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Book summary: The Upward Spiral

Book summary: The Upward Spiral

Mental health has been one of my favorite topics for a few years now, so I've been reading a lot of books about brain circuitry, brain evolution, and naturally, the most common health condition: depression.

One of my favorite books about it is "The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time".

The book itself is quite technical but still understandable by any audience.

This is a short summary of the book I made for self-reference.

Introduction

Neuroscience is the study of the brain, the biological basis behind our thoughts, feelings and actions.

Depression is a mental condition that includes several of the following sympthoms:

  • Numbness
  • Emptiness where you should feel emotion
  • Hopelessness
  • Helplessness
  • Things that used to be enjoyable aren't enjoyable anymore
  • Pains feels more deeply

Depression puts people in a downward spiral that makes it hard to get out of. The problem with depression is that it is a stable state: the brain thinks and acts in ways that keep you depressed. Changes that can help seem difficult.

Part 1: Stuck in a downward spiral

A little bit about biology of the brain:

There is no brain scan, MRI or EGG that can diagnose depression, it is simply a by product of the brain circuits that we have

Simple test to tell if you have depression (simple test, but people should go to trained professional for help). You may have depression if you have 5+ symptoms nearly every day for 2 weeks:

  • Depressed mood (sad, empty, irritable)
  • Decreased interest or pleasure in activities
  • Significant weight loss/gain, decrease/increase in appetite
  • Insomnia or increased desire to sleep
  • Restlessness or slowed behavior observed by others
  • Fatigue or loss of energy
  • Feelings of worthlessness
  • Trouble thinking or making decisions
  • Recurrent thoughts of death or suicide

While most diseases are defined by the cause (Example: parkinson, alzheimer, cancer), depression is defined by the symptoms.

In depression, there's nothing wrong with the brain, is just a matter of the tuning of circuits that create a tendency toward depression.

The brain uses several neurotransmitters:

  • Seratonin: improves willpower, motivation, mood
  • Norepinephrine: enhances thinking, focus and handling stress
  • Dopamine: increases enjoyment, neccessary for changing bad habits
  • Oxytocin: promotes feelings of trust, love and connection, reduces anxiety
  • GABA: increases relaxation and reduces anxiety
  • Melatonin: enhances quality of sleep
  • Endorphins: pain relief, happiness
  • Endocannabinoids: improve appetite and feelings of well-being

A couple of important notes regarding depression:

  1. Depression is not solved by just increasing levels of neurotransmitters
  2. There’s nothing wrong with depressed people’s brains
  3. In addition to genetics, there are things that can influence circuitry towards depression: Childhood experiences, Life stress, Level of social support

Trapped with anxiety and worry

Worrying vs anxiety

  • Worrying: mostly thought based, involves prefrontal cortex
  • Anxiety: has to do with physical like body sensations (upset stomach) or associated actions (like avoiding a situation), involves only limbic system
  • Worrying is thinking about a potential problem, anxiety is feeling it
  • Worrying and anxiety can trigger each other
  • Anxiety and fear activate same response from brain and body, but one is actual danger and other is potential danger
  • Dont maximize decisions, dont be happiest, just be happy
  • Worrying and anxity can be good, cause you think deeply about problems
  • Anxiety has ABC:
    — Alarm: observation that something feels wrong
    — Belief: evaluate alarm and create belief about observation you made
    — Coping: whatever you do after belief (like freaking out, eating ice cream or exercising)
  • Anxiety sometimes makes us see worst possible scenario (catastrophizing)
  • Upward spiral for anxiety:
    — recognize anxiety
    — Focusing on present
  • Sometimes physical symptoms are caused by anxiety: shortness of breath, muscle tension, dizziness

Always noticing the negative

  • The world is not conspiring against you, it’s a byproduct of brain circuitry
  • In depression, brain’s negative bias makes bad situations seem a lot worse than they actually are
  • Reality is almost certainly better than it appears
  • Brain wired to pay more attention to emotional events
  • Depressed people tend to see negative faces in neutral expressions
  • All brains react more strongly to negative events
  • We need a ration of 3 positive events to balance 1 negative event
  • Mood disorders run in families, children of depressed parents have higher tendency to be depressed
  • Mood congruent attentional bias: when mood get worse, you tend to notice more the negative
  • Nonjudgmental awareness: noticing without reacting emotionally.
  • Depressed people feel more pain
  • Depression has a bias towards bad memories
  • Negative bias also affects memories

Caught in bad habits

  • Most people have habbits that are obvious, but not for them
  • Most acts are done not by conscious intention, but by habits
  • Striatum controls habbits (old ancient part of brain), doesn’t distinguish between bad and good habits
  • Habits can be impulses (momentary desire like clicking a link) or routines (actions we take because we’ve done them so many times)
  • Nucleus accumbens learns what is pleasurable and learns to anticipate it (which is why dopamine is released when you see a Snickers)
  • It is much easier to avoid temptation than to resist it
  • In depression, less dopamine is released for long term effect actions, and only thing that releases a lot of dopamine are things like gambling, porn, gambling and drugs
  • You don’t eliminate bad habits, they just get weaker as you develop new stronger ones
  • Addictions start because they release dopamine, but after a while your brain just does them because it’s used to do it, even if it doesn’t release dopamine
  • Fatigue is very common in depression
  • Good coping habits help you feel better when stressed
  • Bad coping habits create more stress and generate a downward spiral
  • Addictions: if you don’t act on yout habit, you feel anxious, and want to act on habit more
  • Stress makes it more likely we’ll act on our habits/routines. It’s harder to keep the diet after a fight
  • If you can control the triger, you can control the habit
  • To stop acting on a habit, the pre frontal cortex needs seratonine. But we only have a limited supply of seratonine

