Attention is drawn to pain

Major road blocks to well-being:

> Unhealed emotional wounds
> Significant emotional and
personality constriction
> Times of facing extreme stressor
our own mortality
Wellness: WHO
A state of physical, mental
and social well-being
not merely the absence
of disease
Well-Being:
A National
and International
Perspective
Well-being and Happiness
in the United States
Among 173 countries surveyed:
USA: # 23

Denmark: #1
Japan: #90
India: 125
Comparison: Now and in 1950
The GNP has increased x3
1950: one car per 2 drivers
now: more cars than drivers
Average sq. ft. house USA: 1950:
1200 sq. ft. now: 2500 sq ft.
Comparison: Now and in 1950
1/5
th
of people graduated from
high school; now
Social changes: civil rights, women's
rights, better health care,
increased access to
entertainment and learning

However
Across Studies:
Experiences
bring more
happiness than
possessions
Perspectives on Happiness
Happiness, an emotional state
characterized by positive or
pleasant emotions ranging from
contentment to intense joy
Perspectives on Happiness
Happy about an outcome (may not
not be associated with feelings
of happiness)
Im happy they caught
that murderer
Perspectives on Happiness
Relief from pain, loneliness,
boredom, fear

All things considered Well-being
may be a more useful term
Happiness and Beyond
Pleasure
Engagement
Meaningfulness
Sacrifice
Transcending suffering and
psychological burdens
(bigger picture)

Daniel Gilbert: Stumbling On Happiness
Emotional Habits:
Why so hard to change ?
Locked-in patterns of
relating with others
Emotional Habits
Automatic, over-learned
response patterns;
often not chosen

Strongly influenced by
deeply entrenched
attitudes, beliefs,
personality styles and
world views
Emotional Habits
Reactions influencing:
> Emotional response in the
Moment
Have influence over-arching
life decisions


Emotional Habits

Driven by ingrained
rather hard-wired limbic system
and basal ganglia-level
reactions
Basal Ganglia
Habitual reaction patterns:

Not consciously mediated.
But can be over-ridden
via top-down control
(frontal lobes)
Frontal Lobes and 5
Emotional Habit Circuits
PFC*
* PFC: Pre-Frontal Cortex
Anterior
Cingulate
Frontal Lobe Circuits
Orbitalcaudatethalamus:
worry loop
Orbitalstriatum: impulse
control/reward
PFC / Anterior Cingulateamygdala: fear
Lateral dorsal: motivation
PFC sadness/happiness

Worry Loop
(Schwartz, 2002)
Orbital
Frontal
Caudate
Thalamus
Orbital FrontalStriatum: Reward and Impulse Control
Orbital
X
Anterior CingulateAmygdala
X
Behavioral
Activation
Therapy
Lateral
Dorsal
Frontal


Frontal Activation:
always is enhanced by awareness,
attention and will
Perspectives on Emotions
Emotional State: Quickly dissipates
Mood: minutes-to-hours-to days
Traits/Styles : enduring emotionally-
toned characteristics; a consistent
way of responding * (i.e. grumpy)
* stable across time: personality and biology

What doesnt kill
you, makes you
stronger


Psychological Resilience
and Ego Strength
The ability to endure significant
emotional pain and hardship
and not collapse/decompensate



Emotional Resiliency
Ego strength
Slow to recover-------------Quick to recover
The ability to regain equilibrium following
a stressful or an emotionally painful event
Dys-control Control









Zone of emotional tolerance
Ego Strength
A major factor:
the ability to face and
withstand strong emotions
The concept of
Top-Down
Control


Area 25: Depression


Hyper-metabolic Area 25
Sadness
Negative thinking
Dis-engagment
Increased cortisol
Decreases in neuroprotective
protein BDNF
Engaging top-down control

