the neurobiology of the adolescent brain: a new look at brain...

The Neurobiology of the Adolescent Brain: A New

Look at Brain Change between the Ages of 12

and 24

A Webinar Session with Daniel Siegel, MD

and Ruth Buczynski, PhD

○

○

○

The Neurobiology of the Adolescent Brain: A New Look at Brain Change between the Ages of 12 and 24 2

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

○

○

○

The Neurobiology of the Adolescent Brain: A New Look at Brain Change between the Ages of 12 and 24

Contents

(Click on the section title to jump to the page)

The Teenage Brain and Risky Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Why Adolescents Are Prone to Risk-Taking . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Human Nature vs . Brain Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Influence of the Dopamine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Creative Exploration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

From the Hyperrational to Intuitive Thinking and Self-Awareness . . . . . . . . . . 13

Changing the Cultural Conversation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

The Addicted Teenage Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

The Process of Pruning: Integrating the Teenage Brain . . . . . . . . . . . . . . . . . 18

TalkBack Segment with Ron Siegel, PsyD and Kelly McGonigal, PhD . . . . . . . . 26

What Stood Out Most . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Teaching the Brain Self-Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

How to Harness Biology and Motivation for Decision-Making . . . . . . . . . . . . . 29

How the Brain’s Growth Spurt Impacts Development . . . . . . . . . . . . . . . . . . . 30

How to Make the World Less Stressful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

About the Speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34



○

○

○

Dr. Buczynski: Hello everyone and welcome. I am Dr. Ruth Buczynski, the President of the National Institute for the Clinical Application of Behavioral Medicine and a licensed psychologist in the State of Connecticut.

I am so glad that you are joining us. We have people joining us from all over the world: many, many people from a variety of professions as well as laypeople – there are lots of parents on the webinar tonight as well as school teachers and school nurses. So, to everyone, we are so glad that you are here.

My guest tonight is not new to many of us; he is Dr. Daniel Siegel. He is a physician, psychiatrist, and Clinical Professor of Psychiatry at UCLA School of Medicine as well as the co-director of the Mindful Awareness Research Center at UCLA.

He has authored and published many, many books – and last December, he published Brainstorm: The Power and Purpose of the Teenage Brain, and we are going to spend our time today focusing on the teenage brain.

So, welcome, Dan, it’s good to see you again.

Dr. Siegel: Thanks, Ruth – it’s great to be here. Thank you for having me.

The Teenage Brain and Risky Behaviors

Dr. Buczynski: I’d like to jump right in. First, I suppose we should define what we mean by the “teenage brain” – just roughly, what ages are we looking at here?

Dr. Siegel: The word teenage usually refers to thirteen through nineteen. In this book, we are talking about the adolescent mind, which is a period of adolescence that extends beyond the teenage years – so really we’re thinking about the second dozen years of life – twelve to twenty-four.

The teenage brain idea is, in fact, that the major changes that begin during the teenage years continue into our mid-twenties.

Dr. Buczynski: Now, teenagers are notorious, or at least they are perceived to be notorious, for high-risk behaviors. Does that have to do with their brains? I’m going to send you an easy question there! Is that related to their brains – and if so, how?

Dr. Siegel: Yes, that’s the first place to start. When parents are concerned about teenage risk behaviors, they are absolutely correct to be concerned!

The Neurobiology of the Adolescent Brain: A New Look at Brain Change between the Ages of 12 and 24

with Daniel Siegel, MD and Ruth Buczynski, PhD

“The adolescent mind extends beyond the teenage years.”

“The research shows that risky behaviors are three times more likely during the adolescent period.”



○

○

○

The research shows that risky behaviors that lead to accidents and permanent damage to the body as well as fatalities from suicide and from murder are extremely high – three times more likely – during the adolescent period.

While the adolescent period – twelve to twenty-four – is a time when your body is actually the healthiest to fight off disease, it is true that it is the most dangerous.

Now, to the next part of your question – “Is this due to what’s going on in the brain?”

Our understanding now is that the changes that happen in the brain help us understand why risky behaviors – thrill-seeking, pushing boundaries, doing things that are dangerous – are prevalent during this period of time.

Our new understanding of the brain and how it changes helps illuminate some of the reasons for risk-taking behaviors.

Why Adolescents Are Prone to Risk-Taking

Dr. Buczynski: Let’s jump into that – and are there particular studies? What do we know about why they are so prone to risky behavior?

Dr. Siegel: The question of why is a great question and it helps us as parents, it helps us as therapists, and it helps us as adolescents, to approach this period of time and to optimize the chance of something positive.

The first way of responding to a why question is to look at the big picture: what is the purpose of adolescence?

We know some of the brain mechanisms – and we will talk about them – but the why really starts with this: why would an adolescent do things a child would not do?

Why would an adolescent do things that later on in life, when they are forty-five, they generally don’t do?

The big response to why is very important. In the popular media, people have said, “Adolescents are just compulsive because they’re out of their minds –they’re nuts.”

Some people say, “This period of time is when they are really not able to think correctly because they are immature. Adolescence is just a necessary period of immaturity that you’ve just got to get through.”

When I had my two teenagers – they moved through their teenage years and have come into their early twenties – they are still adolescents, but as they moved through that period, I looked to the literature, both to the popular literature and in the popular media.

I was shocked to find that those sources of knowledge about adolescents and why they do what they do were very different from the science.

“What is the purpose of adolescence?”

“Is adolescence just a necessary period of immaturity?”

“Our new understanding of the brain helps illuminate some of the reasons for risk-taking behavior.”



○

○

○

So one of the reasons I wrote the book Brainstorm was to clarify for the general public what the science was saying about the adolescent period, including the brain. I wanted to write a book that was as much for the adolescent to read as for parents or professionals.

There wasn’t a book out there for both adolescents and parents to read that dives deeply into the nature of the brain and debunks the myths that are out there.

The first thing to say about why is a simple statement: adolescence is defined as the period between childhood dependency and adult responsibility.

In the old days, a hundred and fifty years ago, adolescence used to be about two or three years long; now it is way past a dozen years, and in fact, in some cases, two dozen years.

The period of adolescence is actually not thought of, from my interpretation of the science, as a period of immaturity, but as a necessary period of transformation that requires the brain to change in such a fashion that the adolescent gets ready to take risks in order to leave the nest and to create a new world.

When you look at this from what is called an adaptive point of view, the big question about why – and we will talk about the mechanisms of how next – but the big question of why is that, to leave home, you have to have some fundamental shift.

Think about it this way, Ruth: You wake up in the morning; the sun is rising; someone comes into your bedroom that loves you like crazy and kisses you on the forehead and says, “Ruthie, can I make you some breakfast? It’s time to get up.”

And you say, “Okay, Mom/Dad.” You then get up and your breakfast is made; you get dressed, you put on your shoes, and go to school.

You go to preschool; you go to elementary school; you play, you learn, and you soak in knowledge; you have fun. You come home; maybe you take a nap, maybe you have a snack; you dance around, you watch a little TV.

Then this loving person says to you, “Ruthie, would you like to have a little dinner now? It’s time for dinner. And then we’re going to get ready for bed; I’ll give you a bath, put you in bed, I’ll sing you a song and I’ll tell you a story,” and you drift off to sleep.

Now, who would want to leave that kind of setup? I mean, most of us are trying to get it back with our spouses!

So, you have to have some fundamental, evolutionarily determined, and genetically programmed change in

“Adolescence is defined as the period between childhood dependency and adult responsibility.”

“Brainstorm dives deeply into the nature of the brain and debunks the myths.”

“The adolescent gets ready to take risks in order to leave the nest and to create a new world.”

“You have to have some fundamental, evolutionarily determined, and genetically programmed change in the brain to get you from childhood and ready to leave.”



○

○

○

the brain to get you from that childhood way of being cared for by your attachment figure and ready to leave that situation.

Our familiar home – whether it is great or not so great – is at least familiar. The world outside the home is inherently risky. It is uncertain; it is full of potential dangers

So you have to have changes in the brain – we will talk about that next – that shift and tell this individual now moving from childhood to the adolescent transformation

period – not immaturity but necessary transformation – that say, “Risks are not only something I am willing to take, they are something I am compelled to take.”

That is what is going to allow this individual to do two things: leave the home and, for our species as a whole, try out new ways of living.

As the ever-changing world is emerging, you now can have this situation where the adolescent is able to adapt and move out to all corners of the planet.

Instead of the adult ways where we have become familiar with what we had to deal with or learned to deal with, now adolescents are at an open state – taking risks, trying out new things, creatively exploring, and driven with passion as they go out to try to populate the world.

