dan siegel

The National Institute for the Clinical Application of Behavioral Medicine

nicabmwww.nicabm.com

The Mindful Therapist

A Teleseminar Session withDaniel Siegel, MD

and Ruth Buczynski, PhD

http://www.nicabm.com

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

The Mindful Therapist 2


Contents

The Scientific Evidence: Why Mindfulness Can Make Health and Mental Health Practitioners More Effective . . . . . . . . . . . . . . . . . . . 4

How Quantum Theory Could Revolutionize Therapeutic Possibilities . . . . . . . . 10

How the Development of Trust Leads to Brain Growth . . . . . . . . . . . . . . . . . . 18

How Mindfulness Can Facilitate Neural Integration . . . . . . . . . . . . . . . . . . . . 20

A complete transcript of a Teleseminar Session featuring Daniel Siegel, MD and conducted by Ruth Buczynski, PhD of NICABM




with Daniel Siegel, MD and Ruth Buczynski, PhD

Dr. Ruth Buczynski: Hello everyone. Let’s get started. I’m Dr. Ruth Buczynski, a licensed psychologist and president of the National Institute for the Clinical Application of Behavioral Medicine.

We’re your hosts for this series on Mindfulness. Thanks so much for joining us tonight and for all the nights that you’ve been with us as part of this series.

This is the sixth and last, open session of our worldwide series for practitioners on the Clinical Applications of Mindfulness. Next week, we begin the first of two bonus calls for the Gold subscribers.

Throughout the five weeks so far, there have been 101 different countries represented. We’re so excited to bring the world of practitioners together in this community. We did check with Google analytics to see if we could come up with a number of exactly how many have listened so far and how many unique listeners we’ve had. They’re reporting that number to be 18,000 or a little bit over. We think that might be just a bit high…and I don’t want to guess because I could be wrong and I dont have a way to prove any number.

I do know that last week we had 3,232 listeners. Here are some of the countries that were participating in the call. There were 6 people from Argentina, 1 practitioner from Bermuda, 1 from the Dominican Republic, 1 from Greece, 28 from Israel, 19 from the Netherlands, 2 from Romania, 2 from Bulgaria, 1 from the Philippines, and 3 from South Africa.

In addition, we had several thousand people from the United States and let me just tell you a few of the states: 81 from Pennsylvania, 67 from Oregon, 6 from Idaho, 57 from Georgia, 4 from Arkansas, and 1 from Alaska.

So, no matter where you’re calling from, state or country, we’re so glad that you’re part of our worldwide community.

We also represent a wide range of practitioners. We’re physicians, nurses, psychologists, social workers, dentists, chiropractors, body workers, dietitians, occupational therapists, physical therapists, and stress management consultants. We represent a wide, wide range of practitioners and no matter what your profession is, we’re glad that you’re part of this call.

I again want to encourage you to keep checking back on the comment board. That’s another part of our worldwide community and an important one where you can see all the different ways people are applying what they’re hearing each night.

My guest today is one of our favorite speakers – Dr. Daniel Siegel. He is a physician and Clinical Professor of Psychiatry at the UCLA School of Medicine in Los Angeles. He is a prolific writer. Most recently, in January, he published a book called Mindsight: The New Science of Personal Transformation, and even more recently than that, a book called The Mindful Therapist.



That’s what we’re going to focus on today: how the mindful therapist can really make a difference in our work with patients. And I’d like to expand that: It’s not just going to be for therapists, because we have doctors and nurses, who don’t work off a 50-minute hour, and we’ll be looking at your work as well.

Dan, welcome to the call and thanks for joining us today!

Dr. Daniel Siegel: Thanks, Ruth! It’s a pleasure to be back with you.

Ruth: Let’s jump right in and talk about why mindfulness can make health and mental healthcare practitioners more effective. There’s more and more science coming out about that all the time. Can you just give us some of the highlights?

The Scientific Evidence: Why Mindfulness Can Make Health and Mental Health Practitioners More Effective

Dan: Well, there are a number of reasons why learning to be mindfully aware helps a practitioner of any kind of clinical intervention be more effective.

On the basic level, the studies have now shown that if a primary care physician learns to develop mindful awareness (which we’ll define in a moment), that individual will be less likely to burn out.

They’ll be more likely to maintain a state of empathy, which now studies are showing as one of the key ingredients for any kind of clinical encounter for a patient or a client to heal and to respond positively to therapeutic intervention.

So, you keep a clinician feeling well themselves; you keep a clinician passionate about their work and you allow them to actually have the very ingredient of interpersonal compassion (empathy) that is needed for effective therapy in any kind of medical or psychotherapeutic encounter.

In all these ways science has now shown that teaching mindfulness to clinicians would be a very important basic step in helping everyone involved in the clinical experience.

Ruth: Particularly for therapy, it seems like the science recently is saying it’s not so much the intervention we use or the theoretical position we take, but the presence of the practitioner that seems to be the overall healing ingredient across so many schools of thought. I know you meant that in your book about family physicians as well.

Dan: Right. When we look at the broad notion of clinician, when we say a clinician is working as a nurse or as a physician with people with medical conditions, even though clearly it matters which medications you prescribe, which surgeries you perform, how you bandage a wound – all those things really matter for medical encounter – but even with those important physical aspects of treatment, the interpersonal aspects are vital.

“If a primary care physician learns to develop mindful awareness, that individual will be less likely to burn out.”

“Teaching mindfulness to clinicians is a very important basic step.”



One research study showed that even if someone has a common cold, they will actually get over their cold faster, they’ll have improved immune function, if the clinician they see was actually empathic with them, was concerned not just about the physical aspect of their medical condition, but what the inner mental experience was – the feelings, the thoughts that go along with it, the frustrations, the expectations that were dashed. All the different ways in which a medical illness affects our minds are important for an expert clinician to tune into.

For those patients who were fortunate enough to have an empathic clinician, their immune system got boosted and they got over their colds faster. So even though it was a viral illness, we can say that empathy actually helps the immune system function better. So there you see that even in the medical world empathy and presence are really important.