Deep brain stimulation (electrodes)
Successful treatment with:
Prozac, Effexor, ECT,
Psychotherapy
decreased activity
in area 25
Resiliency: Biological Recovery
Resiliency: top-down control:
More active left frontal lobe
(EEG studies) better emotional
resiliency
Impact of brain damage
Primitive
Emotional
Responses
Impulsive
Immature
Often Maladaptive
and
Can save your life
Primitive Emotional Responses
sometimes can save your life
Selected to increase survival
Fight-Flight-Freeze
Tend and Befriend
Rewards / approach
Perspectives on Emotion
Appraisal then emotion
S-R can work without a brain
or without consciousness

Perspectives on Emotion
Initial behavioral response:
> Crude; adaptive
> Appraisal:
Safe or dangerous
> Approach/withdrawal
In Humans
Primitive Emotional Responses
Stimulus-Response
Mediated by deep brain
structures (reptilian brain
and limbic system)
Parallel Information
Processing
and Fear Appraisal
Cortical-level Appraisal
Multi-sensory integration
Reflective
(vs. impulsive) style
Can reality testing




Amygdala-Level Appraisal
Acquired: one-trial learning
Rapid, crude, adaptive
Pattern recognition
Cannot reality test
Prone to false alarms

Information Processing and
Responding: Amygdala
Appraisal beneath the radar
of consciousness
Activates Impulsive style:
stimulus-response

Stimulus-Response
SNS nerves travel @ 250 mph
Initial response: GSR:
Acquired Fears
Snakesand.
Perceptions of criticism, rejection,
anger, disgust, physical closeness,
responses to expressions of the self
Inner awareness of: neediness, longing,
fear, welling up of feelings

Acquired Fears often lead
to significant
global
personality constriction:
A major impediment to
experiencing happiness and
living a meaningful life
Reward Circuits in the Brain
Driving Approach Behavior
and Curiosity

more later
Time Magazine Poll (2004)
17% report brimming with
happiness just about all of the time
58% frequently happy
About 25 % almost never experience
much happiness

Sustained Happiness has many influences
Lyubomirksy, 2008
Individual set point (genetics)
Intentional activity (coping)
Objective life circumstances
Life Satisfaction:
A better descriptor
Contentment with ones life
meaningfulness even if not
happy in the ordinary
sense of the word


Authentic Happiness
(Martin Seligman, 2002)
Sensual pleasures: the lowest and
most transitory source
of satisfaction
The wicked witch of
bodily pleasures:
rapid habituation
Happiness & Habituation
Enough is enough

If too much: becomes
more neutral
If done even more: unpleasant
Maximizing Pleasure:
Respecting Habituation
Savor the sensation (20-30 seconds)
Mindfulness: notice the experience
Avoid repeating the experience
right away
Example: food: the 10 minute rule
States of happiness are inherently
transient and unstable
Reward Circuits
Multiple Possibilities for
Reward/Reinforcement
Heighten sense of anticipation
the hunt: sweeter than the kill
Pleasure, per se
Relief from withdrawal
symptoms
Multiple Possibilities for
Reward/Reinforcement
Dampen negative emotions
anxiety, depression
the superego is alcohol soluble


Many substances of abuse
increase dopamine activity.
Alcohol
Tobacco
Marijuana
Opioids
Stimulants
Sedatives

Endo-cannabinoids
Arachidonate lipids
Anandamine
2-Arachidonoyglycerol
Dopamine:
Antidepressants
Wellbutrin;
MAO inhibitors


How do you spell
relief ?

Pleasure via relief
from suffering
Dampening Negative Emotions
not happiness
Amygdala: opiate, oxytocin,
cannabinoid , serotonin
( perception of anxiety)
Brain stem: Locus Coeruleus
(firing rates) ..
The LOCUS COERULEUS
Dopamine
Increased dopamine:
Not pleasure per sebut
Anticipation of reward :
Wanting (not liking)
Cues activate dopamine neurons
Feel tempted
83
Activation upon thinking about cocaine use
Dopamine
Craving addicts may not
even get pleasure from a drug

