rewire your brain

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Rewire Your Brain John Boghosian Arden, PhD

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Page 1: Rewire Your Brain

Rewire Your BrainRewire Your Brain

John Boghosian Arden, PhD

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With CHILDRENWith CHILDREN

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With ADULTSWith ADULTS

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PSYCHOLOGICAL THEORIES

NEUROSCIENCE EVIDENCE-BASEDPRACTICE

THERAPEUTICALLIANCE

Brain-Based TherapyBrain-Based Therapy

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100 Billion Neurons100 Billion Neurons

• Neurons are social:

Each Neuron has approximately 10,000 synaptic connections with other neurons

• Connection = Survival

“Neural Darwinism” (Edelman, 1992):

If connections are not maintained and strengthened, the neurons will die

• Neurons that fire together, wire together (Hebb, 1948)

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The Neurochemical OrchestraThe Neurochemical Orchestra

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The HemispheresThe Hemispheres

LH RH

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Right HemisphereRight Hemisphere

• Sees the “Whole Picture”—the gist of the situation

• Reads emotional expressions and body language

• Has heightened development during the first two years

• Picks up the emotional content in speech

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Right HemisphereRight Hemisphere

• Picks up prosody (rhyme, meter) and cadence in speech

• Responds positively to novelty, new learning

• Is context sensitive

• Expresses in the left side of the face

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Left HemisphereLeft Hemisphere

• Processes positive emotion

• When damaged, “Catastrophic Effect”

• Problem-Solving

• Routinized

• Old learning (e.g., accomplished musicians)

• Not good at reading facial expressions

• Expresses in the right side of the face

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Left HemisphereLeft Hemisphere• Processes Language

• The “Interpreter”: Makes sense of experience or confabulates– Puts positive spin on events (e.g., “The White House

Press Secretary”)

– Confabulation occurs when RH is disconnected

• Detail-oriented

• Uses linear processing

• Sequential

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fMRI and LanguagefMRI and Language

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Brain EvolutionBrain Evolution

•Human evolution is the story of growth & increased complexity of the cortex

•PFC- 20% of the human brain is comprised of the frontal lobes(FYI - 3.5% of the cat’s brain is in the frontal lobe)

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Evolution and Increased FrontalizationEvolution and Increased Frontalization

• PFC expansion in hominids

• 20% of the human brain is comprised of the frontal lobes

• FYI - 3.5% of the cat’s brain is in the frontal lobe

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Pre-Frontal LobesPre-Frontal Lobes

• The “Executive” brain –Executive control center

• Motor pre-frontal lobes are last to myelinate – e.g., teenagers

– Identity

– Insight

– Sense of Self

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Pre-Frontal LobesPre-Frontal Lobes• Dorsolateral pre-frontal cortex---working

memory: 7, plus or minus 2, or 20-30 seconds of information

• Orbital pre-frontal cortex (Phineas Gage)– Social brain

– Affect regulator

– Empathy

– Attachment, warmth, and love

– Connections with limbic area, i.e., amygdala

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Phineas Gage Death MaskPhineas Gage Death Mask

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Phineas GagePhineas Gage

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Your Anatomy Final

QuickTime™ and aApple Intermediate Codec decompressor

are needed to see this picture.

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New Discoveries in NeuroscienceNew Discoveries in Neuroscience

• Affect Asymmetry

• Neuroplasticity and Neurogenesis

• Social Brain networks

• Memory systems

• Nutritional Neuroscience

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Affect AsymmetrySummary

Affect AsymmetrySummary

LEFT FRONTAL LOBE

• Positive emotions

• Approach behaviors

• Labeling thoughts and feelings and developing new narratives (help to

alleviate anxiety and depression)

RIGHT FRONTAL LOBE

• Negative emotions

• Withdrawal behaviors

• Feeling overwhelmed

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Systems of the Social BrainSystems of the Social Brain

• Brain Structures

– Orbital Frontal Cortex (OFC)

– Amygdala

– Insula

– Cingulate

– Mirror Neurons

– Spindle Cells

– Facial expression modules

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Systems of the Social BrainSystems of the Social Brain

• Neurotransmitter systems include:

– Oxytocin

– Dopamine

• Central Nerve

– Vagus Nerve

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The Vagus Nerve

• Tenth Cranial Nerve --a complex of sensory and motor nerve fibers.

