Main Reclaim Your Brain: How to Calm Your Thoughts, Heal Your Mind, and Bring Your Life Back Under Control
Reclaim Your Brain: How to Calm Your Thoughts, Heal Your Mind, and Bring Your Life Back Under ControlJoseph A. Annibali, Daniel G. Amen
A prescriptive guide to restoring cognitive calm, based on Amen Clinic Chief Psychiatrist Dr. Joseph Annibali's three decades of treating patients who suffer from overloaded, over-stimulated brains.
Dr. Joseph Annibali has treated thousands of people with overloaded, over-stimulated brains. Some people describe their brain as being "in chaos"; others feel that their brain is "on fire." But whether they are ultimately diagnosed with "normal" anxiety, disabling OCD, depression, bipolar disorder, or even substance abuse, the underlying problem is a Too-Busy-Brain, a great irritant that interferes with attention, concentration, focus, mood, and often much more. It may even be a sign of undetected damage to either the brain or the body itself. But through practical strategies, understandable explanations, and prescriptive mind-management techniques, Dr. Annibali will help readers finally reclaim their brains and get back in control of their lives.
Dr. Joseph Annibali has treated thousands of people with overloaded, over-stimulated brains. Some people describe their brain as being "in chaos"; others feel that their brain is "on fire." But whether they are ultimately diagnosed with "normal" anxiety, disabling OCD, depression, bipolar disorder, or even substance abuse, the underlying problem is a Too-Busy-Brain, a great irritant that interferes with attention, concentration, focus, mood, and often much more. It may even be a sign of undetected damage to either the brain or the body itself. But through practical strategies, understandable explanations, and prescriptive mind-management techniques, Dr. Annibali will help readers finally reclaim their brains and get back in control of their lives.
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an imprint of Penguin Random House LLC 375 Hudson Street New York, New York 10014 Copyright © 2015 by Joseph A. Annibali, M.D. Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader. Most Avery books are available at special quantity discounts for bulk purchase for sales promotions, premiums, fund-raising, and educational needs. Special books or book excerpts also can be created to fit specific needs. For details, write SpecialMarkets@penguinrandomhouse.com. eBook ISBN: 978-0-698-19439-7 Library of Congress Cataloging-in-Publication Data Annibali, Joseph A. Reclaim your brain : how to calm your thoughts, heal your mind, and bring your life back under control / Joseph A. Annibali, M.D. p. cm. Includes bibliographical references and index. ISBN 978-1-59463-297-6 1. Calmness. 2. Brain. 3. Stress management. 4. Mindfulness (Psychology). 5. Neuroplasticity. 6. Mental health. I. Title. BF575.C35A43 2015 2015025742 158.1—dc23 Although the author and publisher have worked hard to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with your physician. Particular situations may require a particular therapeutic approach not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of family members. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book. Version_1 For Dianne, Chris, and Elizabeth Contents Title Page Copyright Dedication Foreword by Daniel G. Amen, M.D. Acknowledgments REINING IN THE BRAIN Introduction 1. Balancing the Brain MANAGING THE MIND 2. Conquering Negativity 3. Rewriting Your Stories 4. Becoming Mindful 5. Righting Relationships ADDRESSING SPECIFIC ISSUES 6. Bored Brains, Excitable Brains: ADHD 7. Heart Matters: Anxiety 8. Mood Matters: Depression 9. Getting Unstuck: OCD 10. Branded in the Brain: Emotional Trauma and PTSD 11. Balance Your Brain, Boost Your Willpower: Addiction 12. Healing the Hurting Brain and Body: Brain Injury and Medical Problems Conclusion: Beyond Mind and Brain Appendix A: Nutritional Supplements Appendix B: Medications Annotated Bibliography Index Foreword I first met Dr. Joseph Annibali at a five-day conference I was teaching on applying brain SPECT imaging, the brain-imaging tool we use at Amen Clinics. A highly trained psychiatrist and psychoanalyst who had already spent decades in clinical practice, Joe isn’t one to rest on his laurels. He continually seeks out knowledge that will help his patients: people who are hurting, from all walks of life, who come to see him from far and wide. I was so impressed by his broad knowledge, kind heart, and open mind that I asked him to join our medical staff. Within a short time Joe became the chief psychiatrist in our Reston, Virginia, clinic, just outside of Washington, D.C., and is now a powerful leader and mentor among our staff of thirty medical professionals. Our story at Amen Clinics began in 1991 when I ordered my first brain SPECT scans on patients with conditions like ADHD (attention deficit/hyperactivity disorder), severe aggression, and unresponsive anxiety and depression who had not improved with standard treatments. Over the years, with Joe’s help, we have built the world’s largest database of brain SPECT scans, now well over 115,000 scans on patients from 111 countries. These scans have significantly changed how we help our patients at Amen Clinics. We’ve learned that psychiatric illnesses are rarely single or simple disorders. Giving someone the diagnosis of depression is exactly like giving them the diagnosis of chest pain; the diagnosis does not tell you what the problem is and how serious it might be. Treatment needs to be tailored to the underlying problems in individual brains, not a cluster of symptoms. Significantly, with our approach our patients understand that their problems are medical rather than moral, which has increased their willingness to follow the treatment plans and decreased their stigma about having a psychiatric disorder. The most important lesson we’ve learned from our treasure trove of scans, and the lesson that has kept Joe and me excited about this work each day, is that you are not stuck with the brain you have. As Joe discusses in this crucial book, if your brain is busy or racing out of control, if your brain is dysfunctional, you can reclaim it. In many thousands of cases, we have seen that you can improve brain function, even if you have been really bad to your brain. For example, Amen Clinics did the world’s first and largest brain-imaging study on active and retired NFL players, where we saw high levels of brain injury. That was not a surprise. Your brain is soft, about the consistency of soft butter, and it is housed in a really hard skull with multiple sharp bony ridges, so it is easily damaged. All of the news about concussions in sports has been bad, with an increased incidence of depression, suicide, and dementia. But what really excited us with our NFL study was that on our program to help the players reclaim their brains, the same one Joe will outline in this book, 80 percent of our 170 players showed high levels of improvement, especially in their mood, memory, sleep, and brain function. When Joe and I were in medical school in the late 1970s and early 1980s, we were taught that the brain doesn’t heal. But now we know that is wrong. If you put the brain in a healing environment, often it can get better, much better, but it requires forethought and a great plan. And this healing is not just for football players. We have seen improvement in brain function for people with attention deficit/hyperactivity disorder (ADHD), anxiety, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), Lyme disease, addictions, and even improvement in some people with Alzheimer’s disease. In this book, Joe shares many of the important lessons we have learned, while at the same time giving you his unique perspective on healing. I encouraged Joe to write this book because of his extensive experiences and perspective as a master psychiatrist who integrates the latest thinking about the mind with our work on looking at and optimizing the brain. Reading this book will be like sitting on the psychiatrist’s couch of the future. In recent years Joe has also become an expert on the effects on the brain of Lyme disease, in part because his own daughter has had it. Both Joe and I believe infectious diseases, like Lyme, will play a significant role in how psychiatrists will help people in the future, which you will learn about. Joe is also an expert on Irlen syndrome, a visual processing disorder, which can be associated with headaches, anxiety, learning challenges, and irritability. One of the key ideas of this book is that you need first to heal (an injured brain if present) and balance the brain before other interventions can work well. Too often people see therapists to help their minds, when they first need to help their brains work better. Readers will learn a lot about what they can do to help themselves from the tools and approaches presented here. Most readers will not need to come for a SPECT scan to benefit from the information given in Reclaim Your Brain. The book is a great illustration of how much anyone can improve and heal when we pay attention to the mind and brain at the same time. Reclaim Your Brain is your road map to a better brain and a better life. It is packed with useful information, powerful stories, and a completely new way of thinking that can help you feel better quickly as you heal and balance your busy brain, while at the same time teaching you how to protect the most important part of you (your brain) for many years to come. I am excited for you as you embark on reading and applying the principles in Reclaim Your Brain. They have changed my life and the lives of many others. With Dr. Annibali’s expert guidance, I know they will help you change your life for the better. Daniel G. Amen, M.D. Author of Change Your Brain, Change Your Life June 2015 Acknowledgments This book would not exist without the encouragement, support, friendship, and advice given to me by Daniel Amen, M.D., to whom I am deeply grateful. I have profound admiration for Dr. Amen’s trailblazing work, his clinical genius, and his courage. Thank you, Daniel. I am also grateful to the Washington Psychoanalytic Institute, where I spent five stimulating years becoming a psychoanalyst and a number of years afterward as a faculty member. Freud may be dead, but many of his fundamental ideas live on, nourishing those like me who wish to understand other human beings most deeply. Gary Moak, M.D., has been my devoted friend and sounding board for both personal and professional matters for more than forty years. I am grateful for our friendship, which started during our college days at Penn, and for his advice and encouragement about this project that started long before my book proposal ever saw the light of day. Gary reviewed many of the chapter drafts, giving useful feedback that helped enormously to improve areas where my writing and thinking were unclear. Robert Licata, M.D., has been a colleague and dear friend for more than twenty-five years. Bob’s pithy conceptualization of the relationship between the prefrontal cortex and the limbic system gave birth to a number of the ideas I explore in this book. He also graciously reviewed a number of chapter drafts. For many years, Bob and I were members of a study group with our colleagues Dave Gebara, M.D., and Larry Spoont, M.D. In this study group we discussed a number of seminal books and papers and worked over many of the ideas that I explore in this book. I am grateful to Madame Renelle Gannon, my French tutor of more than a decade, for far more than my reasonably proficient command of the French language. I am indebted to Madame Gannon for her encouragement and support, and for fascinating twice-weekly discussions about language, art, politics, history, philosophy, religion, and spirituality, always in French, certainement. My sincere thanks are due to my agent, Celeste Fine, who remarkably obtained for me a book contract in no time flat, and her associate John Maas. This work would not have seen the light of day if my editor, Caroline Sutton, had not stuck with me through my early abortive attempts to learn how to write a book. I am grateful for her confidence in me and in the ideas I wanted to write about. Thank you as well to her associates Brittney Ross and Brianna Flaherty. Whatever coherence and lucidity exist in this book are due in large part to Dedi Felman, writer and editor extraordinaire. She, too, was encouraging as she helped me wrestle my meandering ideas into a conceptual whole. During my moments of discouragement when I came face-to-face with how little I knew about writing a book that tells a clear story, Dedi told me to “trust the process,” which I did. Thank you, Dedi. In addition to Daniel Amen, M.D., many other individuals within Amen Clinics have given me help and support. Dr. Rob Johnson reviewed the chapter on addiction and gave helpful input on that chapter and on the spiritual themes I discuss in the conclusion. Sue Johnston, M.S.W., L.C.S.W., our clinic’s mind-body therapist, reviewed the manuscript and gave helpful feedback. I have been wonderfully blessed by the devotion of my wife and children. My wife, Dianne, has gifted me with her love and positivity, showing me how a loving relationship can heal a wounded soul. A beautiful heart can bring things into your life that all the money in the world couldn’t obtain. For her love, encouragement, and support—both during the writing of this book and throughout our long relationship—I am eternally grateful. Dianne sacrificed in many ways so that I could have the time and energy to work on this book. My son, Chris, and my daughter, Elizabeth, have also been enormously supportive of me as I wrote this book. I have learned so much about life and love from them. It is a wonderful thing to see your children turn out wiser and smarter than you could ever be. I have the most interesting job in the world. I get to talk to people about the things that matter to them most, as we work to find ways to manage their minds, balance their brains, and unleash their healing processes. I am grateful to the thousands of patients with whom I have had the privilege to work during my career of thirty-plus years. At times I’ve felt that I learned and benefited more from our relationships than they did. There are many patient stories in Reclaim Your Brain. In all cases, the patients I write about have been thoroughly disguised and/or melded into composites to protect their privacy. As much as I appreciate the significant help and support I’ve received while writing this book, any misstatements and mistakes are my responsibility. Joseph A. Annibali, M.D. Chief Psychiatrist, Amen Clinics, Washington, D.C. June 2015 REINING IN THE BRAIN Introduction When I first met Emily, a magazine editor, she nervously picked her cuticles as her mobile phone inside her bag buzzed incessantly, alerting her to the umpteenth text message. Emily told me she had trouble concentrating. She described her brain as feeling like a “buzzing beehive” of random thoughts. Lately, she said, her claustrophobia was stifling her life. Then there was Josh, a college student, who was skipping class and close to flunking out. He sat down in my office and we tried to talk. But it was hard to communicate; Josh was agitated, avoided eye contact, and tapped his feet incessantly. His mind, he said, was “like an out-of-control freight train,” going so fast he couldn’t stop it. Corrine, an advertising executive, was also always on call. She juggled many accounts in her job. She felt a bit worried lately; she was mixing up details and forgetting crucial appointments. When I asked her how she felt when she tried to relax, she replied, “It’s like I have three radio stations playing in my head at the same time.” Yet she was confident she could take on even more and bigger projects. Emily, Josh, Corrine, and others like them may have different conditions including stress, ADHD, anxiety, and depression. Yet, fundamentally, the experience they describe and wrestle with is the same—it’s what I call a “busy brain.” Some people with a busy brain describe their brain as being “in chaos”; others feel that their brain is on fire. In and of itself, a busy brain interferes with attention, concentration, focus, mood, and often much more. Busy brains leave us distracted, preoccupied, or quick-tempered. A busy brain is more than just a description or a feeling. A busy brain literally is just that: It functions less effectively because of its own excessive activity. It can’t do a good job selecting the best course to take because it can’t shut off all the mental chatter urging other ways to go. Consequently, a busy brain may lose the ability to solve problems because it’s going off on too many wrong or unproductive paths. In fact, I began my own exploration of busy brains when I noticed that individuals complaining of extra-busy brains had brain scans that revealed excessive activity in one particular area of the brain—the limbic system. As the chief psychiatrist at Amen Clinics in Reston, Virginia, a board-certified practicing psychiatrist for thirty years, and a trained psychoanalyst, I have worked with thousands of people who report this common sensation—an overloaded, overstimulated, and keyed-up brain, regardless of whether they are ultimately diagnosed with ADHD, anxiety, depression, bipolar disorder, OCD, or even substance abuse or autism. Many people come to my office hoping to learn how to function better and to find peace. In this book I want to share with you what I have shared with many of my patients. As we explore the root causes of a busy brain, you will gain a better understanding of what is going on in your brain and your body. Understanding the brain’s physical functions will help you more effectively address problems as they arise. Crucially, you will learn strategies for calming your busy brain and managing your mind. Action plans feature steps that you can take immediately. I begin by taking you on a journey of your brain and its activities. Importantly, the busy-brain feeling we experience typically correlates with actual “overactivity” in specific areas of the brain. When you feel stuck, with your mind going around and around in a loop you can’t seem to get out of, it may be because an area of your brain called the anterior cingulate is overactive, locked with its pedal to the metal. When you wrestle with anxiety, it may be because another area in your brain called the basal ganglia is overactive, revving in high gear. Negativity, anxiety, mood disorders: all of these can be illuminated by understanding how key brain areas function. Understanding what’s literally happening in your busy brain is key to slowing it down, to taming the chaos. A biological, neuroscientific approach illuminates a great deal about our brains. But this is not all we need to know. In order to reclaim your brain—and to best understand the self, the individual, the person, the soul—we need to look at both psychology and biology, mind and brain. Specifically, we must not overlook the power we now have to manage our minds. Given what we now know, managing our mind is crucially important—and more effective than we ever suspected. Why? In a single word, change. What we now understand better than at any time previously is just how much and in how many ways the brain can be altered, and how the brain can transform itself for the better. Many people think our brains are set in stone, but in fact our lifestyles and life circumstances always affect that three-pound organ in our head. Brain changes result from many causes, including developmental experiences, emotional traumas, substance abuse, physical brain trauma, infections, and many other things. Your brain can and does change because of stress—for example, we know that cells in the hippocampus die when an individual experiences prolonged stress—and therein lies the risk of more negative changes in a person’s life when they don’t listen soon enough to their too-busy brains. In fact, according to a comprehensive survey conducted by the National Institute of Mental Health, more than half of Americans are expected to develop a mental illness in their lifetimes. Calming your busy brain reduces the chance that things will get worse. But if brain change can be for the worse, it can also be for the better. The great discovery of what we call self-directed neuroplasticity is that the brain is not fixed, but rather in constant flux, and that you can actually change your brain for the better. Circuits can be rewired; brain maps can be redrawn. New neural pathways can sprout to accommodate new functions or new environments. Whatever your experiences in childhood and beyond, it is possible to learn new ways of thinking, reacting, and behaving; new patterns can be established. In Reclaim Your Brain, I show you how to rewrite your negative stories, how to slow down your busy brain with mindfulness techniques, how to create healthier relationships, and ultimately how to bring your brain and life back under control, all of which increase the likelihood for success and joy in life. We’ll also explore how to manage conditions that contribute to a busy brain, such as anxiety, mood problems, ADHD, stuckness and OCD, addictions, and emotional traumas. Though I am a psychiatrist and I believe wholeheartedly in the use of psychiatric medications where appropriate, my treatment doesn’t begin or end with my prescription pad. Many times it is better to start with more natural and integrative interventions such as lifestyle changes, mindfulness exercises, neurofeedback, and nutritional supplements. I will discuss the many natural interventions that allow the reader to calm a busy brain without professional assistance or medication. Throughout these chapters, I give many case examples, approaches, exercises, and suggestions to help you understand your brain function and find the best ways to calm and balance your brain. No one solution is right for everyone. One important note: sometimes rebalancing our busy, overactive brain requires more than managing our troubled minds. It requires healing what’s broken or damaged. It may seem obvious that healing the brain must take priority. But brain injuries are often missed or not avidly sought out in the first place. In the “Healing the Hurting Brain and Body” chapter at the end of the book, I describe various, often hidden, injuries to the brain and the body that can contribute to an overactive brain. Many are quick to believe that their too-busy brains result from today’s rapid-fire media culture, digital technology, and modern-world megadistractions. These ever-present distractions have a negative impact, no doubt. But an overactive brain is not strictly the result of our modern 24/7 device-driven culture. Hidden contributors to a busy brain can include genetics, vitamin deficiencies, dysfunctional thyroids, heavy metal toxicity, infections, and even physical brain trauma. I assess patients by looking at the whole person: their life circumstances, medical histories, diets, habits, and brain activity. When necessary with some patients, I also use a brain-imaging technique called brain SPECT, described in Chapter 12, to detect imbalances in brain-circuit activity, brain injury, physical brain trauma, and other ways in which the brain can be damaged or malfunctioning without one being aware of it. Please note that although you will hear a good amount about brain SPECT scans in Reclaiming Your Brain, you do not need a brain scan to make good use of this book. Josh, our student with a mind like a freight train; Emily, with her claustrophobia and inability to concentrate; and Corrine, our advertising executive who cannot relax, all profited from mind management techniques alone: managing negativity, learning simple mindfulness techniques, and rewriting the stories about themselves and the world that previously had so powerfully dominated their lives and relationships. The tools and approaches I present will be helpful for most people, regardless of whether you ever have a brain scan. In this book, I offer solutions that will help you feel better, perform more productively, experience less stress, and be more fulfilled in life. With a calm mind, you can find clarity, strength, vision, and hope. You can reclaim your overloaded brain and bring your life back under control. Let’s begin the journey. 