Response Flexibility 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

5. Response Flexibility Between a stimulus and 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

6. Compassion Fatigue Ineffectiveness, helplessness Dissatisfaction, disillusionment Exhaustion, emptiness Compassion fatigue = empathy fatigue Self-Care: Macro: vacation, gym, learn something new Micro: self-compassion break, hand on heart, notice and name

7. Response Flexibility How you respond to the issue…is the issue. - Frankie Perez, Momentous Institute

8. 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

9. Modern Neuroscience How neural structures/circuits develop How brain processes information; communicates within itself How brain learns/installs patterns of coping How brain rewires its memory patterns

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

11. 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

12. 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 brain structures The brain changes itself – lifelong Norma Doidge, M.D. The Brain that Changes Itself, The Brain’s Way of Healing

13. Mindfulness and Empathy Two of the most powerful agents of brain change known to science In the moment, instant shift in functioning Over time, practices in procedural memory Way of being, way of well-being

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

15. 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 Without intervention, is what the brain does Conditioning is neutral, wires positive and negative

16. New Conditioning Choose new experiences Focused attention, compassionate listening, gratitude practice Create new thoughts, new experience of self Create new learning, new memory Encode new wiring Install new pattern of response, new habits, new ways of being

17. Re-conditioning Memory de-consolidation – re-consolidation “Light up” neural networks Juxtapose old negative with new positive Neurons fall apart, rewire New rewires old

18. Modes of Processing Focused Attention Tasks and details Deliberate, guided change New conditioning and re-conditioning De-focused Attention Default network Mental play space – random change De-conditioning

19. De-Conditioning De-focusing, loosens grip of attention Creates mental play space, plane of open possibilities, free association Reverie, daydreams, guided visualizations, guided meditations Brain “plays,” makes own links and associations, connects dots in new ways Generates new insights, aha!s new behaviors

20. Functions of Pre-Frontal Cortex Center of executive functioning: judgment, planning, analysis, decision making Regulates body and nervous system Quells fear response of amygdala Manages emotions Attunement – felt sense of feelings Empathy – making sense of expereince Insight and self-knowing Response flexibility CEO of Resilience

21. Intelligences Somatic:Body-based equilibrium Emotional: managing one’s own emotions and empathizing with others’; compassion Relational: connect, heal heartache, access resources, navigate peopled world Reflective: conscious awareness, mindfulness

22. Somatic Intelligence Regulate ANS – sympathetic and parasympathetic Reside in, expand window of tolerance Use body-based practices to shift mood, restore and expand brain functioning

23. 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

24. 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 Lift each foot; place back down Walk slowly; notice changes in sensations Offer gratitude to your feet that support your entire body, all day long

25. 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 “Power Posing” – Amy Cuddy TED talk

26. 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

27. 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

28. Oxytocin – Neurochemical Balm Close, positive, long-term relationships may offer us a relatively steady source of oxytocin release; every hug, friendly touch, and affectionate moment may prime this neurochemical balm a bit. - Daniel Goleman, Social Intelligence

29. Emotional-social-relational Intelligence Experience, manage, express all emotions Attune, resonate with others’ emotions Empathy, compassion for self and other Theory of mind Trust self, others, relationships Use pro-social emotions to shift brain Open to learning and change

30. Positive Emotions GratitudeAweGenerosity CompassionDelight Serenity Love Curiosity Kindness Joy Trust

31. 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 Resilience is direct outcome

32. Kindness is more important than wisdom, And the recognition of that is the beginning of wisdom. - Theodore Rubin Doing a kindness produces the single most reliable momentary increase in well-being of any exercise we have tested. - Martin Seligman

33. 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

34. Increasing the social connections in our lives is probably the single easiest way to enhance our well-being. - Matthew Lieberman, UCLA Social: Why Our Brains Are Wired To Connect

35. 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

36. Take in the Good Notice: in the moment or in memory Enrich: the felt sense in the body Absorb: savor 10-20-30 seconds, felt sense in body Repeat: 6 times a day, install in long-term memory

37. Relational Intelligence Reaching out and asking for help Setting limits and boundaries Negotiating change Resolving conflicts Repairing ruptures Forgiveness http://lindagraham-mft.net/wp-content- uploads/2013/12/Relational-Intelligence.pdf

38. Compassion Fatigue = Empathy Fatigue Empathy: feeling emotions of others in one’s self; accepting another’s experience “Given what’s happening, it’s perfectable understandable you would feel the way you do.” Compassion: accepting experiencer, moved by pain and suffering of others to care, take wise action

39. Self-Compassion Break [Hand on Heart] 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

40. 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

41. 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.

42. 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

43. Reflective Intelligence Catch the moment; make a choice - Janet Friedman Every moment has a choice; Every choice has an impact. - Julia Butterfly Hill

44. Mindfulness Pause, become present Notice and name Step back, dis-entangle, reflect Monitor and modify Shift perspectives; shift states Discern options Choose wisely – let go of unwholesome, cultivate wholesome

45. Imagine walking down the street Notice someone you know walking toward you Wave “hello!” There’s no response. Notice your response to the lack of response The person notices you and waves “hello!” Notice your response to the response Notice any differences in your responses

46. 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.

47. Practices to Accelerate Brain Change Presence – primes receptivity of brain Intention/choice – activates plasticity Practice – creates new pathways, new more resilient habits of coping Perseverance – “little and often” installs change

48. 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.

49. 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.

50. 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.

51. 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

52. Linda Graham, MFT linda@lindagraham-mft.net www.lindagraham-mft.net The Neuroscience of Resilience Kaiser Permanente Physician Wellness Happiness: Evidence Based Research October 17, 2015