Vagal tone- the ability to modulate target organs without sympathetic arousal

• allows attachment and sustained relationships.

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NeuroplasticityNeuroplasticity• Neuroplasticity is a general term that

describes changes in the brain as you experience and learn (Buonomano & Merzenich, 1998)

• Neuroplasticity involves many changes to the brain including:

– New synaptic connections

– Strengthening of connections through LTP

– The growth of new dendrites (dendritogenesis)

– Neurogenesis (the growth of new neurons)

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Examples of NeuroplasticityExamples of Neuroplasticity

• London cabdrivers - larger right posterior hippocampus. The longer they were on the job, the larger the size of their hippocampus. (Maguire, et al, 2000)

• Adults who juggled three balls for 3 months increased grey matter in the midtemporal area and left posterior intraparietal sulcus. - 3 months of little or no juggling, -- grey matter decreased and approached baseline values. (Draginski, et al, 2003)

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Examples of NeuroplasticityExamples of Neuroplasticity

• Musicians using specific fingers to play their instruments showed enlarged areas of their somatosensory strips associated with those fingers. (Pantev, et al, 2001)

• Blind Braille readers showed enlarged cortical areas associated with their reading finger compared to blind non-Braille readers and to sighted people. (Pascul-Leone & Torres, 1993)

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Good News/Bad NewsGood News/Bad News

• Enriched environments– Neurons sprout more dendrites

– More synaptic connections are formed

• Deprived environments and trauma– Change the brains of abused children

– Chronically elevated cortisol– Smaller left frontal lobes and hippocampal (Bremner et al., 1997)

– Less integration of left and right hemispheres (Teicher, 2004)

– Produce more psychopathology, suicides, and medical problems in adults (Felitt

• Drugs

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Brain EnvironmentsBrain Environments

Enriched Environment

Impoverished Environment

The Medium is

the Message

“Your Brain on TV”

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“What’s Missing?”“What’s Missing?”

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NeurodynamicsNeurodynamics

• The brain is a complex system characterized by nonlinear change

– Pax Medica employs linear causes/effects

• Complex systems:

– Tend toward increasing complexity, i.e., they are self-organizing

– Maintain continuity and flexibility

– Need new inputs to expand (a lake vs. a pond)

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Rewiring: States to TraitsRewiring: States to Traits

• Induce repeated states (weak attractors)

• (i.e. positive moods)

• Repeat often enough so they become traits – (or strong attractors)

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Mind/Brain and communicationMind/Brain and communication

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A Mnemonic “Recipe” for FEEDing Your BrainA Mnemonic “Recipe” for FEEDing Your Brain

• Focus

• Effort

• Effortlessness

• Determination

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Brain Derived Neurotropic FactorBrain Derived Neurotropic Factor

• BDNF plays a crucial role in reinforcing neuroplasticity and neurogenesis.

• BDNF is like Miracle Grow to help:

– Consolidate the connections between neurons. It helps neurons fire together to wire together

– Promotes the growth of myelin to make your neurons fire more efficiently

– Acts on stem cells in the hippocampus to grow into new neurons

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NeurogenesisNeurogenesis

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Adolescent Brain ChangesAdolescent Brain Changes• Brain Thinning

(Synaptic pruning): 5 to 21

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Mirror NeuronsMirror Neurons• Helps us respond sympathetically and

empathically to others

• Gives us the ability to anticipate others’ intentions

• Mirror systems are found in:

– Motor

– Affect

– Cognition Theory of Mind (ToM)

– Social contagion (e.g., yawning)

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Facial ExpressionsFacial Expressions

Left Hemisphere Right Hemisphere

• Controls expression on the left side of face

• Is adept at reading facial emotion

expression

• Controls expression on the right side of face

• Is NOT adept at reading facial emotion

expression (e.g. alexithymics)

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Still Face

QuickTime™ and aApple Intermediate Codec decompressor

are needed to see this picture.