For the psychotherapy world it’s exactly like you’re saying. What the studies show is that, in fact, we can try all sorts of therapeutic strategies, which have an important impact to a certain degree, but the most important impact is the presence of the therapist, the ability of the therapist to be empathic to the internal world of the client or the patient, and for that therapist to actively seek feedback on how therapy is going and be open to what that feedback is, rather than being defensive.

John Norcross, one of the scientists who studied this, has shown in metta analysis of psychotherapy that, in fact, these aspects of the therapeutic relationship are the most vital for positive therapeutic outcome.

Ruth: I haven’t read of any research being done on empathy and an effective empathic response for physical therapists or occupational therapists. If anybody is listening and you know of something like that, please put it on the comment board tonight after the call, so we can all see it. But I would bet that if we are finding this with family physicians, and we are finding this with psychotherapists, then it would make sense that it would matter for a patient who’s seeing a physical therapist or an occupational therapist as well.

Dan: I think you’re absolutely right, Ruth. One thing just to keep in mind is that as human beings we have a whole system of neurons (that we could talk about later on) that are detecting the intention of another person.

Part of what happens with empathy is that not only is one person trying to sense the inner world of another person and then really understand that world (so sensing is one thing, understanding is another, but both of those are parts of empathy), but built into the empathic interaction is the intention of one person to actually care for and be concerned about the other.

“Even if someone has a common cold, they’ll have improved immune function, if the clinician they see was actually empathic...even in the medical world empathy and presence are really important.”

“The most important impact is the ability of the therapist to be empathic to the internal world of the client.”

“Built into the empathic interaction is the intention of one person to actually care for and be concerned about the other.”



So, if I’m the one receiving your empathy, Ruth, I’m going to not only have that sense of connection with you, but I’m going to feel your intention to care about me.

That awareness of your intention inside of me is actually going to help me feel trusting of you, it’s going to help me feel safe. It’s going to give me – in attachment terms – the sense of security.

Throughout our lives – not just for babies and young children – our interactions with other people are always trying to assess whether we can trust that person, whether we can feel safe.

So an encounter with a clinician – a physical therapist, an occupational therapist, an educational therapist, we could go through the whole line-up of clinicians – has got to be enhanced, we would imagine.

And studies show for some of these fields it’s actually been proven to be true. But we could imagine for all clinical encounters, even with a teacher, you want to feel that the intention of that professional is to care about your well-being and nurture your growth.

In these ways we could understand that if mindfulness teaches empathy, which it does, and it teaches this capacity to really be present in an open way, then those are the essential ingredients for the other person to sense that your intention is really to be open and caring about them. This is why it’s a win-win situation. It helps the clinician’s own health, sense of purpose and well-being, and it also helps in the clinical encounter.

In a way, you could make a pitch that mindfulness should really be seen as a basic science of every clinical profession that we have. This really brings up a wonderful opportunity to transform how we create resilience in our clinicians.

The world is a place filled with challenges and we need to support clinicians as they go out and try to alleviate suffering and help people grow toward health. This would be a useful way to begin.

Ruth: Right. And as you’ve mentioned briefly, it does seem that mindfulness has been shown – at least in one specific research study – to help primary care physicians be less burned out.

Dan: Yes, that’s what Krasner (Dr. Michael Krasner) said, who really taught mindful awareness, this way of mindfully communicating.

Mindfulness is a term that we want to define. People have tried to get at it with words in different ways. But ultimately what many of these different writers in the scientific field have tried to articulate is the idea that if you can be open to what’s going on inside of you as it’s happening, without being swept up by judgments or without being taken over by expectations, but rather being very present to your own experience, then that’s a gateway to being open and

“For all clinical encounters you want to feel that the intention of that professional is to care about your well-being and nurture your growth.”

“Mindfulness should really be seen as a basic science of every clinical profession.”

“If you can be open to what’s going on inside of you as it’s happening, then that’s a gateway to being open and present to other people as well...the more you are aware of your own bodily sensations, the more you could be aware of other people’s internal emotional states.”



present to other people as well. That’s where you see the link from an experiential point of view – this openness, non-judgmental-ness of being receptive.

From a brain point of view, mindfulness really encourages people to be very attuned to their own inner sensations. We could go through the circuitry in the brain that allows you to do that, but the take home message is this: the more you are aware of your own bodily sensations, the more you could be aware of other people’s internal emotional states. I think this is the real key that needs to be sent out as a message.

People often say, “Well, if I’m learning to do yoga, or tai chi, or meditation, or centering prayer, any of the mindful awareness practices that are so helpful, that’s a private thing. Isn’t that selfish?”

The fact is that the circuits that you are strengthening with those reflective practices that develop mindful awareness are the exact same circuits that we need to tune into the internal world of someone else.

Some studies at UCLA and at Harvard show that there are structural changes in the very parts of the brain for people who do practice, for example, mindfulness meditation. There are structural changes in the same circuit that we need to support our empathic communication with other people. That’s probably why you see these studies that show that empathy is significantly increased in those who practice mindfulness.

Ruth: That’s great. You were talking about mirror neurons. We talked about that a lot when we had our call in February when you were part of the new brain science. But there are many more people on this call tonight. So let’s take just a minute to even define what we are talking about. I think for some of the people this may be a new concept. So let’s just get into that a little bit and start with a description of what we mean by mirror neurons.

Dan: Sure. If it’s OK, Ruth, let me just take a step before that and just say a couple of general things, so as all of us are having this conversation together, we have the same perspective on this.

The first is to say that before we talk about mirror neurons, it’s helpful to say that for all people, we have this amazing reality that we have our internal subjective life. Like right now, Ruth, you have your thoughts and your feelings and your memories. And those subjective experiences, your feelings go together in time with the firing or the activation of certain neural pathways in your brain.

Now, it’s important to realize that subjective experience (like I have a feeling and you have a feeling) and neural firing, while they correlate with each other, they’re not the same exact thing.

