Practical Brain-Focused Strategies for Working with Depression

Transcription

1 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 1 Practical Brain-Focused Strategies for Working with Depression Why Depression is a Form of Trauma with Elisha Goldstein, PhD National Institute for the Clinical Application of Behavioral Medicine

2 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 2 Practical Brain-Focused Strategies for Working with Depression: Elisha Goldstein, PhD Why Depression is a Form of Trauma Dr. Goldstein: Let s jump in now into understanding the depressed brain. This was my journey looking at a variety of different studies around depression and saying: Is there any evidence that we can learn from looking at brains that have been depressed over time to see what s going on in those brains and then what things can we do to shift the activity in a more balanced direction? That s where all of what we re doing here was born from! First, we had to look at depression again we are just reviewing or revisiting this idea of understanding what depression is. Sometimes phrases/quotes are really helpful in giving us a sense of what depression is if you haven t experienced it for yourself, and Gandhi, who struggled with depression quite a bit said, It s a dryness of the heart that sometimes made me want to run away from the world. The Dalai Lama described depression as, Thoughts and emotions that undermine inner peace. Then, there s the writer John Keats who said, If I were underwater, I would scarcely kick to come to the top. So, just considering those for a moment the first ones describing Depression is thoughts and emotions that undermine inner peace. Depression is the ultimate avoidance strategy. depression the latter one describing major depression I consider depression to be the ultimate avoidance strategy. The comic Leah Pearlman she creates written comics at Dharmacomics.com has some wonderful ones that describe depression. If you can, visualize this: it s a comic of one stick figure looking to another and saying, How re you doing? The other person who s holding up a mask says, Great! In the next slide, the first person says, Really?

3 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 3 Then, the mask comes down and the person says, No. That s like the ultimate avoidance strategy life has become too overwhelming so we re going to shut down. We can look at depression as a medical illness, and some people say: Pneumonia strikes the lung; depression strikes the brain. Dysthymia is more like allergies just ongoing, irritating, low-grade, and hard to get rid of. This is another way of looking at depression. One of the most powerful things is called the depression loop. Pneumonia strikes the lung; depression strikes the brain. People have responded when I talk about natural ways to relieve depression and recover happiness, and this leads up to the neuroscience of depression. Basically, we re getting to why depression is a conditioned reaction. When we look at the depression loop, we see people experiencing it four different ways. First, there are the thoughts of depression: Nothing s ever going to get better. I can t help myself. No one can help me. Then, there are the feelings, which is anxiety or sadness or despair. There are the emotions, not to be confused by sensations, which are like a tiredness, lethargy, or torpor and maybe anxiety mixed in there as well. Avoidance strategies are ways of avoiding life either by isolating or getting involved with risky activities. So, these thoughts, feelings, or emotions can be happening in anybody s given experience, which then all lead to behavior, which is, ultimately, an avoidance strategy. Avoidance strategies are ways of avoiding life either by isolating or getting involved with risky activities drugs, alcohol, sex, excessive buying of things really bad habits Avoidance strategies help people to avoid their feelings and ultimately, this leads to shame and cues stress all a part of the depression loop.

4 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 4 Sometimes I have clients list out thoughts, emotions, sensations and behaviors the ones that are associated with depression for them. That helps them to externalize it a bit, so that when they notice it in their daily lives, they are now relating to it instead of from it. In some ways, it s a bit of a trick to pop them into a more mindful state. When we re able to view something, we have more perspective on it, and that helps us feel more control around it. When we re able to view something, we have more perspective on it, and that helps us feel more control around it. Just having them list out their thoughts, emotions, sensations, behaviors in the loop (and I ll explain to you in a minute why that s important) is also another way to help channel all that for them. It s really powerful. That s the feedback I m getting from thousands and thousands and thousands of people who have worked with this it immediately brought up an Aha moment for them. So, here s a Jeopardy question for you. The prefrontal cortex right behind the forehead, the amygdala the emotional center of the brain the part that takes in all of our senses and says, Are we safe or not? and the hippocampus right behind the amygdala, which is involved with learning, memory, putting things in context these three parts of the brain are associated with what disorder? Judging from the topic we re talking about here, you might say depression. What is depression? is a Jeopardy response. Depression is a posttraumatic stress disorder and chronic stress over time. But here s the reality: it is also a post-traumatic stress disorder and chronic stress over time. The PFC, prefrontal cortex, the amygdala, and hippocampus are all impacted by post-traumatic stress disorder or chronic stress over time, and I ll explain to you exactly how that is. The interesting thing is depression affects three key areas of the brain: the prefrontal cortex, the amygdala, and the hippocampus. And that s the neuroscience of why depression is a trauma to us. When I look at the depression loop that I was describing before, it is a Depression affects three key areas of the brain: the prefrontal cortex, the amygdala, and the hippocampus.

