Microsoft word - 3-15-13 exercises for neuroscience of self-care.docx

PSYCHOTHERAPY NETWORKER SYMPOSIUM, Washington, D.C., March 21, 2013 Neuroscience and the Art of Self Care EXERCISE #1: SHARING KINDNESS Kindness is more important than wisdom, and the recognition of that is the beginning of wisdom.
This exercise is done in groups of four, because a big part of self care is social engagement, meeting each other and developing a sense of community for the day, allowing the regulation and resonance of others to calm and expand ourselves. In your groups of four, you'll each take two minutes to say your name and where you're from, and then share a moment of kindness that has happened to you, this morning already, or earlier in the week, or earlier this year, even back in the third grade. Sharing a moment when someone offered you a gesture of kindness, held open the door, picked up something you had dropped, smiled as you walked down the hallway, sent a supportive e-mail when you were going through a hard time, something that registered in your consciousness as support from the universe, something that gave just a little lift or a little steadiness in that moment. And you'll each take turns doing that for two minutes. Then you'll do another round of two minutes each, exploring what it's like for you, in this moment, to be sharing your story with folks and receiving kind attention, resonance, support, even non-verbally, maybe especially non-verbally, from the others in your group. You'll take turns doing that. Then you'll take a moment to simply become quiet, focus your attention inward, and notice any changes in your sense of being. EXERCISE 2: HAND ON THE HEART We learn tools to calm the body and the mind, because staying grounded in a baseline equilibrium, or being able to return there as quickly as possible when something startling, upsetting, frustrating, angrifying, happens, is essential to our own functioning, our own well-being. These techniques, over time, will help re-set the alarm bell of our nervous system, so that when we experience startle or stress, we can also experience a safety or trust that we can soothe that startle or stress. We develop a safety net of confidence for ourselves that events don't have to overwhelm us, we can comfort and care. First, place your hand on your heart. Feel the warmth of the touch of the hand on your heart. The warmth and the touch signal the brain to release oxytocin, the hormone of safety and trust. It's a natural gesture that soothes the fear and startle reflexes in our lower brain and nervous system. Next, breathe deeply into your heart center. Deep breathing has been taught in the Eastern yoga and meditation traditions for 3,500 years to calm both the body and the mind. When we breathe deeply, especially when we allow a long slow exhale, we activate the parasympathetic branch of the autonomic nervous system, the "rest and digest" branch, which begins to slow down the ramp up of the activating sympathetic branch. Five long slow breaths can be enough to calm down a full-blown panic attack in less than a minute. Next, breathe a sense of goodness, or safety, or ease, or peace, into your heart center. Letting those positive experiences put the brakes on the hard-wired survival responses of fight-flight-freeze-appease. Breathing in positive emotions helps restore a coherent rhythm in the heart rate variability, allowing more ease and flexibility in our responses to whatever challenge we're facing. The next step involves conscious processing, and will help strengthen the structures of the brain we use for regulating the stress responses in our body. Call to mind a moment when you felt safe with another person, when you felt loved and cherished. This may be a moment with your beloved partner or a beloved child, or parent, though the dynamics of those relationships can sometimes be complicated and the emotions mixed, so you may choose a moment of being with a dear friend, a trusted teacher, a close colleague or neighbor, a moment when you felt seen and accepted, loved and cherished. It may be your therapist, your grandmother, a third grade teacher. This person could be a spiritual figure like Jesus or the Dalai Lama. Could be a beloved pet. Pets a great, actually. As you remember this moment in your mind, let yourself feel the feeling of that moment in your body; any warmth or ease or glow. When the feeling in your body is steady, you can let go of the image and just bathe in the warmth of the feeling. When we remember a moment of feeling safe, loved and cherished, or when we are experiencing in the moment feeling safe loved and cherished, we further activate the release of oxyoticn in the brain. Oxytocin is the direct and immediate antidote to the stress hormone cortisol. Knowing we are safe and loved, safely connected to others, is the body's best protection against the damaging effects of stress. Sue Carter of the Chicago Psychiatric Institute and one of the nation's leading. researchers in oxytocin says, "People under the influence of oxytocin don't have the same stress response that others do; bad news rolls off them more easily." EXERCISE 3: PROGRESSIVE MUSCLE RELAXATION There are many techniques taught nowadays to encourage a more relaxed state of body and mind over time. You're probably familiar already with progressive muscle relaxation, popularized by George Benson at Harvard 40 years ago. It works because we now know the body cannot be tense and relaxed at the same time. Sitting or lying comfortably, tensing one muscle group in the body like the muscles in your right foot for 7 seconds, then relaxing that tension while counting to 15. Then tensing the muscles in the calf of your right leg for 7 seconds, then relaxing for 15. Progressing through the entire body, including the head and face, until you help the body come to a state of complete relaxation. The counting to 7 and to 15 gives the mind something to do while the body is relaxing, so we don't keep stirring up thoughts that would tense us up again. This technique is particularly effective to help clients, or ourselves, sleep at night. I have had clients who have used this technique every night for two weeks, and repeatedly fall asleep before they get to the end of the exercise. EXERCISE 4: BODY SCAN A similar technique, gaining in popularity because it is taught in Mindfulness Based Stress Reduction, is the body-scan. When you, or you teach a client to, lie down comfortably, you simply focus your