How do physicians get through the tough times?

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By: Karen Miotto, Professor of Psychiatry in the Semel Institute for Neuroscience & Human Behavior. She is the chair of the Medical Staff Health Committee.

Physicians sacrifice for the privilege of caring for others. Caring for people with difficult and often chronic illnesses can be a draining experience. Medical school and residency provide excellent training and conditioning to ensure that your emotional and physical needs come last.  The long hours of work are fueled by caffeine and adrenaline. Sleep becomes a luxury. Exercise falls into the, “not enough” category. Friends and family adjust, or not, to the long hours and exhaustion of training and practice.

The recent changes in medicine, such as the electronic medical record, promise time efficiency and better coordination of care but require long adoption and optimization periods to appreciate the benefits. The provider and patient both have to acknowledge the keyboard and monitor as important fixtures in the examination room.  The Accountable Care Act is a seismic change that is shifting the landscape of medicine in both anticipated and unpredictable ways. These stressful changes lead to hallway conversations like, “I tell my children not to go into medicine.”

Resilience requires humor, self-care, and connection. Lets break this down to smaller more manageable pieces.

Physicians need a sense of humor when friends and family recommend, “get more sleep and don’t take your work home with you.”  You have to laugh, because if you did not laugh you would consider strangling the person who recommended the impossible so glibly.

Self-care requires an emotional vocabulary. Doctors become Alexithymic. Alexithymic, if you do not remember from your psychiatric rotation, is “a personality construct characterized by the sub-clinical inability to describe emotions in the self.”  The core defect is a dysfunction in emotional awareness and attachment. Adaptive alexithymia allows care providers to carry on in the service of others and squeeze one more patient in at noon or at the end of the day.

Connection, whether it be venting with colleagues, or spending time with loved ones at home, is essential. While finding the time to grab lunch or dinner may be difficult, a coffee break may be just enough time to connect with someone and feel human again.

What do the uber doctors do? 15 minute naps. Meditate. Take “recess” between patients, even if it means just taking 3 deep breaths. Write down any follow-up phone calls or consultations that need to be done so you are not trying to remember 10 things at the end of the day. Take time to eat something healthy. Identify priorities, set boundaries, and say “no” to tasks you don’t have time for. Exercise. While many are walking around the medical center throughout the day, others struggle to find even 15 minutes to exercise. Make time for your well-being. Find a technique that centers your mind and allows a beginning and an end to a patient care encounter. These practices help prevent “taking the patient home with you.”

Start small. Little changes can make a big difference when it comes to getting through the tough times.

Enlightened?—How can we all achieve well-roundedness and find contentment?

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By Maxwell James

In the last three years I’ve spent at UCLA, I now know the good and bad changes I have experienced have contributed to an overall image of how to be the best student and person I can be.

But I always have struggled with the “how.” It seems near impossible to stay “well-rounded”—a healthy body, mind and spirit seems rather to just be a working, changing and endless goal. And for starters, this struggle has expanded, flip-flopped, gone dormant and shifted throughout college.

I also admit that I get anxiety in the constant awareness of what I am not doing. It’s all so hard to stay balanced and excel through. Demands. Demands. Demands.  It’s a never-ending cycle of rewritten iPhone calendar alerts and reminders.

So what I created for myself in an attempt to stay balanced and sane—to be completely honest—is formulating a schedule where physical, emotional, mental and spiritual exercise work in near perfect concert. A red flag goes up when I know my time spent studying at Peet’s coffee shop exceeds 5 hours or on the other hand, when a full-length novel is unread and way overdue.

My day-to-day fluctuates between daily meditation, physical exercise, academic work and social interaction. I rarely am able to perform these in equal doses but I make the intention to keep my life well-rounded between my mind, body and spiritual health.

Although meditation, exercise, eating healthy, etc. are all not groundbreaking lifestyle choices by this decade, meditating regularly, personally, has helped build my self-esteem.  I can attest to how a lack of self-confidence enables my entire day to just plummet. I even react physically—slacked shoulders, tense muscles, and uneasiness throughout my whole body.

To counteract this, I integrate meditation at the start of the day, around when I wake up: every morning, I sip on my cup of coffee and spend about 30 minutes meditating before I begin the adventures and even perils of the day. Even the space I designate for my mediation resonates with tranquility and positivity. It’s discipline and learned, but I ingrain meditation into my daily life. It has allowed me to connect with myself for a small block of uninterrupted time, without inner and external distractions immediately chipping away at my feelings, thoughts and behaviors for the day.

