Sunday, August 25, 2019

UNDERSTANDING ATTENTION CAN PROFOUNDLY ILLUMINATE THE NATURE OF MENTAL ILLNESS AND MENTAL HEALTH

There are a number of mental health issues for which it can be illuminating to understand how the brain shapes attention.  Issues relate to the two major forms of attention described below affect depression, anxiety, obsessive-compulsive disorder, bipolar disorder, psychotic disorders, and in a particularly profound way, autism. 

Dr. John Yates, a former professor of neuroscience and now full-time meditation teacher, describes the two fundamental modes of attention this way:

·     There is “selective attention,” which is linear and literal;  it analyzes, takes apart experience, and focuses on the details. It tends to be analytic, detached from experience (from emotion, imagination, sensation and intuition), and by itself often has difficulty understanding the full picture in any situation. It sees the trees but has trouble seeing the forest.
·     And there is “peripheral awareness,” which is non-linear and metaphorical, it intuits, imagines, feels, senses – it is immersed in experience, and is able to grasp the “whole.”  It can see the whole forest as well as the trees (though it needs selective attention to be able to fully appreciate boththe trees and the forest).

Dr. Iain McGilchrist, in his book, “The Master and His Emissary,” presents over 20 years of research on hemispheric differences to provide us with inspiring information about attention.

His overall message is very simple. It is similar to the view of Dr. Yates with some interesting additional insights.

Our brain has two major modes of attention.  It is NOT true that the “left hemisphere” is “logical” and the “right hemisphere” is “emotional.” But it IS true that each hemisphere tends to attend ot the world in different ways.  The left hemisphere works by what Dr. Yates describes as ‘selective attention’  - focusing on bits and pieces of the world and oneself, often having much difficulty seeing how these bits and pieces relate to each other - and the right hemisphere works by “peripheral awareness” – taking in the whole scene, the whole world of experience all at once.

Dr. McGilchrist gives an example of a bird searching for food.  If the bird sees a worm or plant, it needs to examine it very closely to make sure it is safe to eat. In other words, it needs to apply the left hemisphere capacity for selective attention. But at the same time, it needs to maintain “peripheral awareness” (the job of the right hemisphere) to stay attentive to potential predators somewhere in the environment.

Here is an excellent, 11 minute overview (a very enjoyable animated explanation) of McGilchrist’s view, with his own voice as narrator)

https://www.youtube.com/watch?v=dFs9WO2B8uI


McGilchrist uses the simple term “left-mode thinking” to mean “selective attention,” and “right-mode thinking” for “peripheral awareness.”

Here are some more ways of understanding left and right mode thinking (note – this has nothing to do with the politics of “Left” and “Right”!!)

Left-mode thinking is logical, linear, linguistic (language-based), and literal. And, as you might guess, the left hemisphere loves that these words all start with “L”.   Left-mode thinking enables us to create categories that help us make sense of the incredibly complex world in which we live.  In fact, it’s the left-mode's ability to analyze, predict, and control that, to a large extent, has helped us to produce the extraordinary technology that defines our modern civilization. 

However, left-mode thought has difficulty dealing with the unpredictable, the immeasurable, and the unknown.   It tends to interpret new things that happen in terms of past beliefs and assumptions, and finds it difficult to let in new information that contradicts what we’ve assumed to be true in the past.

 While left-mode thinking uses language to create categories, the right-mode thinks more in images.  It’s also informed by our emotions and our body sensations in a way that the more “heady” left-mode is not.  While the left-mode pays attention to details, the right-mode sees the big picture all at once.  When we use right-mode thinking, our minds tend to be  more flexible – we’re open to new ways of seeing things and tend to think in “both/and” rather than “either/or” terms.      

 But if we’re dominated by right-mode thinking, we may tend to get lost in fantasy, imagining all kinds of wonderful possibilities, but lack the ability to stand back and plan how to rationally make them happen.

You might think that in contrast, when left-mode thinking dominates, we’d be good at making decisions.  And actually, the left-mode is very good at analyzing the details of a situation.  However, without the emotional and sensory information which the  the right brain provides, it can’t make decisions.

It tends to go back and forth, endlessly weighing the pros and cons of various options. We need to be able to feel the emotional value of the different options, and to see them in a larger context before we can determine which choice is the better one.

In fact, we need both right-mode and left-mode thought for all aspects of our lives. When the two modes are working harmoniously together, we can be in touch with our emotions and the emotions of others, and still maintain perspective without getting swept away by our feelings. We can make sensible, rational judgments based on a clear-headed analysis of the situation, while keeping the bigger picture in mind, taking into account what’s best for all involved.  Ultimately, an integration of left and right-mode thought increases our ability to be both reasonable and compassionate, and can even lead to a dramatic improvement in our physical health.
   
Training the Brain to Balance Left and Right Hemispheres

           Dr. Les Fehmi, in his book Open Focus Brain, tells the story of a client who, after just a few months of brain training, was able to reverse the negative effects that a left-right imbalance had been having on her physical and emotional health.  

          Paula, as he calls her in the book, was a nurse who worked round-the-clock shifts in the high-stress environment of an ICU in a major medical center. When she first went to Dr. Fehmi for treatment, she was having many troubling symptoms, including “bouts of [severe] anxiety, frequent and debilitating headaches, constant stomach pains, endometriosis, mild depression, and insomnia.” She wasn’t interested in taking medications that would just “mask her symptoms” and so she decided to try the kind of brain training that Dr. Fehmi had been teaching.

