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Guiding Self-Directed Neuroplasticity:

A Mindfulness Investigation

A Teleseminar Session withRick Hanson, PhD

and Ruth Buczynski, PhD

The National Institute for the Clinical Application of Behavioral Medicine

http://www.nicabm.com

The National Institute for the Clinical Application of Behavioral Medicinewww.nicabm.com

Guiding Self-Directed Neuroplasticity: A Mindfulness Investigation 2

A complete transcript of a Teleseminar Session featuring Rick Hanson, PhD and conducted by Dr. Ruth Buczynski, PhD of NICABM

Guiding Self-Directed Neuroplasticity: A Mindfulness Investigation

Contents

Self-Directed Neruoplasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Mechanisms of Change – How the Brain Changes . . . . . . . . . . . . . . . . . . . . . . 5

The Practical Benefits of Self-Directed Neuroplasticity Within a Clinical Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Neuropsychology of Negativity and Positivity . . . . . . . . . . . . . . . . . . . . . . 8

Mindfulness Exercises: How to use Neuroplasticity for Clinical Purposes . . . . . 15



Dr. Buczynski: Hello everyone! I’d like to get started. I want to welcome everyone to this call tonight. I know you are calling in from all over the world and you are in many different time zones; it is in the morning for people, it is in the middle of the night for people, and in the middle of the afternoon! So no matter what time it is at your location, welcome to this call.

I am Dr. Ruth Buczynski. I am the President of the National Institute for the Clinical Application of Behavioral Medicine – I will be your host tonight and I’d like to say hello.

I also want to mention that we have a range of practitioners on this call: we have physicians, nurses, psychologists, social workers, counselors, marriage, and family counselors. We have dieticians, physical therapists, occupational therapists, chiropractors, stress management consultants, coaches. We represent the full spectrum of our health and mental health community. So, again welcome to the call.

My guest tonight is Dr. Rick Hanson. Rick is a PhD in Clinical Psychology from Wright Institute in 1991. He is the author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom. He is the founder of Wellspring Institute for Neuroscience and Contemplative Wisdom and the Wise Brain Bulletin which is a very wise bulletin indeed!

So, Rick, thanks for being part of the call, and welcome!

Dr. Hanson: Oh, thank you. It is truly a pleasure and a privilege to be here.

Dr. Buczynski: So, Rick, I guess I should say welcome back because you participated in our Program on Mindfulness and again last year when we did our first Brain Series. There is so much that you know and so much that needs to be known about the brain that we don’t have to worry about duplicating what we did last year.

I’d like to get started, though, and talk about self-directed neuroplasticity. So first I think we probably should get to some definitions. What is self-directed neuroplasticity?

Self-Directed Neruoplasticity

Dr. Hanson: Sure. Well, the basic idea is that there is what is called experience-dependent neuroplasticity; the nervous system and the brain in particular, learn from experience.

That is not breaking news and in a sense we all have been engaged in self-directed neuroplasticity our entire lives. We certainly do that with our clients, helping them see things in new ways, work with attention and become more mindful in different ways of managing their emotions, developing more impulse control, improving executive functions, have insight - all of that is changing the brain, fundamentally, because what else is learning?

Guiding Self-Directed Neuroplasticity: A Mindfulness Investigation

with Rick Hanson, PhD and Ruth Buczynski, PhD



In other words, the structure and the processes of the brain have to change in some way to be the physical substrate of any kind of learning.

What the breakthrough is, and why I think the term “self-directed neuroplasticity” is actually useful these days, is that, with the doubling of knowledge in neuroscience in the last twenty years, what is just beginning to happen is that it is becoming increasingly clear what the neuro substrates of various wholesome states of mind or mental factors actually are.

In other words, what are the neuro substrates that affect regulation, resilience, the management of negative effect, the establishment of attentions and so forth?

And then what we can do is we can work backwards. With targeted mental activity you can actually stimulate the specific neuro substrates you care about, thereby strengthening them. There is the classic saying by Canadian psychologist Donald Hebb, “Neurons that fire together wire together.” So if you stimulate that substrate, you are going to be strengthening it.

I should add the caveat, of course, that there is so much we don’t know. Neuroscience is a baby science compared to astronomy, chemistry, or other sciences.

But what is exciting to me is that, because now we are all participating in a wonderful, great “taste conference,” basically in a laboratory which does not require a million dollars worth of equipment to open up DNA molecules or peer into the heart of the atom.

Basically we, including everyone on this call, are participating in a kind of a clinical investigation into self-directed neuroplasticity. And that is very exciting to me because we can make genuine contributions to the progress of knowledge right now - every clinician, who wants to get into this.

Dr. Buczynski: So what you are saying is that when we are changing emotions, reactivity patterns, and when we are experiencing insights, that our brains change?

Dr. Hanson: Yes. Just as our brains change when we learn what two plus two is or when we register what we had for dinner the night before and can recall it the next day, yes.

Dr. Buczynski: Okay. Can you be any more specific - how does that brain change?

“...we all have been engaged in self-directed neuroplasticity our entire lives. We certainly do that with our clients, helping them see things in new ways, become more mindful of managing their emotions...all of that is changing the brain...”

“Basically everyone on this call, are participating in a kind of a clinical investigation into self-directed neuroplasticity”

“...our brains change when we learn what two plus two is or when we register what we had for dinner the night before and can recall it the next day.”



Mechanisms of Change – How the Brain Changes

Dr. Hanson: Oh, sure! Well, if you mean the mechanics of neuroplasticity, experience-dependent neuroplasticity, there are multiple mechanisms and that is where the breaking news is. People have a greater understanding of exactly how it is happening, which can also have practical implications.

So, for example, there is what is called localization of function in the brain; in other words, different parts of the brain do different things. For example, if we are trying to help our clients be more mindful and more deliberately controlling of their attention, then we want to develop the part of the brain called the

“interior,” which means frontal cingulate cortex, which is very involved in that particular function.

In that region, if someone is doing mindfulness training like MBSR, mindfulness-based stress reduction, over a period of time, they are using that part of the brain so it is going to get more blood flow. In other words, more capillaries will develop in that area of cortex, literally measurably thickening it because capillaries are now bringing more glucose and oxygen, more supplies for that busy region. So that is one kind of experience-dependent neuroplasticity.

A second mechanism is through epigenetics, through the expression of genes, the little strips of atoms inside these longer, twisted-up molecules of DNA. To express genes you have to unpack the molecule - that is epigenetics.