In a way, they are two sides of a coin. If you have a coin, one side is heads and one side is tails. You’ve got the coin in your hand, but there are two sides of this one coin.

In the same way we could talk about – as we are going to talk about – feelings and intentions. Those are mental states that have a subjective quality to them. At the same time, there’s a neural firing pattern that seems to go along in time, or roughly around the same point in time, so we say they are correlated, or they correlate. They relate to each other simultaneously.

“Studies show that empathy is significantly increased in those who practice mindfulness.”

“These mirror neurons have this amazing window into this blend of the subjective inner world and the neural firing world.”



The important reason for saying that is that these mirror neurons that you are asking me about have this amazing window that they give us into this blend of these two sides of the coin – the subjective inner world and the neural firing world. We need to be very careful how we articulate it so we don’t make it too reductionistic or too overly simplified.

So, I just wanted to start there, so we are really on safe ground when we start getting all excited about the neurons and stuff. Is that fair to say?

Ruth: Sure, absolutely.

Dan: In the mid-90s in Italy several wonderful neuroscientists, including Gallese and Rizzolatti, were studying the motor area of the monkey brain (In 2007, Vittorio Gallese with Giacom Rizzolatti and Leonardo Fogassi received the Grawemeyer Award for Psychology for their discovery of mirror neurons.)

They found that when the monkey perceived an action that some other being was enacting – let’s say, a human being was eating a peanut – the same motor neuron that fired when the monkey ate a peanut would fire when the monkey perceived the researcher eating the peanut.

The many relevant aspects of that finding are these:

One, there was a link between the motor area of the brain and the perceptual area of the brain. That was very exciting to find.

Secondly, this linkage of the same single neuron (these were electrodes in a single neuron, not just areas of the brain, but one neuron), this one neuron having both perceptual abilities and motor abilities was an exciting finding.

But it only acted when the action that was perceived had predictable sequences associated with them. Basically, that means that the brain was calculating whether a sequence of movements being perceived in another person could be predicted. If it was predicted, then it itself would mirror the action.

The reason why I’m being very careful about how to say this is because people jump to all these statements about mirror neurons – “they cook eggs” and “they plan your financial future” and all these things.

Mirror neurons are very specific. They embed perceptual predictions of motor actions in both the perceptual system and the motor system. To say it simply: they let you imitate an intentional action.

Now, once we say it that way, then you realize the exciting aspect of that when we’re really careful. We believe that the collection of mirror neuron interactions with other areas of the brain – like there’s an area called the superior temporal cortex, which is not a mirror neuron area, but it links very closely with it – we believe that those work together to create a map. The brain is always making maps which are clusters of neural firing that have symbolic meaning.

Here the map is of the intentional state of the other person. So, when the monkey sees the researcher eating the peanut, we believe that mirror neurons working with this other area basically make a map of

“Mirror neurons embed perceptual predictions of motor actions in both the perceptual system and the motor system. To say it simply: they let you imitate an intentional action.”



the intention of the researcher. Intention is a mental state. The absolutely revolutionary finding here is that these researchers were able to illuminate the way neural firing maps create symbolic neural firing patterns that are mapping out mental states. That’s huge! To say it simply: the brain makes a map of the mind of another person.

Now, once you see that, then you go, “Oh my gosh…This is really, really exciting.” Then you can do what other researchers, like Marco Iacoboni has done at UCLA, and it is to search for the ways that these mirror neurons are not only involved in imitation of action, but the simulation of internal states, which is the gateway to empathy.

Simulation, basically, means that if I were with you in person, Ruth, and you had tears in your eyes, I would perceive your tears. My mirror neurons would pick up this intentional state in you, not so much a motor action, but a behavior, a signal, a communication.

Inside of me, down through an area called the insula (the insular cortex), I would drive that information of your tears down into my body. I would start having a change in my limbic area, my brain stem, even in the way my heart was functioning, my lungs, my intestine. I would begin to resonate with you. This is emotional resonance.

In that change in my bodily state, my subcortical areas – limbic, brain stem, and body are below the cortex, so we call them sub (or below) cortical – so the subcortical resonance comes back up through this area of the spinal cord called lamina (of the vertebral arch).

When it comes back up there, it joins with these brain stem and limbic changes up through my insula, and now back into my cortex, where we believe awareness correlates, neural firing patterns correlate with consciousness. Now I become aware of my internal state called interoception, and I feel my own bodily feelings.

In the next stage, I have another area of my brain, right adjacent to that, in the middle part of the prefrontal region just behind the middle of the forehead, and I then say, “Well, if I’m feeling choked up inside here - my chest is heavy, my intestines are churning, tears are coming from my eyes - I wonder if Ruth is sad.”

So I simulate your state, and my awareness of my own bodily state lets me know how you may be feeling. It’s empathic imagination. I can only take a guess. I can never know for sure.

The mirror neurons play a crucial role in that, because they let us understand how we pick up your internal state, simulate it and then become aware of our own state to take a guess at what’s going on in someone else.

If there’s any block in any of those steps, you and I could be interacting, you could be crying and I could just be telling you what I had for dessert last night and ignore those tears, because they wouldn’t have had any meaning if my system isn’t working properly.

Ruth: In a way, are we talking about the physiology of empathy?

“The brain makes a map of the mind of another person.”

“My awareness of my own bodily state lets me know how you may be feeling. It’s empathic imagination.”



Dan: Totally. This is the physiology of empathy. It’s also the neurobiology of “we.” It’s how you and I would get close with each other, because you would sense that you, your neuro-signals, are inside of me. Certainly, you are separate from me, but not only can you be Ruth and I be Dan, but we could be a “we.” That’s what you feel like when you are joining with someone, not just understanding somebody, but really connecting and joining as a “we.”

Ruth: I’d like to move into quantum theory just a little bit. You were writing a bit about the plane of possibilities as a model. Can we talk about that?