        Fehmi identified her primary problem as relying too heavily on a particular way of relating to the world which he characterized as “a narrow objective attention style” – a style associated with the left hemisphere. This attention style in itself is not necessarily problematic – in fact, it is very useful in nursing where a small mistake can have life-threatening consequences. 
 

However, the tendency of left-mode thinking to get overly caught up in details can make things more difficult.  You know how when you’re stressed out, the least little thing that goes wrong can practically send you over the edge?  This results from being focused so narrowly that you lose perspective, making it easy for any little difficulty or mishap to feel like major catastrophe.      

With narrow focus, our attention gets stuck on one point on the rim of the wheel of awareness – a style of attention that Fehmi refers to as “gripping the world.” [NOTE: see  http://txrecommend.blogspot.com/2019/07/your-amazing-brain-and-wheel-of.htmlfor more on the wheel of awareness]. This kind of tense, narrow focus can make a simple mishap seem like a catastrophe, and we lose sight of anything else.  With open focus, we can attend to the same mishap, but hold it more lightly.  That way we won't be inclined to make it bigger than it is.    We can also maintain an awareness of life and world beyond the mishap, and can easily choose to shift our attention to other points on the wheel.

Over the course of several weeks, Fehmi taught Paula a different way of relating – an attention style which he calls “open focus.”  He simply taught her to broaden her focus instead of, as he put it, “gripping the world” with her attention.  
        
 “Open Focus” attention involves more than just a shift toward greater right-mode functioning.  It’s about developing the flexibility to choose the style of attention that is most appropriate to the situation we’re in.  As Fehmi described it, Paula learned she could “narrow her focus and respond alertly when she needed to,” but she could just as easily soften and widen her attention in order to avoid accumulating stress. In other words, she learned to use left-mode and right-mode functioning in a more balanced way.

If we look at this in terms of the wheel of awareness metaphor, Paula was learning to sit at the hub of the wheel instead of being narrowly focused on a particular point on the rim. [NOTE: see http://txrecommend.blogspot.com/2019/07/your-amazing-brain-and-wheel-of.htmlfor more on the wheel of awareness]  Seated at the center, she was able to widen her focus and was free to choose what parts of the rim she wished to attend to.  In brain language, Paula was exercising her prefrontal cortex (her “PFC”) helping it to become stronger and more skillful.

And what was the result of this training? Fehmi wrote that Paula noticed “the sometimes manic speed of her inner dialog… slowed considerably. Muscles she had unwittingly been holding tense for years began to relax. Her face, eye, throat, shoulder, and neck muscles in particular began to soften; for these are all muscles that support gripping the world with narrow-objective attention.  Color returned to her face. Tension headaches became rare, and her migraines were virtually eliminated.  Chronic pain from a spastic colon and endometriosis all but vanished. Her personality softened. After several sessions she described herself as much more at ease and centered. ‘I can’t believe how my life has changed,’ she said after a few months. ‘Every single thing in my life was affected for the better.’”

   And that’s one of the wonderful things about training your brain:  

          The more you practice 

                    the more you develop your prefrontal cortex (“PFC”)

                                    the more integrated your brain becomes,

     and the more it can change everything in your life for the better.


*******

It would make this post too long to go into detail about how these modes of attention relate to various mental illnesses. I'll just mention here that it is very common to see in autism an overemphasis on "selective attention."  Depression seems to be related in some ways to an over-emphasis on peripheral awareness to the detriment of selective attention (a vague, "holistic" dreamy awareness that misreads details, failing to analyze them appropriately, leading to misattribution, catastrophizing, and a general negative self-image.  

For more on this, see the works of Bonnie Badenoch, who studied with Dan Siegel, and incorporates the wheel of awareness in her work. You may enjoy her more detailed, "Being a Brain Wise Therapist" or her much briefer, "The Brain-Savvy Therapist's Workbook."



Tuesday, August 13, 2019

https://beyondthematrixnow.files.wordpress.com/2019/08/rtb-8-13-19.pdf

If you've arrived at this page, you are probably a mental health worker or teacher I've spoken to about how to use information about the brain with your patients or students.

In addition to the link above, there are several other resources on this site and other sites that I often recommend.

Here is the framework I've been using recently for psychological evaluations:

https://txrecommend.blogspot.com/2019/07/framework-for-psychological-evaluations.html

In a way, you might say that virtually every psychotherapeutic intervention  - whether psychodynamic, cognitive behavioral therapy, motivational interviewing, family or community therapy, psycho-education of any kind, or any other intervention - is ultimately about finding ways to help shift from the chaos, conflict and confusion on the "rim" to the peace, quiet joy and calm of the "center" of the wheel of awareness.

Imagine, for a moment, if we lived in a world where all therapists, all teachers, all politicians, business people, tech specialists, artists, athletes... in short, everybody - was eagerly and joyfully building neighborhoods, communities, towns, villages, cities, states and nations in which we all as one found infinitely diverse yet common ways of assisting each other in shifting our attention to this quiet joyful center of awareness!

What a wonderful world it could be.