1 Balancing the Brain Many of us have at least some familiarity with the “busy brain” feeling of being overwhelmed. We all have days when instead of catching up, our task list seems to grow ever longer. A new work project lands on our desk even as we rush to complete the previous one. A young child or elderly parent falls sick, with the caretaking burden falling squarely on our shoulders. And then comes the last straw: the transmission on our old reliable car fails, incurring an expense we can’t afford. With all that is on our plate, we feel revved up and in overdrive, perhaps on the brink of a panic attack. Thoughts go around and around, but instead of resting somewhere, they continue cycling: How will I catch up on the job? Take care of my children? Fix my car? Pay my bills? What’s literally going on in our body and brain when we experience these sensations of a busy brain? What does it mean for our brains to be “revved up,” in overdrive, or, most crucially, unbalanced? A tour of the brain will help us begin to answer these questions. The cerebral cortex, or the bulk of your brain, houses four lobes: the frontal lobe, the temporal lobe, the parietal lobe, and the occipital lobe. Located underneath your temples and behind your eyes on both sides of your brain, the temporal lobe is essential for speech, language, memory, and emotion; processing immediate events into recent and long-term memory; and storing and retrieving long-term memories. It is also involved in processing sounds and images. Traumatic brain injury often involves damage to the temporal lobe, leading to changes in memory, mood, and personality. The occipital lobe is in charge of visual processing. The occipital lobe is also affected by Irlen syndrome, which is a little-known but common visual processing difficulty that I’ll discuss later. The parietal lobe is a general integration center that processes information from your different senses that is then passed to the front of the brain to use for decision making. It also controls bodily awareness and position sense, letting one part of your body know where it is in relation to the rest of the body and giving you an idea of where your body is located in space. For the purposes of our discussion of balancing the brain, however, the frontal lobe, or the part located at the front of your brain, is absolutely crucial. The part of the frontal cortex closest to your eyes is called the prefrontal cortex, or PFC. This is the executive control center of your brain; think of it as the “governor” or the “CEO” of the brain. It manages your attention, concentration, short-term memory, organizational ability, impulse control, planning, judgment, learning, motivation, problem solving, and goal setting. Quite a list. A well-functioning PFC is crucial to your ability to rewrite the negative stories you tell yourself. Importantly, the PFC holds the limbic system in check, which helps the brain find and maintain its balance. The limbic system is the seat of your emotions. Found in the center of your brain, beneath the cortex, it is a more “primitive” brain area compared to your organizational, learning, and impulse-controlling PFC. Major components of the limbic system include the anterior cingulate, the basal ganglia, the amygdala, and the thalamus. The anterior cingulate is your brain’s gearshifter. When the anterior cingulate is too active, you become “stuck.” Problems that involve the anterior cingulate include negative ruminations, obsessions, compulsions, and addictions. The basal ganglia sets the rate of your body’s idle, much like a car engine. If it’s running too high (and this can be the result of your genetics), you’ll likely feel chronically anxious, worried, and keyed up. Excessively active basal ganglia are often accompanied by panic attacks and unhealthy avoidance of conflict. The amygdala, an almond-shaped area (amygdala means “almond” in Latin) is involved with basic survival issues. It is the equivalent of a primitive emergency alarm system. It quickly assesses threats and then triggers a fight-or-flight reaction. Problems arise when high levels of stress create “amygdala overactivation.” Your executive function center, the PFC, can even be hijacked and shut down when the amygdala is in overdrive. The result? You’ll be overwhelmed by anxiety, fear, or terror, and your brain won’t be able to call on your PFC—the thinking part of your brain—to help you calm down. The problems we’ll look at associated with the amygdala include post-traumatic stress disorder (PTSD) and other emotional traumas such as early childhood neglect and abuse. Finally, the thalamus is involved in appetite, sleep, bonding, and sexual desire; this part of your brain colors your emotions. Conditions that are related to a problematic thalamus include depression, bipolar disorder, and even premenstrual problems. I’ve described the busy brain as an unbalanced brain. The balance referred to here is that between the prefrontal cortex (PFC) and the limbic system. When the brain is unbalanced, the evolutionarily more modern PFC is either too strong or too weak to counter the more primitive limbic system. On the one hand, if there is too much guidance, too much control by the PFC, you have somebody who is ruled by his head and not enough by his feelings, passions, and urges. Think of Mr. Spock from Star Trek. He is in such mastery of his emotions that he sometimes fails to benefit from the insight others naturally derive from their passions or gut. When the PFC dominates, the brain is unhealthy and unbalanced. On the other hand, if the limbic system is too strong and/or the PFC is too weak, you have an individual who is ruled by her passions and urges and controlled too little by her head, by rationality. This would be an individual with overwhelming feelings and impulses but insufficient rationality to select goals and guide behavior. The Anti–Mr. Spock. Someone out of control, in extreme cases maybe even someone manic. Most—but not all—instances of a busy brain fit this second pattern, a PFC or governing system that is not strong enough to control the limbic system. Critical imbalances between the limbic system and the prefrontal cortex adversely affect mental and emotional stability. Take Sierra, who cares for her mother who has worsening dementia; Sierra is overloaded between ministering to her mother, her duties at work, and the need to keep her own home running. When the April 15 deadline for filing her taxes rolls around, Sierra’s already revved-up limbic system goes into overdrive as she rushes to complete her return. The stress of doing the tax return, an otherwise routine yearly chore, overwhelms the delicate balance between her prefrontal cortex and her limbic system. Her PFC is no longer holding back her limbic system. Her feelings and impulses start to overwhelm her. Sierra begins experiencing panic attacks. Similarly, Thad, who has worked day and night for sixteen months preparing a major proposal for his company, finds himself becoming sleep-deprived, burned out, and depressed. With his stress response fully activated for sixteen months and his limbic system in sixth gear due to his work on the proposal that will make or break his career, the delicate balance that Thad’s PFC has struck with his limbic system is thrown off and Thad can no longer ward off depression. When the limbic system is too strong and/or the PFC too weak, the PFC is not strong enough to control the wild horses of the limbic system and the herd runs amok. How do we rein in the wild horses if the prefrontal cortex isn’t doing its job properly? In the chapters that follow, I will discuss strategies for balancing an unbalanced brain. In essence, we can manage our minds. You may have heard that meditation has a positive impact on the brain, a finding supported by research and verified by brain scans. Similarly, in learning to rewrite the negative stories we tell ourselves, we can also have a positive impact on the brain: we can strengthen the control of the PFC over the wayward limbic areas, bringing the brain into better balance. Simultaneously, by learning new models of relationships, we may calm our hyperarousal and create new patterns of behavior. — But before we turn to the specifics of how we can exert more control over a runaway limbic system, there’s another piece to the brain puzzle we must grasp. And that has to do with the necessity of healing a broken brain. For not all busy brains are equal. And if a brain has sustained significant injury, it must be treated and healed before we can effectively apply techniques of mind management. Earlier in my psychiatric career, I was often stumped because I found that some patients markedly improved with treatment, whether via rewriting their stories, implementing mindfulness approaches, talk therapy, psychiatric medications, or other treatments, while other patients didn’t get better at all, or they had a response to treatment opposite to what I expected. It wasn’t supposed to be this way. After all, I was a well-trained psychiatrist and I really wanted to help my patients. But despite my professional knowledge and experience, and my sincere attempt to be of assistance, I wasn’t always helping my patients as much as I’d hoped to. I wondered why this was so. I was prescribing the newest medications; I kept up with the advancements in the field. But few of the basic scientific discoveries had yet been translated into the field of psychiatry, and my own treatments continued at times to fall short. What I was missing became clearer when I met Bill, a patient who came to me for treatment shortly after I started working at Amen Clinics. Bill’s case gave me the conviction that a brain must be healed and balanced before mind-management techniques can succeed. Bill first came to see me after attempting suicide in his dorm room. A twenty-year-old Yale student, Bill was bright and had always been self-motivated, even as a kid. He taught himself to read and devoured science books. As a three-year-old, he seemed to know nearly as much about dinosaurs as professionals who had spent their lives studying them. Despite his intellectual gifts, Bill nonetheless experienced bouts of severe, extreme depression. And his overdose at Yale had nearly killed him. While home on winter break from Yale, Bill “borrowed” his mother’s Ambien without her knowledge. Back at school, he took a potentially lethal cocktail of Ambien, Effexor XR, and a fifth of whiskey. Bill left a suicide note underscoring the seriousness of his wish to die. Fortunately, Bill vomited the pills and whiskey, probably because he was not used to consuming that much liquor. That saved him from a likely fatal overdose. Unfortunately, Bill aspirated the vomit and developed aspiration pneumonia. It was touch and go for him in the ICU for several days. Bill’s roommate called 911 when he discovered Bill unconscious and covered with vomit. Bill was rushed to the hospital, which notified his shocked parents. They immediately drove to New Haven to be with him. Bill’s mother said, “I worry that I’ve let my son down somehow. We’ve tried to do everything we could to help him, but we’ve failed.” Understandably, Bill’s mother felt guilty, as mothers tend to do. Once Bill was stabilized and discharged from the hospital, his family insisted that he take off a semester from Yale and get psychiatric help, which was when Bill came to see me. I attempted to treat Bill with antidepressant medication, taught him techniques to rewrite his negative stories about himself and the world, and met with Bill for twice-weekly psychotherapy. Bill improved, but only moderately so. He smiled more and was able to laugh a bit, but he continued to feel down and depressed. Antidepressant medications—and we tried several with Bill—really never altered his fundamental negativity and his proneness for severe depressive dips. In psychotherapy, we explored his underlying rigid and unreasonable expectations of himself—in essence trying to help him rewrite his internal narrative, his story—but this was not sufficiently useful. Bill cooperated with treatment, but our treatment had not made enough progress to help Bill move toward being fully free of depression and able to return to Yale. Because Bill had not made sufficient progress, I told him about brain SPECT scanning, a way to look at what the brain is doing, and asked him to consider it. I hoped that SPECT might reveal something about the root of Bill’s problems that we were missing. Bill and his parents agreed, and Bill had his brain scanned a week later. We were not disappointed. The SPECT results showed that Bill’s brain was hurting in a way none of us had anticipated. He had significant damage to his left temporal lobe. Bill’s brain wasn’t just unbalanced; it was injured, even broken. I knew that temporal lobe problems, especially on the left side, can contribute to or cause marked depression and negativity—and also rage at times, which fortunately Bill didn’t have. Bill’s SPECT findings showed me why antidepressants hadn’t helped him; antidepressants don’t fundamentally address brain injury, especially injury in the temporal lobes. I carefully questioned Bill and his parents about whether he had a history of head injury. They had no specific recollections of head trauma, but they did tell me that Bill played soccer throughout high school. This was consistent with my experience with other patients; I’ve seen quite a few soccer players who had head injuries from playing that sport. Heading a hard soccer ball is not a good thing for the brain. The evidence of physical brain injury reduced Bill’s parents’ guilt. They hadn’t failed him. Bill’s