Part 2: Creating an Upward Spiral

Exercise your brain

  • Downward spirals usually start with a small change
  • You’re more likely to do it if you view it as “being active” or “having fun” instead of “exercise”
  • Exercise: most straightforward and powerful way to start upward spiral
  • Depression is a stable state; your brain acts in ways that keep you depressed
  • Effects of exercise:
    — Depression makes you letargic and tired, exercise gives you more energy and vitality
    — Depression messes sleep patterns, exercise improves sleep
    — Depression affects appetite, exercise improves appetite
    — Depression makes it harder to concentrate, exercise gives you focus
    — Depression depresses you, exercise improves your mood
    — Depression keeps you isolated, exercise brings you to the world
  • Exercising in pleasant environments boosts the benefits of exercise
  • Exercise increases brain derived neurotrophic factor (BDNF) which is steroids for brain
  • Exercise boosts seratonin activity
  • Intense exercise increases norepinephrine
  • All drugs called “uppers” (crystal meth, cocaine) are jacking up your dopamine
  • Any addiction hijacks brain’s natural capacity to enjoy things
  • Exercise releases endorphins, which reduces pain and anxiety
  • Endorphin release is highest during intense exercise
  • Even if it doesn’t feel like exercise is working, it’s still causing tons of unnoticed brain changes

Set Goals, make decisions

  • It’s better to do something only partially right than to do nothing at all
  • Make a good decision, not the best decision
  • Decision making helps start upward spiral because engages prefrontal cortex, and that helps you get better
  • Deciding on a goal makes prefeontal cortex change the way the rest of the brain perceives the world, specifically, ignoring irrelevant info
  • In depression, it may seem there is no solution, but solutions are there. You can’t just see them because you’re overwhelmed by irrelevant details
  • We are happiest when we decide to pursue a goal and then achieve it
  • Deciding on goal and achieving it is more pleasurable than if something good happens by chance
  • Decide for something you want, not against something you don’t want
  • Dopamine is released not only when you achieve a long term goal, but is also release with each step you take
  • Use specific goals:
    — “Spend more time with my kids” vs “play board games with my kids every sunday”
  • Creating specific, meaningful and achievable long term goals can be powerful way to reverse depression
  • Deciding creates perceived control
  • The important thing is not actual control, but perceived control

Give your brain a rest

  • Poor sleep is one of the most common symptoms of depression
  • Poor sleep worsens mood, lowers pain threshold, makes you more impulsive, and interferes with learning and memory
  • Key to improve sleep: dealing with anxiety and sleep hygiene
  • Sleep hygiene: combination of actions and environment that preceeds sleep or interferes with it (routine, noise, light)
  • Brain’s internal clock (circadian rhythmus) controls variety of hormones and neurotransmitters on a daily cycle
  • Sleep architecture:
    — Stage 1: light sleep (5–10 min)
    — Stage 2: deeper
    — Stages 3 and 4: slow wave sleep
    — REM sleep: brain is more active
  • One sleep cycle is 90 min, and it has to go sequentially
  • Circadian rhythms are synchronized to daytime by sun or bright lights
  • Many light sources can shift the circadian rhythm (lamps, TVs, phones)
  • Changes in bedtime can also shift circadian rhythm
  • Brain is like a dog, it needs to be trained by repetition
  • In depression, it is common to wake up in the middle of night and have trouble falling back asleep because prefrontal cortex has increased activity during slow wave sleep
  • If you have insomnia, you’re more likely to develop depression, and viceversa
  • Sleeping somewhere uncomfortable activates brain’s stress response
  • With good sleep hygiene, brain releases melatonin 30 min before sleep
  • Sleep disruptions are big source of stress (common in new parents)
  • Most important factor is not total amount of sleep, but amount of continuous sleep
  • Sleep cleans brain from trash (broken down chemicals)
  • The older you are, the less sleep you need
  • Improve sleep hygiene:
    — Sleep for 8 straight hours
    — Use bedroom for sleeping
    — Create routine to prepare for sleep
    — Avoid caffeine near bedtime
    — Eat and drink in moderation (no large meals 3 hours before bed)
    — Exercise

Develop positive habits

  • Habits: things you do when you are not thinking about what to do
  • Habits that release more dopamine require less repetition (like smoking), habits that release less require more repetition (like flossing)
  • Starting a habit requires intervention by the frontal cortex, but then it shifts to the unconscious effortless dorsal striatum
  • Self affirmation (“i am a good person”) makes it easier to change habits
  • Stress biases the brain toward old habits over intentional actions
  • Prefrontal cortex only overrides habits when it’s paying attention
  • Seratonin helps control impulses
  • Ways to increase seratonin:
    — Sunlight
    — Massage
    — Exercise
    — Remembering happy memories
  • Ways to activate prefrontal cortex:
    — Keep long term goals in mind
    — Practice self awareness
  • Procrastination won’t get you anywhere, just start doing something productive