Drug abuse tricks the brain into
over-valuing opportunities
Hedonic Hot Spots
Activated during pleasure
Hedonic Hot Spots
Nucleus Accumbens
Ventral Pallidum
Insula (images of loved oneorgasmsmusic)

Ventral Pallidum
lesions here abolish all pleasure
x
Insula
89
Beyond Dopamine:
Pleasure Molecules
Hormones and
Neurotransmitters
Endorphins, GABA, Oxytocin,
Endogenous Cannabinoids
warm, cozy, calm,
satisfied feelings
Hemispheric Differences
SOME research suggests: Left PFC
is associated with
with the ability to
sustain happiness
Hemispheric Differences
SOME research suggests:
damage t0 Left PFC:
associated with depression
and pathological crying
Studies with Infants
Sophisticated EEG monitoring
Stimulus:
> water: no specific activation
> sweet: left activation
> bitter (lemon) right activation
Studies with Infants
EEG Monitoring
Actress:
> Smiling: Left activation
> Crying: Right activation
Depression
EEG at rest
Decreased left activation
Increased right activation

EEGs and Videos
(Davidson)
Cute puppies: Left activation
Fear, disgust: Right activation
Hemispheric Differences
SOME research suggests that
increased activation of the
Right PFC is associated
with negative emotions
Hemispheric Differences
But a meta-analysis (Murphy, et al. 2003)
suggests that these results
are equivocal

Bad Emotional Habits
Strongly associated with past learning
(often one-trial learning)
Most often associated with attempts to
cope and survive
Anticipation of aversive outcomes
(social anxiety)

Emotional Habits
Sometimes: Solutions that Backfire
Tension reduction (rocking, repetitive
movements; self-mutilation)
Avoidance (isolation)
Grit teeth (excessive
emotional constriction)
Substance abuse

Habits Also Associated with
Outlook
How you characteristically
view life.
Negative to Positive
Cognitive Stoppers

> dont rock the boat
> dont tryyoull be rejected
> youll fail
> youll look stupid
> dont show off
Habits:
Entrenched
Neural Pathways
Clinical Examples:
Obsessive-Compulsive
Disorder,
Rumination and
Generalized Anxiety
Disorder
The Caudate and Gating
Adaptive Responding
(Schwartz, 2002)
Orbital
Frontal
Caudate
Thalamus
Strengthened Pathways and
Improved Gating
(Schwartz, 2002)
PFC
Anterior
Cingulate
Caudate
Exposure + Response Prevention


Obsessive-
Compulsive
Disorder
Elements of Change: Role of the PFC
Resist the urgeinhibit impulses
Actively re-directing ones attention
Attention and willfully resisting the
urge: activates and strengthens
the PFC and its neural
network of inhibition
J. Schwartz (2007)
Fires up
little-used inhibitory pathways
and weakens old
pathological ones
The PFC and anterior cingulate
Impact on Frontal Lobes
SSRIs (e.g. Prozac)
Exercise
Worry time
Habit Change Requires
Slow, deliberate acquisition
of emotional skills:
Conscious intention,
focus and will

Re-wiring of the brain
Changing emotional habits
is difficult.
Keep in Mind:
Somewhat genetically determined
Conscious awareness can break this up
Automatic Negative thoughts
and feelings set the tone
H & N perceptionsanticipations/expectationsmotivation
EXERCISE & OUTLOOK
and Action Strategy
Diurnal Patterns:
Energy and Tension
Negative Appraisal and
Prediction of Problem Outcome
Highest: states of:
low energy and
increased tension

(Thayer, 2001)
10 minute
Brisk walk
Brain Change:
Neuroplasticity
Potentials for Plasticity
Throughout Life

Dendrite proliferation
Synaptogenesis
Re-routing and strengthening
neural networks
Nerve Growth Factors
BDNF revisited: brain-derived
neurotropic factor
BDNF: Impact on
Dendrite growth: 24 hours
BDNF