problems weren’t the result of lack of adequate effort or love on their part or bad parenting; rather, there was a clear physical problem with Bill’s brain. And Bill needed to reexamine the unhealthy negative stories he believed about himself, that he was weak and fundamentally flawed. This dramatic shift in understanding about the causes of one’s difficulties is typical when brain SPECT reveals significant but previously unknown brain injury. With this new information provided by SPECT, I put Bill on Lamictal, a medication that targets temporal lobe problems. Lamictal was the answer to our prayers. Gradually, Bill improved. Eventually, after several months, he was close to 100 percent, with hardly any trace of depression. Bill continued Lamictal, returned to Yale the following semester, and ultimately graduated with honors. Following Yale, Bill attended and graduated from a top-notch law school and now works as a fourth-year associate for a large law firm. Without much exaggeration, SPECT imaging allowed me to save Bill’s life; I am certain that, given the severity of his depression and suicidal urges, he would have ended up killing himself if we had not found successful treatment for him. Detecting and stabilizing his left temporal lobe was the key step in Bill’s successful treatment. And it obviously impressed me that I was on the right track in looking at brain function, especially in individuals who did not respond previously to “treatment as usual.” As stressed here, hurting brains must be healed before we can proceed with managing the mind. But your brain isn’t always broken, and none of this is meant to say that readers will need a SPECT scan. Further, due to neuroplasticity, mind management alone can result in important changes to the brain. Most readers will and can effectively employ the tools of mind management that follow. With a better picture of the workings of the brain, let’s get started with all that you can do by yourself to change and rebalance your overactive brain. MANAGING THE MIND 2 Conquering Negativity When I first began to explore the busy-brain phenomenon, I quickly recognized another pattern in those who have it. Many of these individuals also struggled with excess negativity. It was as if not only were their brains caught in a loop, but that loop was almost uniformly negative. Remember Thad, who had been working sixteen months on a career make-it-or-break-it proposal? He was typically overwhelmed by his busy brain. The balance between his PFC and limbic system was thrown off. The wild horses had seized control. But even more striking, Thad was sinking into depression as his negative thoughts began to overtake his confidence. His busy brain was caught in a loop of feeling inadequate to the task, panic about the future, and general negativity. There is an undeniable connection between the busy brain and the negative brain. Why, and what can be done about it? Gwen’s story may provide some instructive lessons. Gwen, twenty-nine years old and single, consulted me for help with her relationships with men. To be more specific, she hadn’t had a relationship with a man for six years. Gwen was well educated, stylishly dressed, attractive, outgoing, even playful; I couldn’t understand what the problem was. Gwen said it was depressing not to be able to have relationships with men, but she was not depressed. Her health was good, she did not abuse drugs or alcohol, and she had never been physically or sexually abused. What was happening? Here was a woman who said that she wanted to find a life partner, marry, and have children. There was obviously a roadblock, but what was it? Gwen wanted to meet with me weekly for psychotherapy to work on her relationship issues, which we did. Our discussions centered on her stories about different men becoming interested in her, their initial approaches, and reciprocated interest on Gwen’s part, which were followed by Gwen’s abruptly breaking off contact when things got too close. Whenever a relationship was close to becoming sexual, Gwen would end it. Gwen reported a number of satisfying college relationships that had included sexual intimacy. So why now the dismissals of otherwise viable partners? As her pattern with men became clearer, I was able to point out to Gwen that she broke off the budding relationships for reasons that did not ring true. In one case, it was because the fellow couldn’t attend her college reunion with her; he needed to be out of town for an important business trip. In another case, the guy didn’t call her when he promised; it later became apparent that he’d lost his phone, but she terminated their relationship nonetheless. Soon, Gwen felt safe enough with me to share that she had a secret that she’d never told anyone. She wasn’t willing to tell me the secret, at least not yet. But she did say that the secret was so horrible, so disgusting, that she was sure that I would not want to continue seeing her if I knew it. We continued meeting, reviewing her aborted attempts at forming relationships. The pattern became clearer and clearer. Gwen broke off each relationship just before it would have become sexual. And she continued to hint that her important secret had something to do with this. From time to time I commented that whatever the secret was, it seemed so important that it needed to see the light of day. Could we find a way to discuss it? Finally, after six months, Gwen consented to tell me her secret. She first made me promise that I would not stop seeing her once I learned the secret. And she said that she would tell me the secret only if she turned her back on me, so she would not see what she imagined would be the disgust on my face when she told me her secret. I knew it was important to make it safe for Gwen to tell me her secret, so I agreed to her requests. And then she finally told me the secret. What was it? What had such a powerful hold on Gwen that it derailed relationships and made her so strongly fear rejection from me? The answer: that she had herpes. Her last boyfriend, whom she’d met in college, had herpes and passed on the infection to Gwen. Let’s be clear: no one who gets herpes is going to rejoice about it. Once diagnosed, it is not uncommon to have an initial reaction of shame or feeling dirty. Many also are angry at the person who infected them. They may feel overwhelmed by the idea of having a lifetime of symptoms and the need to manage the disease over such a long time. But few also react to the news quite as catastrophically as Gwen did. After an initial period of adjustment, most individuals infected with genital herpes learn to talk to existing and potential partners about it, to incorporate the new medication regimen into their daily routine, to avoid sex during periods of inflammation, and to generally move on with their lives. Genital herpes is more common than diabetes or asthma; about one in five Americans is infected. Most people, by necessity, learn to cope. For Gwen, the problem was not the herpes itself; it was her thinking about it. Once diagnosed, Gwen believed that the herpes was so bad, so horrible, that nobody would want her. And as she held on to the secret, its impact on her only grew. As a result, that initial period of adjustment that most go through lasted six years for Gwen. During that time, she pushed away potential partners and could barely bring herself to tell me, the doctor she’d come to for help. Gwen was caught in an exceptionally bad case of negative thinking. Why do some people seem to possess a natural optimism, while others spin downward in a negative spiral? What causes the brain to busy itself with negative thoughts rather than positive ones? Negative tendencies aren’t all bad. They often reflect a realism that springs from experience. Whatever path we plot, obstacles may arise and mistakes can happen. On the upside, planning for the worst forces us to be prudent and to attend to the details. And details matter. Richard III said, “For want of a nail the shoe was lost . . . ,” leading to the loss of his kingdom. Modern life is adorned with problems because someone neglected to take care of the little things. Perhaps you’ve been feeling too busy to take care of a toothache until it becomes an after-hours dental emergency. Or your friend was thinking a water spot on the ceiling isn’t important until water floods through the roof during the next big storm. Or maybe you missed the first charge on your credit card bill made by someone who stole your account number. The caution and vigilance associated with negativity can serve as an effective preventive. But excessive negativity can also be a self-fulfilling prophesy. There seems something true about sending out negative vibes and having the universe respond in kind. Plus, seeing only the negative can blind us to positive lessons to be learned from our experiences. Individuals who are stuck in negativity and feel that the world is against them often get locked in a vicious circle. Precisely because they feel powerless to combat what they see as the unfairness of life, they don’t engage in the solid planning, persistence, and frank hard work that would allow them to attain realistic goals. We may never really know all the factors that have contributed to our tendency to be negative. What’s important to understand is that negativity is not unalterable. In fact, later I’m going to share with you approaches to counteract negativity that have worked for many people, including myself. It’s also important to understand that negativity is not a defect. In fact, negativity is the default position of the human psyche, part of the brain’s survival system, which is why it’s so hard to eradicate. Blame Our Wiring for the Intransigence of Negativity Why would our brains make us so negative? The reality is that the brain is hardwired for negativity. Studies of brain development and observations about early traumas support this. First, let’s look at brain development. We have two brain hemispheres—the right and the left. To simplify greatly, the right hemisphere deals more than the left with emotions and the gist of sensory experience and pattern recognition, while the left hemisphere deals with language, logic, and problem solving. Now it turns out that the right hemisphere is more negative than the left; the left hemisphere—to the extent that it does deal with emotions—is more positive than the right. Strokes in adults in the left hemisphere reduce positivity, and the individual often becomes depressed. Likewise, adult strokes in the right hemisphere reduce negativity, and the individual often becomes inappropriately happy or manic. The left hemisphere orients itself toward positive emotions related to approach, exploration, and connection with others. The right hemisphere, as we have discussed, is oriented toward negative emotions related to withdrawal and self-protection. It is more closely related to the limbic system and to the rest of the body than is the left hemisphere. Think of emotions as experiences that move us toward or away from something or someone. Emotions are the ways we experience and interpret the impact of our brain networks on our body states. The negative emotions we experience—think fight or flight—are more primitive and basic than our positive emotions. And negative emotions—grounded as they are in the right hemisphere and the primitive amygdala—can even override the more positive and logical left hemisphere when we are threatened. Situations of significant threat or danger can literally render us speechless—the left (verbal) hemisphere shuts down, and the right hemisphere and the amygdala dominate our experience. The kicker is that in an ironic twist of fate, Mother Nature has seen fit to develop the negative right hemisphere before the more positive left hemisphere develops. Because in typical brain development the right hemisphere comes online first, infants and toddlers experience the world with a negative tinge and of course have no language or logic with which to understand or correct their early perceptions. Thus, a baseline, a foundation, of negativity is set early in life. Later, the left hemisphere matures and we develop language and an ability to apply logic to otherwise emotionally driven situations. But the foundation of negativity has already been set in stone. Because so much of early emotional learning is guided by the right hemisphere, negative experiences early in life can have a detrimental and long-lasting impact on how we feel about ourselves, our personality structure, and how we tend to experience the world. The development of our memory system also hardwires us for negativity. To again simplify greatly, we have implicit and explicit