How Quantum Theory Could Revolutionize Therapeutic Possibilities

Dan: Sure. The exciting thing is that we take the step of really trying to be very careful about how we articulate things like relationships, or brain, or mind. In the field that I work in, and this is called interpersonal neurobiology, we try to base everything we do on science, but then show the applications of the exciting fields of science to psychotherapy, clinical practice, medicine, conceptual foundations in the field of health, teaching, etc.

We try to really be clear in our teachings about where the science points and where the practical applications can extend those scientific findings, but haven’t been proven yet.

When you are careful about it, then you can make statements like these. I’ve interviewed about 95,000 mental health practitioners in the various teachings I’ve done, and I’ve found that only 2-5% have ever been given a lecture on the mind. That means 95% of us – and I’m one of those 95% – have never had even a single lecture on the mind.

So, in our field, in interpersonal neurobiology, for almost two decades now we’ve given a working definition of the mind that is basically a core aspect of our mental life (not all of what the mind is, but it’s a central feature), as this embodied and relational process that regulates the flow of energy and information.

Once we are in the position to talk about the regulation of energy and information flow, you then can look deeply not only at the body - and extend that to the nervous system and relationships, how we communicate with each other – but you look at the monitoring and modifying aspects of regulation.

You have to ask the question, “What is energy?” If we are talking about energy flow, can you really have a conversation with the physicist, for example, about what the energy is? Of course, when you

start talking to physicists, you realize they themselves don’t have a firm definition of energy, except the capacity to do work or to do something….

When you go deeply into energy, you realize that, as Einstein told us, mass – even something like holding a cup in your hand or a pen – is just very condensed energy. When energy is in very large

“We try to really be clear in our teachings about where the science points and where the practical applications can extend those scientific findings.”

“95% of us have never had even a single lecture on the mind.”

“The mind is this embodied and relational process that regulates the flow of energy and information.”



form, it has certain aspects of certainty to it. So when you hold that pen in your hand right now, you know it’s a pen. Three minutes later, if you pick it from the desk where you put it down, it’s still a pen.

So very condensed energy that we call mass has properties that follow what is called Newtonian mechanics. You know that’s a pen. I can look at the book on my shelf right here, and I know it’s a book. I look again in five minutes, and it’s still a book. Newtonian rule says this is a kind of inertia…this is a book, it’s going to stay a book, and it’s going to require a lot of energy to change that.

When you look at energy that’s not in highly condensed conglomerations that we call mass, but rather is in the more fluid form we’re used to – like light or the electrical flow-down, ions going in and out of membranes that we call action potential, or heat, or all these different forms of energy that in fact are not accumulations of mass – then we start realizing that from the physics point of view, Newtonian rules don’t apply. So that rather than absolute certainty or huge amounts of certainty (a book is still a book), we look at the probability.

Quantum mechanics is a very old theory that’s been around for awhile. We know that there’s the theory in science, it’s full of different arguments this way or that way.

But the essence of quantum theory is that when energy that’s smaller than the size of an atom, like an electron or photon, is moving across time, its movement goes across the fields of probability rather than certainty. You can’t know for certain where that electron or where that photon is going to go.

So the first thing about quantum mechanics is that it’s all about the probability fields. The next really interesting thing about it is that you can’t predict; you can say that certain things influence probabilities.

Awareness is something that influences probabilities. When a scientist actually decides to study where a photon’s going, the act of observing the pathway of the photon changes its pathway. This is the fascinating aspect of quantum theory that you cannot remove consciousness or observation from the understanding of the probability changes as energy flows across time.

This, of course, is appealing to any therapist when you look at the process of therapy and realize that every major form of psychotherapy that I’ve been able to find uses awareness as its essential feature in its toolkit. Even though they may be at war with each other or seem contradictory, they all use awareness. You see that quantum theory puts awareness right in front of itself to say that awareness influences probability functions.

Then you are in this interesting position of saying that what we do in psychotherapy with the mind, as this process that regulates the flow of energy and information (information is just swirls of energy that have symbolic value), is that we are playing with the interactive experiences, including the therapeutic relationship that will alter the probability of certain patterns of energy flow, which we call thought, or feeling, or memory.

“When energy is in very large form, it has certain aspects of certainty to it.”

“The first thing about quantum mechanics is that it’s all about the probability fields.”

“Awareness is something that influences probabilities. Every major form of psychotherapy uses awareness as its essential feature in its toolkit.”



It’s important to realize that there are at least two sides of this one reality of energy and information flow and that those two sides are the subjective side and the neural firing side….

I had just came from spending a week, about a year ago, with a bunch of physicists, talking about the science of spirituality. After that meeting I was taking a train back to the airport, and I had three students with me, two graduate students and one undergraduate. They said, “Gosh, we didn’t talk about how neural firing relates to subjective experience.”

So, I took out my journal, and I started drawing for them this visual image of how to understand the relationship between neural firing and subjective experience and the impact of quantum perspective on probability shifts. That’s the origin of this notion of the plane of possibility.

Basically it goes like this. When we are totally open and probability is wide open for all sorts of things to happen, then you can see that there is a large plane of possibilities where the probability of what’s happening is zero. So you don’t know what’s going to happen from that plane.

When I say to you “Eiffel Tower,” you start thinking about France. When you and I are going to go to lunch, you may say, “Let’s go get some crepes for lunch.” So just by my saying “Eiffel tower” I could have raised you up in the flow across time to a plateau of French food. Then you say “crepes,” so you’d go up to a peak of certainty. You want a crepe for lunch.

Then we drop down. We go to the French restaurant and it’s closed. Now what do we do? Well, we’ve got to lower ourselves down from the peak of crepes for lunch and maybe find some other French restaurant, or drop down to the open plane and say, “You know, let’s just go and have a picnic on the beach, and let’s get some salads from a local store.”

We can move in and out of this. You can then understand all sorts of ways that the mind functions in health or un-health, in the freedom by which people move from peak of certainty to plateau of probability to open plane of possibility.