There are many examples, including a study I will mention in a moment, of changes in experience or conscious mental activity. Changes in experience correlating with, and I think possibly leading to, changes in the expression of various change.

For example, people who routinely practice relaxation will have improved expression of genes that down-regulate, inhibit, or put on the brakes or control the stress response. In other words, through a genetic and epigenetic mechanism, people who routinely relax become more resilient in the face of stress.

The genes themselves don’t change, but the expression of the genes change. Remarkably, it is now getting clearer and clearer that there are actually ways in which parents can pass on to their children changes in gene expression that are based on experience.

The genes don’t change but the expression of the genes does change and that genetic pathway, that epigenetic pathway of transmitting psychological factors actually can cross multiple generations; from grandparent, to child, to grandchild. That’s pretty exciting!

And then a third mechanism, just to finish up here, with the quote by Donald Hebb, “Neurons that fire together wire together.”, when you get neurons that fire within a few

“...if someone is doing mindfulness training...over a period of time, the brain is going to get more blood flow...more capillaries will develop in that area of cortex, literally measurably thickening it.”

“The genes themselves don’t change, but the expression of the genes change. It is now getting clearer and clearer that there are ways in which parents can pass on to their children changes in gene expression that are based on experience.”



milliseconds of each other, and it has to be very close to that, a variety of things will happen. For example, it will sensitize existing synapses and make them more responsive so the two neurons are now in effect hooking up with each other. They are synchronizing, they are changing based on mental activity which maps to neural activity.

Also new synapses will form, even literally within a matter of minutes. I have seen electron photographs, electron micrographs of the formation of new synapses in the mouse brain in ten minutes or less.

So those are some of the mechanisms that show what we think and feel make a difference. I find for myself at a practical level, without making my clients’ eyes glaze over, that a little bit of this can go a really long way in terms of encouraging motivation. Because people increasingly appreciate that what they are doing with their mind that might have seemed really airy-fairy, ineffable and pointless, is actually sculpting their brain.

Dr. Buczynski: Okay. Can you give us some steps for how you would relate that to a patient? How do you give your five cents worth of neuro-psych in hopes of motivating the patient?

The Practical Benefits of Self-Directed Neuroplasticity Within a Clinical Setting

Dr. Hanson: Yes, I would say the patients I work with range from, pretty low-functioning and pretty distressed, although not usually psychotic, all the way to pretty high-functioning, self-actualizing people looking for a personal growth experience, the full range. I work south of San Francisco, so you can imagine the culture here.

So in that range I find that patient education is the first step. All kinds of patient education, whether it is educating someone about the health consequences of more than a bit of alcohol a day or educating parents about the research on child development. As someone who is trained psychoanalytically, you have to think about the transference impact of educating a client about something. Obviously, there are skillful ways to do that.

But generally speaking I am very matter-of-fact and a little information goes a long way. I find the London taxi cab example is very persuasive to people, probably many callers know it. I will tell it very briefly.

As part of their training a London cab driver has to memorize the spaghetti-style street of London. At the end of their training, the hippocampus, the part of the brain that does visual spatial memory, creates

memory for context, and calms down or puts the brakes on the alarm bell of the brain, the amygdale, cab drivers have a thicker hippocampus. In other words, because the cab drives have worked that part of their brain, it has gotten bigger.

So I use that example with clients; I will talk about a bit about research and studies that shown that as they routinely are practicing

“I find that patient education is the first step.”

“...people increasingly appreciate that what they are doing with their mind that might have seemed really airy-fairy, ineffable and pointless, is actually sculpting their brain.”



self-awareness, opening to their own experience and seeing what is there, developing more of an observing ego kind of function and more inner mindfulness, that they are actually thickening the insula, the part of the brain on the inside of each temporal lobe.

And studies have shown that when you do that, you actually become more capable of self-awareness. As a double benefit, a bonus here, you become more able to tune-in to the emotions of others because of a kind of mirroring function.

The insula, a part of the brain that really tracks one’s own gut feelings and inner emotional state also resonates with, also activates when one registers those same emotions in other people, giving us a felt sense from the inside-out of what it is like to be them.

These are not mirror neurons per se, which track actions; these are neurons that track emotions which are actually more essential to empathy than tracking actions.

But it is an illustration of how the client, taking a few minutes every day, to tune-in to his or her body and just kind of be aware of the body, can become more empathic in a relationship and many people would like more of those kinds of skills.

I find that I will draw pictures occasionally. I see kids as well as adults and I find kids, all the way down to five or six, are fascinated by the idea that they can actually make changes in their own brain.

It is also a way to get across the key point here, which is that experience-dependent neuroplasticity is automatic and relentless, for better or worse. I will quote a traditional saying that illustrates that point,

“The mind takes the shape of whatever it rests upon - for better or worse.” And the updated version is, “The brain will take the shape, because of experience-dependent neuroplasticity, on what the mind rests upon.”

So if you are routinely resenting things and ruminating, which as you know is a risk factor for depression or if you are grumbling in your mind relentlessly about the people you live with, work with, or sleep with; your brain is going to take the shape of anxiety, low mood, sensitivity, and distress. Because those stress response mechanisms, operate in terms of vicious cycles. If you get stressed today, you are more reactive to stress tomorrow.

The other way, though, is that if they do the simple things they want to do in therapy, that I suggest we are doing in the session, or that they are doing in particular out of sessions, where they are resting their mind

more and more on developing skills like self-awareness, or emotional control, then the mechanisms that accomplish that in their brain are also getting bigger and stronger. So now their brain is taking a different shape over time.

“The client, taking a few minutes every day, to tune-in to his or her body and can become more empathic in a relationship and many people would like more of those kinds of skills.”

“...experience-dependent neuroplasticity is automatic and relentless, for better or worse’’



Anyway, I find that that is very motivating. And if I could say something perhaps politically incorrect as a gross generalization with many exceptions, I find there are two populations who are really willing and motivated to do more of the work in therapy. They are teenagers and men. When they hear about how their brain works, it physicalizes it. It somehow makes it material and real.

“Oh, I get it!”

Also it de-stigmatizes it, which is great. It is like, “Oh, okay, no wonder - my brain did what brains do; brains learn.” You know, your brain did what brains are supposed to do in childhood - it really learned. Now it’s time to unlearn that and learn something different that is adaptive, because you are no longer living with them and you have a lot of other options as an adult.