MAY BE ACTIVATED BY:
* Antidepressants
* Lithium, Depakote,
Tegretol, Lamictal
* Seroquel
and

123
Helplessness
versus
Mastery
Selectively Activating
Specific Neural
Networks of Brain
Structures
Use it or lose it

Use it a lot
it grows
Focused attention
increases brain
activation

and why this matters
Primary Tactile Area: Parietal
Increasing Size of Brain Maps
Most brain areas: increased size
via dendrite proliferation
Learning Braille:
> 2 hours of class, 5 days a week
> by 6 months, noticeable
increase tactile area


Pascual-Leone, R., et al. (1999)

Potentials for Plasticity
Dendrite proliferation
Synaptogenesis
Re-routing and strengthening
neural networks
DENDRITE SPINES & SYNAPSES
Spine Growth
one-half hour
Potentials for Plasticity
Dendrite proliferation
Synaptogenesis
Re-routing and strengthening
neural networks
Another Example:
Over-Coming
Acquired Fears
Fear Thou Not
Neurobiology of Courage
Nili, et al., Neuron, 2010

Ss: > afraid of snakes
> not afraid of snakes
Functional MRI
136
Fear Thou Not
In scanner: asked to move
a snake closer and closer to
their heads
Measured metabolic activity,
GSR, and subjective sense of
fear
138
Fear Thou Not
Neurobiology of Courage
Nili, et al., Neuron, 2010

Ss: > afraid of snakes: advance
> afraid of snakes: retreat
> not afraid of snakes
139
Fear Thou Not
Advancers: on-going activity in
anterior cingulate (AC)
Reduced activity in amygdala
Reduced GSR (galvanic skin response)
despite reported fear
Retreat: drop in activity in AC
140
The Choice to Face Fears
Impact on two levels:
activation of PFC
and cognitive changes
(view of ones self)


Neuro-feedback
.
EEG assisted biofeedback



Wellbeing Prerequisites
Nature
Nurture
Fate
Wellbeing: Prerequisites
A functional
nervous system
(circuits and neuroendocrine)
(especially: emotion regulation
and attachment)
Optimal Brain
Regulation
Coping,
Adapting,
& Healing
The Equator
Evolution
5 million years
Hunter-gathers
Activity level

Walking 10 miles
a day
Mood Regulation Exercise:
Different Approaches
Must be aerobic
Intensity in keeping with
level of fitness
30 minutes 3-4 times a week
Two 10 minute periods of
exercise every day
Exercise: Doses
Otto, et al. (2007) Journal of Clinical Psychiatry
10,000 steps per day
(5 miles)
Average: 6000
Quick Fix
Exercise: an alternative
Energy Booster
10 minute brisk walk: energy
60-120 minutes
Mood: feel as good as you
feel during any other
part of the day
(Gauvin, et al.., 2000)
Brain Regulation:
The importance of Sleep
Sleepthe bath
and balm of
hurt minds

William
Shakespeare
Americans Sleep
On average:
1 hours less each night than
they did 100 years ago
500 hours: less sleep per year
Need for Sleep ??? 6.5 hours a night
Realistic 7-9 hours
Normal Sleep Architecture
Slow wave (deep) sleep
Restorative (deep) sleep
Deprivation:
> Fatigue
> Troubles concentrating
> Impaired emotion
regulation
Disrupt Deep Sleep
Anxiety
Depression
Sleep Apnea
(frequent episodes of arrested breathing)
Pain
Substance use
Increasing slow wave sleep
Regular exercise
(not 3 hours before bed)
Calm evenings
Sleep cool
Melatonin: 0.5 mg.
3 hours before sleep

Increasing slow wave sleep
Avoid substances that
interfere with
slow wave sleep
Drugs and Sleep Disturbances
Caffeine
Alcohol
Tranquilizers
Some Sleeping pills
Normal Sleep Architecture
Non-Habit-forming Sleep Meds
Trazodone 25-75 mg *
Remeron 7.5-15 mg *
Elavil 10-50 mg *
Silenar 3-6 mg *
Benadryl 25-50 mg
Remeron (activates melatonin receptors)
Seroquel 25-200 mg (sedating
antipsychotic)