When there’s fluid movement back and forth, we would call that health. When people get stuck in a plateau, we would call that un-health. They may get stuck in depression, or mania, or obsessive thoughts, or they may have these recurring peaks that constantly bombard them with worries or posttraumatic memories that are intrusive.

In many ways you can then use this to show how the neural firing patterns are locked into certain high probability states that keep a person a prisoner. Then the therapeutic relationship can be understood as bringing that person into a more fluid balance, integrated balance among peak, plateau and plane.

Basically, in The Mindful Therapist, we talk about that through the whole book, about this quantum view of psychotherapy that allows you – not in any kind of weird way, but actually in a very practical way – to alter the probabilities of neural firing so that the subjective

“The mind functions in health or un-health, in the freedom by which people move from peak of certainty to plateau of probability to open plane of possibility.”

“When there’s fluid movement back and forth, we would call that health. When people get stuck in a plateau, we would call that un-health.”



experience of a person can be freed up, and then how to use the subjective focus of attention to actually change the structure of the brain, because that’s what we know that you can now do. Ultimately, changing those structural connections in the brain alters the way the brain makes for probabilities and certainties.

Ruth: Now, that leads us into neuroplasticity, but before we get to that, I think you said something really important and it came out so fast that I just want to make sure that people got it. You said that we are going from the peak of certainty to the plateau of probability and then what was the last part?

Dan: To the plane of possibility…the best thing to do is to see it in the book or wherever you might get a hold of this drawing, because you can see it in a flash. A picture’s worth a thousand words.

So yes, there are at least three dimensions. First, there’s the open plane of possibility where everything can happen and you are open, receptive.

Then, you rise up to the plateau of probability which is necessary in life. You have to prime yourself to get ready to play tennis, or pay your taxes, or whatever you are going to do. So that’s the plateau of probability.

Then there’s the peak of certainty, where you are definitely going to try to get crepes or definitely pay this amount of money for your taxes.

And it’s not that we are sitting cross-legged in an open plane of possibility for our entire lives and that’s it, or that it’s nirvana or something. We are saying that healthy living is the active freedom to move from plane to plateau to peak, back and forth again, because we do have to stop at a red light!

You can’t just sit and say, “Well, that light could be red,” but it’s not red, and then – bam – you crash. You’ve got to make commitments. You have to put your feet on the brakes and stop the car now.

So this isn’t at all to put down a notion that certainty is like a bad thing or anything like that. This is just the idea of fluidity, where some people get stuck in one place or the other and they don’t have this fluidity to move back and forth.

Ruth: It’s an interesting concept, especially if you take a big-picture look at the process of psychotherapy or at the process of what we are trying to do with the patient.

Dan: Absolutely. When you apply this, it’s really exciting to see. Then you see the role of the therapist…and in his/her own mind to also develop this healthy movement back and forth.

So, if I’m with a patient, and I’m convinced about what’s going on with her, but then I start getting some information that doesn’t match the narrative in my head, I’ve got to be able to move back from that plateau down to the plane to be more receptive to what’s truly going on inside of her.

I’ve given an example of that from when I was a pediatrician. You can have one idea or teachers can have one idea, but sometimes you’ve got to really let go of those ideas, those judgments, or those expectations.

“The therapeutic relationship can be understood as bringing that person into a more fluid balance, integrated balance among peak, plateau and plane.”

“Healthy living is the active freedom to move from plane to plateau to peak, back and forth again.”



Mindfulness in many ways is this capacity to move to the open plane of possibility, so you are truly receptive and open to what’s going on, rather than laying on your judgments that filter what you see. This model also applies to the whole field of mindfulness.

Ruth: Mindfulness, in a way, could be the skillful movement back and forth, as in all those possibilities.

Dan: Absolutely. I think that’s a beautiful way of saying it, Ruth, – the skillful movement back and forth from peak to plateau to plane. And this is the homework in an online course that I teach that students apply this model to their daily life experiences.

So they begin to be able to perceive their own internal state: whether they are at a peak, at a plateau, or whether the plateau is high and they are limited in what may come up, or whether the plateau is raised off the plane, or whether it is broader and more flexible or even way down on the plane.

The neat thing is that you can actually do mindful awareness practices – there’s one we do called the wheel of awareness – which opens you to understanding how consciousness itself can be experienced in a very integrated way. So you become really very mindfully open to what’s going on rather than just being swept up by things that happen – thoughts, feelings, memories, and things like that.

So, as you asked me to talk about, there are actually very practical applications that this plane of possibility brings up. It’s basically a metaphor for what the science of the architecture of the mind is at the deep level of energy flow patterns.

Once you get to that basic foundation, it becomes really fun, because then you’ve laid this solid grounding, and then you can build on it all sorts of really exciting predictions (science has established some of those predictions). You are really on solid ground to keep on moving in this deep way to understand the basic mechanisms of healing.

Ruth: Now, let’s go into neuroplasticity. In a way, when we were discussing this movement, it almost seemed like it was a lead into or another way of talking about neuroplasticity or what’s happening in a neuroplastic situation.

Dan: Yes, I agree. One thing just to start out with is the word neuroplasticity. It’s a wonderful word that implies how the structural changes in the nervous system, especially the brain and the skull…how these change in response to experience. So, neuroplasticity means how experience changes the structure of our brain.

In the old days, people believed that after adolescence, the brain was pretty fixed, and you were on the road to ruin as your brain would just deteriorate. We now know this is just not true. So that’s the great, great news.

“Mindfulness is this capacity to move to the open plane of possibility, so you are truly receptive and open to what’s going on, rather than laying on your judgments that filter what you see. ”

“The wheel of awareness opens you to understanding how consciousness itself can be experienced in a very integrated way.”

“Neuroplasticity means how experience changes the structure of our brain.”



If you ask what the most useful take-home message from the field of neuroplasticity is for clinicians and teachers, here are some basic principles. If I can just outline them for you, I think they are really good for everyone in the field of helping another person’s mind develop, whether you are a teacher or a clinician ….

Here are the basic rules. There are four essential ways that the brain changes in response to experience, and there are six ways that you can really apply them in everyday life. So let me start out with the concepts of how this is really happening.