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D SmilesD Smiles

• Guillaume Duchenne (1806-1875) identified the activity of the orbicularis oculi muscle

• Non-D smiles possibly masking negative states and more likely to be asymmetrical

• D smiles -- L-PFC activation

• Non-D smiles -- R-PFC activation (Ekman, et al,

1996)

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Pupil DilationPupil Dilation

• The “Window to the Soul,” the eye is the only visible part of the brain

• We like large pupils more than small pupils

• People with large pupils are perceived as being more trustworthy, attractive, interesting, and interested

• Men find large pupils more attractive while only women who like “bad boys” prefer large pupils

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BlushingBlushing

• Involuntary

• Depends on an awareness of being observed

• Occurs more on the side of the face we are being looked at

• Communicates to the other that we are emotionally aware of them and having feelings about what we are doing

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Two Memory SystemsTwo Memory Systems

Implicit Explicit

Amygdala-driven Hippocampus-driven

• Procedural• Emotional• Generalized

• Declarative• Autobiographical• Semantic• Context Specific

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AMYGDALA

HIPPOCAMPUS

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HIPPOCAMPUSExplicit Memory System

AMYGDALAImplicit Memory System

• Fear Conditioning• Emotional Valance• Generalized• Cortisol Heightened

Sensitivity (Hypervigilence)

• Matures Early• “Little Albert”

• Many Cortisol Receptors• Context Specific• Heightened Cortisol

leads to atrophy• Matures Later• Infantile Amnesia• “H.M.”

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Henry MolaisonHenry Molaison

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The Dynamics of FearThe Dynamics of Fear

• Amygdala memories are hard to forget (“Stone tablet”)

• Hippocampal circuits tell us what to fear and in what context (“Etch-a-Sketch”)

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Memory (summary)Memory (summary)

• A moderate degree of anxiety works best to facilitate neuroplasticity and new memory

• “Flashbulb Memories” (e.g. JFK’s assassination and 9/11) are facilitated by the release of adrenaline and norepinephrine

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The Slow Circuit to the AmygdalaThe Slow Circuit to the Amygdala

• Goes from the Thalamus through the Cortex and Hippocampus to the Amygdala

• Worries and GAD

• Fears and Phobias

• Taming the Amygdala

• Exposure, New Thinking (cortex) and Deconditioning

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The Fast Circuit to the AmygdalaThe Fast Circuit to the Amygdala

• Goes from the Thalamus directly to the Amygdala

• Fight or Flight: HPA activation

• Emotional Learning

• Fear Conditioning

• PTSD, Anxiety, etc.

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Memory SkillsMemory Skills

• Memory is not a thing• Childhood memories

–The case against repressed memory

• Memory is always being rewritten–Heraclitus…

• Working Memory and Long Term

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Improving Your MemoryImproving Your Memory

• Prepare your brain– Diet– Exercise– Avoid memory depressors (ETOH & MJ)

• Attention skills—open the gate• Make it mean something to you

– Get you nucleus accumbens involved!

• The inverted “U”• Repetition (cells that fire together…)

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Improving Your MemoryImproving Your Memory

• Spacing • Chunking • Combine different types of memory– State based memory– Combine visual, auditory etc • Using Associations– Mnemonics: NATO– Pegging – Loci– Story-link

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Hypothalamo-Pituitary-Adrenocortical (HPA) Axis:

Cortisol Levels

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Long-Term or Traumatic Stress Long-Term or Traumatic Stress

Cortisol Cascade Hypothesis:

• Stress causes production of cortisol• Excessive cortisol causes dendrites in the

hippocampus to shrivel up (Sapolsky, 1996)

• This feedforward loop leads to heightened reactivity of amygdala

• The hippocampus is essential for turning off HPA axis, damage to it leads to even more cortisol release as time passes

• PTSD patients with smaller hippocampi (Bremner, 1999)

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Allostasis Allostasis

• Allostatic adjustments are adaptive over the short term—cortisol helps orchestrate adjustments by: – enhancing or inhibiting gene transcription – regulation of BDNF– up regulates amygdala activity– targets prefrontal systems involved in stress

and the emotion (Sullivan & Gratton, 2002). – maintaining stability through a change (McEwen, 1998).