UCLA’s MARC center continues to do incredible research and active work in establishing the benefits of mindfulness meditation, including improved immune-system functioning, decreased stress, improved awareness. And studies also prove how brief meditation can improve academic performance.

However, my initial question when I first started meditating is how the hell am I supposed to turn off my thoughts?! Text messages sent, even flirtatious texts received, Facebook status alerts, the oh-so-frustrating-career changes, family obligations, oh my god—do I have to go on further? I literally googled how to meditate two years ago. Then I googled how to stop thinking while meditating. I thought maybe I am not cut out for this. But my interest was piqued by the not-so New-Age world beckoning for me to experience the apparent wonders of meditation. I wanted immediate results though.

Then it finally started to click. I still struggle. But the affirmation of “I’m going to set aside time for myself” is what counts. Even if my 30 minute meditation is spent just focusing on my breath, I find gratitude in the intention, in the moments of just “being.” Instant gratification gives way for the experience of patience, gratitude and contentment invested in stillness.

Last weekend, I attended a yoga class in downtown Santa Monica at Bryan Kest’s Power Yoga studio.  Of course, my slight tardiness—obviously traffic induced—results in my awkward entry; as I knock over candles and step over yogis’ mats while the class is silenced in downward dogs, I manage to settle in, yet cursing myself for running late again.

Yoga is supposed to eliminate stress? Right. So I straighten out my yoga mat and look around to mock what pose the class was following.  I straighten my arms, curve my back and stagger my feet, left, right, left, right. I take my first deep breath in the class—inhale through my nose and exhale through my mouth, “ahhh.”And silence.  Just breathe, Max.

The yogi leading the class, Dan, walks around in between mat spaces, casually guiding us into complex core poses but simultaneously, he inspires. His humor and modern insight on what it means to be mindful in this crazy, brave new world makes the class so less intimidating but a chance to transition and stop.

“Instead of reaching or straining, just be. Sometimes we can’t always be what we want to be, but it’s trying, it’s showing up that makes the difference.” His words resonate with me. It’s not about achieving perfection. The intentions make a difference.

I can empathize with the “strive for perfection” and the near-always let down. It’s impossible to do everything. And we all know that, but there’s this part of me that adds too many goals to my weekly agenda and of course, I fail in keeping up with all these demands. What results is this semi-toxic, unsettling feeling that even a pint of Ben and Jerry’s is unable to subside.

Instead, I’ve learned that the authentic  me is the one making that transition from stressful appointments, study dates, thoughts, and text messages into purely being—whether that be yoga, class, or even work.

To be mindful is not about an enlightened Zen-like achievement but merely showing up, completely late, tired, grumpy, upset, disappointed, or angry. These negative emotions are part of us all, but it’s the coming-into-the-experience, with full recognition that we are flawed, that makes the moments real and “well-rounded.” That first breath I took at yoga this weekend became that instant where I was able to transition from the ego part of myself into the authentic me—eager and excited to learn but also tardy, a little frustrated and embarrassed.  Immersing myself into yoga encompassed the whole 100% of me.

My spiritual journey as of yet keeps diverging, twisting and changing paths, but it’s been a learning process centered around the knowledge of how to be mindful and balanced in what I am. I know I cannot achieve perfection in school, physical health, work and my social circle. Yet, I set priorities for myself—what do I need for myself right now?

This tuning into my “needs” has been one of the most powerful life lessons I’ve discovered so far: stay true to who you are. I eliminate the negative, admit the good, and accept the beautiful.  We are always learning, but this process of “tuning in,” in itself, is an incredibly valuable tool in making the best you.

-Maxwell James is an undergraduate student finishing his final year as an English major. His interests include mindfulness meditation, consciousness awareness, transpersonal psychology and mind/body health. He is also a member of Innergy and is actively practicing yoga. If you have any questions, please feel free to contact him at maxwellajames@gmail.com.

WANTING

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Do you want to win the lottery? Chances are, you answered Yes. Okay, so you’ve got the first part down. It’s a fact, focusing on what you want rather than what you don’t want is key to improving mood and living a better life. But, where do you go from there…what about taking action… making change… actually achieving what you want? Do you buy a lottery ticket everyday? Chances are, you answered No. This is because our brains spend energy and currency (thoughts and actions) on things and events that we actually expect to happen, not on things we just merely want to happen. If you truly expected to win the lottery, you would most likely buy a lottery ticket each and every day.