The first is (at the level of the) synapses. The connection among the neurons are at the level of neuron-to-neuron connection is called the synapse. You can grow new synapses, you can strengthen synapses, and you can make them more efficient. There are all sorts of things you can do that you can just call synaptic change or synaptogenesis, which is the formal term. That’s one basic way.

Basically, memory is how the synapses change and respond to experiences. Right now, if you are listening to this and really paying attention to it, you can make synaptic changes pretty quickly, so that you will remember things first in the short-term for short-term synaptic changes, but then the long-term changes will establish (medium length memory, then long-term memory and then , in fact, permanent term memory). There’s a whole series of changes that we could talk about, but the bottom line is memory, and memory is based on synaptic changes.

The next kind of change you can make is neurons. We didn’t believe this, but now we know this is true at least in the area called the hippocampus (but maybe in other areas as well). You can actually take uncommitted neural stem cells – they divide every 24 hours or so – and with novelty and the close paying of attention, you can get the daughter cell of this stem cell division. Instead of this daughter cell just deteriorating and just dying, you can stimulate that daughter cell to develop into a fully differentiated mature neuron over the course of 8-12 weeks.

You can actually see that this neuron will become fully integrated into the whole system. That’s throughout our adulthood. So we have synaptic genesis, we call this neural genesis, the stimulation of the stem cells to differentiate and you continue the stem cell line with the daughter cell. Basically, you can grow new neurons. That’s very exciting.

Thirdly, with skill development, we believe you grow myelin. Myelin is a fatty sheath; it’s what creates the white matter of the brain…. When myelin is laid down over the axon, the long length of the neuron, it connects two neurons to each other and it can create among many neurons a more efficient circuit.

Why does myelin create more efficiency in the action potential or the electrical current equivalent going down and letting the neurons communicate with each other? It does it for two reasons. One, the speed of conduction of the electrical current, called the action potential down the axon, is sped up by 100 times.

“You can grow new synapses, you can strengthen synapses, and you can make them more efficient...memory is how the synapses change and respond to experiences.”

“Throughout our adulthood we have synaptic genesis, neural genesis, and the stimulation of the stem cells to differentiate. Basically, you can grow new neurons.”



After neurons fire, they need to rest, and that’s called the refractory period. If you have myelin around you, the refractory period is actually sped up by 30 times. So if you multiply 30 by 100, you got 3,000.

So, when you watch the Olympics and you see the amazing things athletes do…their athletics, you say, “I can’t do that! It’s impossible.” You are absolutely right, because you haven’t spent 10,000 hours to lay down the myelin that allows their circuits to be 3,000 times more effective than yours.

That’s why they can do something that looks impossible for you to do, because it is impossible for you to do. But they’ve taken the time and the discipline and worked on it to develop these myelin circuits. So myelination is a third way that experience can change the brain. That skill development takes many, many hours.

A fourth way that we change the brain is really quite a startling finding that is just beginning to be elaborated in ways that have profound implications for everything human. That is the area of epigenesis.

Genetics, of course, is the study of our genome, of the DNA and the sequences of nucleotides and nucleus of every cell (except the red blood cell). These genes are like books in the library. The way a book expresses itself in the world is that the librarian has to let the book out and people have to read it.

Epigenetics is basically a study of how experience changes the regulation of gene expression. So we are just beginning to learn that on the chromosome there are areas of this genetic material that are not the sequences of nucleotides that determine protein production (as classically what the gene does), but these are regulatory areas on the chromosome that determine gene expression. So epigenetic change is experience induced change in the regulation of those molecules within the nucleus that control gene expression.

It’s like the librarian rather than the book. If you have a change in your librarian who doesn’t let out certain books or encourages these other books to be read, you are going to change the impact in the world.

These epigenetic changes are like changing the librarian in the library. So you are changing the way genes are expressed, the timing, the manner in which they are expressed.

One study by Michael Meaney showed that if kids…are exposed to very harsh, abusive conditions early in life, there are changes in the regulatory molecules in their genome that determine how the genes that help regulate stress response are going to be controlled. Meaney was able to show that these changes seem to last for a lifetime, especially without therapeutic intervention.

So kids who were treated harshly early on, and as unfortunate as that is, at least we’ve been able to study the integrative areas of their brains…that aren’t functioning well, and as a result, the kids can’t regulate themselves.

Meaney has been able to show that it’s not only structural changes in the nervous system, but epigenetic changes as well. So these kids have a much more difficult time responding to stress. Their hypothalamic-pituitary-adrenal axis (the HPA axis) that allows you to respond to stress well, or not well, has been altered based on these epigenetic changes.

“Myelination is a third way that experience can change the brain.”

“Epigenetics is basically a study of how experience changes the regulation of gene expression.”



So, you have four ways (the brain changes): 1) epigenetic changes, experience changing the regulation of gene expression; 2) myelination, laying down the sheath; 3) neurogenesis, the creation of new neurons that can become fully functional neurons after a month or two; and 4) synaptic changes, which happen pretty readily.

These are the four layers of change where you see neuroplastic effects in which experience alters how the structure of the nervous system is and how the function, of course, follows the structure. So that’s the background.

There are six ways I want to just describe to you, Ruth, but let me just pause for a moment. I know my enthusiasm makes this flow out sometimes in a pretty rapid way. But it’s just very exciting to know all this stuff.

Ruth: I think it is exciting, too. In a sense, it’s the science of things that we talked about way back even in the 1960s and 1970s, nature and nurture, and which has the most impact…. Only then, we had no science to talk about how experience affected the brain.

Dan: Exactly. It raises the complicated, but important finding that’s just beginning to emerge, so we need to look for the science to know that this is absolutely true.

There are now implications, initial implications, that what we experience as adults, in fact, can be passed through epigenetic changes through our sperm and egg. So our children and our children’s children can be impacted by the stress we experienced in our own lives.