So then people go, “Oh, okay!” It’s kind of like rehabbing a knee - it’s not so personal, you know. And then they are willing to engage the process and be less defensive about it.

Dr. Buczynski: You brought up an interesting point about neuroplasticity, when we say that the brain can change, it doesn’t necessarily - these aren’t your words - but it doesn’t necessarily mean that the brain is going to change in a positive way; it could change in a negative way. And I think you were saying that if we are focused on negative things, the brain is going to change more likely in a negative way. Did I get that right?

The Neuropsychology of Negativity and Positivity

Dr. Hanson: Yes. I think that is the neuro basis for the very common finding that ruminating, for example, typically focuses on negative themes and is a major risk factor for depression.

Also if you think about the research on fear or trauma memory, you find that, unfortunately the brain changes for the worse in trauma. Typically, the more vulnerable the individual is, the more severe and chronic the trauma. So, yes, it definitely changes for the worse.

In that regard I think there is a very telling example - I find it is almost haunting to think about and I will tell this to my clients. Mechanisms evolved to help our ancestors get away from charging lions, let’s say, or potentially lethal aggression inside their primate, early human band, or between bands which were very aggressive. Early human bands were very violent toward each other generally speaking. A lot of research has shown that the death rate between bands of hunter-gatherers was actually about fifteen times the death rate to males due to war during the twentieth century. So it is useful to appreciate how intense it was. If a person is severely stressed or chronically stressed, it is useful to appreciate the mechanism.

“...when developing skills like self-awareness, or emotional control, then the mechanisms that accomplish that in their brain are also getting bigger and stronger. So now their brain is taking a different shape over time.’’

“...ruminating, for example, typically focuses on negative themes and is a major risk factor for depression.’’



The same machinery that evolved to manage survival in early man activates today when people are irritated, stuck in traffic, frazzled, just resentful in a business situation, or trapped in a job they don’t like - what have you.

Anyway, those mechanisms kick into gear and that releases cortisol. And the point is, in my vicious cycle example, that when cortisol moves into the blood stream and then into the brain, it does two things.

It sensitizes the amygdula over time, so now we have an alarm bell that is even more reactive and more a hair-trigger. And over time cortisol degrades the hippocampus, literally to the point of losing a quarter of your hippocampal volume because cortisol excessively stimulates hippocampal neurons and in effect, they die of exhaustion after a while.

The result is a vicious cycle because now you have stress today releasing cortisol that sensitizes the amygdula, making it more reactive to stress tomorrow and you have stress today releasing cortisol that weakens the hippocampus, which puts the brakes on the amygdula as well as, the hippocampus.

Through signals to the hypothalamus it calms down cortisol production. So you have a vicious cycle in which the alarm bell is now getting louder and louder and the brakes on the alarm bell system are getting weaker and weaker and weaker. And that is an example of the brain changing for the worse.

I find that chronic stress and stress in general is something to really be careful about. And while I think that there is a place for mindful awareness of pain, we can’t just walk through life with rose-colored glasses. My contemplative background is more Buddhism than anything else. We have the noble truth of suffering, there is suffering, to be sure. We have to face it, bear it, and all the rest of that.

But, first, we want to really surround it with mindfulness, spacious mindfulness, as best we can, activating the neuro substrates of mindfulness and dampening the impact of that painful experience. Secondly, we don’t want to pass the point that is productive. Dwelling on negative experiences and going into them again and again is just like doing one more lap in hell and every time you go around the track you deepen it.

I think that it is like the “just right” spot; it is the “Goldilocks spot.” It is not too hot and not too cold, it is the point where we move on. But while I think that mindfulness alone is often very powerful, I also think it has gotten overrated in psychology in the last ten years.

It is important to be aware of other phases of healing which involve, for example, not just being with pain or being with what is negative or difficult, but also letting go of it and then over time replacing it with something more positive.

“...in research on fear or trauma memory, you find that, unfortunately the brain changes for the worse in trauma. Typically, the more vulnerable the individual is, the more severe and chronic the trauma.”

“The same machinery that evolved to manage survival in early man activates today when people are irritated; stuck in traffic, frazzled, or trapped in a job they don’t like.”



Dr. Buczynski: You know, if there is one thing that became really clear from last year’s series on the New Brain Science, it was the deleterious effect of continued constant stress.

Dr. Hanson: Yes.

Dr. Buczynski: And we know, as you are saying, that we are pretty much hardwired to focus on the negative and we have got a brain that is ready to move into action to fight tigers, even though we are only dealing with traffic jams.

Let’s go into why it is that we are hardwired to focus on the negative even though focusing on the negative isn’t good for us.

Dr. Hanson: Yes. Well, I think there are two parts to that answer. The first part is the age-old question; “What is human nature, good or bad, loving or hateful, happy or depressed?” I think that there is evidence that when people are not threatened, when people are not disturbed by pain, threat, relationship loss, or chemical disturbance in the brain, etc., they default to a fairly good place that I summarize as calm, contented and caring.

There are three motivational systems in the brain that evolved along with the evolution of the vagus nerve. The first system avoids harm. The second system that came in approaches rewards, that developed with reptiles and early mammals. The third system which really came in with mammals, birds, and especially primates and humans, attaches to us.

So, we have avoid, approach, attach. When we are not threatened, we default to a mode where we are recovering from expenditures, we are recovering from disturbance, and we are building up our reserves. We are storing up our defenses, as it were. And that mode that we default to when, again, we are not disturbed, is a nice place of calm, contentment and caring, in terms of those three systems. That is the good news.

The bad news is that Mother Nature also evolved hair-trigger mechanisms that drive us from that home base at any kind of threat or difficulty. And that goes to your point about the negativity bias; in terms of

being driven from home.

We have to go get carrots and also avoid sticks - so why, one asks, do we not have a positivity bias, you know, going after carrots all day long? The reason is that while carrots are important, if you fail to get a carrot today, in the Serengeti you will probably get a chance to get a carrot tomorrow. But if you fail to avoid a stick today in the Serengeti, whap! No more carrots for ever.

“I think that there is evidence that when people are not threatened, when people are not disturbed by pain, threat, relationship loss, or chemical disturbance in the brain...they default to a fairly good place that I summarize as calm, contented and caring.”

“...we don’t want to pass the point that is productive. Dwelling on negative experiences and going into them again and again is just like doing one more lap in hell...”