I worked with a patient who wanted so badly to be in a mutually loving and committed relationship. She created vision boards, collaging pictures of happy couples and she wrote daily about the happy relationship she desired so strongly. After spending time researching and writing about the cognitive power of anticipation, I asked her, out of 1-10 (1 being the least likely and 10 being the most likely) how much she actually expected to be in the type of relationship she wanted, and she replied, “2, sometimes 3”. Right there I knew she barely stood a chance. She could go on wanting a relationship every day, just like you and I, who want to win the lottery, but without a strong expectation that she was likely to be in one soon, she would be spending very little brain currency on allowing herself to meet her match.

GREAT EXPECTATIONS LEAD TO GREAT ACHIEVEMENTS

I have spent a lot of time working specifically with people on identifying their wants and expectations, revealing huge gaps between the two, then guiding the work and efforts to close this gap, making the relationship between wants and expectations much more symbiotic and positively correlated. Achieving your goals and dreams require you to know what you want but, beyond that, it requires work and a shift in your expectation. So, next time you set a goal or have an intention or desire, ask yourself these questions: What is it that I want and How much do I expect this to happen? 

There is a RIGHT Way to Want: 

1. Identify what it is that you want. This can be surprisingly difficult. Unfortunately, at times, it is much easier for us to identify what it is that we don’t want, rather than what it is that we do want. You can use this as a tool to identify what you do want.

2. Once you figure out what it is that you do want, write it out clearly, as a positive statement. Our brains work much better within these contexts. For example, when presenting our brain with, “I want healthy lungs” rather than “I want to quit smoking because it is bad for me” our brain tends to have more availability to create positive steps of action to achieve goals. Our brains don’t tend to work well with negative statements which is why many times telling yourself “Quit smoking” or “Quit bitting my nails” is not an effective way to cease habits or addictions.

3. After identifying a clear and positive want or goal, identify why it is that you want this. What about this would make your life that much better? Change is a very hard state for humans, the only way change happens is if you can identify wanting something so much more than what your current state is and why.

4. Now you are ready to ask yourself the magic question, “From a rating of 1-10, How much do I expect this to happen?” The lower the number you rate, the more work around improving your expectation you will have to do. Regardless of your answer, go on to step 5.

5. Now that you have identified what it is that you want and why it is that you want it, spend some time visualizing what it is like to have this already. Visualize, using all of your senses, having healthy lungs, or that new job, or a secure and loving relationship… Many studies have proven that if you can visualize a goal, especially utilizing all of your senses (what does it feel, smell, taste, sound and look like) you are much more likely to achieve it … this is because you are much more likely to increase the likelihood of EXPECTING that this could happen for you!

6. Now, make this very important statement, “Now that I can (see myself achieving that new job/ feel what it is going to be like to be in such a loving relationship/ feel how easily I could breathe and how my healthy lungs enabled me to become a runner… ) my new expectation of how likely it is for this goal to occur is ___ (this number will definitely increase)

After going through these sets and mapping our a goal or a want in this way, you are significantly more likely to develop the small steps and actually take action towards achieving your goal. 

Happy Wanting! 

~Dr. Deepika Chopra holds a doctorate in clinical psychology with a concentrated interest in Health Psychology, the connection between mind/body and Innovative Cognitive Science. Dr. Chopra is an alumna of multiple UCLA programs.   In addition to completing her BA in Sociology from UCLA, she also completed post-doctoral training programs at the David Geffen School of Medicine and our affiliated site at Cedars Sinai Medical Center.  Dr. Chopra is passionate about studying the benefits of optimism and is driven to innovate new methods that help individuals enhance their positive future and present thoughts and behaviors. She can be reached at drdeepikachopra.com.

Use of Mindful Exercise to Promote Wellbeing

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There is currently extensive use of complementary and alternative medicine (CAM) — also known as integrative or mind-body medicine — in the United States to sustain well-being in both children and adolescents and in aging baby boomers. The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM therapies as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine,” with “conventional” medicine being defined as the approaches used by clinicians in the routine daily practice of Western or allopathic medicine that are within the currently accepted standard of care.