* Sedating antidepressants
Circadian Rhythm
Wake and asleep times
Body temperature
Release of specific
hormones
Regulation of the immune
system
Recalibrating the brain
Bright Light Exposure:
Florence Nightingale
1820-1910
First to note benefits
from bright light
exposure
High-Intensity Light Therapy
High-intensity light Exposure
10-20 minutes a day
Light entering the eye
not the skin: dont get melanoma
Light box or going outside
(without sun glasses)
Contraindicated for people
with eye diseases
Caution with bipolar disorder:
can provoke mania
Families of Fatty Acids
Omega-3: for cognition and
mood regulation (1-2 grams)
> LNA: seed and nut oils
> EPA: fish oil *
> DHA: fish oil *
*cross the blood-brain barrier
167
Families of Fatty Acids
Omega-3
> LNA: seed and nut oils
> EPA: fish oil *
> DHA: fish oil

* Impact on mood
168
Folic Acid

400 micrograms
per day
Mediterranean Diet Plus Exercise
Fruit, nuts, legumes, fish
Moderate alcohol use
N: 10,094.Spain
4.5 year follow-up study

Mediterranean Diet Plus Exercise
Significant decrease: dementia
Significant decrease: depression
Better control of glucose

Archives of General Psychiatry
(2009)66:1090

Parasympathetic
Nervous System
Parasympathetic Nervous System
If dominant: produces relaxation
Activated when no threat is
perceived
Can over-ride sympathetic arousal
Sympathetic: Fight or flight
Can be activated willfully

Parasympathetic Dominance
Decreased:
heart rate, blood pressure,
respiration, perspiration, and
GSR: galvanic skin response
Alternate
activation of
right and left
hemispheres
Eye Movement Techniques
Body scan
Holding neck still
Eye track, back and
forth (one second)
20 times
Repeat: 3 series
Body scan after
each series
Activates Parasympathetic N.S.
Eye movements: GSR,
respiration, heart rate,
and blood pressure
(Wilson, 1999)
Eye Movement Techniques

Animal behavior
parasympathetic over ride SNS
(R. Stickgold, Harvard, 2002)
Other Approaches:
Alternating bilateral brain
activation

(physical therapists,
my dentist)


Activating the PNS
Bear down and / or
Kegel response:
impact on vagus nerve
(20-30)
rapid activation of PNS
Diaphragmatic Breathing: Stretch
Affect Regulation Techniques:
Relaxation Techniques*
see handout
Reduce Upward Arousal
Other Rapid
De-escalation Techniques
Exercise (10-15 minutes)
Crying
CRYING BEHAVIOR
(William Frey)
Average Duration of Crying Spells:
1-6 minutes
Felt better after a Good Cry:
Women: 85%
Men: 73%
40% decrease in affect intensity

Realistic, Healthy
Attitudes and Beliefs


Maintaining
Perspective
Healthy, Adaptive Attitudes
and Perspectives


Realistic expectations
about life:
Healthy, Adaptive Attitudes
and Perspectives


Realistic expectations
about life:
life is not safe
roller coaster metaphor
Emotionally healthy
people are capable of
mourning losses and can feel
the 10,000 sorrows and the
10,000 joys life has to offer
Will People Like You ?
What to expect
25% yesno matter what
25% yesfor a while
25% nobut may grow to like you
25% no.forget it !
Buddhist Tradition
* To feel suffering:
not pathological

*Acceptance of suffering
as a part of life

First noble truth






Buddhist Tradition





Struggling against pain
suffering
Accepting Limitations
and
Radical
Acceptance
Healthy, Adaptive Attitudes
and Perspectives


Shoulds (vs. what is)
Buddhism: attachments as a
source of suffering.
Attachments to outcomes