“I think that it is like the ‘just right’ spot; it is the

‘Goldilocks spot.’ It is not too hot and not too cold, it is the point where we move on.”



So you have positive events, both in the wild and in most people’s lives today. With some sad and/or even tragic exceptions, most people’s lives have a relative abundance of positive events. The problem is that negative events have more urgency, you have to deal with them immediately. And they have more impact in terms of survival.

So thus the negativity bias, which shows up in our physiology and our brains in all kinds of ways. The bring-it-to-home example is you have a partner or someone at work, you go through a day and twenty

little things happen; ten are positive, nine are neutral, and one was irritating. What is the one thing that your mind tends to go to before you fall asleep that night? It is the negative one. It is the irritant.

There is research that shows, for example, that people can register angry expressions on faces more rapidly than they can register happy expressions. The body activates more to a negative stimulus than it does to a positive stimulus of equal intensity. People remember negative events, particularly recent ones. You know, that is what they remember about the day, “The day was the one where I had the traffic accident.” Everything else they forget about.

I think about Seligman’s research on learned helplessness and the ways in which it is remarkable. How easy it is to train mammals, like dogs that have limbic systems very much like humans do, in helplessness. It takes half a dozen trials for dogs to learn helplessness. But very often, it takes fifty to a hundred trials to help that dog unlearn helplessness, that sense of utility and the realization that it does have some control over its fate.

That actually is a very useful thing, I have found, to explain to clients. They start to appreciate the importance of not focusing on the negative past the point that is useful, past the “Goldilocks” point.

Secondly, clients often start to really appreciate when I will bring in some of the research on positive emotions. The importance of doing what I call “taking in the good”. Taking those little moments, half a dozen, a dozen or more times a day on the fly, to deliberately internalize the positive experiences.

Dr. Buczynski: So now let’s get back to that in a minute - but staying with the negativity bias for a moment longer - I wonder if that is at play when - let’s say you are a physician or a nurse or a physical therapist, or an occupational therapist perhaps - you are treating a chronic pain patient, and I am thinking that one thing we know about chronic pain patients is that they are ever-vigilant for the pain.

Dr. Hanson: Yes.

“...you go through a day and twenty little things happen; ten are positive, nine are neutral, and one was irritating. What is the one thing that your mind tends to go to before you fall asleep that night? It is the negative one.”

“The problem is that negative events have more urgency, you have to deal with them immediately. Thus the negativity bias, which shows up in our physiology and our brains in all kinds of ways.”

“There are three motivational systems in the brain...we avoid, approach, attach.”



Dr. Buczynski: Do you think that is related to the negativity bias? That they moved in a certain way once and it hurt really badly, or they get this injury and it really hurt, and now they are holding themselves very stiff to prevent, in their minds, to prevent that from happening again?

Dr. Hanson: Yes, I think that is a great illustration of the negativity bias. You know, “Once burned, twice shy,” right? There is a lot of research that is about how, whether it is rats or humans, mammals learn much faster from pain than from pleasure, generally speaking.

So here we have a pain patient who is a “one-trial learner;” you know, that patient has learned that if they move in a certain way,

“Ouch!” and since they have learned that they are not going to move in that way again. Or you can think of psychological versions of that, a person who has a panic attack on crossing a bridge.

Dr. Buczynski: I was just thinking the same thing.

Dr. Hanson: Yes! And they are never going to cross that bridge again.

Dr. Hanson: I think flooding mechanisms for dealing with physical pain or emotional pain probably have some place; but I think that a lot of the recent research is quite cautionary, about trying to habituate people to pain so they tune it out.

And I think there is a great place of course for surrounding inescapable pain, emotional and physical, with lots and lots of spacious awareness.

I mean, there is the MBSR research I think, and other similar research, on the benefits of skillful awareness practices. But I think it is also important, as much as possible, to crowd-out the pain with positive

influences; in other words plant flowers, if you will, in the garden of the mind.

And that is where I have actually been quite struck by the possibilities related to physical pleasure. If someone is in chronic pain, very often they are depressed, of course. Chronic research generalizes that chronic pain is probably, the most wearing factor on mental health.

So here we have someone with a depressed mood. When you say, “Gee, you spent some time with your grandchild today. You went outside and the flowers were blooming. Can you open up to that as a resource?” They are like, “I know the facts but I don’t feel it.”

So it is hard to register positive experiences, to balance the negative experiences, to buffer them and capture the research-established benefits of positive emotion with this population.

“There is a lot of research about how...mammals learn much faster from pain than from pleasure.”

“Clients...start to appreciate the importance of doing what I call ‘taking in the good’. Taking those little moments...to deliberately internalize the positive experiences.”

“...the MBSR research...on the benefits of skillful awareness practices. But I think it is also important, as much as possible, to crowd-out the pain with positive influences...”



But physical pleasure is an undisturbed pathway. These are people who will report physical pleasure from, “fill in the blank” - whether it is a glass of water on a hot and muggy day, a chocolate cake or cookie, a shower, getting their back scratched, or getting their hair brushed. And I think - this is a sidebar - that has a lot of opportunity with regard to people who are severely depressed and/or are dealing with chronic pain. Exploring the benefits of appropriate physical pleasure as a pathway to some kind of enjoyment; some way to plant flowers, in the garden of the mind.

Dr. Buczynski: Now you have used a term a couple of times that I would like you to expand a little bit - and that is “spacious awareness.” I am thinking that, for the folks listening tonight who aren’t mindfulness practitioners, they might not understand why you are using the word “spacious” with “awareness.”

Dr. Hanson: Sure. You know, it’s like “Shoot me if I get pedantic!” - but mindfulness is a word these days, it is like “bungee cord.” It is like rubber, it stretches, it means anything you know? I’ve seen it

actually used two different ways in one sentence.

So, what do I mean? You know, “attention” obviously means that there is a kind of focused awareness, there is a target of attention. And so what is “mindful” distinct from that?

Mindful basically has to do with a kind of meta-cognitive awareness of awareness; in other words you are attentive to attention in some ways. And I think that is one of the places where the teachings on mindfulness from people who are deeply trained in mindfulness - namely in the contemplative traditions.

All the great religions, Christianity and others, have contemplative traditions.

In the Buddhist contemplative tradition, the root of the word “mindfulness” has to do with memory. In other words there is a kind of recollectiveness that is recursive.