• Allostatic load --When demands exceed the balance of energy expenditure against the energy and regulatory gains from rest and recuperation. (McEwen and Wingfield, 2003).

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Measures of Allostatic Load Measures of Allostatic Load

• ↑BP

• Waist-to-hip ratio

• Blood cholesterol

• Glycosylated hemoglobin (glucose metabolism over a period of days)

• ↑cortisol and norepinphrine in overnight urine

• All the above can predict cognitive deficits 2 years later (McEwen, 2002)

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Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

EarlyDeath

Adverse Childhood Experiences

Death

Disease, Disabilityand Social Problems

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StressStress

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AnxietyAnxiety

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Neurodynamics of AnxietyNeurodynamics of Anxiety

• Two routes to the amygdala, the fast and slow

• Right hemisphere bias in general for anxiety disorders

• Under-activation of the left frontal lobes and in Broca’s area explains why some people feel “speechless” when they’re scared (Rauch et al., 1997).

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Avoiding AvoidanceAvoiding Avoidance

• Forms of Avoidance

–Escape behaviors

–Avoidant behaviors

–Procrastinating

–Safety behaviors

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Avoiding AvoidanceAvoiding Avoidance

• Why avoidance is hard to resist:

– It works to reduce fear over the short term

– The more you engage in avoidance behaviors the harder it is to resist repeating them in the future because they become habits

– There is a superficial logic to avoidance, such as “Why wouldn’t I avoid something that makes me anxious?”

– You get some secondary gain from it like extra care because people around you feel sympathy

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Taming the AmygdalaTaming the Amygdala

– Exposure

– Exercise

– Changing thinking errors

• automatic thoughts

• assumptions

• core beliefs

– Global/Passive (R-PFC) vs. Detail/Action (L-PFC)

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Interoceptive ExposureInteroceptive Exposure

• There are a variety of interoceptive exercises including:

–Running in place--- to increase heart rate and hyperventilation

–Holding your breath--- to tighten the chest and create sensations of suffocation

–Spinning--- leading to dizziness

–Hyperventilation or breathing through a straw---leading to light-headedness

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PanicPanic

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Four systems-related categories associated with depression:

Four systems-related categories associated with depression:

• Mood changes (dysphoria, hopelessness, suicality, anhedonia, anxiety)

• Circadian dysregulation (low drive, energy, appetite, sleep, libido)

• Motor deficits (slow movement, restlessness, agitation)

• Cognitive impairment (poor attention, working memory, executive function, ruminations)

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SSRIs

• Debuted in 1974• Shift from meaning to pharmacology

• Correct “chemical imbalances in the brain”

• By 2005, antidepressants became the most frequently prescribed drug in the US

– About 1:20 men and 1:10 women use antidepressants

– 1:20 Americans sees a licensed mental health professional for any type of psychotherapy

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Serotonin Hypothesis Revisted

Serotonin Hypothesis Revisted

• A re-analysis of the anti-depressant medication meta-sample was published in the New England Journal of Medicine. All but one of the positive 38 studies were published; but only one of the 40 negative studies made it into print.

• Positive studies 12 times more likely to be published than studies finding negative results

• A lower effect-size for antidepressants (just over placebos but not by much).

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Medication SSRIMedication SSRI

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Cognitive Behavior TherapyCognitive Behavior Therapy

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Depression and HippocampusDepression and Hippocampus

• Some previously depressed people show hippocampal shringage in the range of 8 to 19%

• Causes?:–Corisol (Sapolsky, 2001)

–Excitotoxicity (Margarines, et al, 1999)

–Blocking neurogenesis (Jacobs, et al, 2000)

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Neurodynamics of DepressionNeurodynamics of Depression

• Exercise reduces depression, boosts BDNF, increases serotonin, norepinephrine, and dopamine

• Fatty acids also play a part in making us depression-proof by limiting the devastating effects of cortisol on neurogenesis

• Medication works on a bottom-up basis

• Therapy works on a top-down basis

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Hemispheric Asymmetry and Depression

Hemispheric Asymmetry and Depression

• Evidence from neurology—strokes– Left side stroke—catastrophic effect and

become very depressed– Right side stroke— laissez-faire effect and

demonstrate more acceptance and much less depression.