In the past we’ve always said it was the Lamarckian view, from a researcher named Lamarck, and we didn’t agree with that view that the genes are changed by our experience and that view was disproved. But he referred to genetic changes. These are epigenetic changes.

We are just beginning to get the preliminary evidence that shows that you can literally inherit epigenetic changes that are acquired from birth, things that happened to your grandparents through the nucleus, through the epigenetic regulatory molecules.

So it’s not just the experiences we have and our grandparents and our parents and stories they tell and the way they treat us, but it could be what’s passed through the sperm and the egg. This has huge implications.

Ruth: Do you see this as similar to the concepts of morphogenetic fields?

Dan: In which fields, in physics or in biology?

Ruth: When you think about how experience and that you’re laying it down in an epigenetic way…that it gets passed down from parent to child to grandchild, it almost seems like we are making a field of experience that’s beyond just one person or even one family.

“Our children and our children’s children can be impacted by the stress we experienced in our own lives.”

“It’s not just the experiences we have and our grandparents and our parents and stories they tell and the way they treat us, but it could be what’s passed through the sperm and the egg.”



Dan: Yes, in that sense, I absolutely agree. There’s a beautiful work by Christakis and Powers on the social networks and the invisible forces that connect us. Their beautiful book called Connected would absolutely reinforce what you are saying, Ruth. We live within these fields of influence that we actually can’t see.

When you take an image that our subjective mental lives are kind of dancing along these neural firing patterns, sometimes those neural firing patterns can sweep us up in these larger fields in which the body is just one node of a much larger network. Yet we look at the body as some identity of self, but in fact the self, if we are going to use this term, is probably plural. It involves these many nodes of which we are just one part of a much larger network.

It’ll be like a heart cell saying, “Well, I’m just a heart cell, I don’t have anything to do with the bones, or the liver, or the nervous system. I’m just a heart cell. That’s my identity.”

And you say, “Hey, heart cell, you are a part of the system called the body.” In the same way, just like you’re saying, I think we are getting more and more evidence from all these fields of science that we are simply nodes in a larger network. That doesn’t belittle us. That just lets us embrace a larger reality. We are all interconnected and interdependent.

It also lets us know – I think this is an important thing for all clinicians to consider – that the brain has a tendency, especially with certain cultural influences, to identify the body as a separate self. “This is me,” and “This is mine,” and all this kind of stuff. In a way, as Einstein said, “It’s an optical delusion that the brain itself creates.”

So part of therapy, when you look at all the studies of happiness and wisdom and kindness, you can show that when people relax that rigid sense of bodily defined identity and open up to realizing we are all a part of the interconnected whole, it’s not that we lose the self, but we actually expand the self to include a much larger sense of interconnection. People are happier; they’re wiser; they’re healthier. Knowing that and appreciating that doesn’t have to take away anything from us. It actually can enrich our lives.

Ruth: I’d like to spend a little bit of time talking about how the development of trust can lead to brain growth.

How the Development of Trust Leads to Brain Growth

Dan: There’s beautiful work from a researcher named Stephen Porges, which looks at this issues of how you turn on what he calls the social engagement system. His views involve something he’s named as Polyvagal Theory. It’s a wonderful conceptualization.

“The self, if we are going to use this term, is probably plural.”

“We are simply nodes in a larger network. We are all interconnected and interdependent.”

“When people relax that rigid sense of bodily defined identity and open up to realizing we are all a part of the interconnected whole, we expand the self to include a much larger sense of interconnection.”



But the take-home message here for our purposes is just that when you sense that another person is tuned into you and caring and can be trusted, the state that’s created in your own nervous system is like… I don’t know if we did this last time. Did we do the no/yes experiment? I don’t remember if we did it, but we’ll do it now very, very briefly, because we have a few minutes….

If you just listen to these words, you’ll feel the difference between being reactive or being receptive. If I go: “NO! NO! NO! NO! NO! Yes. Yes. Yes. Yes. Yes. Yes. Yes.” Did you notice the difference between no and yes?

Ruth: Absolutely.

Dan: How would you describe that, Ruth?

Ruth: The one felt harsh and shut down and I sort of separated myself. The yes felt sweeter and safer and more approachable.

Dan: Beautiful. That sweeter, safer place would be what Porges would call a receptive state. You could see what parts of the brain would be activated in this receptive state. This relates to those six things I wanted to make sure to outline, which I can do very briefly.

Our relationships with each other can help the brain grow. In Louis Cozolino’s The Healthy Aging Brain, you could show that when we have relationships in our life, we have longevity in our life. Relationships are profoundly important. So relationships of trust help the brain grow. You can feel it in this yes/no experiment.

The other things that help the brain grow – just to name them – are:

• Sleep and rest, which are very important. That’s when we consolidate memory.

• Good nutrition, including Omega-3s, so you can have the soil of the brain, allowing the seeds of awareness to work as you’ll see in a moment. So we need good nutrition including the Omega-3s that we can’t produce ourselves that are part of the membrane of the nervous system.

• Aerobic exercise. Not just exercise in the brain, of course, which we’ll do in a moment, but exercise in the body. Getting the heart rate going, if you are medically able to do it, is really, really helpful for brain health and brain growth.

• Novelty, bringing new things into our lives, new ways of doing things. Not just doing crossword puzzles over and over, but trying out new musical instrument, learning a new foreign language, trying a new way to walk around the block, and things like that. Novelty stimulates the brain in certain ways. One of the extensions of that is this sixth area, which is the close paying of attention.

• The close paying of attention. I don’t mean multi-tasking and doing a million things all at once. But the close paying of attention does two things. It allows you to specifically activate certain neural pathways. If those are healthy ones, in interpersonal neurobiology we talk about neural integration and you can actually learn to focus your attention to integrate the brain in these domains of integration we talk about.

“Relationships of trust help the brain grow.”

“Novelty stimulates the brain.”



And this is what you are doing: you are paying close attention and that gives you specific neural firing. The close paying of attention seems to activate a part of the brain called the nucleus basalis. You change the acetylcholine that’s released throughout the brain and those neurons that have been firing not only get the benefit of acetylcholine, which enhances the way genes get expressed, but also this firing of neurons can allow brain-derived neurotrophic factor to be released locally.