memory systems. Implicit corresponds to nonverbal. Think of riding a bicycle. We remember how to do it, but we cannot explain it in words. That’s implicit. Explicit corresponds to verbal. We can remember the name of our fourth-grade teacher or the date we memorized for the attack on Pearl Harbor. The implicit memory system is centered on the amygdala, which learns quickly and crudely about dangers but seems to hold on to them like a steel trap because it deals with threats to existence. The amygdala is for the most part not plastic; its memories are relatively fixed and rigid. The explicit memory system is based in the hippocampus, which is “plastic,” or changeable, so we can learn new things and forget what is nonessential. The problem is that the explicit system, like the reasoning left hemisphere, takes longer to develop, leaving the infant once again prone to negatively tinged experiences of the world provided by the earlier-developing amygdala system. The perceived dangers from early traumas, branded into the more primitive parts of the nervous system, including the amygdala, can last a lifetime. We all wish that love would triumph over fear, but neurobiologically speaking, that’s a tall challenge. The infant and young toddler have only the amygdala memory system active in their brain. So they have the right hemisphere, which tends to interpret things negatively, and they have their only memory system being the amygdala. The amygdala’s steel trap just won’t let go of early traumas. Later, as language skills begin to develop, young children begin to develop an effective explicit memory system centered on the hippocampus, in which memories can be modified and even forgotten. In fact, full development of the hippocampus likely occurs only in early adulthood. But until they are at least past the toddler stage, the only memory system children have is the amygdala system, which holds on to traumatic memories like the proverbial elephant—never forgetting. Experiences early in life about relationships, trust, security, and love are under the control of the right hemisphere because the left is less functional at that point. We do not recall early traumas in words. That is to say, we do not recall them verbally, at least not in the familiar left hemisphere language-based way of remembering. But the impact of these traumas may be there nonetheless, in the nonverbal right hemisphere and amygdala, having a significant impact on us and affecting our functioning and relationships. We often thus repeat an early relationship pattern without being fully conscious that we’ve retained those feelings and patterns, a phenomenon that Freud described as transference. As Freud said, we repeat, rather than remember. These issues have much to do with why psychotherapy can fail: nonverbal and preverbal issues are intrinsically more difficult to address than those that arise out of the more logical left hemisphere. It’s difficult to interrupt deep-rooted right hemisphere patterns of behavior, especially patterns of which you’ve only recently become aware. Again, that the implicit memory system develops before the explicit memory system means that any kind of negative experiences early in life can have far-reaching and often unrecognized effects. A negative foundation is established, often without our conscious awareness. A Busy Brain Is Most Often a Negative Brain That we are hardwired for negativity goes a long way toward explaining why a busy brain is almost always a negative one. As the PFC loses control over the limbic system, the result is a flood of often negative thoughts and emotions. Let’s look a bit more closely at what exactly is going on inside your busy brain. Let’s first take a big-picture view of how the brain works. Think of the brain as a modified reflex arc. With a simple reflex arc, we have an environmental stimulus (say, tapping on the kneecap tendon with a reflex hammer). The stimulus is relayed to the spinal cord and processed minimally, and then a nerve impulse is sent to the muscles of the leg to cause a jerk. This reflex arc is a simple mechanism to protect the organism from danger, with minimal processing of the stimulus. Now consider the brain as a more complicated reflex arc system to manage stimuli from the environment. We have stimuli that come into the brain, processing occurs, and then the brain orders a response. The pattern is STIMULI PROCESSING RESPONSE. Stimuli from the environment enter the brain. The brain has to process the stimuli and decide what, if anything, the organism should do. The brain “wants” to be calm (i.e., no pressure to decide or to act). But the brain becomes aroused, goes on alert, and springs into action when there is uncertainty, a threat, and also a potential reward (food, sex). When the brain is aroused, we eventually will be pressed to do something (run away or fight, gather the food, pursue our sexual object . . .). The pressure to do something is tension. It is unpleasant. This is the connection to negativity. In a busy brain, the pressure and tension to do something are amplified, and thus the negativity is amplified. As mentioned earlier, in a busy brain, the limbic system and prefrontal cortex are out of balance. The prefrontal cortex potentially brakes the limbic system’s pressure for us to feel an emotion or act on an urge, to take some action in response to environmental stimuli. It’s like being in your car and pressing on the accelerator and brake pedal at the same time. The revving of the limbic system is the busy brain; we experience the excessive limbic activity as too-muchness and displeasure. If the prefrontal cortex is up to the task of managing and guiding the revving—the urges of the limbic system, the wild horses I mentioned earlier—we’ll be in good shape. But if the prefrontal cortex is too weak, we’re in trouble and the revving of the limbic system is too strong, resulting in an out-of-control busy brain. This out-of-control brain is inherently a negative one. Think about the limbic system revving up: a busy brain often results from people being overloaded with stimuli, threats, demands, and so on. They have too much to process with insufficient guidance from the prefrontal cortex. They are overloaded, flooded. This is a dysphoric, unpleasant state, and negative almost by definition. Being stuck in a negative loop is also how patients with a busy brain describe their emotional states. They complain about their busy brains and comment that they are usually focused on the negative. For example, Sarah, twenty-three, seeing me for ADHD, attacked herself for not being able to complete her term papers. Over and over, she’d say to herself, “I should be able to sit down and write those papers.” And to top it off, Sarah then berated herself for attacking herself about her inability to do the term papers: “OK, I struggle to do the papers, but it is so stupid that I keep attacking myself over it. What a waste of time and energy. It’s bad enough that I can’t write the papers, but then I foolishly waste time and energy ruminating about it. I mean, there are worse things in the world. I’m not hurting anybody.” People stuck in these negative loops continuously beat themselves up. When we examine brain SPECT scans of individuals stuck in these negative loops, the data tends to back up the individuals’ self-reports. Busy brains as observed on brain SPECT correlate closely with reported subjective negativity. Also, a busy brain on SPECT often—but not always—includes overactivity of the anterior cingulate. An overactive cingulate usually makes one stuck on negative thoughts and feelings. Sarah had markedly overactive anterior cingulate activity that contributed to her stuckness and her tendency to get stuck on attacking herself for being stuck. The negative thoughts in her mind were like the mirrors in a scary fun house, bouncing off one another in troubling ways. Why Is There More Dysfunctional/Negative Thinking Nowadays? One interesting question raised by the prevalence of busy brains is whether there is more dysfunctional thinking now than previously, and if so why that might be case. If the busy-brain problem seems more widespread than ever, could that be connected to a modern plague of negativity? Evolution might hold some answers. Let’s go back to the model of the brain as a sophisticated reflex arc. The guiding principle of evolution vis-à-vis brain function seems to be to ensure survival and reproduction. Because of the ever-present threats to an organism’s existence, the brain is biased to first interpret stimuli as negative. This negative bias optimizes chances for survival because behavior is based on the principle of “better safe than sorry.” But the cost—in terms of negative thoughts and feelings—can be high. What increases our chances of survival may not be the same thing as what makes us happy. Though we don’t live in the jungle or the savannah anymore, the old evolutionarily determined patterns are still there, bred deep in our beings. But the threats to existence (lions, other hostile tribes) faced by our long-ago ancestors are minimal to nonexistent. Our modern lives are safer. So why would the modern-day world have more negative/dysfunctional thinking? Why would our brains feel even busier, as if the threats were multiplying rather than decreasing? In part, we feel the pressure because the threats are still there. They’ve merely taken new forms. Threats come from credit card companies trying to manipulate us into signing up for high-interest-rate cards, hackers stealing our financial information, banking houses that are manipulating the stock market, potential employers who promise the moon and don’t deliver when you take the job, and so on. In a sense, the modern world is akin to a magician—the threats are not obvious; we must always worry about what’s up their sleeve. And we have to acknowledge that there continue to be real threats to safety and existence. Physical abuse, sexual assaults, and violence remain daily possibilities for many, especially females, the young, and those of us who are vulnerable to being preyed upon. Life can be difficult and dangerous. Going back to the stimulus-response model of brain function, apart from these legitimate threats to health, safety, and even existence, consider that we are nowadays flooded with many more stimuli. Everyone is wedded to their iPhones, iPads, and iWhatevers. So many iStimuli. We have too much to process, most of it not essential for survival, not to mention successful, fulfilling relationships. We may never be able to get an accurate measure of the overall increase in dysfunctional thinking brought on by the iWorld. But it does seem clear that the information overload can contribute to the arousal of the primitive fight-or-flight mechanisms we have been discussing. And our brains can become so flooded, so overwhelmed, so scattered by the endless flood of information, that true cognitive impairment, or “digital dementia,” can be the result. We should not lose hope, however. As stated earlier, negativity, if not curable, is treatable. Let’s look first at the common forms that negativity can take. As you begin to recognize the patterns of negative thinking, you’ll be better prepared to address them and manage your negative thoughts. What Is Negativity? As those stuck in its viselike grip know well, a negative outlook encompasses gloominess, pessimism, a lack of hope. Negativity includes the way we view the world, the past, and the future. In our mental worlds we are critical or hostile toward ourselves or others. We judge rather than understand. Negativity is destructive; it would rather curse the darkness than light a candle. I might even go so far as to say that negativity is the opposite of love for oneself and others. Here are some examples of negative thoughts: “I’m a total loser because I didn’t make the basketball team.” “Nobody will ever love me.” “Everybody is against me.” “I can’t do anything.” “If I apply to college, they’ll never accept me.” “If I ever got a flat, I could never change the tire.” “She didn’t want to go with me to the prom; I’ll never get a date.” “Bill is frowning; I bet it’s because of what I said.” Negative thinking is typically a species of black-and-white thinking, in which the nuances, the shades of gray, are left out. Cognitive behavioral therapy (CBT) is a widely accepted treatment for anxiety, depression, and other issues. It focuses on changing unhealthy thinking patterns that contribute to our difficulties. Specialists in CBT define a number of different negative-thinking problems that they call cognitive distortions. All-or-none thinking relates to defining yourself in extreme black-and-white categories