The most recent comprehensive assessment of CAM use in the United States found that roughly 40% of US adults had used at least one CAM therapy within the past year. An estimated 33-88% of older adults will use CAM therapies. In addition, Americans make more visits to CAM providers each year than to primary care physicians and spend at least as much money on out-of-pocket expenses for CAM services as they do for all conventional physician services combined. Patients with mental disorders turn to CAM for relief of symptoms of anxiety, mood, insomnia, impaired cognition, and perceived stress. The most commonly used CAM techniques include prayer for health and the use of multivitamin supplementation. Given widespread use of CAM services among patients, there is an urgent need for greater awareness and familiarity with its applications and outcomes.

As baby boomers age and increase use of CAM, health professionals require a working knowledge of CAM techniques intended to address physical and mental disorders. CAM treatments of mood and anxiety disorders include acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga.

Complementary and alternative medicine encompasses a number of techniques collectively known as mindful exercise (e.g. yoga, Qigong, and Tai Chi), or meditation. This ‘physical exercise executed with a profound inwardly directed contemplative focus’ is increasingly utilized for improving psychological well-being. In general, mindful physical exercise contains the following key elements:

  1. Non-competitive, non-judgmental meditative component
  2. Mental focus on muscular movement and movement awareness combined with a low to moderate level of muscular activity
  3. Centered breathing
  4. Focus on anatomic alignment (i.e., spine, trunk, and pelvis) and proper physical form
  5. Energy centric awareness of individual flow of intrinsic body energy, otherwise known as prana, life force, qi, or Kundalini.

Mindful exercise has been shown to provide an immediate source of relaxation and mental quiescence. Scientific evidence has shown that medical conditions such as hypertension, cardiovascular disease, insulin resistance, depression, and anxiety disorders respond favorably to mindful exercises.

There is a growing database of the physiological effects of mindful exercise and meditation. Tai Chi and Qi Gong have been shown to promote relaxation and decrease sympathetic output, and to benefit anxiety, depression, blood pressure, and recovery from immune-mediated diseases. Tai Chi and Qi Gong have been shown to improve immune function and vaccine-response. These practices have also been shown to increase blood levels of endorphins and baroreflex sensitivity, and to reduce levels of inflammatory markers (CRP), adrenocorticotrophic hormone (ACTH), and cortisol, implicating the hypothalamic-pituitary-adrenal (HPA) axis as a mediator of stress and anxiety reduction. Brain wave or electroencephalopathy (EEG) studies of participants undergoing Tai Chi and Qi Gong exercise have found increased frontal EEG alpha, beta, and theta wave activity, suggesting increased relaxation and attentiveness. These changes have not been found in aerobic exercise controls.

In our studies, yogic meditation (Kirtan Kriya) for stressed family dementia caregivers resulted in lower levels of depressive symptoms, and improvements in mental health and cognitive functioning. Participants in the yogic meditation group showed a 43% improvement in telomerase activity after 12 minutes of daily practice for 8 weeks, compared with 3.7% in relaxation music control participants. This suggests that brief daily meditation practices can benefit stress-induced cellular aging. Kirtan Kriya reversed the pattern of increased NF-kappa B-related transcription of pro-inflammatory cytokines, and decreased IRF1-related transcription of innate antiviral response genes in distressed dementia caregivers. This reinforces the relationship between stress reduction and beneficial immune response. In the same study, nine caregivers received brain FDG-PET scans at baseline and post-intervention. When comparing the regional cerebral metabolism between groups, significant differences over time were found in different patterns of regional cerebral metabolism suggesting brain-fitness effect different from passive relaxation.

Studies of meditation also report decreased sympathetic nervous activity and increased parasympathetic activity associated with decreased heart rate and blood pressure, decreased respiratory rate, and decreased oxygen metabolism. Functional neuroimaging studies have been able to corroborate these subjective experiences by demonstrating the up-regulation in brain regions of internalized attention and emotion processing with meditation.

In a recent systematic review of neurobiological and clinical features of mindfulness meditations, Chiesa and Serretti (2010) provided evidence on the neurobiological changes related to Mindfulness Meditation (MM) practice in psychiatric disorders. Meditation practices that focus on concentration of an object or mantra seem to elicit the activation of fronto-parietal networks of internalized attention; meditation techniques that focus on breathing may elicit additional activation of paralimbic regions of insula and anterior cingulate; and meditation techniques that focus on emotion may elicit fronto-limbic activation. Future studies will be needed to disentangle the brain activation patterns related to different meditation traditions.