What those two things do – global acetylcholine and local BDNF (brain-derived neurotrophic factor) – is they show

how you pay attention. The close paying of attention can increase gene expression and increase how structural changes are established in the brain. In other words, your mind can change the structure of your brain by activating genetic expression. We now know that for sure. We used to guess at this 10 years ago, but now it’s been established in various research paradigms, and that’s the excitement.

When you think about these issues of trust, in therapeutic experience, then we want to create the yes state which primes the brain for neuroplastic changes. We want to align ourselves through these profound ways of therapeutic relationships to move toward presence, this open plane of possibility, and we can then invite the client, the patient to participate in this journey, where they themselves now can start using their mind to change the way their brain is firing in the moment. How you change brain firing specifies how you change brain wiring.

When a therapist is informed about how to produce the kind of experiences in a relationship in therapy that brings that brain toward integration, then the person is going to move the very structure of their brain toward health.

You move away from the chaos and rigidity that come from states of non-integration, and you allow the person to achieve these new and lasting states of integration, which basically is the experience of harmony, flexibility, compassion and connection inside, and connection to a larger world.

Ruth: Dan, we don’t have a lot of time left, but I want to tie all this back to mindfulness and where mindfulness fits in with everything that we’ve been talking about.

How Mindfulness Can Facilitate Neural Integration

Dan: Mindfulness is, in many ways, a focus of attention. So in our research center at UCLA we use the term mindful awareness practices. Mindful awareness is a form of awareness, which is open. It isn’t swept up by judgments and it involves two things.

One, you’re paying attention to where your intention is. So if you are doing a practice of meditation where you’re focusing on the breath, then that harnesses the ability to also be aware of your own awareness.

“We can then invite the client, to participate in this journey, where they themselves now can start using their mind to change the way their brain is firing in the moment. How you change brain firing specifies how you change brain wiring.”

“You move away from the chaos and rigidity that come from states of non-integration, and you allow the person to achieve these new and lasting states of integration...the experience of harmony, flexibility, compassion and connection.”



Those processes are about seeing the mind. Your intention and your awareness are aspects of the mind. So you’re developing this larger skill that we talked about last time called mindsight.

In all these ways, mindfulness contributes to a change in how the individual is actually having a relationship with themselves. They become more attuned to themselves.

They’re strengthening the circuits of regulation that allow them to have more emotional flexibility, more empathic connection, more capacity to plan, more ability to stay within what we call the hub of the wheel of awareness and stay present to things.

As they do, the amazing thing is that with this mindful awareness practice, you can actually transform chaotic and rigid states in lasting ways. This is why for any field of clinical intervention, doing this first as a therapist is so important.

We need to bring the resilience to our own lives so we don’t get burnt out. We need to bring that resilience to our own lives too, so we maintain the empathy that then invites the client, the patient to actually develop the same integrative circuits in themselves.

So, mindfulness is a practice. It’s also a way of being that really is profoundly integrative. It’s not that mindfulness should be seen as separate from the larger picture of what the mind is and how we develop a healthy mind. It’s one part of a larger process of integration as the root of health.

Mindfulness is one of the most wonderful practices. It’s been around for thousands of years, studied in recent times, but it’s a profoundly integrative practice. That’s where mindfulness fits in beautifully into this larger framework of understanding the mind and how to bring health to our lives.

Ruth: I’m afraid we’re out of time, but I want to say to everyone a couple of things.

First of all, I’m going to send you an email, and in that email I will give you links to Dan’s two latest books. I will give you links to Amazon, you can check it out. I’m not saying that you should buy it. If you want to go to your library and see if they have it, perhaps, you can print out the Amazon review and take it to your library. You may want it for your own library, in which case Amazon is probably the least expensive way for you to get it. But I just want to provide that for you.

We’re also going to give you a link to the comment board. The comment board is our community board. We’d like to hear from everyone on how you’re going to apply what you heard tonight. Tell us your practice specialty. Give us your first and last name, your city and state or country, and your profession, and tell us how you’re going to use in your work what you’ve heard tonight.

So no matter where you’re calling from, countries all over the world and cities and states throughout the United States, thank you for being on this call.

“Your intention and your awareness are aspects of the mind.”

“We need to bring to our own lives so we maintain the empathy that then invites the client, the patient to actually develop the same integrative circuits in themselves.”

“Mindfulness is a practice...a way of being that really is profoundly integrative.”



Dan, especially to you, I want to thank you for all of your work. You have done so much and you’re such a wonderful teacher at making this cogent and clear. And, I would say, you’re a careful thinker as well. So thank you for all of your work.

Dan: Thank you, Ruth! It’s a pleasure to be here with you.

Ruth: Good night everyone.

References:

Christakis, N.A., & Fowler, J.H. (2009). Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. New York, NY: Little, Brown and Company.

Iacoboni, M. (2009). Mirroring People: The New Science of How We Connect with Others. New York, NY: Farrar, Straus & Giroux.



About The Speaker:

Dr. Siegel is currently a clinical professor of psychiatry at the UCLA School of Medicine where he is also on the faculty of the Center for Culture, Brain, and Development and the Co-Director of the Mindful Awareness Research Center at UCLA. An award-winning educator, he is a Distinguished Fellow of the American Psychiatric Association and recipient of several other honorary fellowships.

Dr. Siegel is also the Executive Director of the Mindsight Institute, an educational organization that focuses on how the development of mindsight in individuals, families and communities can be enhanced by examining the interface of human relationships and basic biological processes. His psychotherapy practice includes children, adolescents, adults, couples, and families.

Mindsight: The New Science of

Transformation

The Mindful Therapist: A Clinician’s Guide to Mind-sight and Neural Integration

The Mindful Brain: Reflection and Attunement in the

Cultivation of Well-Being

Books by Featured Speaker: Daniel Siegel, MD

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