and is related to perfectionism. Take the example of a student with a bad case of the flu who did poorly on her exam and then thought, “Now I’ll never get into law school,” ignoring her otherwise stellar academic record and forgetting the impact her severe flu had on her exam performance. Perfectionists often fear failure or making mistakes. As all-or-none thinkers, they hence try to avoid situations in which they might fail. Unfortunately, however, this also means they cut off meaningful opportunities to grow. Another kind of negative thinking is the mental filter. This is where we focus on one small piece of the puzzle to the exclusion of all else. I have a large nose. If I focused constantly on my large nose, thinking I’m ugly because of it, I wouldn’t see the rest of what others (my wife, at least!) say is reasonably good-looking. Mental filters can also turn otherwise positive experiences into negative ones. Corey held a dinner party that was by all accounts a smashing success. But he couldn’t stop focusing on the fact that one of his colleagues had to leave early. Though his guest reassured Corey that it was because he had to be up early the next morning, Corey worried that the real reason was that the colleague had been offended by something said at the dinner. His colleague’s early departure colored Corey’s whole view of the evening. Despite the guests’ protestations that they’d all had a great time, Corey’s mental filter led him to see the party as an utter failure. When we’re trapped in a negative loop, we often overgeneralize. We think that if something happens once, it will happen again and again. A teenage boy who asked a female classmate to the prom was devastated when she declined. “I’ll never get a date,” he said. Once he overcame his overgeneralization and asked another girl, the next girl he asked actually gladly accepted. Another kind of negative thinking is disqualifying the positive, or refusing to see or recognize the positive implications of what you’ve done. For example, the research proposal you slaved over for weeks was accepted immediately, yet you reject the evidence of the great work you did on the proposal and continue to see yourself as a loser who doesn’t deserve his job. Catastrophizing is imagining the worst, expecting disaster. You lose a document on your computer. “Oh no,” you think. “That will make the project fail.” You go immediately to the imagined catastrophe, rather than problem solving and realizing that your coworker likely has a copy of the document you lost. We may also jump to conclusions or arrive at a negative conclusion not justified by the facts. Your boss fails to say hello to you and you conclude that your job is in jeopardy. What you don’t realize is that your boss was distracted because her toddler was up all night with the flu. When you jump to conclusions, you are performing mind reading, but badly. Labeling is the toxic application of labels to yourself. “I am a complete failure,” you tell yourself. Complete? Really? No positive achievements? We can also destructively apply negative labels to others: “He never does any good work.” Emotional reasoning refers to concluding that your feelings are accurate descriptions of how things really are. How we feel about something may or may not reflect the actual situation. Feelings are just that—feelings. They are not necessarily a representation of reality. “I feel like this presentation didn’t go well,” I might say to a colleague, later to find out that my colleague—and our boss—thought the presentation was quite good. Finally, there are the Shoulds. Later we’ll see how destructive should and shouldn’t can be. “I should be able to do this without any struggle.” “He should not go on vacation; rather, he should stay home and study.” “I shouldn’t be gay.” These statements generate internal pressure and create personal guilt and shame when we direct them at ourselves. When we direct them toward others, they make us judgmental and even toxic. Can we ever really know what we or others “should” do? What can be done to combat rampant negativity? First, it’s important to recognize that we all have an inner critic or judge inside our heads. It often feels like a stranger has invaded us, a stranger who judges others harshly and tortures or even hates us. Second, it’s important to understand that the critical stranger actually is an invader. Because the negativity isn’t you; it’s your brain activity. And the two are not the same. Let me reemphasize that—you are not just your brain, you are not just your thoughts. Why do I make this claim? Well, the whole is greater than the sum of the parts. The brain is a key part of who we are, yes. But we find that the real us is beyond our thoughts. This is why Buddhist and other meditative traditions claim that we find ourselves only beyond our thoughts, apart from our thoughts, in a state of mental peace, often in meditation or silence. Our heart beats, but we are not our heartbeat. Our brain thinks, but we are not our thoughts. That’s why, as we’ll see shortly, you can learn to separate yourself from the rampant negativity in your brain. And in separating yourself from your poisonous negativity, you can calm your busy brain. Managing Negativity Managing negativity rebalances a brain that is out of balance or leaning toward the negative. The techniques to manage negativity strengthen the capacity of the PFC to offset the limbic system; they help to offset the negative default position of the brain. You are literally strengthening your PFC when you do these exercises. When you distract yourself and manage to get distance from your negative thoughts, and counteract the negative thoughts with more rational responses, you are enhancing your PFC’s control over the limbic system. And a stronger PFC ultimately helps check the emotional turmoil we feel from an out-of-control limbic system. A stronger PFC not only reins in the horses, it helps prevent them from bolting in the first place. How Do We Manage Negativity? Distance and Detach: Remember, “You are not just your brain, you are not your thoughts.” Thoughts arise automatically, just like the heart beats automatically and we breathe automatically. We don’t control our thoughts. And yet they can control us if we let them. If we remind ourselves that our brain makes our negative thoughts, that we are not our brain, we gain much-needed distance from our negative thoughts. They happen; that’s it. Don’t fight them. But we can think about our thinking. We can put things into perspective: Our thoughts are not facts. With practice and experience, we can learn to more automatically gain distance from our negative thoughts. Try observing the flow of negativity in your mind, the way you might sit on the bank of a stream and watch the water flow by. You might even view your negativity as a scientist would: “Oh, how interesting that there are self-critical thoughts occurring now.” Another way to create distance and detachment is what I call the “Ronald Reagan Approach.” In his presidential election debates with Walter Mondale, Mr. Reagan repeatedly and quite effectively said to Mr. Mondale: “There you go again.” Tell yourself: “There’s my brain being negative again.” Distract Yourself: Pour yourself into something productive and positive or at least seek out a change of gears. When we are preoccupied with something we enjoy (a crossword puzzle, a good book, a game of catch) or even just find something to absorb us (take a coffee break or talk to a colleague), it gives our system a chance to calm down and our thoughts a chance to refocus from negative to more neutral, if not positive. Another distraction technique is something I call “Sole Therapy”: Focus on the bottom of your shoes as you walk. It moves your attention away from the negativity, distracting you. Remember Your Values: Remind yourself what your values are. If you are ruminating over negative thoughts and decisions, refocusing on your core values will help reduce the negativity. Practice Gratitude: Embrace an attitude of gratitude. Write down three things for which you are grateful. Studies show that simply writing down what you are grateful for can really change the brain and improve mood, moving you away from negativity. Shun the Shower of Shoulds: Get out of the “Cold Shower of Shoulds.” Among the torment of negative thinking that afflicts us often is a constant flood of “shoulds”—“I should do this . . . I should do that . . .” This cold shower of “shoulds” is nothing but destructive. Once we become more aware of our tendency to stay too long in this destructive shower, we have a better chance of stepping out of this negative shower stall. Twist the Dial: Imagine that there is a dial on the side of your head that you could use to turn down the negative thoughts. Imagine yourself turning down the negativity by twisting the dial. Have a Laugh: Can you find the humor in what the negative critic is saying to you? Laughter can be the best medicine. Make fun of the negative thoughts. Laugh at them and yourself for believing them . . . but make sure that you do so gently. Power Up Your Problem Solving: If the negative thoughts relate to a clear problem (e.g., a serious health issue), make a list of the steps you can take to deal with the situation. Break down the potential solution into small, achievable steps you can take to improve things. Find the Positive: Try to find the positive in what seems to be a negative situation. Turning around a negative thought often shows us another side of the situation. A problem or crisis can even be an opportunity. Search for it. Breathe: Take slow, deep breaths. This relaxes the body and the brain and reduces brain overactivity. We’ll talk more about breathing in later chapters. Move: Do something physical; exercise. Don’t stay stuck and immobile, literally and metaphorically. When Gwen, my patient with herpes, first revealed her secret, her reaction to telling me was striking. She told me some of the details. Then she wasn’t able to discuss it for another several weeks. I gave her the time she needed to feel safe before we circled back. Eventually, we were able to begin to explore what it meant to her. Gwen needed to overcome her persistent, terrifying negative belief that she would be rejected immediately and permanently if she told any prospective partner about her herpes. First, I helped Gwen realize that her incredibly strong negative thoughts about herpes were just thoughts. They were not her, just her brain. Her brain made these thoughts just like her heart made heartbeats. When Gwen noticed the thoughts that “Any man will reject me if I tell him about my herpes,” she learned to create distance by telling herself, “These are just my thoughts. They are not me. They are not true.” Frankly, it took some doing to get her to accept this point of view, but she did eventually. Reminding herself of her intrinsic values and of the good she brought to the lives of others, especially through her volunteer work tutoring immigrants in English, helped soften the strength of the negative blows Gwen delivered to herself in her psyche. Writing down things for which she was grateful also helped move Gwen away from her negativity. She wrote down things such as “I am grateful for my health,” “I am grateful for my good job,” and “I am grateful for my supportive friends.” Gwen embraced examining her “shower of shoulds.” She imagined her negative comments, such as “I shouldn’t have herpes” and “I should accept that I’ll be single my whole life,” coming out of the shower nozzle. This helped Gwen to imagine herself stepping out of this cold shower of shoulds, getting away from these comments and wiping them off with a towel. Focusing on her breathing also helped Gwen distract herself from her negative thoughts. At first, she thought my idea of imagining turning down a dial on the outside of her head was silly, but she tried it one day and it helped. Finally, Gwen, who loved shoes, effectively used sole therapy, focusing on the soles of her shoes as she walked, to distract herself from thoughts like “I’ll never be happy because nobody could want or love a woman like me with herpes.” It took time and hard effort, but eventually the approaches above were quite successful for Gwen. Her negative thoughts declined about 90 percent over a ten-month period as she used the preceding approaches. We were finally able to speak openly about herpes. Gwen could feel comfortable enough to talk with her doctor to get antiviral medication to use to try to prevent herpes outbreaks. We practiced how she could tell a potential partner that she had herpes and how she might answer his questions. Ultimately, Gwen was able to stop