And I think that is what happens in the brain; we set up these recursive loops whereby when we are mindful of what is happening in the mind when our partner in therapy says something snarky, let’s suppose, or we are watching and trying to be aware of our emotional reactions to this, let’s say, chronic pain again that is sharp and we are really suffering it right now - when we are doing that, there is a kind of recursivity where we are both aware of what we are paying attention to, but we are also aware of how we are being aware. That is part one.

Part two is if you have a sense, using embodied cognition, that what you are aware of is held in a larger space. In other words there is a sense of distance from it, like a bird’s eye view or airplane view. Or you are not in the movie; you are back twenty rows eating popcorn, watching the movie of your

“...research generalizes that chronic pain is probably, the most wearing factor on mental health...”

“Exploring the benefits of appropriate physical pleasure as a pathway to some kind of enjoyment; some way to plant flowers, in the garden of the mind.’’

“Mindful basically has to do with a kind of meta-cognitive awareness of awareness; in other words you are attentive to attention...”



life. Another metaphor is awareness is like a great boundless, it is edgeless like the sky, and pain, anger, fear, or loss, moves through the sky like clouds but it is held in a larger space. Well, when you do that you are capturing the benefits and embodied cognition of physically distancing oneself from something that is painful or difficult.

And studies have shown that when you, prime people by having them measure or estimate a distance that is quite far apart and then when you, in the second phase of the experiment, put them in an unpleasant situation, they rate it as less unpleasant than other people who have not been primed with that kind of distancing.

Dr. Buczynski: That’s great!

Dr. Hanson: Yes. And for me, again, this is an illustration of how to play with or use the tools, the self-directed neuroplasticity. We want to understand that, “Gee, we evolved with sensory motor learning in an evolutionary sense” as the foundation, whether it is iguanas or rats, and then layered on top of that is a much higher order cognition, yet nonetheless the foundation of cognition is sensory motor.

So if you can work with those sensory motor systems around things like this sense of distancing, either visualized or just more conceptualized or using language. Anyway, the more that you do that, the more you are able to get a sense of separation from it so it is not so overwhelming.

So “spacious awareness” can sound kind of lofty, but I think the basic idea is to be aware of something in a larger field, where there is more of a sense of the whole environment and everything around the client or patient, while they are also aware of some specific difficulty.

Dr. Buczynski: So let’s say we have got someone on the call who is a physician, or a nurse, or maybe a psychologist, social worker, or counselor, and they are working with a parent whose son or daughter is about to go off to Afghanistan or some other war. What could they recommend to the parent that might help them help their child? Is there any way to try to coach the child so that you can inoculate these young soldiers?

“In the Buddhist contemplative tradition, the root of the word

‘mindfulness’ has to do with memory...there is a kind of recollectiveness that is recursive.”

“...when you, prime people by [distancing] when you put them in an unpleasant situation, they rate it as less unpleasant than other people who have not been primed with distancing.”

“So ‘spacious awareness’ is to be aware of something in a larger field, where there is more of a sense of the whole environment and everything around the client or patient’’



Mindfulness Exercises: How to use Neuroplasticity for Clinical Purposes

Dr. Hanson: That’s a great question. Yes, there I think I would really draw on, and it is not original at all to me, the research on resilience and stress inoculation. I would just review, what helps buffer you against stress.

One is sleep. I have read that people doing long tours are averaging barely four hours a night of sleep. That is very problematic. And, you know, routinely people will be taking stimulants before they go into a combat-type situation.

So, as best one can, I would say try and get all the sleep you can, obviously there are going to be limitations, but sleep is critically important and let other things move to the side. That would be one.

Second, is a very strong sense of social support, a classic buffer against stress, so a sense of connection with the other people in your unit, a sense of camaraderie. Obviously the military works hard to develop that, but any way you can have that felt sense of connection with others - that is enormously buffering.

People about to experience pain in an MRI are going to get a mild shock. Research shows that if they are allowed to hold the hand of someone they care about and feel that social support, the brain reaction to the physical pain is less, as well as the reported subjective to stress of the pain. So, second point social support.

Third, would be a sense of as much control as possible. There is so much about being, in a combat-type situation, a military situation, where there is so much that you don’t have control over. That is a major factor for trauma. Inescapable pain is basically the definition of trauma.

So the more you can focus, taking a page out of Seligman’s book on learned optimism and his research on learned helplessness, the more you can focus on where you do have efficacy; where you are a hammer and not a nail, in terms of your actions to the extent possible or your attitude about the situations you are in. That is another key, that maximization of any kind of sense of efficacy.

And then the last one is a sense of purposefulness. If people feel that their suffering is pointless, then that really tends to exacerbate the impact of stress, including traumatic experiences. But if, on the other hand,

they feel there is some value to their mission that can also help buffer against stress.

I think these ideas would be quite helpful, yes.

Dr. Buczynski: Thank you. So let’s go back to this whole negativity bias. You have said before that it is almost as if positive experiences flow through us and we don’t retain them or savor them. How would you retrain someone who is biased towards a negative

“...a very strong sense of social support [is] a classic buffer against stress, so a sense of connection with the other people in your unit, a sense of camaraderie.”

“Research shows that if [patients] are allowed to hold the hand of someone they care about and feel that social support, the brain reaction to the physical pain is less...”



perspective? Or how would you retrain a couple, that you might be working with, to move more toward noticing the positive and savoring some good that happened?

Dr. Hanson: Yes, that’s a great question and there are a lot of ways to do that. I think the first point, though, is it goes to the joke, “How many therapists does it take to change a light bulb? Only one - but the light bulb has to want to change.”

And very often what happens in therapy is we see that it is clinically indicated to try to help draw a person’s attention to the legitimate good facts of daily life, most of which are individually small yet there are a lot of them. What emerges is the client’s obstruction in doing that, what Freud would have called “resistance.”

For example, many people are afraid to feel good because it is when they felt good as a child that they really got punished. Maybe it was because they were getting exuberant and annoying to their parents or an older sib or because when they felt good they lowered their guard and that is when, “Whap!” they were really nailed.

Maybe it was because there was a depressed parent and it felt almost disloyal to be happy or maybe they grew up in a culture which considered it vain or sinful to really look happy or to try to make oneself happy.

For whatever reason, very often I find that what is actually wonderfully powerful about going after the benefits of positive experiences is that it surfaces all kinds of clinically relevant material. So that is point one.