Our species supports that and all mammals have adolescence, as far as we can tell.

Humanity has taken advantage of this, and adolescents, in many ways, are the most courageous and creative elements of our society – they are the most creative and courageous individuals in our human family.

Dr. Buczynski: That’s very interesting. That’s the big picture.

Human Nature vs. Brain Shift

Let’s bring it down to what a schoolteacher or the guidance counselor, or a mom or dad, might say, “Yes, but how do I talk to my child, or a student, to prepare them for the fact that certain things like driving fast, driving and drinking or driving with other kids is risky? They seem to know all that, and they agree that those are unwise things to do, but they do them anyway when they are out with other kids.”

So is that just human nature, or is something going on brain-wise?

Dr. Siegel: Yes, and that’s a great way to say it – but let’s look at the mechanisms first and then look at the pathway to try to reduce risk.

The mechanisms we believe are in place have to do with ESSENCE – this is an acronym I’ve created to help me remember the essence of adolescence.

“The world outisde home is full of potential dangers.”

“Risks are not only something I am willing to take, they are something I am compelled to take.”

“Adolescents are the most creative and courageous individuals in our human family.”



○

○

○

The ESSENCE of adolescence is comprised of the following four dimensions: The first is ES – emotional spark. Let’s take what we have done in past courses, Ruth,

Take your hand model of the brain and take your thumb folded in the middle of your palm and fold your fingers over the top – it is a pretty useful model of the brain.

Dr. Buczynski: Let me stop you for a minute, Dan, and just say to listeners to try this – just follow along with Dan because maybe this is going to be something useful for you to teach someone else. So go ahead, Dan.

Dr. Siegel: Yes, absolutely – thank you, Ruth.

We can use this as a model just to show you. I’ll reach over here and grab this plastic brain – we have this double-sized brain – it is big, but the hand model would basically be shaped like this – where the back of the brain is the back of your hand and the front of the brain is the front here – where your fingernails are.

When you open up the brain, which I will do here with the hand model now that we have it, what you find – and this is obviously just a plastic model – but what you find are three major areas we can talk about.

The brain stem is the deepest area. That would be represented if you open up your fingers and your thumb – this area here in the plastic model – and in your hand model – is right there in your palm.

Then this area here – you can’t really see it because it is actually more inside the medial temporal lobe – is the limbic area. There is a left and right side – that is the thumb area.

Then the outer bark of the brain, here, is the cortex, represented by your fingers like that. You see how that is just an enlarged view.

In the hand model, let’s just go through it and see what we know changes in the adolescent brain.

If you lift your fingers up and lift your thumb up, you now have your brain stem. This is where your fight, flight, or freeze and faint processes are mediated by certain neurons – the basic cells of the

brain – and also whether you are awake or asleep.

Clearly, the changes in sleep patterns in adolescence are changing during this period, too. Adolescents stay up later, they need to sleep longer, and schools don’t respect that, and so we are having a lot of adolescents whose natural sleep rhythm change is not taken into account.

These kids are profoundly sleep-deprived, and sleep deprivation, as you know, directly impairs neural functioning. Your ability to remember what you learned, your ability to pay attention, even your ability to stay awake is impaired.

Sleep deprivation affects insulin processing, so there’s a tendency to gain weight and the likelihood of diabetes is massively increased. The ability to fight off stress and disease is reduced because the immune system isn’t functioning well.

“ESSENCE makes up the four dimensions of adolescence.”

“We have a lot of adolescents whose natural sleep rhythm change is not taken into account.”

“Sleep deprivation impairs neural functioning.”



○

○

○

We are going to go through each part of the brain, but what we are saying is that both the change in sleep timing and the amount of homework they generally have – plus all the digital things that stimulate the brain and keep the brain up long after it should have been going to sleep – are problems for the adolescent.

In all these ways, the basic physiological processes mediated by the brain stem are hugely challenging for an adolescent. That is just to put a frame on it – we’re not just talking about risk.

When you put your thumb over – two thumbs would be a perfect model – this is the limbic area in the hand model of the

brain. There are five major functions of the limbic area that we have talked about, and I will review them for you.

One is generating emotion by working with the brain stem and the body itself – that is the subcortical origin of emotion.

In Jaak Panksepp and Lucy Biven’s book, The Archaeology of Mind – and I am the founding editor of the Norton Series on Interpersonal Neurobiology – that is one of the books in our series – we look deeply at these subcortical origins of emotions. So, emotion is function number one.

We know that for the adolescent brain, emotions are pushing much more up into the cortex, the higher part of the brain where you reason, than they were in childhood. We can call that the ES – the emotional spark. That is the prelude to our ESSENCE – ES is emotional spark.

The next function (of the limbic area) is motivation. The brain stem and the limbic area are the two areas that work together to motivate us.

Motivation shifts in adolescence. Sometimes middle school and high school experiences are not that motivating for kids, but they can be motivated to do all sorts of other things.

We need to understand that deep in the limbic area, adolescents are getting shifts in the brain on motivation.

One of the motivations is to push away from parent figures. You can see from our adaptive model why that would be useful to do – to have these deep structures getting you ready to leave the nest; you need to

push away.

That is not immaturity – it is a form of transformation, not immaturity. A lot of parents don’t know how to understand that.

This is what is exciting about the Brainstorm book – people who have taken it in have said, “Wow – this totally changes how I interpret my adolescent’s behavior.”

Even for adolescents themselves, they can understand that there is a natural push deep here in the limbic area and how it is working with the brain stem.

So that is function number two. We now have emotion and motivation.

“The change in sleep timing and the amount of homework are problems for the adolescent.”

“Motivation shifts in adolescence.”

“One of the motivations is to push away from parent figures, which is not immaturity but transformation.”



○

○

○

The number three function is called appraisal, and it is very important.

Appraisal is basically your limbic area filtering both stimuli from the outside world and stimuli from the inside world: thoughts being the example of the inside world and perceptions from the outside world.

The limbic area evaluates the meaning of them. It says, “Is this thing important or not? If it is important, is it good or bad? If it’s good, I want more of it – how do I get it? If it’s bad, I want less of it – how do I get away from it?”

The appraisal system of the limbic area is changing in adolescence – as it needs to. If teachers keep on drilling kids with the same kind of thing they had in third and fourth grade, it is not going to work.

I am working with school systems – whole districts in fact – to take a Brainstorm approach to this and say, “Why don’t we embrace some of these understandings of the adaptive transformative brain changes that are needed, to try to invite the appraisal system of an adolescent

brain to say, ‘This is important and I want more of it?’”

There are ways we can talk about later of how we do that. So, function number three is appraisal – changes.

Number four is memory. As we said, sleep deprivation makes it hard to remember. The hippocampus is in this region, and stress decreases hippocampal functioning.

We need to realize that stress does that – and we will see later on – that the pruning that is going on in the brain, especially in the cortex, can be exacerbated by stress.

The hippocampus, along with the hypothalamus, are working in our stress response and helping to regulate ourselves.

The fifth function of the limbic area that also changes and is challenged during adolescence is attachment.

Attachment, in the simplest way, is how we, as mammals, need an attachment figure to give us four S components. We are seen by the attachment figure; we are safe with the attachment figure; we are soothed by the attachment figure; and we feel secure with the attachment figure.

All these S features – seen, safe, soothed and secure – we have with our parents when we are children, infants, toddlers, elementary-school-age kids, but then the limbic area changes.

So, this is the attachment aspect of limbic functioning, and it changes during adolescence such that, instead of turning to our parents, we turn to our peers.

“Appraisal is filtering stimuli from the outside and inside world.”

“The appraisal system is changing in adolescence.”

“Stress decreases hippocampal functioning.”

“In childhood, we are seen, safe, soothed, and secure with our attachment figure.”

“During adolescence instead of turning to our parents, we turn to our peers.”



○

○

○

I call this social engagement – the second dimension of our acronym ESSENCE: we have emotional spark and now we have social engagement.

The social engagement is essential for the adolescent’s adaptation. If you leave the nest and go out into the wider world without an adolescent support group in the wild, you are as good as dead.

Social engagement is not just about caving under peer pressure; it is an evolutionarily created push, driven by the limbic area, to have membership with your adolescent group so that you don’t die.

Literally, it works with the fight/flight/freeze reactive states of life-threat to work together and motivate you to belong somewhere.

When an adolescent comes to a parent and says, “I need this kind of jacket” or “I need to have some kind of clothing,” you don’t have to buy it, but at least you can, as a parent, appreciate the sense of life and death that your son/daughter is feeling about it.