Given the noninvasive nature of mindful exercise and meditation, these exercises are an appropriate option for consumers and clinicians, particularly for conditions that have been examined in controlled studies. Significant evidence supports the assertion that Tai Chi and Qi Gong and yoga and meditation can improve physical and mental health, and quality of life. Ethical considerations should be taken into account when practicing or recommending spiritual interventions by healthcare professionals to respect patients’ beliefs in choosing mind-body interventions.

~ Helen Lavretsky, M.D., M.S.
Dr. Helen Lavretsky is a Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA, a geriatric psychiatrist with the research interest in geriatric depression and caregiver stress, as well as complementary and alternative medicine and mind-body approaches to treatment and prevention of disorders in older adults.  

Picture This: Healing Trauma through Art

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The creative arts therapies are uniquely effective in the treatment of trauma. Board certified art therapist Erica Curtis, a leader in the field of art therapy, offers reflections on the power of art therapy in addressing trauma.

“It was like reaching into your insides and pulling them out”, “like a war
zone”, “a downward spiral.”

These words, from those affected by the recent devastation at Sandy Hook Elementary, are more like an evocative painting than a chronicle of the event. And it is no surprise, given how our brains store and process trauma. Trauma is encoded differently than regular events that can be told like a narrative. Traumatic memory is not inherently verbal. It is felt physically. It is known emotionally. It is re-experienced visually. Yet, to prevent serious mental health issues from
taking root, the brain must learn to analyze and understand the trauma as it does other events. As such, there is hope for healing in the sensory and visual experience of art.

Making art makes sense, quite literally. Art can help people make sense of the illogical experience of trauma by serving as a communication tool that is, itself, both visual and sensory. What’s more, art therapy*, the art based and visually informed psychotherapy practice, can harness these qualities of art to help survivors access, observe, and analyze memories that are stored as visual and sensory material. In this way, the targeted use of art (often in combination with the art therapist’s knowledge of neurology, cognitive-behavioral intervention, somatic therapies, and more) bridges the visual-sensory realm and the verbal-logical functions of the brain. This aids in the meaning-making that is so important to coping and recovery.

Of course, art-making itself can be an inherently therapeutic experience for children and adults by allowing expression of difficult feelings, fostering support by bringing people together, or providing a soothing experience in an otherwise jarring existence. Art therapy, however, may be indicated when symptoms suggest the body and brain are under stress. In children these may include: repetitive play focused on the event, change in sleep or eating habits, rocking, social withdrawal, decreased interest or enjoyment in play, increased worries or fears, hypervigilance, tantrums, flat affect, irritability, distractibility, or hyperactivity. In this event, an art therapist can intervene with appropriate art directives and media to gently challenge the individual toward recalling the trauma without feeling re-traumatized. More than using art as just a communication or soothing tool, the art therapist can use targeted art-making to stimulate affective experience or cognitive processes when appropriate, identify internal resources, move toward the creation of narratives, reinforce a sense of safety, and temper fear responses that could be triggered during the process.

As declared by so many impacted by the Sandy Hook tragedy (or hurricane Katrina, or 9-11, or car accidents, or abuse): “There are no words.” But there are images and these images can find expression through art, which can lead the way toward healing.

*Art therapy is a master’s level psychotherapy profession that often requires a license or credentials to practice depending on state regulations. To learn more about art therapy, visit the American Art Therapy Association atwww.arttherapy.org.

———-

Erica Curtis, MA, MFT, ATR-BC

About the author:
Erica is a licensed Marriage and Family Therapist and Board Certified Art Therapist. She is a faculty member at the Loyola Marymount University department of Marriage and Family Therapy, served 6 years on the board of directors of the American Art Therapy Association, and is a program advisor for UCLArts and Healing. Erica has a private practice in Santa Monica. To learn more visit www.TherapyWithErica.com.

Originally published by UCLArts and Healing. To receive, search for, or post information on topics such as this, visit www.uclartsandhealing.org

The Balancing Brain: Finding Harmony and Awareness

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Jill Bolte Taylor’s TED talk  and book — “My Stroke of Insight” — offer vivid and intensely personal recollections of her life-threatening brain hemorrhage. Her stroke shifts a delicate balance of complementary forces in her brain, generating a dramatic upheaval in her sense of self and the world around her. How can we best understand her experience, and what does this tell us about our own minds and brains?