Then let’s say you have worked through that, and you have people who realize, “Okay, this is a good thing. I should try to do that,” then what I will do is a combination. I will both describe to people how to trick memory to transfer a positive experience from short-term memory buffers to long-term storage in the implicit memory, emotional memory.

Dr. Buczynski: So how do we trick memory? So we are going to try to get it from short-term to long-term memory. How do we do that?

Dr. Hanson: Yes! So basically memory research shows that there are probably four factors in particular that really have huge impact. One is intensity of experience or information you are trying to learn. Here we are talking about learning not events, but in effect learning experiences. We are talking about the implicit

memory of a positive emotion, a positive view, or a behavioral inclination. So, one, intensity; two, duration; three, whole body, or enacted; and then fourth, personal relevance.

So in other words, if a person can just savor an experience for ten, twenty, thirty seconds in a row and let it be as intense as possible, as whole-body as possible, and have a sense of how it is personally meaningful, at a mechanical level deep down in the brain there is a dosing effect. The more you rely upon, or evoke,

“If people feel that their suffering is pointless, then that really tends to exacerbate the impact of stress. But if they feel there is some value to their mission that can also help buffer against stress.”

“...many people are afraid to feel good because it is when they felt good as a child that they really got punished.”



or activate those four factors, the deeper the memory traits will tend to be.

Novelty helps, but very often positive, mild-positive experiences are not particularly novel. But we still have an opportunity to take them in.

So, to summarize quickly there are three steps. Number one, let good facts become good experiences. That is the hardest step for most people to actually let the needle move, to register it emotionally that there is actually a good event here, or a good condition, or a good thing in oneself. Two, savor it ten, twenty, thirty seconds in a row. And then three, sense and intend that it is sinking into oneself. That will prime, bias, and stimulate memory systems to really register this experience.

So those are the three schematic steps for deliberately internalizing a positive experience. I did not invent those steps - but I have never seen anyone, you know, lay them out as analytically as I am trying to do here. They are implicit in many therapies.

Dr. Buczynski: It doesn’t matter who invented it - it is good and helpful to have the list. But I want to go back to the third one - sense and intend - because I am not sure if that is clear to everyone, what you mean by that.

Dr. Hanson: Yes, that’s a great question. With clients I will use metaphors like, “What you are doing is you are basically trying to let this sink in. In other words, as you sink into this positive experience, you are getting a sense that it is going into you.”

Just that alone people relate to. Sometimes they will use metaphoric language like “water into a sponge”. I do

this method routinely with kids or coach parents to do it with their kids. It is a very powerful method with kids. They are naturals, especially not just on-the-fly.

People take in the good both on-the-fly and at a specific times with children. For example, doing their Three Blessings Exercise just before sleep. Reviewing good things about their day or about their life altogether, just before sleep is another marked moment to do this.

Another example is the notion of a treasure chest in the heart and putting a jewel of one little experience into that treasure chest or the sensation of warmth, of a hot cup of cocoa going into your hands on a cold day, that kind of idea. And people get that. You know, it is like I remember being with my wife in Hawaii, and an unbelievable sunset, and thinking to myself - I can see it right now - “Remember this.” That is what people are doing; they are basically saying to themselves, “Remember this.” But they are doing it with lots of little things, half a dozen to a dozen times a day.

“...memory research shows that there are probably four factors...that really have huge impact. One is intensity of experience or information you are trying to learn.”

[Schematic steps for...internalizing a positive experience] “Number one, let good facts become good experiences...Two, savor it ten, twenty, thirty seconds in a row...And three, sense and intend that it is sinking into oneself.”



The other way I do this with clients in sessions is not just explicitly teach this method, but very often during treatment I will try to slow things down so they have an opportunity to actually register and stay with a positive experience.

It is striking that when people are talking, like I am doing right now, they tend to move quickly, right? And that is how it is with cognition, that is how conceptualization flows. But the registration of emotion, particularly the felt sense of a positive experience, to notice the sensations of it, that takes longer. And you have got to stay with it for it to really sink in.

Dr. Buczynski: You know, much of the time as psychotherapists we focus on the negative. Is there any harm just from the sheer volume of our attention to the negative?

Dr. Hanson: I think that there is a risk, I would put it like that. And that is why I think in terms of three great phases in any kind of healing. And this framework has guided me and has been very useful to me. Briefly, the first phase is to be aware of what we are feeling, to experience the experience. That is to be mindful or to be with it.

The second phase, at that Goldilocks moment, as best you can, is to let go of it, to release it. And there are lots and lots of methods, cognitive methods, emotional methods, insight methods, for releasing negative material.

And then the third phase is to replace it; to internalize some positive alternative.

So I think that the foundation of those three phases is the first one. It is the most important one of all, it is very important to be mindfully aware of it. But because of the negativity bias of the brain and because of the nature of experience-dependent neuroplasticity, I think clinicians should be cautious about whether they are way past the Goldilocks point where they are doing more laps in hell.

And that is why I think it is also very important when a client is dealing with negative experiences, including outside of our office, you know, in the other 167 hours of the week in addition to the one they spend with us, that we really focus on resourcing them so that when they are in that first phase of being with their experience, they are able to be with it in ways that buffer its impact.

The things that particularly help there is the sense of distance from it, that is observing ego, “I have this anger, I have this fear” rather than, “I am this anger, I am this fear.” Also, that is where spacious mindfulness comes in.

“With clients [sinking] into this positive experience...the notion of a treasure chest in the heart and putting a jewel of one little experience into that treasure chest...And people get that.”

“...very often during treatment I will try to slow things down so they have an opportunity to actually register and stay with a positive experience.”

“...three great phases in any kind of healing...the first phase is to be aware of what we are feeling...The second phase...is to let go of it, to release it...And then the third phase is to replace it; to internalize some positive alternative.”



Second, is the felt sense of being with others who care about us. That is critically important, to be able to activate that. Whether that is the sense of your own therapist, loved ones, or spiritual beings who are with you as you deal with your pain. That also really helps buffer the pain.

So, yes, that is it.

Dr. Hanson: A well-known way to resource people is a felt sense of others with you. There are other ways as well, a sense of perspective, and cognitive methods of good self-talk. AA has a wonderful saying,

“The mind is a dangerous neighborhood - never go in alone.” And if we are sending our clients out to be with their experience, explore it, open up to it and be self-aware - I think it is important that we do so with some thoughtfulness about resourcing them before they go into that neighborhood.