The same thing is true with just belonging. Each of these dimensions has upsides and downsides.

The downside, of course, is you cave under peer pressure. If your peers are asking you to do wild things like take risky behaviors – that’s not good. But we need to recognize there is an upside to it, too.

Now, while all this is happening – we’ll fold our fingers over the top – the cortex is also changing. The whole system is changing by two fundamental processes: pruning and myelination.

What we didn’t know before but we do know now, in the last dozen years or so, is that there is a massive change in the brain.

Some groups at UCLA believe and other groups don’t – it’s kind of controversial – that around ten or eleven, before puberty hits, there is

this resurgence of growth. There is a growth spurt. Other labs do not believe that, so that is up in the air.

But what is not controversial – whether there is a growth spurt or not – is that during the adolescent period, pruning and myelination happen.

Pruning is where you are carving away neural connections and even neurons that you don’t need. It is a “use it or lose it” principle, maybe exacerbated by stress, which may be the reason, by the way, that every major psychiatric disorder has its onset, most likely, during the dozen years of adolescence.

It is absolutely amazing. It is pruning that is happening rather than thinking of it as hormones out of control – there is no evidence for that.

“Each of the dimensions of ESSENCE has upsides and downsides.”

“Social engagement is essential for the adolescent’s adaptation.”

“The whole system is changing by two fundamental processes: pruning and myelination.”

“Pruning means carving away neural connections and even neurons that you don’t need.”



○

○

○

Of course, with puberty, you have a rise in sexual hormones but we believe it is this pruning process that may unveil genetically vulnerable circuits or experientially induced circuits, or some combination of the two.

Pruning actually reveals underlying vulnerability in circuitry.

What we know too is that, besides the pruning, there is myelination. Basically, myelination is laying down connections

among the remaining neurons so their coordination, balance and speed are three thousand times more effective.

First, we have a hundred times faster – the speed of ions flowing in and out of the membrane called the action potential – and then we have a thirty times quicker refractory period where you recover from having sent an action potential down.

Thirty times a hundred is three thousand. So, for a given myelinated circuit, you are three thousand times more effective.

Overall, what that means is the adolescent brain is becoming more integrated. It is differentiated through pruning; it is linked through myelination and it is becoming more efficient – surprising, actually, to many adults – but it is.

The Influence of the Dopamine System

Now, this is not the only thing that is changing. One of the things that changes throughout the whole system – limbic area, brain stem and cortex – is the influence of what we call the dopamine system.

The influence of the dopamine system gets to the question of why kids do risky behaviors/how they can do them.

One of the leading scientific thoughts at this moment – and of course that’s always changing – is that the dopamine system, which is the neurotransmitter of reward, is lower in its baseline

level – that’s the dopamine circuitry in the adolescent brain – but the release levels are higher.

This finding helps us to understand that there is a restless sensation with an adolescent – boredom, “I’ve got to do something” or “I’ve got to do something that releases my dopamine.”

Now, one of the basic releases of dopamine is novelty. So, one of the thoughts about risk-taking behavior is that you are driven, because of this dopamine shift – lower baseline elevated release. You are compelled to try something new, because novelty secretes dopamine.

The good part about that is you can leave home – it is new to leave home – you can leave the familiar world, and you can populate the planet in new ways that the adults that raised you never thought of.

“Myelination lays down connections among neurons to increase their coordination, balance, speed, and integration.”

“During adolescence, a myelinated circuit is three thousand times more effective.”

“The dopamine system is lower in its baseline level in the adolescent brain, but the release levels are higher.”

“Novelty secretes dopamine.”



○

○

○

Those are the goods things. That is the novelty of the ESSENCE. So, now we have emotional spark, ES; social engagement, SE; novelty or novelty seeking, N.

This novelty, then, is wonderful. The downside is drugs abuse and other activities that stimulate dopamine release.

Some people say video games and others say the eating of high-glycemic foods that rapidly release high levels of blood sugar in rapid ways are addicting.

We know that during adolescence, if you are going to become addicted, it is most likely during the second dozen years of life – during adolescence. So this is the downside, but there’s an upside, too.

Creative Exploration

I just want to say, in response to your question, that the last part of ESSENCE – emotional spark, social engagement, novelty – is creative explorations, CE.

In the brain of an adolescent, since it is pushing away from adults and pushing away from the status quo, the cortex itself is mapping out all sorts of things.

The back is mapping out three-dimensional space, usually with the eyes; the side is mapping out sound; the upper side – the parietal lobes – is mapping out the limits of the body.

The frontal lobe for thinking conceptually is developing a lot during adolescence, especially the prefrontal cortex. The prefrontal cortex is transforming and it is pruning in myelination – it is becoming more and more integrated through time.

We believe that what this means is that you are literally able to think about things in new combinations called creative explorations.

What happens in this process is something people didn’t realize because everyone was saying, “Oh, adolescents are doing risky things because they are impulsive.”

Now, that is partially true. In early teenage years – the ability to resist an impulse, in fact, is hard to do because of the remodeling of the brain – so that is true. But risky behavior continues when impulsivity has subsided, and there is another mechanism beyond, and in many ways more concerning, than impulsivity.

Impulsivity is learning to control your impulses – you can do mindfulness meditation, or whatever you are going to do to develop more self-awareness – that is important, for sure.

But the second mechanism is something that surprised everybody, and it is called hyperrational thinking.

“Risky behavior has two mechanisms: impulsivity and hyperrational thinking.”

“Novelty is wonderful. The downside is drug abuse and other activities that stimulate dopamine release.”

“The last part of ESSENCE (emotional spark, social engagement and novelty) is creative explorations, CE.”

“Risky behavior continues when impulsivity has subsided.”



○

○

○

From the Hyperrational to Intuitive Thinking and Self-Awareness

If you picture the hand model of the brain, hyperrational thinking is where the limbic area is appraising the significance of the positive, thrilling, boundary-breaking aspects of a possible activity, and minimizing the appraisal of significance to the downside – to its risk and to its cons.

Hyperrational thinking elevates the pros – “Should I do it or not? Yes – Pro! Pro! Pro!” It minimizes the cons.

So, unlike what many parents think, that adolescents are just not informed about danger, research shows that, in fact, they usually do know about the danger.

In fact, in some situations, they overestimate the likelihood of danger but they carry out the behavior anyway – which is totally confusing.

Why is that? The limbic area is skewed to minimize concern about the dangers and maximize/hyper-emphasize the pros.

Now, here’s a hyperrational thinking example. Supposing I’m an adolescent and Ruth, you say to me, “Dan, here’s a gun. I’m going to give you one bullet, six chambers; I want you to spin it around. I want you to shoot it at your head. What is the most likely thing that will happen and what will you do?

Now, obviously this is an extreme, but just to give you a feeling for what hyperrational thinking is all about, I’d say, “Why would I do this, Ruth?”

You say, “I’ll give you six million dollars.” I go, “Oh, wow. That’s a pretty cool gift. Thank you, Ruth. Let’s see. If a hundred of me did it five-sixths of the time – that would work out fine – right?

Five-sixths compared to a sixth is a majority of the time – five-sixths of six million is five million dollars so the likelihood of a hundred of me doing it is the likelihood that I’ll get five million dollars.” That’s the average for every person doing it. “And since it’s the most likely thing to do, I think I’ll do it!”

Now, that is hyperrational thinking. When you de-emphasize the downside, of course, you shoot the gun because it is true: with a hyperrational probability calculation, the statement is saying, “The most likely outcome is for Dan to get the money.” That’s totally rational – right?

So, Ruth, why wouldn’t you do it? What in your experience would get you not to do it?

Dr. Buczynski: The downside is too awful.

Dr. Siegel: The downside is too awful. What gave you that feeling?

Dr. Buczynski: You would die if you successfully shot the bullet into your head.

Dr. Siegel: Right. But isn’t it true that the most likely outcome is that you’ll get the money?

Dr. Buczynski: Oh, absolutely – I agree.

Dr. Siegel: So then why wouldn’t you do it? What’s wrong with you?

“The limbic area is skewed to minimize concern about the dangers and maximize/hyper-emphasize the pros.”



○

○

○

Dr. Buczynski: The downside is too costly!

Dr. Siegel: The downside is too costly. So you are feeling the reality of the cost of the downside.

We are saying that the adolescent, limbically, is not evaluating the meaning of the downside, which is what we believe is true because that allows you to go out of the house and take risks – otherwise they would stay at home.