Take advantage of biofeedback

  • Yoga improves depression, decreases chronic pain, and reduces stress
  • Biofeedback: brain changes its activity based on what the body is doing
  • Frowning makes you feel worse, and more likely to frown
  • Music and dancing engages limbic system and can regulate emotions
  • Smiling increases positive feelings
  • Standing up straight and opening chest helps you be more decisive
  • Furrowed brown -> tense muscles
  • People with breathing problems have higher risk of developing depression
  • Breathing slowly can reduce anxiety

Activate a gratitude circuit

  • Gratitude is antidote to negativity because it doesn’t depend on life circumstances
  • Gratitude is a state of mind
  • Benefits of gratitude:
  • Decreased depression symptoms
  • Improved physical health
  • Increases social support
  • Write a detailed thank you letter to someone who has been specially kidn to you
  • Keep a gratitude journal
  • Write down three things you are grateful for
  • Gratitude’s effect on brain:
    — Improves activity in dopamine circuits
    — Boosts seratonin
    — Improves sleep
  • Optimism is a form of gratitude for the future
  • Appreciating jokes is a variant of gratitude
  • Don’t compare yourself to others who are less fortunate when trying to be grateful

Rely on the power of others

- Depression is an isolating disease, it makes you feel separate and alone, even around other people
- Downward spirals are more likely when you are alone
- You don’t necessarily need to interact, just being around helps
- People who yearn the closeness are most sensitive to rejection
- Social exclusion activates same circuitry as physical pain
- People with low self esteem are more sensitive to social rejection
- Oxytocin:
— Love hormone
— Released during caresses and sex, or when someone trusts you
— Decreases feelings of stress, fear and pain
- People with depression have deregulated oxytocin systems
- Benefits of being with other people:
— Reduce pain and discomfort
— Improve mood
— Ease stress and anxiety
— Counteract social rejection
- If you don’t feel like talking, do an activity with a friend
- Volunteering improves symptoms of depression
- It can be easier to absorb feelings of happiness from others than to generate them in yourself
- Oxytocin and dopamine interact with each other
- Ways to increase oxytocin:
— Hugs and handshakes
— Massage
— Interacting with friends
- While some people find conversations relaxing, others require greater prefrontal processing during face to face conversations and find them tiring
- The more agreeable you are, the less prefrontal effort is required
- Pets reduce depression, change focus, and boosts oxytocin
- Having someone look to you for support can increase oxytocin
- Oxytocin levels can change at beginning of relationships and after breakups
- Oxytocin can makes us worry about other people and that may generate stress
- People who had bad relationships with their parents have hard time getting positive effects of oxytocin

Your brain in therapy

- Psychiatrists and psychologists are part of upward spiral
- Medication helps 30–50% of people get much better, while the rest only get small improvement
- Psychotherapy helps 30–50% of people as well
- Combining medication and psychotherapy doubles chances of getting better
- How psychotherapy changes brain:
— Reduces limbic reactivity
— Increases enjoyment in the brain
— Reduces anxious prefrontal activity
— Strengthens serotonin
- Psychotherapy and medication work in different ways to cure depression
- How antidepressants change brain:
— Finding right medicament is trial and error
— Medicaments allow seratonin to stay in synapse longer and have bigger effect

Conclusion

  • Depression is dysfunction in frontal limbic communication
  • Prefrontal cortex manages emotions and desires so you can plan future
  • Dorsal striatum acts out on old habits
  • Nucleus accumbens controls enjoyment and impulses
  • Anterior cingulate manages attention to negative and positive
  • Insula is responsible for emotional sensations
  • Amygdala mediates anxiety
  • Hypothalamus regulates some hormones and controls stress response
  • Hippocampus is essential to learning and memory
  • Seratonin helps with impulse control, willpower and resilence
  • Dopamine helps enjoy and habits
  • Norepinephrine modulates focus and concentration
  • Oxytocin helps with relationships-
  • All is connected in a feedback loop:
    — Gratitude improves sleep
    — Sleep reduces pain
    — Reduced pain improved mood
    — Good mood reduces anxiety
    — Reduces anxiety helps focus and planning
    — Planning helps decision making
    — Decision making helps enjoyment
    — Enjoyment helps gratitude
The Upward Spiral Workbook: A Practical Neuroscience Program for Reversing the Course of Depression (A New Harbinger Self-Help Workbook): Korb, Alex: 9781684032426: Amazon.com: Books
The Upward Spiral Workbook: A Practical Neuroscience Program for Reversing the Course of Depression (A New Harbinger Self-Help Workbook) [Korb, Alex] on Amazon.com. *FREE* shipping on qualifying offers. The Upward Spiral Workbook: A Practical Neuroscience Program for Reversing the Course of Depressi…

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