• Relative inhibition of the left PFC and relative activation of the right PFC (Davidson, 2000).

• Left PFC associated with positive emotions and is action oriented

• Right PFC associated with negative emotions and is passive--withdrawal oriented

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Cultivating DepressionCultivating Depression

• Pessimism

• Self-critical

• Irritability

• Apathy

• Inactivity

• Poor diet

• Alcohol/drugs

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Effort-Driven Reward Circuit (Lambert, 2008) Effort-Driven Reward Circuit (Lambert, 2008)

• Nucleus accumbens-striatal PFC network

– ↓accubens—loss of pleasure

– ↓striatum—sluggishness and slow motor responses

– ↓PFC—poor concentration

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Effort-Driven Reward Circuit (Lambert, 2008) Effort-Driven Reward Circuit (Lambert, 2008)

• Kindling this circuit by activities

– ↑DA and 5-HT

– ↑positive feelings

– Efforts reap rewards and problem solving

i.e. Behavioral Activation

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Effort-Driven Reward Circuit (Lambert, 2008) Effort-Driven Reward Circuit (Lambert, 2008)

• PFC activates when you plan an activity

• Striatum activates as you do it

• Accumbens activates when you feel the pleasure of doing it

• All the above increases the sense of self control

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Loneliness and Depression Loneliness and Depression

• In Portugal 1000 people 65> assessed Loneliness was the single most important predictor of distress and not knowing the neighbor increased the probability of depression (Paul, et al, 2006)

• In London 2600 people 65> More than 15% were at risk for social isolation and depression (Illife et at, 2007)

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Mindfulness and DepressionMindfulness and Depression

Mindfulness targets depression by neutralizing:– Monotony– Ruminations: via wide spectrum

observation and detachment– Thinking errors: via affective

labeling– Fixations on imperfections: via

acceptance

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Cultivating Positive MoodsCultivating Positive Moods• Methods for getting out of negative mood states and

cultivating positive moods:

– Priming positive moods

– Light chemistry

– Constructing narratives

– Taking action

– Aerobic boosting

– Wiring positive thinking

– Social medicine

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5 Healthy Habits 5 Healthy Habits

Planting SEEDSS—Social MedicineE—ExerciseE—Education D—Diet S—Sleep Hygiene

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The Effects of Social MedicineThe Effects of Social Medicine• Cardiovascular reactivity (Lepore, et al, 1993)

• Blood pressure (Spitzer, et al, 1992)

• Cortisol levels (Kiecolt-Glaser, et al, 1984)

• Serum cholesterol (Thomes, et al, 1985)

• Vulnerability to catching a cold (Cohen, et al, 2003)

• Depression (Russell & Cutrona, 1991)

• Anxiety (Cohen, 2004)

• Natural killer cells (Kiecolt-Glaser, et al, 1984)

• Slows cognitive decline (Bassuk, et al 1999)

• Improves sleep (Cohen, 2004)

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Touch, Voice and SmilingTouch, Voice and Smiling

• Touch is a critical aspect of early communication and bonding (Sapolsky, 1997).

• Even physical proximity directly effects the electrical activity in each individual’s brain (McCraty et al., 1998).