In the old days, maybe the danger was that you would have a lion run after you and maybe you would get eaten, or you’d go out and you’d be scared.

But now, we have drugs, we have guns, we have cars that kids drive when they’ve had alcohol – so the stakes, in many, many ways, for real, are much more serious maybe than in the old days.

We have kids with guns going into schools – these are mostly adolescents – and shooting other adolescents – right?

We are living in a different age where the stakes are much higher. There is no question about that.

So people say, “What are you going to do if the limbic area is imbalanced in this way?”

And this is what I talk about in the Brainstorm book. I appeal to the adolescents reading it and the adults reading it, too, to take on what I call mindsight exercises.

The way around this and the research suggests – no one has proven it but we have to do the best we can with the science that we now have – that you can teach an adolescent to go beneath the emotional limbic appraisal and go to intuitive reasoning.

This intuitive reasoning literally comes from, we believe – and we need more research to validate this but this is the thought – the neural networks around my heart and the neural networks around

my intestine.

They are going to literally process my value system, which is perfectly intact in me as an adolescent.

I may not have conscious access to it; I may not be able to articulate it, but I can have a gut feeling and a heartfelt sense.

So, when you offer me the gun, that’s limbically pushing up on my cortex, I can hyperrationally say, “Of course I’ll shoot it!”

Or, as one guy – a nineteen-year old – did. Sadly, just in the street right near here, he drove ninety-five miles an hour and killed my favorite teacher.

I am sure when he got into the car, he was just thrilled at the idea of going ninety-five miles an hour on a curvy street – and maybe there was a one-sixth chance that a person would be in his way – but a five-sixth chance that there wouldn’t, and he’d been doing this for a while.

“We are living in a different age where the stakes are much higher.”

“I appeal to the adolescents and the adults to take on mindsight exercises.”

“You can teach an adolescent to go beneath the emotional limbic appraisal and go to intuitive reasoning.”



○

○

○

So what is the story here? The story is – and this is partly why I wrote Brainstorm – if someone had taught that nineteen-year-old to have more self-awareness, including this process we now call interoception – the outcome could have been different.

Interoception is the perception of signals from the heart and the intestine.

These signals go up lamina one – layer one of the spinal cord, they go up the tenth cranial nerve – the vagus nerve, and they ultimately find their way past the brain stem and up past the limbic area into – some people call it limbic, but basically the area is called the anterior cingulate and the interior insula on the right-side of the brain.

This gives you a feeling, probably with the von Economo neurons that link the interior cingulate to the interior insula, of self-awareness.

If this nineteen-year old had been given reflective exercises in school or his parents had encouraged him to read Brainstorm when he was a younger adolescent, my hope – my deepest hope – is that, in a preventative way, he and others with that kind of self-awareness – with interoception – would gain access to the positive values.

You, as an adult, can’t say to an adolescent, “Don’t do it!” I mean, you can say it but it’s not going to have much effect.

You can try to inform them by saying, “Don’t you know it’s dangerous?” The studies show that that is not going to have much of an effect either.

But if you tap into the positive values that adolescents have – I like to think of it like an internal compass – the heart and the intestine will literally send the wisdom of the body up into the right interior cingulate and right interior insula linked by the von Economo neurons that you can probably grow.

We need research to prove this self-awareness, but I bet it will be shown within the next five years, and this adolescent – the nineteen-year old – will say, “I really want to drive fast but you know something? Something doesn’t feel right about it. I’m getting images of killing someone, and I don’t like to kill people. I might even die! That doesn’t feel right. I’m not going to do it.”

That “dialogue” comes from an internal compass – not an adult’s mandate.

So, hyperrational thinking has a counterpart, which is self-awareness, and it comes through mindful practices.

I call these mindful practices mindsight practice, which includes insight, empathy and integration.

“If someone had taught that nineteen-year-old to have more self-awareness, including interoception - the outcome could have been different.”

“Interoception is the perception of signals from the heart and the intestine.”

“The counterpart of hyperrational thinking is self-awareness that comes through mindsight practice.”



○

○

○

Throughout the Brainstorm book I am teaching the idea that we need to do this not only in a crisis, but we need to do this as a matter of fundamental education where people can develop this kind of self-awareness.

I’ll bet you we can reduce the actions that adolescents do that harm themselves or harm others, including the loss of my teacher.

Sadly, my teacher was killed and for this nineteen-year-old who is now obviously much older – all this happened years and years ago – he has had to live his whole life knowing that an action that he chose to do killed a human being.

That is a lose/lose situation.

Changing the Cultural Conversation

Can we channel the need for speed somewhere else? Can we channel this need for risk into rites of passage and have non-parental adult figures stay within the lives of adolescents?

We can all change the cultural conversation about adolescence.

Instead of saying, “Adolescents are immature and they’re impulsive; they can’t pay attention; they’re nuts; it’s just a horrible period,” we can say, “You know something? If we think deeply about what’s actually going on, these adolescents are the most courageous and creative people on the planet.”

We need to tap into their creativity, harness their courage, channel all this passion and allow ourselves to support one another, and that would be changing the cultural conversation!

After all, most adults were once adolescents, as far as I know – and we can do this.

This is about cultural change mediated by professionals, educators who run school systems, teachers, therapists, policymakers, parents, and mediated by adolescents themselves.

There can be a cultural shift in how we approach this incredibly important and wonderful period of life.

The Addicted Teenage Brain

Dr. Buczynski: Let’s talk more about the addicted teenage brain. Can you first just give us an idea of the dopamine system, because that seems to be so relevant to the addicted brain?

Dr. Siegel: Yes. Let’s talk about two parts: we will talk about the dopamine system and we will talk about epigenetics.

Changes in gene expression are happening in general during the adolescent period.

“Adolescents are the most courageous and creative people on the planet.”

“There can be a cultural shift in how we approach this incredibly important and wonderful period of life.”

“Mindsight practice includes insight, empathy, and integration.”



○

○

○

If you are exposed to a substance and you are potentially vulnerable to becoming addicted, it looks like that genetic shift and gene expression actually can make it so that using that substance becomes incredibly compelling.

Here, there’s a focus on a particular substance, if you will, and in the clinical literature we call it substance of choice. We need to

understand that epigenetics are affected, too, by exposure to chemicals that are potentially addictive.

Our understanding of addictive substances as well as addictive behaviors is that they engage the dopamine system.

Adolescents are particularly vulnerable because of these shifts in the dopamine system that we described earlier, where you are getting this lower baseline and this increased release. That is what is thought at this moment.

When you imagine that, you realize that any behavior or substance that is addictive is activated in the dopamine system.

It is entraining the system – the system gets “used to” being released by this jolt that we used to think was just from the substance itself.

Now we need to realize that studies are suggesting that, yes, the substance may induce dopamine release.

Let’s say I am a student who is starting to use alcohol, a very common drug of abuse that you can get addicted to.

Not everybody gets addicted to it but some people may be vulnerable to alcohol.

I talk about this in one of my cases – a patient I saw who was emerging with alcoholism – you will see here the way I tried to describe this to her and help her come to terms with the idea.

When your dopamine system becomes entrained to have release from a substance, it makes other things like friendships that can release dopamine less exciting.

You are getting a sudden jolt with a substance, whereas a friendship or working hard on an art project may give a gradual rise.

Supposing that you’ve finished the project and you put it into an art show. You wait, you wait, and you wait. Some people like it; some people don’t.

The dopamine rises and falls – rises and falls. You can tolerate that rise and fall.

But for people who are addicted – as my patient was – they need the sudden rise.

“Addictive substances as well as addictive behaviors engage the dopamine system.”

“Changes in gene expression are happening during the adolescent period.”

“Any behavior or substance that is addictive is entraining the system.”

“When your dopamine system becomes entrained to have release from a substance, it makes other sources of release, like friendships, less exciting.”



○

○

○

Now, the sudden rise, of course, is followed by a precipitous drop, and that drop, for an adolescent, goes to a baseline that is lower.

There is then this restless feeling and now you get used to the rise again.

We have learned in recent times that it is not just the substance; it is the behavior around the substance, which means the environment you are in can release dopamine – you get used to drinking with the friends you are with and being with those friends can release dopamine – maybe not to the same degree.

Also, the anticipation of using the substance can release dopamine.

The experiments are fascinating where they have people anticipate getting something and they start getting a rise in dopamine.

You can look at it and then say, “Well, then just don’t give the substance.” After a while, people realize that they are not getting the substance – but here is the issue.

In addiction, the substance takes over your whole life. It is not just, when you get it; it is when you are anticipating getting it; it is planning and organizing your whole life around this substance.