aborting her relationships with men just as they were about to become sexual. She told me about the first time that, with trepidation, she risked telling a man about her herpes. Fortunately, he was sympathetic and accepting of Gwen, and they were able to deepen their relationship, which eventually included satisfying sexual intimacy. Gwen did have to put in the work to tackle her negativity. I admired Gwen for being willing to face her secret and work it through. Freud wrote that you can’t slay a dragon in absentia. Gwen had to look her dragon in the eye in order to slay him, and slay the dragon she did. Eventually, Gwen became engaged to a good man. I was happy to receive a note from her with a wedding picture of the happy couple. ACTION PLAN Detach: Don’t fight your negativity. Rather, practice stepping back from your thoughts five times each day. Shun the Shower of Shoulds: Pick one half day per week and notice and total up the number of times you have a thought like “I should . . .” or “I shouldn’t . . .” This will help you become more aware of how often you are attacked by these thoughts. Practice Gratitude: Write down three things each day for which you are grateful. Have a Laugh: At least three times a day, find the humor in what your inner critic is saying to you. Laugh at it. 3 Rewriting Your Stories When I first met Carl, approaching fifty, he’d been an accountant for most of his working life. His accounting work was good, but he never seemed to be able to keep up with the required pace and volume of work that the firm’s partners assigned him. The April 15 deadlines were killers every year, especially because of his severe procrastination. Carl was disorganized, lost documents, and never turned in the billing sheets used to charge the clients on time; he often forgot to bill clients for legitimate work as well. Accordingly, Carl’s income suffered, and he and his wife never met their reasonable financial goals. Carl’s poor attention to detail and inability to concentrate on aspects of work that were less interesting to him curtailed his ability to earn a good income. Carl knew that he was struggling, and he had repetitive negative thoughts about himself. “I’m next to worthless. Why can’t I keep up and do my work like everybody else?” he would ask himself again and again. When Carl’s son was diagnosed with ADHD, his son’s doctor suggested that Carl get an evaluation for himself. Diagnosing Carl with ADHD was straightforward. Lifestyle changes like dietary optimization and exercise helped some, but Carl continued to have problems with attention, focus, concentration, procrastination, and other ADHD issues. Carl had the definition of a busy brain. Ultimately, because lifestyle changes were not sufficient to help Carl improve, I prescribed Vyvanse for him. Vyvanse is a prescription medication that boosts dopamine, improving function in the brain’s prefrontal cortex, the area often underfunctioning because of ADHD. Vyvanse is similar in action to Adderall and other stimulant medications, just longer-acting and smoother in its effects. It didn’t take long to find the optimal dose of Vyvanse, and Carl had a great response with few side effects. Specifically, Carl noted an immediate, marked improvement in focus, attention, and concentration. His procrastination was reduced. His energy increased, and his work performance improved significantly. Carl was now able to keep up with organizational demands like proper completion of client billing sheets; his income jumped. All in all, after seeing me for only two months, Carl seemed to have a great response. His brain worked better, clearly, and he was more productive and effective at work and at home. But Carl still felt bad about himself. He continued telling himself he was a loser, not worth much, next to incompetent, and unable to match his peers at work in productivity and work quality. Medication had remedied Carl’s brain problem. But his old “tapes” kept replaying his unpleasant story. Carl’s case illustrates a fundamental principle. We can often rebalance a brain with ADHD, like Carl’s. But even after improving the low functional level of his PFC, the cause of the ADHD, with the Vyvanse, there was another repair that needed to take place. To get Carl’s brain to stop playing the busy tapes, we still needed to heal Carl’s mind, his spirit, his soul. Carl grew up with ADHD, struggling in school, hearing frequently that “You’re not trying hard enough. . . . You are capable of more.” Indeed, Carl was bright—his intelligence and hard work took him far in school and in his accounting profession. But because of his struggles, Carl’s spirit had taken a big blow. Carl’s personal story was of being a defective, inadequate, incompetent individual. And this negative self-narrative lingered even after the brain problem had been treated. Carl needed more than just an approach that would rebalance his brain with medication. He also needed to go further than just conquering negativity. Carl needed to strengthen his PFC in a much more fundamental fashion: he needed to learn to manage his mind by rewriting his negative stories. Conquering negativity and rewriting our stories are obviously connected. However, rewriting our stories is a more thoroughgoing renovation of our psyche than conquering negativity is, resulting in even more profound change and healing. The Stories We Tell How do we become so stuck in inaccurate stories about ourselves? One thing we must understand is that just because we create a story about ourselves and others doesn’t mean that story is true. We may get attached to a story if we repeat it enough times. Like Carl, we may convince ourselves we’ve created a valid picture of ourselves and the world. But it isn’t necessarily the case. Our stories are representations of ourselves and the world. But they are not real. These maps, these stories, are simply the best we have. We never can really know the world. The best we can do is to learn to better know our thoughts, our stories. For some individuals, an inability to generate and to tell consistent, meaningful stories is related to attachment problems early in life. Research shows that children with attachment problems with their mothers or fathers have greater difficulty generating coherent stories when they grow older. Why? Because a poor attachment relationship to one’s mother or father makes it difficult to have a coherent sense of oneself in relation to others. Because their mothers or fathers were preoccupied with their own troubles, they rarely experienced their child as a separate, developing individual. These children thus also could not see themselves as a distinct entity and as a result had an underdeveloped sense of themselves. Perhaps no one asked them about their schoolwork or their experiences with friends. Perhaps there were few opportunities for the children to generate narratives, stories that began with “I.” Healthy attachment experiences are the foundation for a healthy sense of oneself and others. With unhealthy attachment experiences, we could say that there is less of a “self” there, the “I,” about which to generate a story. An example is Lisa, a woman I know who was raised by a disturbed single mother in a chaotic home in which there was extreme poverty, drug and alcohol abuse, legal trouble, and sexual abuse of all the female children, including Lisa. Lisa does not have ADHD, anxiety, or depression. She is not psychotic. Yet when Lisa talks, it is difficult to understand what she is talking about. Lisa will tell a story, but it is rarely clear if she is talking about herself or another person. Sometimes she will slip from present to past and back to present. It’s as if she can’t distinguish what happened in the past from a more recent encounter with a family member; or maybe it’s more accurate to say that she has little experience telling stories about herself. Her confusions are most likely related to the fragmented and ambivalent interactions she had with her mother. Lisa simply has too little “self” to generate a coherent narrative. When a lack of coherent story-telling ability reflects a more fundamental lack of coherence in one’s sense of self, as it does with Lisa, rewriting your story on your own may not suffice. Psychotherapeutic assistance may be needed to help give birth to and develop a functional self. If you try the storytelling approach that I present in this chapter, and you find that you are stuck or cannot make progress, consider consulting a psychotherapist for help. Most of us, however, can address the unhealthy stories we tell ourselves and how we generate them. We can rewrite our stories. And by doing so, we’ll improve our capacity to function with fewer internal inhibitions and improved overall brain function. We will strengthen our PFC, take a giant step toward reclaiming our brain, and move in the direction of bringing our life back under control. Trying to know oneself is like being in a fun house full of mirrors! Which makes sense. A perfect, static model of the self is overly ambitious. That said, models can be more or less true. The healthiest stories about ourselves emerge from our ability to engage in self-reflection. The path to self-reflection begins with the prefrontal cortex. In large part, the prefrontal cortex generates our stories. The temporal lobes generate the memory traces that we call upon when we reflect, and the prefrontal cortex takes the memory information and generates cause-and-effect relationships. It is these cause-and-effect relationships that give me so much difficulty when I talk with Lisa; I can never figure out who is doing what to whom in her stories. When we retell our stories, we thus recruit the PFC to look at itself. Retelling stories does at least three important things: It counterbalances our intrinsic negative tendencies. In retelling our stories we take a more complex, more nuanced view of the story, overcoming to some extent the brain’s default negativity. It allows us to see our own thoughts. In essence, we are thinking about our thinking, thinking about our stories. If we are true to the task of retelling our stories, we necessarily reexamine what we think about ourselves and others. It strengthens self-reflective capacities. Story-telling and self-reflection are analogous to lifting weights to build muscle strength. The muscles become stronger through the repetitions. Analogously, our PFC can become stronger through retelling our story exercises. And the stronger the PFC becomes, the easier it becomes to self-regulate, self-reflect, and create even more coherent, nuanced, and adaptive stories for oneself. This story-rewriting approach freezes our thoughts. It allows us to meditate and focus on the stories as if we have put them under a microscope, and essentially it recruits the help of the prefrontal cortex to modulate the activity of the more primitive limbic brain centers. We are recruiting the thinking brain to help offset the busy, emotional brain. Being able to self-reflect is not just about adjusting our self-narrative and calming our busy brain. It crucially helps us connect with others. Retelling stories helps integrate us into our social world. And hearing the richly shaded stories of others allows us to identify with their healthy, more balanced worldview. For example, maybe you and your team are down to the wire on an important presentation when you realize that Bob bungled a key piece of data in the PowerPoint presentation. Your first reaction might be fury at Bob’s incompetence. Then a colleague explains that Bob is going through a terrible divorce and is under great strain. Your colleague’s version of the story is more charitable and compassionate than your instantaneous anger. Suddenly, rather than seeing Bob as a talentless idiot, you might realize that he’s a hurting soul in the midst of a personal crisis. It doesn’t excuse Bob’s mistake per se, but it does help you understand it and put it into a more nuanced context. Through telling and hearing stories, other people can serve as external brains that we can use to improve our own brain function and improve our capacity to understand the world. We learn to live and let live. To see others’ perspectives. To nurture tolerance, empathy, and compassion for others. Being able to see all sides of a story, being able to see the other person’s position, is advantageous for social organisms like humans because it allows us to get along better in our social world. It may sound like magic that after years of telling incorrect stories about ourselves, such as Carl told himself, by rewriting those stories we will suddenly see the light: we will become less negative, more social, more kind to ourselves and