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Smiling—to kindle positive moods Smiling—to kindle positive moods

Perceiving the smiles of others triggers the release of DA (Depue & Morrone-Strupinsky)

Presenting smiles for a fraction of a second followed by neutral stimulus increases the positive reaction to that stimulus (Dimburg & Ohman, 1996)

Bilateral smiles ↑L-PFC positive moods

Smiling during periods of stress ↓cardiovascular arousal back to baseline (Fredrickson & Levenson, 1998)

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Laughter is Good MedicineLaughter is Good Medicine

• Improves cognitive function (Fry, 1992)

• Exercises and relaxes the muscles (Kuhn, 1994)

• Increases heart rate and blood pressure (Pearce, 2004)

• Decreases cortisol levels (Berk, et al, 1988)

• Increases natural killer cell activity (Takahashi, et al, 2001)

• Altering gene expression (Hayashi, et al, 2006)

• Stimulates the dopamine reward system (Mobbs, et al, 2003)

• Increased longevity (Yoder & Haude, 1995)

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Psychological Boost of HumorPsychological Boost of Humor

• Anxiety (Yovetich, et al, 1990)

• Stress (Wooten, 1996)

• Depression (Deaner & McConatha, 1993)

• Self esteem (Martin, etal, 1993)

• Energy and hope (Bellert, 1989)

• A sense of empowerment (Wooten, 1996)

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Love Love

Activation of the reward systems to see with rose colored glasses

• Medial insula, Caudate, Putamin and Ventral anterior cingulate

Deactivation of fear (i.e amygdala and R-PFC)---↑potential blindness to red flags

Oxytocin—the “cuddling hormone”• Activating the vagus nerve• ↓heart rate and ↑relaxation

↑ Dopamine “in love”

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Exercise OptimizesExercise Optimizes

• Cognition

–alertness

–attention

–motivation

–cognitive flexibility

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Exercise OptimizesExercise Optimizes

• Mood

–↑ neurotransmitters

»Serotonin

»Dopamine

»norepinephrine

–physical health

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Exercise OptimizesExercise Optimizes

• Neurogenesis

–new neurons in the hippocampus

• Neuroplasticity

–↑ BDNF

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Exercise and Repair ProcessesExercise and Repair Processes

• Insulin-like Growth Factor (IGF-1)

• Vascular Endotheclial Growth Factor (VEGF)

• Fibroblast Growth Facto (FGF-2)

• Brain Derived Neurotrophic Factor (BDNF)

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Breaking a FastBreaking a Fast

• Skipping Breakfast

↓ problem solving

↓ short-term ↓ attention and episodic memory

↓Mood swings– Difficulty concentrating– Low energy– Increased stress reactivity– Increased anxiety and depression

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Amino Acid Neurotransmitter Effects

L-Trytophan Serotonin Improves sleep and calmness and mood

L-Glutamine GABA Decreases tension and irritability

L-Phenylalanine Dopamine Reduces anger and increases feelings of pleasure

L-Phenylalanine Noreprinephrine Increases energy, feelings of pleasure, and memory

Amino Acids Amino Acids

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Deficiencies of B VitaminsDeficiencies of B Vitamins

Low B-1 Low B-2 Low B-6 Low B-12 Folic Acid

*Decreased

Alertness

*fatigue

*Emotional

Instability

*Decreased

reaction

time

*Trembling

*Sluggish

*Tension

*Depression

*Eye

problems

*Stress

*Nervousness

*Irritable

*Depression

*Muscle

weakness

*Headaches

*Muscle

Tingling

*Mental

slowness

*Confusion

*Psychosis

*Stammering

*Limb

weakness

*Memory

problems

*Irritable

*Mental

sluggishness

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Stress and Fatty AcidsStress and Fatty Acids

• Stress can have a destructive effect on fatty acids. Those effects include:

– Inadequate replacement of lost fatty acids

– Destruction (rancidity) of long-chain fatty acids in the brain

– Depletion of long-chain fatty acids in the brain contribute to depression (Hibbeln, 1995)

The imbalanced ratio between Omega-6 and Omega-3 has been correlated with depression.

• Increased triglycerides (vegetable oil and animal fat) is correlated with depression (Glueck, 1998)

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Excessive Trans-fatty AcidsExcessive Trans-fatty Acids

• May be taken up directly into your nerve membranes.

• May block your body’s ability to make its own essential fatty acids—so critical for your brain.

• May alter the synthesis of neurotransmitters such as dopamine.

• May negatively effect your brain’s blood supply.