Now, the great news about dopamine is that it is rewarding, at least in novelty, and that means we want to harness constructive, positive, health-promoting novelty.

Because the brain is firing in all these different ways, you can take a different approach.

This is why I think mindful approaches to substance abuse and getting off of substances when you are addicted to them is so powerful.

In many ways, mindfulness allows you to create novelty in everyday moments.

Drug addiction is serious and one of the psychiatric conditions among the many others like schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, that generally the majority of people

who are going to develop them – not all but the majority – have their onset during adolescence.

The Process of Pruning: Integrating the Teenage Brain

Dr. Buczynski: I want to work our way into integrating the teenage brain, but before we do, I want to go back to the pruning you talked about and the whole idea of epigenetics.

If we are pruning the brain, it can bring out some of the vulnerable parts of the brain if the person has had epigenetically vulnerable experiences.

I follow that because you have been with us through the brain series the last several years and also through the trauma series – but for the people who haven’t been with us, can we just unpack that a little more?

“The behavior around the substance can release dopamine.”

“Mindfulness allows you to create novelty in everyday moments.”

“Dopamine is rewarding and that means we want to harness constructive, positive, health-promoting novelty.”



○

○

○

Dr. Siegel: Absolutely. Whenever we unpack ideas like this, as you are so beautifully doing in your series, Ruth, we need to be really humble about presenting a perspective and having that perspective built from science, but knowing, too, that science is an unfolding story.

We need to see where we are now in the science of things, and know that we can always change.

Also, as we work as parents or work as clinicians, we need to be open about how we build the practical ways with a parent, or provide therapeutic interventions that are informed by science, knowing we need to go beyond science, of course, so that when a person is in front of us, we work with our clinical intuition, our clinical presence in all sorts of ways.

I will present the science about this. To me, it explains a lot about what you want to do.

What we do in interpersonal neurobiology is create a framework that then can be set up and then later tested so that you find more supportive evidence – maybe not proof but supportive evidence.

If you read the book The Developing Mind – Second Edition, you will find this effort to disprove what I am about to say – but there is a lot of supportive evidence for it.

So, let’s look at integration. In interpersonal neurobiology, just to give you the broad, broad picture, we say that health comes from a process called integration.

Integration, the linkage of differentiated parts, happens within your body – it is how your nervous system, for example, links different aspects of itself and connects them.

We look for what is called neural integration that you can reveal now, and what is called the human connectome – the connectome is the interconnected nature of the differentiated parts of the nervous system.

It is a beautiful and lovely way of talking about what we have talked about in interpersonal neurobiology for years, which is the process of integration. But now, in modern literature, it is being called the human connectome.

You can make proposals, which we did back in the nineties, and our proposal was that integration leads to harmony – it leads to this flexible, adaptive, coherently held together, energized and stable movement of a system across time.

In the nervous system, integration creates adaptability; in a relationship, like between you and me, we would honor differences and promote linkages, and that would be an integrative relationship.

As an attachment researcher, I look deeply at patterns of communication between parents and children, and when they are integrated, they promote well-being in the child.

“We need to be humble about presenting a perspective built from science, but knowing, too, that science is an unfolding story.”

“Health comes from integration, which leads to harmony.”

“The connectome is the interconnected nature of the differentiated parts of the nervous system.”



○

○

○

Now we are beginning to unveil how, in fact, integrated communication stimulates the growth of integrative fibers in the brain.

The reason that is important is that integration of the brain is the basis of all regulation.

So whether you are regulating emotion, attention, thought, behavior, interpersonal understanding – all of those regulatory functions that some people call self-regulation – other people like to call executive function – they all emerge out of a process of linking differentiated parts of the nervous system.

To get to your question about pruning, we need to realize that the brain grows based on three fundamentals.

First, you have the genetics you are born with, which is the sequence of nucleotides that comprise your genes and your chromosomes that you inherit.

Second, you have the epigenetic factors that you either inherit as histones and methyl groups – these non-nucleic acids, molecules, sit on top of the DNA, that alter the structure of the double helix to make it either more likely or less likely that the gene will be activated or expressed.

Those are called epigenetic regulatory expressions, and we know you get them either by inheriting them or acquiring them through your own experience, which is mind-blowingly new.

It is only within this millennium that we are really learning about the epigenetic factors that regulate genetic expression – it’s incredibly important.

The two realities are that you can change the epigenetic control of gene expression through your own experience, for example, if you were abused, and you can inherit the experientially derived epigenetic factors from your grandparents, depending on the timing.

That is an incredibly new finding – and we need to just state it straight out.

So, we have the genetic, the epigenetic, and the third factor is experience. Experience not only changes epigenetic regulation, which fits into our second category, but it also changes the way neurons link up to each other.

Literally, the function of the nervous system is changed by experience.

With either intense experience or repeated experience, you can change the structural connections in the nervous system, and these include growing new neurons and neuronal linkages called synapses. Even myelin is affected by experience.

“Integration of the brain is the basis of all self-regulation.”

“Integrated communication stimulates the growth of integrative fibers in the brain.”

“You can change the epigenetic control of gene expression through your own experience.”

“Intense or repeated experience can change the structural connections in the nervous system.”



○

○

○

In all those ways, the myelinated interconnected structure of the neuronal complex system of the nervous system is affected by experience.

All that being said, in our view – in interpersonal neurobiology – any of those three factors can contribute to inhibiting the healthy integrative growth of the brain.

You can have a genetic predisposition, let’s say, for schizophrenia and if your mother was exposed to the flu virus, you may reveal that. But another mother who is exposed to the flu virus and you weren’t genetically predisposed, you won’t get schizophrenia.

That is one of the many hypotheses about schizophrenia: nothing you experience from attachment causes schizophrenia, but exposure to a virus if you are genetically at risk, can cause schizophrenia. You need to understand that.

Schizophrenia, according to Marcus Raichle, is impaired integration in the brain. When is it often revealed? During adolescence!

Now, let’s use bipolar disorder as another example. We don’t know the exact genes or epigenetic issues, but we don’t believe it is from attachment, so genetics or epigenetics could be involved.

Hilary Blumberg’s work out of Yale shows that in bipolar disorder, you have a compromised integrative set of functions from the ventral lateral area, especially on the right side of the brain, down to the amygdala. This would be impaired linkage as a demonstration of impaired integration.

What happens in manic depressive illness? You are prone to either becoming chaotically manic or rigidly depressed.

In our view, chaos and rigidity are areas outside the river of integration, which is harmony. When you flow through that river, you either go to the bank of chaos or the bank of rigidity – manic depressive illness is an example that we can use.

Marcus Raichle also has shown that integration is impaired with bipolar disorder as well as in autism and those areas are not caused by experience.

There’s the work of Marty Teicher at Harvard University and McLean Hospital that shows experientially derived impairment integration with abuse and neglect.

It has been shown that these forms of posttraumatic conditions have impairments to the major integrative fibers of the brain: the prefrontal cortex, which links cortex, limbic area, brain stem, body and social world together, does not grow well after neglect or abuse.

The same goes for the corpus callosum connecting the left and the right and the hippocampus, which integrates memory.

Those are the three major areas that Teicher has found to be impaired following experience.

“In bipolar disorder, there is impaired linkage and integration.”

“Chaos and rigidity are areas outside the river of integration.”

“Posttraumatic conditions have impairments to the major integrative fibers of the brain.”



○

○

○

But let’s stick with a non-experiential example of someone with bipolar disorder and let’s look at what may happen – and let me give you just a hypothetical – these numbers are just for the sake of teaching and thinking about this conceptually.

Let’s say for your mood to stay within equanimity, to be balanced and integrated, you need your prefrontal region to keep your limbic area and your brain stem and the input from the body in some kind of balance.

Let’s just say you need two thousand fibers to go from the prefrontal cortex downward toward the limbic area to keep things regulated. Those would be inhibitory fibers that would secrete GABA - gamma-aminobutyric acid or other substances that downplay the firing of the reactive limbic area influenced by the brain stem and the body.

That would be called, in regular terms, emotional balance, and let’s say that you need two thousand of those fibers.

Now, let’s say that during the prepubertal period – preadolescence – you are now seven/eight/nine years of age. You have had fine attachments and your relationships are great, but you have genetically inherited too few of those cells – you have three thousand of them.

Let’s say the pruning process, just to make the math easy, carves away fifty percent of the connections – you have three thousand and you are eight years old.