Dr. Buczynski: Okay. So let’s say the psychotherapists on the call frequently see people who are dealing with hurt and rejection. Let’s go through how they might think conceptually about what they want to do with that.

Dr. Hanson: You mean in terms of researched methods, right?

Dr. Buczynski: Well, yes.

Dr. Hanson: Or what might be the value-added, as it were, from this perspective - people dealing with hurt and rejection.

Dr. Buczynski: Right, and you put it together in a sort of a - maybe you didn’t put it together - but a rainbow.

Dr. Hanson: Oh, you saw that. Oh, that’s great!

Dr. Buczynski: Yes, I studied-up for this!

Dr. Hanson: There we are! That’s great! Well, as some listeners may know, there is an acronym that was developed by Michelle McDonald; and a wonderful therapist and teacher Tara Brach has really popularized it. It is the acronym RAIN. And many clients have gotten benefit from it.

“R” stands for “Recognize”. In other words you just recognize. Let’s say you are upset about something; so you realize, “Oh, I’m still mad about that stupid interaction I had with my mate this morning,” alright.

“A” stands for “Accept”. You accept the fact that you are upset. You don’t make yourself wrong, you don’t beat yourself up for being irritated or anxious about something.

“I” is “Investigate”. So there you are really trying to unpack it and open it up.

And then “N” stands for “Not self-it”. This is where you try to see it in the larger perspective, see it in the more objective way, and not take it so personally.

And very often RAIN is sufficient. It is pretty much a mindfulness practice and not much more than that. And that is great! On the other hand, I think many people who are grappling with rejection, hurt,

“AA has a wonderful saying,

‘The mind is a dangerous neighborhood - never go in alone’...”



or recurring flashbacks to painful, even traumatic experiences, just investigating it and not selfing-it is insufficient. And that is where, with tongue-in-cheek, I thought of “RAINBOW”.

Because for me, “B” is to “Breathe”, in other words, to release, to relax the body, to get some parasympathetic nervous system activation; to start focusing on that second great phase of healing or personal growth where you are releasing painful material.

“O” in BOW is to “Open” to new possibilities. And “W” is to really “Welcome” them in.

So for me it is a useful acronym to offer clients and I have known a number of people who have gotten a lot of value from that. In terms of, walking through somebody who is hurt about something, the RAIN part is to really unpack and open up that experience and capture the well-known benefits of mindful awareness of something.

But then, when it is time to let go of feeling hurt, I think it really helps to relax the body, to imagine that those painful feelings are releasing out of oneself. There are various methods for doing that. Here is where the third phase, replacing, is really useful. Taking in the good, to draw on the felt sense visceral in your body of being cared about by somebody, or belonging to something, or having some kind of connection.

And most people have something like that in their life today. It is usually not a perfect pie - but at least there is one slice of that pie that is clean; it is really a place where they are cared about; they are liked, they are appreciated, and they are seen.

Or they have a memory in their life that they can draw on, a time when they were young, grandma’s cookies and so forth. Or the worst case, they can imagine it in almost all cases. They can imagine maybe a spiritual being, or a fairy godmother, or somebody who really cares about them. And then that is a great buffer to feeling hurt or rejected.

Dr. Buczynski: Okay.

Dr. Hanson: Oh, and if I could - I don’t think that is the only way to work with such a big issue of hurt and rejection, but to me that is a useful way to walk it through. The larger point I think is to appreciate all three phases and to ask yourself when you are working clinically with people - I do it routinely - “Hmm, am I getting stuck in a phase? Are we just being stuck in investigation and it really is time to let it go?

Or have we jumped too quickly and prematurely to letting it go, to releasing it because the client, like me, is sort of a Mr. Fix-It kind of person and no, no, no no…?” You know, we need to go back to the first phase and really understand this, especially the younger layers of this because we are not getting a result from a cognitive behavioral method of releasing, so we need to go back into the investigation.

“...for people who are grappling with rejection, hurt, or recurring flashbacks to painful, even traumatic experiences, just investigating it and not selfing-it is insufficient.”

“...when it is time to let go of feeling hurt, I think it really helps to relax the body, to imagine that those painful feelings are releasing out of oneself...”



Dr. Buczynski: Okay. So let’s take a different type of patient, maybe someone who can’t make any further psychological progress until they are able to start empathizing with others. What kind of self-directed neuroplasticity exercises might we use with someone to help them increase their level of empathy, their ability to empathize?

Dr. Hanson: Yes, I think as contexts there are a number of cases or areas where the new, the infusion of neuroscience and the psychotherapy does not add value. It may seem glamorous but it doesn’t really add value. But this is one place where I think there really is a lot of value.

Let’s see, I will answer the question like this. There are three basic circuits of empathy in the brain. Broadly defined, the first one tracks or simulates actions of others. Those are like the mirror-like networks. And those mirror-like networks are mainly housed in the temporal parietal junction, those different lobes of the brain.

Then there is a second system that tracks the emotions of others rooted, as I said previously, in the insula.

And then there is a third system that is involved in theory of mind tasks, centered in the prefrontal cortex, where we in effect simulate the thoughts of other people.

So understanding something about that neural circuitry is quite useful because it can help somebody become more empathic. For example, in terms of the mirror-like systems that track intentional actions, I would encourage clients to observe the body of others and in ways that are not mimicry, imagine what it would feel like in one’s own body if one were sitting, or moving, or gesturing, or having facial expressions like the other person.

Also without being a jerk about it, model or mirror to some extent what that other person is doing with his or her body. That is a way to really work with those mirror networks and to explain why we are suggesting that to the client in a way that the client can find plausible.

A second exercise relates to the insula and is a wonderful method to get clients to tune into their bodies more. As I said previously, the insula has a dual function. It tracks the interior state of our own body, gut feelings, the movement of joints into a reception, or the sense of cool air coming in, warm air going out. When the insula does that, it gets thicker, measurably thicker, but it also gets more capable of registering

the emotions of other people.

So with this client I might say, “You know, there is something you can do just in your ordinary life and you don’t need to meditate. You don’t need to track the sensations of breathing. You can just really pay attention to your elbows and your knees when you are golfing. Or what is really happening in your body when you do Pilates or you are walking the dog. If you do it repeatedly and lengthily, like five, tenor thirty minutes in a row, you are going to build up your insula, and thereby your capacity to track the emotions of others.”