to others. But this isn’t magic; it works. And the reason it works is that just as healing your brain helps calm your overactive mind, changing the mind—that is, changing the stories that you tell yourself—can also change the brain. How? Because the brain is plastic. In essence, we are talking about self-directed neuroplasticity. The mind, the self, you, can rewire your brain circuits by rewriting your stories. Brain scans show evidence of brain alterations that resemble the changes brought about by medication in people who undertake cognitive behavioral therapy (CBT), which is simply a structured version that teaches retelling of your stories. Other brain scan research also supports this claim of self-directed neuroplasticity from rewriting your story. For example, the work of Jeffrey Schwartz, M.D., at UCLA demonstrates brain changes from mindfulness-based interventions for obsessive-compulsive disorder (OCD). Schwartz’s mindfulness approach is close to retelling your story. The key point is that changing how you talk to yourself, changing what you say to yourself, how you tell yourself stories, changes your brain. By learning techniques to manage our minds and brains, we are breaking old habits and patterns (related to particular brain circuits) and causing newer circuits to form. If our new stories are more nuanced, these newer brain circuits are also more adaptive. For example, if we develop the habit of seeing shades of gray in a spouse’s behavior, when our spouse repeats that particular behavior, our mind more naturally goes to those shades of gray rather than a rigid black-and-white interpretation of the event. For example, perhaps at one point we viewed a spouse’s unwillingness to talk about their day as a personal rejection. We might come to understand that their quiet doesn’t stem from a lack of desire to share. It’s simply exhaustion after a long day. Now when our spouse returns home lacking their usual talkativeness, we may ask if it’s been a hard day and express compassion. The mind has literally rewired the circuitry of our brain in a more nuanced, more adaptive fashion. Self-directed neuroplasticity, changing our brains ourselves, is the basis for hope that we can change. But it requires sustained effort to break old patterns and learn new ones. In fact, co-created story revision is the essence of good psychotherapy with a skilled therapist. Intensive psychotherapy may well be one of the best ways to address intransigent maladaptive patterns. Many story patterns, however, are less deeply ingrained. And you should find success with the techniques I describe next. Rewriting Our Stories In order to rewrite our stories we must let go of the negative interpretations of our lives that hold us back. Think of the goal as trying to move from a black-and-white story theme to one that includes a palette of many colors. Rewriting our stories, in thinking, appreciating nuance, being able to think about thinking, adds a richness and a dimension to life that would not exist otherwise. The whole point is greater inner freedom—we don’t want to be weighed down by inflexible stories. One of the most important tools for rewriting is self-reflective capacity. We need to be able to reflect on the meaning of our experience and on our stories; we must not take our stories at face value. Self-reflection not only strengthens our PFC—our ability to govern ourselves. It also gives us inner freedom. We are talking about a mindful stance, one that allows us to think about our thinking—awareness of awareness. Do you have the courage it takes to be one-on-one with your thoughts? It might take more courage than we often realize. A series of studies done by Timothy Wilson at Harvard University and the University of Virginia showed that most people prefer doing something—even hurting themselves—to doing nothing or sitting alone with their thoughts. Remarkable, isn’t it? Study participants were asked to quietly be alone with their thoughts for six to fifteen minutes. Many participants found the time alone with their minds to be unpleasant. Two-thirds of the men and one-quarter of the women preferred self-administered electric shocks to sitting quietly with their thoughts. The researchers suggest that the mind’s primary job is to deal with the external world. In primitive times the mind was almost always directed outward—for survival reasons, for food, sex, countering attacks, and so on. Once people did not have to worry about such things, the individual had the luxury to begin to look inward, to contemplate the nature of human existence, to create art, literature, and music. But these studies suggest that dealing with the inner world, our minds, is still difficult for many of us. What to Do: Self-Reflecting and Story Rewriting If you have the courage, the will, to look at your thoughts, your stories, how do you go about it? Here are the steps that I have found helpful for my patients and myself in trying to sort through the troublesome stories, the soap operas, in the brain. Write It Down It is important to write down your thoughts and stories. I find that writing down my thoughts and stories on paper or on an electronic device helps me freeze my thoughts so that I can assess them. Thoughts are slippery devils. They’re here now, gone in a moment. How can we really work with our thoughts if we can’t grab them, pin them down, and take a focused look at them? You really need to be able to hold your thoughts still so you can shine a spotlight on them. You may be tempted to talk out your thoughts instead of writing them down. But grabbing hold of and nailing down your thoughts in writing is key to the process. As Carl, my ADHD patient from earlier, and I began to work together to rewrite his negative account of himself, I explained to Carl that because thoughts come and go so quickly, it would be important to write them down in order to work on them. He wasn’t too keen on this initially, but he agreed to try it. As he found it useful, his initial reluctance to write down his thoughts and stories passed. True or False? Pick a simple story. Summarize it in a few lines. Write down whether your story is true or false. You could select any painful thought, feeling, story, or belief. Anything that causes you pain. For example, Carl wrote, “I was a lousy student who didn’t try hard enough.” If we are honest with ourselves, we recognize that our stories are incomplete, if not untrue. Have you believed your thoughts? Have you believed your stories? I bet you’ve done that. I have. What a change it can make to realize that thoughts and stories are fiction, a narrative that emerges from brain activity. “He doesn’t like me.” Is that really true? Can I really know for sure? If we wait, take the time really to look inside and be truthful with ourselves, the answer is almost always no. As I worked with Carl to help him rewrite his story, I suggested that he really look at the truth of his statement that he was a lousy student who didn’t try hard enough. At first, he was quick to say yes, it was true. I asked Carl to slow down, to really look inward, as if this question were a kind of meditation. This time, Carl said no, this story of being a lousy student who didn’t try hard enough was not true. I asked Carl to explain. Carl admitted that he achieved grades of B or B+ in high school and graduated from a well-regarded state university. He couldn’t have been lousy. Then I asked Carl about the second part of his statement, that he was capable of more. Again, Carl at first said yes. But I asked him to really reflect on that statement, to look inside to seek the truth. After a few minutes, with tears in his eyes, Carl said that it wasn’t true that he was capable of more. In fact, he said, he knew that he always worked much harder than his peers, but he’d never known why. He stayed up late, missing out on sleep. Often he declined social activities to try to study. He’d assumed his problems were because he was less intelligent, but now Carl was realizing that it was the ADHD that was the problem, not whether he was capable of more. I could see the glint of recognition in Carl’s eyes as he saw the more nuanced version of his educational experiences. The truth was that he had not been capable of more. He’d figuratively knocked himself out to accomplish what he had accomplished. He’d used every ounce of energy he had. How could he have been capable of more? After you write down your painful thoughts, feelings, stories or beliefs, examine them for their truth. More likely than not you will spot an error in the thought that is causing you pain and affecting how you see yourself and the world. Time Traveling Where are you in time? Is your story about now? Or are you more likely stuck in the past or projecting yourself into the future? We keep talking about wanting to live in the now. But our thoughts go endlessly into the past or future. Recognizing this in yourself can bring you back to the present. When Carl dwelled on his school struggles, he was stuck in the past. Yet Carl wanted to be more present for his wife and children. When we discussed his “time travel,” Carl began to realize how much of his mental life was spent away from the present. Simply recognizing this made it easier for him to spend less time in the past and more time in the present with the people he cared about most. Ask yourself: Are you spending the time you want to be spending in the present? Are you living in the past or the future, or are you living in the now? Judgment Look honestly at whether you are judging yourself or others in your story. Christianity and other religious traditions teach leaving judgment in the hands of God. Unfortunately, eschewing judgment is difficult for Christians and most others, given human makeup, especially the way brain evolution and the resulting brain function contribute to our negativity. But it is important to try to avoid judgment. Judgment usually does little good and often stirs you up. Judgment is often in the search for who or what is right or wrong, really an extension of that negative, black-and-white thinking. Think about the common saying about being the peace you want to see in the world. Our judgmental tendencies get in the way of having the internal peace that we need to start with. Why not let go of judgment and just be? When Carl and I talked about judgment, it really struck a chord. Carl realized that he’d felt judged harshly in school and that he constantly judged himself, and always negatively. Carl was eventually able to move away from this judgmental stance and just be, without criticism or judgment of self and others. It wasn’t easy and it took time, but he was able to do it. Whose Business? Whose business are you in? In your story, your internal drama, whose affairs are you concerned with? Yours? Somebody else’s? God’s/the universe’s? We can really only change ourselves, and even that is difficult. We’ll never know what is best for others. Parents of my teen patients get worked up if their son or daughter doesn’t want to attend college. Can we really know that someone should go to college, even our children? Some people do not attend college and have wonderful and successful lives, sometimes contributing much to society. I don’t mean to say we shouldn’t talk with our children, calmly and lovingly, helping them consider and think through the pros and cons of attending college. But after that, what can we do? If our child isn’t inclined to try college right then, so be it. It’s the child’s decision, and it should be, after we helped them think it through. This is akin to the Buddhist concept of acceptance. In the case of the college decision, it’s not my business after I helped my child think it through; it’s my child’s business. But what about God’s or the universe’s business? Well, that has to do with situations like whether I have a stroke, or whether a meteor falls on my house. I owe it to myself and my family to try to remain as healthy as I can and take care of myself, but that might not be enough—I still could have a stroke. And, if so, that’s God’s business. It’s also God’s or the universe’s business when a tsunami strikes in Asia. I cannot do anything about that, other than donating money and supplies for relief, which I do. These are horrible tragedies, and they seem to happen far too often. But they are beyond my control. I asked Carl to consider whose business he was in with his story of being a lousy student who didn’t try hard enough. He thought that he was in his own business; after all, who else was there in this story? I agreed, partially, but Carl was a bit surprised when I told him that I thought he was also in God’s or the universe’s business. Why? Bec