But your friends have six thousand – but all you need is two thousand to function well. So for a teacher, a friend or anybody looking at what is going on, you are all fine.

The phenotype, what is expressed as an eight-year-old, is fine; the genotype, though, may be that you have too few. No one knows that for sure, but let’s just put that as the model.

Now, you enter the adolescent period, which can correlate with the onset of sexual maturation or puberty, or it can be different – and now you start carving away your fifty percent because you are genetically programmed to differentiate, link, and integrate over this next period of years – the adolescent period.

So now, from three thousand, you are going to go to half. What do you go to?

Dr. Buczynski: One thousand five hundred.

Dr. Siegel: One thousand five hundred – but you need two thousand for your brain to work well.

The sad thing, at that moment, is that you don’t have enough inhibitory fibers.

In the natural way of the body, the brain stem and the limbic area are going to push this emotional juice upward – which is fine and it is bigger during adolescence.

This emotional juice is the emotional spark – and it has to run into at least two thousand fibers to be regulated but there are only fifteen hundred now.

“For your mood to stay within equanimity, you need your prefrontal region to keep your limbic area, brain stem and the input from your body in balance.”

“The emotional spark has to run into at least two thousand fibers to be regulated.”



○

○

○

That creates massive dysfunction: chaos of mania, explosive emotions, rigidity, and feeling depleted and depressed.

Even more sadly, what we believe happens is that the cortisol secreted from the increased stress of being dysregulated increases pruning.

Now, you don’t stay at the fifteen hundred. Because of your own genetic predisposition plus genetically programmed natural healthy pruning, you not only cut down from three thousand to fifteen hundred, but you have more stress.

Maybe now you are down to a thousand, or maybe down to seven hundred and fifty!

Depending on how your family responds or how the school responds or whether you have therapy or not early on or maybe even medications, the stress is bad and it gets worse and worse if none of that support is there.

Certainly if you have mindfulness meditation taught to you, because that can grow these fibers, that can help with the stress.

The unfolding of a psychiatric disturbance is understood by the pruning process, and its natural evolution can massively be changed depending on how early intervention is introduced.

Interventions can include medication, but can – and should include – interventions like mind-training programs that increase the potential for regulation.

David Miklowitz at UCLA is engaged in an active study – the results aren’t in yet but the preliminary pilot study that he did is very positive.

The case examples I have are not a study – they are just case examples – but they are data that makes us hopeful – we need to finish the controlled randomized double-blind study, which is being done.

This study takes women who want to get pregnant and who have bipolar disorder – and you cannot take those medications when you are trying to get pregnant – they are toxic to the fetus.

Ethically, it’s difficult. These are women who must come off their medications, but bipolar disorder is at risk of suicide so it is not a simple thing to say, “Come off your medication.” These women, though, have to and they want to.

David Miklowitz is teaching them mindfulness meditation.

We need to see how mindfulness can work. The results aren’t in yet, but from the pilot studies, it looks good even though we need to do it in a controlled way.

“We believe that the cortisol secreted from the increased stress of being dysregulated increases pruning.”

“The unfolding of a psychiatric disturbance is understood by the pruning process, and its natural evolution can massively by changed depending on intervention.”

“Interventions can include medication, but should include mind-training programs that increase the potential for regulation.”



○

○

○

We need to see if, in fact, you can use a mind-training program even in someone who we believe is genetically or epigenetically at risk for this too-few-number of neurons – that is the study out of Yale – and then say, “Can we grow those fibers?”

That is also the work of Marcus Raichle – to show that it is impaired integration, and he is looking at what is called the default mode.

In any case, what we want to do is grow these integrative fibers through mindfulness training.

That doesn’t mean a person won’t need medications – maybe they do. This doesn’t make medication the “bad guy.”

In fact, some studies of lithium show that it promotes neuroplasticity – the growth of neurons in response to experience.

But here’s the point: Why not offer a mind-training program that is designated to growing the very fibers that may be genetically deficient?

The great, great news is that if this works, we are basically saying that, even if the cause is genetic, the solution may be experiential. We shouldn’t separate these out.

This is not nature versus nurture. It doesn’t make any sense – it is bio-illogical to say that!

We can use the focus of energy and information streams – which is the mind – to stream energy through the nervous system – which is the brain – so that you can actually grow fibers – and that’s neuroplasticity. That’s the integrative process.

This is what makes being in the mental health field now so exciting.

Whether you are in medicine or nursing or social work or doing psychotherapy as a psychiatrist or psychologist, the great news is that we can all work together when we encapsulate the idea that integration is health.

Impaired integration leads to any of the syndromes of the DSM; they are all examples of chaos, rigidity or both.

The proposal, then, is this: How can we use a psychotherapeutic intervention to promote integration?

Adolescence, as you can see, is such a crucial time because of the pruning process and then the myelination, which theoretically may be impaired with stress.

We want to optimize myelination and optimize pruning.

You need pruning, and you want to make sure that if you have vulnerable circuits, which may be there from experience even though the proposal

“We want to grow integrative fibers through mindfulness training.”

“Why not offer a mind-training program that is designated to growing the very fibers that may be genetically deficient?”

“Even if the cause is genetic, the solution may be experiential.”

“Integration is health. Impaired integration leads to any of the syndromes of the DSM.”

“We want to optimize pruning and myelination.”



○

○

○

was that it is genetic, but if they are from experience, then adolescence is a really important time to try to capture a connection – helping adolescents to build the strength of integrative circuits of the brain.

The reason I wanted adolescents to read Brainstorm is that I believe so deeply in prevention.

My feeling was this: if you could teach these mindsight skills that grow integrative fibers to everyone, then it is a win/win situation.

You don’t have to wait to see if a ten-year-old, when he or she is eighteen, is going to unveil suboptimal circuitry.

Why not give everyone these tools? If they start showing trouble, they have set a foundation with these skills.

Dr. Buczynski: I am sorry – I’m afraid we have to stop.

But, to everyone, check out Dan’s book; it came out last December, and it is called Brainstorm: The Power and Purpose of a Teenage Brain.

I think you will find it very, very informative, and you will want your kids to read it as well – I highly recommend it.

Dan, thanks so much for your work and for all that you have done, and for being here as part of our series tonight.

Dr. Siegel: My pleasure, Ruth. Thank you very much.

References:

Blumberg HP, Krystal JH, Bansal R, Martin A, Dziura J, Durkin K, Martin L, Gerard E, Charney DS, Peterson BS. Age, rapid-cycling and pharmacotherapy effects on ventral prefrontal cortex in bipolar disorder: a cross-sectional study. Biological Psychiatry 2006, 59:611-618.

Miklowitz, David, The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know, 2010

Raichle, Marcus and Posner, Michael. Images of Mind. 1999.

Teicher MH, Andersen SL, Polcari A, Anderson CM, Navalta CP, Kim DM: The neurobiological consequences of early stress and childhood maltreatment. Neurosci Biobehav Rev 2003; 27(1-2):33-44

“If you could teach the mindsight skills that grow integrative fibers to everyone, then it is a win/win situation.”



○

○

○

TalkBack Segment with Ron Siegel, PsyD and Kelly McGonigal, PhD

Dr. Buczynski: I always enjoy talking with Dan Siegel.

Now we are going to start our TalkBack Segment and I am very eager to hear what my colleagues have to say about the webinar we just finished.

Again, we are joined by Dr. Kelly McGonigal and Dr. Ronald Siegel.

Kelly is a lecturer at Stanford University, in the Center for Compassion and Altruism Research and Education.

Ron is a licensed psychologist and Assistant Clinical Professor of Psychology at Harvard Medical School.

Both of them are prolific authors. As I have mentioned on several of the webinars, Kelly is the author of The Willpower Instinct and Ron is the author of Mindfulness for Anxiety – those are just some of the books they have written.

What Stood Out Most

But let’s jump in – and I guess tonight we will start with you, Kelly. What stood out to you most during this webinar?

Dr. McGonigal: The first thing that stands out to me is how absolutely delightful it was to hear Dan talking about some of the most cutting-edge research in neuroscience and developmental psychology.

This webinar was actually packed full of ideas that are really, really at the forefront of how people are thinking about the brain and brain development.

It is very refreshing to see someone who is able to not only communicate that science accurately and clearly, but also practically – exactly what the science means to us.

What I loved so much was Dan giving us a compassionate frame for rethinking adolescence.

That is something everyone can take away from this webinar – trying to communicate some of the science to parents who are struggling with their teenagers.

When you understand some of the science that he talks about, you realize that what is happening is both normal and common – teenagers aren’t the enemy, they are not crazy, they aren’t out of control – there is a reason for what is happening.