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Omega-3 Fatty AcidsOmega-3 Fatty Acids

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AlcoholAlcohol

• Drinking on a regular basis -- cognitive deficits such as:

– ↓performance on tests of visual and spatial perception

– ↓visual and spatial learning ability

– ↓ ability to make fine motor movements

– ↓ adaptive abilities

– ↓ short-term memory

– ↓ non-verbal abstract learning

– ↓ abstract thinking ability

– ↓ conceptual thinking ability

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AlcoholAlcohol• Alcohol contributes to the following problems as much

as several days after drinking:

– ↑stress and anxiety

• ↓GABA—panic attacks common

– ↑depression

• ↓serotonin and DA for as much as a few weeks after the last drink

– Alcohol-related insomnia (mid sleep cycle awakening).

• ↓ deep sleep (Stage 4)

• ↓REM sleep.

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The Importance of Sleep for the Brain

The Importance of Sleep for the Brain

• Protein synthesis (Ding, et al, 2004)

• Synthesis and transport of cholesterol (Cirelli, 2005)

• Expression of molecules associated with synaptic plasticity (Taishi, et al, 2005)

• Increase LTP (Cirelli, 2005)

• Gene expression (Cirelli, 2005)

• Memory consolidation

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“Learned” Insomnia“Learned” Insomnia

• “I’m not going to get to sleep tonight.”

• Bed becomes an enemy—a negative cue.

• Sleep later on the weekends to compensate.

• Next night you feel as you are losing sleep.

• You try too hard to get to sleep.

• Thoughts about sleep add to daytime stress.

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Sleep HygieneSleep Hygiene

• Don’t “try too hard” to go to sleep.

– You’ll frustrate yourself, leading to a paradoxical effect, and work yourself into an anxious state of mind.

• Tell yourself “it’s okay if I get just a few hours sleep tonight. I will catch up the next night.”

– This change in expectation will free you up to be able to relax. The harder you try to go to sleep the harder it will be to induce sleep.

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Sleep HygieneSleep Hygiene

• Avoid drinking large quantities of liquid at night.

–This will lower the sleep threshold and cause you to wake up to urinate.

• Avoid bright light at least a few hours before going to sleep.

–Don’t work on the computer into the late evening.

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Sleep HygieneSleep Hygiene

• Try eating a light snack with complex carbohydrates before bed.

– Foods rich with L-Tryptophan are advisable. Don’t eat anything with sugar or salt before bed.

• Avoid protein snacks at night because protein blocks the synthesis of serotonin and as a result promotes alertness.

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Sleep HygieneSleep Hygiene

• Exercise 3 to 6 hours before you go to bed. A brisk walk before or after dinner time is perfect.

• Avoid alcohol

• Sleep scheduling technique.

• Try the relaxation exercises. These help you go to sleep or go back to sleep if you wake up during the night.

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Mindfulness Meditation Mindfulness Meditation

Decentering – thoughts and feelings are events—not realities

Intentionality – breaking out of automatic thoughts and behaviors

Reducing Avoidance -- turning toward difficulties

Anti-ruminative – here and now focus not the past or future

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Mindfulness and the BrainMindfulness and the Brain

• Long-term meditators show increased thicknesses of the medial prefrontal cortex and also enlargement of the right insula (Lazar, et al, 2005).

• The process of verbal labeling of affective states reduces anxiety and negative affect (Leiberman, et al, 2004)

• The middle prefrontal cortex has been associated with self observation and mindfulness meditation (Cahn and Polich, 2006).

• A shift the left PFC which puts a positive spin on the experience (Davidson, et al., 2003).

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Mindfulness for Tx of Diagnostic Groups

Mindfulness for Tx of Diagnostic Groups

• Borderline patients in dialectic behavior therapy (Linehan, 1993)

• Patients with OCD (Baxter, et al., 1992)

• Patients with depression (Teasdale)

• Patients with general medical problems such as chronic pain (Kabit-Zinn, 1990).

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SpiritualitySpirituality

Common threads:

--Being here now

–Compassion

–Unity

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