Muddy water
Let stand
Becomes clear

- the Buddha
Cultivating Inner Peace
Fleishman (2004)
Befriend sorrow.fleeing
Sorrow never leads to
inner peace
Facing
Existential
Issues
Frontal Lobes & Time Travel
Transcend the emotion
of the moment
Project into the
future
Aliveness &
Doing what matters

Deathbed Regrets
9/10 regret what they
didnt do rather than
what they did

Explore: to what extent
are you doing
what you value?
Finding a calling
making a difference
Sharing as a means of
reducing isolation and
facing difficult life
circumstances


Incubation Chambers
Some Data

Polls:
> 94% of Americans
believe in God
> 90% pray
Some Data

Polls:
> 85% of Americans
report that because of
faith their lives have
meaning and purpose

Koyaanisqatsi
Life out of Balance



Hopi concept
Dominicans
Seven Actions for a Whole Life
Stimulation of the intellect
Appreciation for nature
Physical Exercise
Play..Recreation
Employment
Charity
Prayer


Mindfulness
(Mind-fullness)
its not just about meditating
Mindfulness
(mind-fullness)
Increasing awareness and
Activating Frontal Lobes
95% of Human Behavior is
Automatic
J. Bargh and T. Chartrand (1999)
Not chosen
Lots of the time
we are asleep

Mindfulness:
Awareness
both Internally
and Externally

(mindless psychology student)
Ways to Foster Mindfulness

Regular, consistent reminders
to be in the moment
Moment to moment awareness
when doing routine daily tasks
Body scan
Inward focusing
(attention)
and shifting attention
activates frontal
circuits
Mindfulness: Brain Changes
(Sara Lazar: Harvard, Davidson and Kabat-Zinn, 2003)
Mindful meditators
Increase left frontal activation
(better affect regulation)
Mindfulness Mediatation
(Crestwood, et al. )
.
Naming
> Naming physical sensations
> Naming Emotions
> Naming: Increases activation of the
anterior cingulate
Developing Specific
Emotionally Healthy
Habits
Habit Change:
General Strategies
Requires effort,
follow-thru
and a Coach
Prepare the Brain
for Habit Change
Break up routines
(toothbrush; pants; routes)
Activate acetylcholine
system
Focused Awareness
Happy people take things in:
moment-to-moment
Concrete reminders to savor the
moment

Savoring
Look around your environment
and take note of one or
more things that you often
take for granted.
Self-Aware Emotions
Happy people
express:
Gratitude
Empathy
Compassion
Re-circulating
Joyful States
The habit of recapturing positive
memories
Photos, scrapbooking, digital
photo frames
reminiscing with old friends
Having Fun
During stressful times:
having fun, self-nurturing
and humor are
the first to go
Positive activities list

Positive Psychology
Focus on positive feelings and
resiliency
Empirically-validated techniques
Note: some will fit better than
others
Acknowledge Strengths
Combatting loss of self and
self-confidence
Getting clear about your
strengths
Rank order: top ten
What went well today?

Each day ask:
what three things
went well today?
What went well today?
University of Pennsylvania Study
> N= one million subjects from
200 countries
Used this strategy: every day
for one week
Robust positive outcomes

Beyond the scope
Setting Limitslimit rescues
Know what to ignore and choose
your battles
If you are riding a dead horse
get off !
(toxic people and obligations)
Dont be stupid
Beyond the scope
Forgiveness (Scott Peck.Pardons
and cheap forgiveness)
Travel light
Make amends
Own regrets
Share secrets, confide, confess
7 Actions that Have Highest
Yield in Promoting Happiness
The most potent way to improve
mood:
Once a day: an act of kindness
Every day: write: 3 things for which
you feel grateful
7 Actions that Have Highest
Yield in Promoting Happiness
Ongoing work toward a valued goal
(keeping clear about what
matters)
Daily contact with nature and
other living creatures

7 Actions that have High Yield
in Promoting Happiness
Establish a daily routine
Keep your environment
cool
Giving money away