To even have that perspective can go so far in helping parents stay connected to teenagers, especially when their teenagers are acting in ways that might otherwise create a real sense of separation.

“The webinar was packed full of ideas at the forefront of how people are thinking about the brain.”

“When you understand some of the science you realize that what is happening is both normal and common.”



○

○

○

Dr. Buczynski: How about you, Ron – you have just finished raising two daughters out of “teenagerhood” and into adulthood. What stood out to you in Dan’s webinar on the teenage brain?

Dr. Siegel: I’m acutely aware and I don’t feel quite that finished. I have twin daughters and they are twenty-four, which is supposed to be when they graduate from adolescence, as Dan put it – and they have in many ways, but it is interesting how one of the things that stood out is just how long the period of adolescence is in humans compared to other mammals.

Kelly’s point, I think, is a very important one. One of the things so wonderful about neurobiological research, generally, is how it helps us to normalize experience – how it helps us to no longer think that something that is happening, even if it is difficult, is about “me or mine,” but is simply part of our biological heritage in the human condition.

Dan did a wonderful job of doing this, discussing adolescence, and in particular, helping with the problem that I saw as central. I have done clinical work with adolescents for years, which really means doing work with families.

It’s amazing – the number of parents that forget their own adolescence. They forget their experiences or how they did something like it or something even worse.

Parents are simply identifying with a prefrontal lobe position of rationality and attendance to consequences, but that’s not how it feels when you’re younger.

It’s important to talk about how necessary it is to have the motivation to leave the nest – to have this kind of emotional energy to be able to overcome the fears about leaving the nest and to seek reward more vividly than seeking risk – which we also need.

If we were at all rational as adolescents, we would never leave home – it is much too scary out there!

I really enjoyed that focus – it was very helpful. I liked his making sense out of how so many psychopathologies appear in adolescence with this intensive period of myelination and pruning that allows brain structures that may not be up to the task of life to manifest more clearly.

Finally, I really appreciated his humility around it. He very often said, “This seems to be the state of the science today,” rather than declaring these things as though we know them – it is such a fluid field, and while the advances in neurobiology are fascinating, we are still more in the dark than we are in the light.

Based on my understanding, there are as many synapses in the brain as there are stars in the universe, and virtually every neurotransmitter circuit feeds back in either an inhibitory or excitatory way on other neurotransmitter systems.

“One of the things that stood out is just how long the period of adolescence is in humans compared to other mammals.”

“Parents are simply identifying with a prefrontal lobe position of rationality and attendance to consequences, but that’s not how it feels when you’re younger.”

“While the advances in neurobiology are fascinating, we are still more in the dark than we are in the light.”



○

○

○

The tools with which we look at these – PET scans and functional MRIs and MRIs and high-resolution EEGs – are pretty crude instruments. It is hard to see clearly.

Just to hold that in mind as we are looking at this is fascinating. We are discovering so much, and yet there is so much we don’t know. I thought Dan did a really nice job of representing that balance.

Dr. Buczynski: Thanks.

Teaching the Brain Self-Awareness

Dan mentions that self-awareness can help the teenage brain to make better decisions.

That leads me to ask: How can we teach self-awareness? How can we train the brain to consistently be more self-aware?

Dr. McGonigal: It is really helpful to start by understanding how it is that teenagers get a sense of self.

When you are a teenager, your sense of self is very much mediated; it is mediated by the mirror, the physical mirror – so many teenagers are used to looking outward to assess how they are and who they are.

Then, there is the social mirror – they are very much attuned to feedback from others about what they should want, what they should do, and who they are.

One of the best ways to counter the sometimes destructive nature of having a mediated sense of self is to rely on something that Dan talks about as interoception, which literally means self-sensing.

Interoception is the ability to sense what is happening within the self.

That includes both what is happening physically in different systems of your body – detecting your heart rate and your breathing – but also, importantly, detecting your emotions and detecting the embodied aspect of emotions – being able to rely on gut decisions.

When Dan talked about that, I thought it was very important in terms of thinking about what is helpful to train in teenagers.

One of the ways that I like to train interoception in young adults – and I have taught this to eighteen-year-olds in Stanford University – is through the practice of yoga and the practice of learning to direct your attention to what is happening to the body from the inside out – but not using mirrors.

“When you are a teenager, your sense of self is mediated by the physical mirror and the social mirror.”

“Interoception is the ability to sense what is happening within the self.”

“There are as many synapses in the brain as there are stars in the universe.”

“You can use the process of attending to sensation in the body as a tool when you are trying to make decisions.”



○

○

○

I’ll ask: “What does this pose feel like? What does this stretch feel like? What does your breathing feel like?”

You can use the process of attending to sensation in the body as a tool when you are trying to make decisions or make choices.

Here’s one of my favorite exercises to teach younger and older people. If you are making a difficult decision or you are trying to figure out, “What do I want in this situation?” you sit quietly, turn your attention to your body and breath, and pretend like you have made up your mind – “The decision I am going to make is X. I am going to say yes to this. I am going to do it.”

Then, you sit and breathe, and notice what arises in the body – and you use that as information.

Then you flip it – try on the other: “What would it feel like if I said no to this? Let’s pretend that my decision is no.” You sit and use this ability to sense how the body changes in response to that decision.

These are two ways that you can train interoception to support the kind of self-awareness that Dan talks about as being one that motivates young people to do things that are in their best interest in the long term.

How to Harness Biology and Motivation for Decision-Making

Dr. Buczynski: Ron, how can we help to guide an adolescent into making good decisions when they are biologically motivated to push away from us and to push away from parental figures in particular?

Dr. Siegel: Yes, that is a great question, one that has faced anybody who has tried to raise or counsel adolescents.

It is so true that there is this biological thrust toward separation and independence from parents and it so easily leads to “Romeo and Juliet” effects where kids are drawn to precisely the activity that their parents are saying they don’t want them to do.

Now, sometimes this can be used skillfully in a way which is a little like Judo. Richard Gardner, a prolific psychiatrist out of New Jersey, wrote all sorts of books on child treatment. I once heard him talk about the brilliant innovation of long hair on boys in the 1960s.

He said it like this, “What a great cultural event that was because here was something that was completely and utterly harmless. Kids could have intense arguments with their parents about long hair instead of the arguments of a decade earlier about driving their cars to the edge of a cliff or drinking excessively. All they had to do was not go to the barber! It was such a more benign way to play this out.”

One answer is to know that this is part of what is going on.

“You sit and breathe, and notice what arises in the body – and you use that as information.”

“This biological thrust toward separation and independence from parents so easily leads to

‘Romeo and Juliet’ effects.”



○

○

○

If your kid, or the one you are counseling or caring for or in some way advising, is involved in some kind of tension where you can sense that the tension may simply be about the need to differentiate – this need to pull out of the nest – then go ahead, and have a battle over something silly.

Knowing that the argument is over something silly can perform a very important function.

That can help to create the balance. I’ve seen how this can be very effective in making clear the few things that are completely non-negotiable because the consequences are completely irreversible.

Each family is going to have their own rules about this – there are going to be things like intoxicated driving perhaps, getting someone or becoming pregnant, contracting an STD – each person would have their own list – maybe it would include cigarette smoking – the definite “baddies” that we are trying to say, “That’s over the line.”

The only way that works, though, is if there is “money in the relational bank.”

I used to train clinicians about this a lot – most clinicians were reasonably well-behaved as children – but I would say, “What did it? What made you behave more or less reasonably? Was it the hope for reward or the threat of punishment in a very tangible way?”

Usually it is not that – usually it is the sense of or internalization of the benign parent – there is a connection with and a feeling of, “I don’t really want to rupture the bond in my own heart and mind with that other person.”

And the way that comes is by putting money into the relational bank, drip by drip – finding empathic ways to relate to the kid, showing understanding, playing together, doing things you enjoy together, and not having everything be about the coercion and control battles.

Once there is “money in that bank,” then you can draw on that for the absolute. Then, you can fight all you want in colorful ways about long hair or whatever the current “issue du jour” is.

How the Brain’s Growth Spurt Impacts Development

Dr. Buczynski: Kelly – Dan mentions the idea of the brain experiencing a growth spurt. Do you believe that it does? What are your thoughts about that, and if it does, how do you think that affects development?

Dr. McGonigal: The adolescent brain experiences a plasticity spurt. In adolescence, the brain is more sensitive to environmental influence than it was a few years earlier.