5 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 5 conditioned reaction just like getting bit by a dog might cause you to flinch if you see a leashed Chihuahua walking around the corner. Having a depression in the past causes the brain to say, That s something I don t want to experience again. Any cue from it, I m going to move away from I m going to avoid or escape from whatever it might be. The number one way the brain does that and we ll talk about this later is by thinking. The brain goes into thinking. It goes into rumination, figuring it out, and problem-solving. Then, of course, we believe everything we think, and so there it goes the loop is fueled and fueled and ongoing self-fueling itself. Let s just describe this for a second. Depression impacts the prefrontal cortex. Let s imagine two halves split in the prefrontal cortex: you have the right side and the left side. Now, we re not talking right brain/left brain here. We re talking right side/left side. So, the right side lights up when people are experiencing depression the experiencing of negative emotions. Also, the avoiding of things in life lights up the right side of the prefrontal cortex. The left side lights up when we re engaged and experiencing more positive emotions. That s when you see more activity going on in the left side. When you re looking at a depressed brain, you ll see an overactive or enlarged amygdala. It would be interesting to consider: How do we create that left prefrontal shift in activity? What does that for us? When you re looking at a depressed brain, you ll also see an overactive or enlarged amygdala, which means that someone is highly sensitive to the environment. In some brains of people who have had depression just going back to the prefrontal for a second generally you ll see a smaller prefrontal cortex. With the amygdala enlarged and the prefrontal sometimes smaller definitely that right prefrontal shift what we want to do is help cool down the activity in the amygdala.

6 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 6 In the hippocampus, we ll see some dendritic attrition going on, and remember, that s for learning, memory, and putting things in context. So, what we want to do is see if we can create more neural growth. What creates neural growth in the hippocampus? Here we might find some secrets of some natural ways to work with depression. One thing we know for sure, beyond a shadow of a doubt, is that in the feedback loop of depression, culturally and individually, depression is shrouded in shame. People walk outside, and they don t want to talk about depression, or even the mention of depression creates shame. What s shame? In the feedback loop of depression, culturally and individually, depression is shrouded in shame. Shame is read by our nervous system in the same way that stress is it creates stress. You ll notice this in the work by Allan Schore at UCLA. Shame and stress both create sweating, body awareness, shaking, uncoordinated activity, and gaze aversion those kinds of conditions. Basically, what s happening is you re already feeling depressed. You re getting that right prefrontal shift and what happens is you experience shame, culturally reinforced, and then that increases the stress and ultimately increases that right prefrontal shift. No wonder it s so hard to get out of depression: you re relationally fed and pushed over to the right prefrontal side, and the increasing amount of shame and increasing amount of stress layer on top of the feedback loop that s already happening. One other area that I want to mention, aside from the prefrontal, the amygdala and the hippocampus, is the vagus nerve. Steve Porges, who you might have heard on NICABM plenty of times, and Dacher Keltner at UC Berkeley have talked about the vagus nerve quite a bit. It s the nerve that connects the heart to the brain. Basically, when you have high vagal tone, more or less, you re feeling well and content; when you have low vagal tone, it s associated with anxiety, depression, low voice tone, and flat affect.

7 Practical Brain-Focused Strategies for Working with Depression Video 3 - Transcript - pg. 7 What we want to do is see if we can increase our vagal tone. What are the natural things that increase vagal tone? With these different areas of the brain and the nervous system, can we impact them naturally? I just want to pause right here for a minute and ask you to remember at the beginning of our time together, we were thinking about this as a mindfulness experience so just notice if your mind is wandering at this point. If it is wandering, again, see-touch the thought where it wandered to, write it down it might be an important thought and gently go back to being here with us right now. So, what do we need to do in regard to depression (as we close with this segment)? We need left prefrontal activation. We need lower amygdala activation. We need to strengthen the hippocampus. We need to increase vagal tone. For extra credit, we might consider how to reduce cellular inflammation, because that is also associated with depression. We might consider what things help us increase dopamine, because some studies have shown that dopamine goes down with depression, too. We might consider what things help us ignite a little GABA, which helps us feel more relaxed, as well as oxytocin, which helps us feel more connected. So, this is where we ll be launching off to right now more of our natural antidepressants. In the next segment, we ll just do a brief overview of how the brain changes and then launch back in.