In Dr. Bolte Taylor’s narrative, the hemispheres of the brain serve as a neuroanatomical metaphor for a duality of consciousness, the hosts of a dynamic tension between competing powers that exist within us all. She emphasizes contrasts between “parallel,” “holistic” and “nonverbal” processing of the right hemisphere, versus “serial,” “analytic” and “verbal” processing of the left hemisphere. Others have emphasized the role of the right hemisphere in dealing with novelty, while the left hemisphere designs and deploys rules, tactics and other “descriptive systems” (language, math, the rules of games). I like to view hemisphere differences from an evolutionary perspective, and particularly think about how the hemispheres contribute to the overall balance of stability and flexibility of brain activity. On one hand, we need to keep ourselves on track by stabilizing and then executing our plans for action. On the other hand, we need to flexibly adjust these plans as needed to match the exigencies of our changing world as we experience these through our sensorium. What happens when the scales are tipped?

Imbalance between brain systems is often the source of problems. Ever had a moment when you might have been a tad too “rigid,” or when you had difficulty “staying focused?” Consider the plights of those with obsessive-compulsive or attention deficit disorders. Taylor’s portrayal is unique in revealing a benefit of imbalance: the “silencing” of some systems may “unleash” others, and yield extraordinary vision and perspective. Taylor reports uplifting sensations of beauty and euphoria that seem to reflect a release from domination by critical analysis. She experiences an expansive state marked by connection to humanity, and freedom from the incessant “chatter” of her verbal brain. Her stroke also had distressing consequences — for example, paralysis on the right side of her body and a loss of intelligible speech. But the upside of her experience was so profound and alluring, that viewers of her talk ask: “How can I turn off my left hemisphere? Do I need to have a stroke?”

Let us hope readers will not abandon their New Year’s diet and fitness resolutions, hoping to clog precisely those cerebral arteries that might help them relive Taylor’s experience. There are other ways! Methods for personal brain management  might help readers enjoy some of the benefits without the risks. Some techniques have track records spanning a few thousand years. Ancient contemplative practices may provide the best-documented means to “silence the chatter” by engaging what have been called discursive or open monitoring modes of meditation. Relaxation exercises, particularly those promoting awareness of internal somatic states, may enhance the flexible and connected mode of brain function. Similar states may accompany yoga, tai chi, or vigorous exercise.

More radical (read this as relatively untested, possibly dangerous) methods center on direct management of brain activity. Drugs provide one method to alter the balance of brain function, and there are uncanny parallels between aspects of Taylor’s experience and reports from experiments with psychedelic agents. A burgeoning literature now shows that transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) may enable stimulation or inhibition of neural activity in specific regions of the brain. While provocative articles have suggested that tDCS may promote increased cognitive function and even “flow” (a mental state of effortless immersion and engagement), this method is still under investigation and the potential adverse effects remain unknown. There are also ways to use neurofeedback — monitoring of one’s brain using visualizations of electrical activity recorded from the scalp — but here too, there is so far no well-tested formula to produce effects like those experienced by Taylor.

Before embarking on a brain-altering search for deeper understanding, we should first reflect on what we really want to achieve. While Taylor gained enormous insight, she also suffered tremendous trauma and dedicated 8 years to recover lost functions. The most powerful approaches to self-improvement may aim to promote the dynamic balance of forces in the brain rather than the quieting of some to release others. Since antiquity, seekers of truth, beauty, and harmony have traveled paths that balance opposing forces: consider the Middle Way of Buddhism, and the Golden Mean of Aristotle. When we delve into the meditation practices, we find that the most advanced practices engage open monitoring together with its complement, focused attention, and importantly — these synergistic forces are engaged simultaneously. We have found that similar methods, focused on balancing the brain systems for both flexibility and stability, which lead to the generation of novel work that is also perceived as valuable, are cornerstones of the neuroscientific bases of creativity . Intensive psychotherapy offers another route to remodel thinking and overcome the barriers to achieving better brain balance. We will review these and other emerging methods for managing one’s own brain at the UCLA Summer Institute on Brain-Mind-Wellness . Meanwhile, with a fresh 2013 before us, we can be inspired by Taylor’s concluding comments about the moment-to-moment alternative mental states that may be available to us and ask: “Which do you choose, and when?” Increased insight into these processes can only help us choose more wisely and precisely who we want to be.

Robert M. Bilder, Ph.D