“There are three basic circuits of empathy in the brain. The first one tracks or simulates actions of others...”

“...a second system that tracks the emotions of others...a third system centered in the prefrontal cortex, in effect simulate the thoughts of other people.”



And then in terms of theory of mind, prefrontal cortex, that is where I think hypothesis testing, is really useful for clients, where you just try on guesses, good guesses. What is a plausible guess about opportunities for the man in a classic-case heterosexual couple to become more empathic?

So if he is, let’s say, in this illustration, starting to form more guesses about, “What was it that really bugged my wife when I just blew her off about how to load the dishwasher the right way?” Hmm… you know?

You try on different hypotheses and then you check those hypotheses against your own body like, “If I were my wife and if the possibility that for me to blow her off about the dishwasher violates her desire to feel like we are a team, you know, we are joined, we are unified, we are together ” Here in this undertaking of making a family, let’s say, “What would I feel in my body? Oh, I wouldn’t like that. I would be angry. Oh, that’s interesting.”

So those would be three things I do with clients to help them become more empathic, that are grounded in, and I think are usefully fed by, some understanding of what is happening in the brain.

Dr. Buczynski: Wow! Thank you very much! I really appreciate getting action-oriented, things that we can apply right away. We have just a minute left - let’s take a minute to look at a different type of patient. Suppose you have a patient who has been a doormat all their lives.

Dr. Hanson: Yes. As to what to do, well, from a neuro experience, from a neuroplasticity angle, that thread, in the larger tapestry of a good therapy, I would obviously think about the person’s structure of neurosis - to use that term really broadly - as the avoidance of a dreaded experience. That is the structure of it.

So the question is, based on that person’s history, what is the experience they expect - either because they lived through it themselves, or very often they saw it around themselves? In other words it is kind of like vicarious dread. Let’s say, they saw their siblings beaten for being assertive. Whatever it is, what is that experience that they usually unconsciously expect or anticipate, that they are now strategically avoiding?

And so I think that is part of working with this idea. It is where you really appreciate the power of early training around fear. Because that is what it is - it is fear training. It is we dread an experience. So that would be part one.

Part two, I think that the more that people can access an embodied felt sense of various resource states, the better. So

“...the insula has a dual function. It tracks the interior state of our own body. When the insula does that, it gets...measurably thicker; but it also gets more capable of registering the emotions of other people.”

“...I think hypothesis testing, is really useful for clients, where you just try on guesses...What is a plausible guess about opportunities for the man in a heterosexual couple to become more empathic?”

“...based on that person’s history, what is the experience they expect - either because they lived through it themselves, or very often they saw it around themselves?”



the question then is what are some key resource states. What I mean by that is that, the body, the emotions and the thoughts are lit-up like a Christmas tree. What is that positive resource state for someone who feels like a doormat? Well, one positive resource state is a felt sense of strength in the body.

So I will draw people to visceral memories, kinesthetic memories of times when they were strong. Almost everybody has something like that; when they were at the gym and they worked really hard to lift that last repetition or when they were into rock climbing - a background where they really came through.

Oftentimes people who are a doormat with regard to their own needs are actually quite assertive on behalf of others - like a pet, or a child, or a friend. That would be another example of where there was an opportunity to track a visceral felt sense of strength.

The last thing I would say with regard to a resource state that is very useful for someone who is a doormat is again, that felt sense of being with someone who cares about you.

Because of social support we evolved in bands where exile was a death sentence. It is critically important to feel like you have allies and an internalized felt sense of allies.

So those would be the two things that I would particularly go after with someone who is a doormat, in terms of activating resource states; the felt sense of strength, and also the felt sense of being with others who care about you, obviously amidst a larger therapy that deals with the cognitions and all the rest of that.

Dr. Buczynski: Thanks. You know, this hour has flown by and I am so sorry that it is over already. I want to say to everyone thanks for being on this call. I know that it has been a wide range of time zones, and for many people it has been an inconvenient time - in the middle of the night or very early in the morning, or very late at night. Thanks for making the sacrifice to be part of our global community so that we could all listen together to this.

And now we want to continue the dialogue. We are going to be sending you an email - it will come momentarily - and in that email I am going to give you a link to the Comment Board. And when you go to the Comment Board, put your first and last name, your city and state or country, and then tell us how you are going to use what you heard tonight. That is an important part of this process because that will extend the dialogue far beyond this one hour. So please go do that now before you do anything else.

And the other thing that I will include in the email is a link to Rick’s book. The book is called, Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom. You might want to consider using it

“It is where you really appreciate the power of early training around fear. Because that is what it is - it is fear training.”

“What is that positive resource state for someone who feels like a doormat? Well, one positive resource state is a felt sense of strength in the body.”

“It is critically important to feel like you have allies and an internalized felt sense of allies.”



as something you recommend to your patients to get and read. So I will just send you a link to Amazon so you can check that out, read the reviews, and see what you would like to do.

Meanwhile, Rick, thank you so much - you have really put this together in such a useable way, for a wide range of professions. And I know I was throwing at you, “What about this?” or “What about that?” and just seeing where our conversation would go - so thanks, I really appreciate what you have shared with us.

Dr. Hanson: Oh, thank you! What an opportunity! And I hope I didn’t go on too long in some of my answers.

Dr. Buczynski: No!

Dr. Hanson: But this material is so great - so thank you again for the chance to talk here.

Dr. Buczynski: Yes, it was a lot of fun. Goodnight everyone!

References:

Brach, T. (2004). Radical Acceptance: Embracing Your Life With the Heart of a Buddha. New York, NY: Bantam.

Hebb, D.O. (2002). The Organization of Behavior: A Neuropsychological Theory. London, England: Psychology Press; New edition edition.

Seligman, M.E.P. (2006). Learned Optimism: How to Change Your Mind and Your Life. New York, NY: Vintage .



About The Speaker:

Rick Hanson, PhD is a neuropsychologist, author, and teacher at the intersection of psychology, neurology, and contemplative practice and author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom. He co-founded the Wellspring Institute for Neuroscience and Contemplative Wisdom and edits the Wise Brain Bulletin.

He is an experienced neuropsychologist who works with adults, couples, and children, and has written and taught extensively on personal well-being, family relationships, and integrating mindfulness with everyday life.

Find out more about this and related programs at: www.nicabm.com

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