Foreword Daniel G. Amen, M.D. Author of Change Your Brain, Change Your Life June 2015 Acknowledgments 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." Excerpted from Reclaim Your Brain: How to Calm Your Thoughts, Heal Your Mind, and Bring Your Life Back under Control by Joseph A. Annibali All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