There seem to be a few times in our life’s history where the brain is much more sensitive to what is going on in the environment, and at those times, the brain will restructure and reshape itself in a way that is allowing you to meet the environment.

“Connection comes by putting money into the relational bank, drip by drip. Once there is ‘money in the bank,’ then you can draw on that for the absolute.”

“Knowing that the argument is over something silly can be very effective in making clear the few things that are completely non-negotiable.”



○

○

○

It happens in the womb; it happens right after birth; it happens the first years of life when the attachment is forming to the caregiver; it happens again during adolescence, and, interestingly, it happens when you become a parent or a caregiver.

Those are times when the brain is most sensitive and most willing to change in relationship to what you experience.

What’s really helpful for a parent or clinician to know and think about is: What are the environmental influences that most dramatically shape and change the brain during in adolescence?

Theories that I am familiar with would suggest that there are really two influences that matter if you are hoping to make good use of that plasticity spurt: the brain learning to become resilient and the brain learning to develop in the way that you would hope.

The first is the trusting relationship with adults. One of the big things that the adolescent brain is attuned to is how safe the environment is and how safe it is to have emotional needs and to try to connect with others.

Peer relationships are important but it does seem like having a trusting relationship with an adult is especially important. It doesn’t have to be the parent – research has shown that you can have that trusting relationship with a coach or someone else in your life.

That is incredibly important – and I am so glad that Ron has talked about “putting money in the emotional bank.”

That is one of the best ways to make sure that a teenager develops in the way that the brain is meant to develop – self-control, resilience, and emotion regulation will happen naturally when influences are in place in the environment.

Here’s the other thing that seems to really matter: the adolescent needs to have successful stressful experiences.It is very important to have both – successful and stressful.

Teenagers need to experience struggle; they need to experience failure, and they will have needed to have that experience in a context in which they still feel adequate for life.

They don’t necessarily need to succeed at everything, but they need to have the experience of doing things that are difficult and knowing that it is okay to engage with challenges. It is okay to take risks toward your goals,

“The brain is willing to change in relationship to what you experience.”

“What are the environmental influences that most dramatically shape and change the brain during adolescence?”

“The adolescent brain is attuned to how safe the environment is and how safe it is to have emotional needs and to try to connect with others.”

“‘Putting money in the emotional bank’ is one of the best ways to make sure self-control, resilience, and emotion regulation will happen naturally.”

“There seems to be a few times in our life’s history where the brain is much more sensitive to what is going on in the environment.”



○

○

○

and, “My parents won’t stop loving me if I fail. It’s not the end of the world if it’s not perfect.”

It is really important to have the experience in adolescence of having true challenges that are meaningful and not necessarily succeeding in all of them.

When you have that combination – in your environment there is at least one adult you can trust and you can learn through difficult experiences to trust yourself to go after your goals – then the brain reshapes itself to become an adult who is much more resilient, better at regulating emotions, and has more self-control.

Those are the qualities that I would be thinking about trying to foster in teens during this very important time of additional plasticity.

How to Make the World Less Stressful

Dr. Buczynski: Ron, how do we make the world less stressful for teens when they have to deal with the stress of school, friends, their social lives, and just growing up in general?

Dr. Siegel: Just the other week I was invited to a local high school here to talk about this. I had lengthy conversations with parents about stress, and it brought me back to thinking about what stress actually is and how come humans have so much stress.

Stress obviously is pretty close to the word fear and pretty close to the word anxiety. Stress has to do with this activation of our fight/freeze/flight system.

What exactly activates that in teenagers? The answer is: a few things. One is the fear that they are going to have some kind of failure experience – some kind of experience of rejection with peers, perhaps some kind of academic failure, or perhaps athletic/competitive failure.

Those are the things that parents identified most often as what their kids are preoccupied with.

One way to work with this is to step back and see, “Where does this come from?”

All of the concern with competitive success seems to derive from our basic mammalian habit of comparing ourselves to the other members of the primate troop and being concerned with our position in that troop – it is a kind of vestigial preoccupation, much as our love of donuts is quite strong but is not all that helpful to us.

“How come humans have so much stress?”

“The concern with competitive success derives from our basic mammalian habit of comparing ourselves to the other members of the primate troop and being concerned with our position.”

“The adolescent needs to experience struggle and failure.”

“When you have at least one adult you can trust and you learn to trust yourself, then the brain reshapes itself to become more resilient, better at regulating emotions, and has more self-control.”



○

○

○

I am inclined, with adolescents and particularly with their parents, to talk about how this gets going: how we become so concerned, as though these are life-or-death issues, when so many of the issues are simply symbolic representations of our worth, up or down, in the troop.

Parents have to work on this because parents have so many concerns about their kid being the star – their kid getting into the best university, their kid being better behaved than the other kids. But this is all a representation of the parents’ rank in the primate troop as well.

It takes a concerted effort on the part of everybody to deconstruct this fairly instinctual compulsion to have to succeed frankly.

This doesn’t mean to not engage in life or put out effort – but it does mean to not be so concerned with self-esteem.

One alternative to that – and my friends Kristin Neff and Chris Germer have been doing a lot of work with this– is developing self-compassion.

When kids do have these disappointments – when things don’t go so well and saying, “Well, even though you didn’t make the team, you’re

a whiz at math,” and continuing the idea that social rank is what is so important – we could say instead, “Yes, I was disappointed, too, when I didn’t make the team and I know that kind of thing can be painful, but it’s great that you tried out, and we’ll see what happens next time.”

This can be more normalizing of winning and losing rather than hooking kids even more deeply into what they are naturally inclined to get all stressed-out about.

Dr. Buczynski: Thanks. I am sorry to say this kind of wraps up our series. We are going to have to close here.

To everyone – thank you so much for participating in these webinars; your brain is so important and taking good care of it is so important.

We need to know more and more – and we are learning more and more all the time. Next year when we have the series, we will know even more than we do today.

Ron and Kelly, thanks for your part here – it has been lots of fun to get together with you and chew on these ideas and get your input and insights. Thanks so very much for your contribution.

To everyone – take good care – we will see you next time.

“It takes a concerted effort on the part of everybody to deconstruct this fairly instinctual compulsion to have to succeed.”

“One alternative is developing self-compassion.”



○

○

○

About The Speaker: Daniel J. Siegel, MD received his medical degree from Harvard University and completed his postgraduate medical education at UCLA with training in pediatrics and child, adolescent and adult psychiatry.

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 Co-Director of the Mindful Awareness Research Center at UCLA.

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.

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

Brainstorm: The Power and Purpose of the Teenage Brain

Featured Book by Speaker: Daniel Siegel, MD

Click HEREto Purchase Now!

http://www.nicabm.com

http://www.amazon.com/gp/product/158542935X/ref%3Das_li_ss_tl%3Fie%3DUTF8%26camp%3D1789%26creative%3D390957%26creativeASIN%3D158542935X%26linkCode%3Das2%26tag%3Dbillohanlon



○

○

○

About The TalkBack Speakers:

Since 1989, Ruth has combined her commitment to mind/body medicine with a savvy business model. As president of The National Institute for the Clinical Application for Behavioral Medicine, she’s been a leader in bringing innovative training and professional development programs to thousands of health and mental health care practitioners throughout the world.

Ruth has successfully sponsored distance-learning programs, teleseminars, and annual conferences for over 20 years. Now she’s expanded into the “cloud,” where she’s developed intelligent and thoughtfully researched webinars that continue to grow exponentially.

Ronald D. Siegel, PsyD is an Assistant Clinical Professor of Psychol-ogy at Harvard Medical School, where he has taught for over 20 years. He is a long time student of mindfulness meditation and serves on the Board of Directors and faculty of the Institute for Meditation and Psychotherapy.

Dr. Siegel teaches nationally about mindfulness and psychotherapy and mind/body treatment, while maintaining a private clinical prac-tice in Lincoln, Massachusetts. He is co-editor of Mindfulness and Psychotherapy and co-author of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain.

Kelly McGonigal, PhD, is a health psychologist and lecturer at Stanford University, and a leading expert in the new field of “science-help.” She is passionate about translating cutting-edge research from psychology, neuroscience, and medicine into practical strategies for health, happiness, and personal success.

Her most recent book, The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do to Get More of It, explores the latest research on motivation, temptation, and procrastination, as well as what it takes to transform habits, persevere at challenges, and make a successful change.

http://www.nicabm.com/?loc=deccon09a/presenters/&menu=presenters&bot=1&top=30&speaker=Bill_O%27Hanlon,_LMFT

the neurobiology of the adolescent brain: a new look at brain...

Documents