awareness on one particular part of the body, perhaps starting with the right foot, or even the big toe of the right foot. Noticing any tension or contraction in that part of the body, gently breathing a sense of peace and ease into that tension or contraction. I like to smile and say "hello!" to that part, even feel grateful for the health and well-being of my big toe. Then slowly moving awareness from one part of the body to another, until you have breathed a relaxation or releasing into every part of the body, perhaps smiling and saying hello to every part of our bodies. The body scan works because it strengthens the parts of our brain that focuses attention, help us know what's going on in our bodies, and helps regulate or soothe what's going on in our bodies. The kindness of the smile and the hello! helps soothe and comfort any distress or trauma that the body might be carrying. EXERCISE 5: MOVING THE BODY TO REWIRE DIFFICULT EMOTIONS This%is%a%simple%experiential%exercise%I%learned%from%the%psychologist%Natalie%Rogers%to%mindfully%and%compassionately%use%varying%body%positions%to%rewire%(recondition)%difficult%emotional%and% mental%states.%Please stand up and move to a place where you will have some space to move your body a bit. This is a very interior exercise, so please keep your focus inward, not on anyone else in the room. 1.%Identify%an%afflictive%state%that%you%would%like%to%explore,%process,%and%shift.%It%could%be%an%emotion%like%fear,%anger,%or%sadness;%it%could%be%a%mental%state%like%confusion%or%agitation.% Come%into%awareness%of%the%body%sensations,%images,%feelings,%and%thoughts%of%this%state.% %2.%Allow%your%body%to%lead%you%and%come%into%a%body%posture%that%embodies%this%state.%Stay%in%this%posture%for%thirty%seconds.% Don't%do%a%lot%of%thinking%or%figuring%out%here:%just%let%your%body%express%what%you%are%feeling,%or%the%state%of%thinking%you%are%working%on.%For%example,%you%might%allow% your%body%to%assume%the%posture%of%collapse:%perhaps%bending%over,%curling%shoulders%inward,%hiding%your%face%in%your% hands.%Feel%your%way%into%your%body's%experience%of%this%posture.%%3.%Now,%without%thinking,%without%going%to%your%head%at%all%or%putting%anything%into%words,%allow%your%body%to%lead%you% into%a%posture%that%is%the%opposite%of%this%state.%Remain%comfortably%in%this%second%posture%for%thirty%seconds.%For%example,% your%body%might%select%a%posture%opposite%to%collapse%that%involves%standing%tall,%spine%straight,%arms%outstretched% in%exuberance.%Feel%your%way%into%your%body's%experience%in%this%posture.%%4.%Without%thinking,%return%to%the%first%posture,%and%hold%it%again%for%fifteen%seconds.%Then%resume%the%second%posture%again%and%hold%it%for%fifteen%seconds.% %5.%Allow%your%body%to%find%its%way%into%a%posture%that%is%midway% between%the%first%two.%The%middle%posture%may%incorporate%elements%of%the%other%postures,%or%it%may%feel%entirely%new.% %6.%Take%a%moment%to%notice%the%sensations%and%feelings%in%this%middle%posture.%What%are%you%experiencing?%Notice%any% differences%between%the%postures,%between%the%states%they%embodied.%Reflect%on%your%experience.%What%shifted?%What% state%are%you%in%now?%EXERCISE 6: SELF-COMPASSION 1. Mindfulness. As we pay attention to our ongoing experience, we pause and recognize: this is a moment of suffering. This sucks. Or "Ouch, this hurts." Not a judgment, but a realistic appraisal, a wise discernment: this is suffering. When we pause and notice, we give our minds the precious few seconds it needs to notice and name the suffering. I'm upset. I'm furious. I'm scared. I'm lonely. I feel sad. I feel rejected. Noticing not just the experience, but our reactions as the experiencer. Noticing and naming keeps our higher brain on line and functioning, which keeps us mindful of our reactions. We may have a chance to not over-react to this experience of suffering. When we're not hijacked, we're present, we're engaged; we can deal. 2. Self-compassion involves pro-active self-care. It evokes a moment of, "Oh, sweetheart! I'm so sorry you're having to experience this! Aw, I understand; I care, I love you and accept you exactly as you are in this moment." So, we take a moment in the pause to go beyond noticing and naming - this is a moment of suffering - to care, to allow ourselves to care about this suffering. This moment of caring primes the brain, primes ourselves, to take wise compassionate action to address the suffering. 3. Another step is the moment of the wisdom of inter-connection - remembering this pain is not just my personal pain. This is one moment of the pain of the human condition. I am not the only person on the planet who has ever felt this pain; other people have felt, and are feeling, exactly as I'm feeling in this moment. This recognition allows us to hold our pain in a larger awareness, a larger compassion. We open out of our contraction to a larger view; we move from "me" to "we". We let ourselves be held in a grace larger than we can even imagine. EXERCISE 7: SELF-COMPASSION BREAK Take a self-compassion break, many times a day. Checking in, how am I doing? Is there any suffering here? How can I be mindful and compassionate in this moment? How can I help myself here, feel safe, more at ease, more connected to my own experience and to others? How can I use the experience of this moment to remember my true nature, my own inner goodness? Take a moment to say silently to yourself: May I be safe from inner and outer harm; May I be free of suffering, from all causes of suffering, from causing any suffering. EXERCISE 8: Slipping One's Self into the Stream of Compassion 1. Bring to mind a moment when it was relatively easy for you to "feel with" someone else's heartache or sorrow. Your neighbor struggles to carry heavy bags of groceries up the driveway with a recently broken ankle. Your cousin lost his luggage two airports back before he arrived at your house for a weekend visit. Your 8-year old was late for an after school meet-up and the school bus took off for the class picnic without him; he came home and collapsed in tears. Your cat sprained his hip jumping down from too high a kitchen counter, and has limped around the house for three days. 2. Imagine this person, child or pet sitting in front of you. You could even imagine a child or pet actually sitting in your lap. Notice any warmth, concern, goodwill arising in your own heart as you sit with them. Feel the "feeling with," the empathy, compassion and love flowing from your body, your heart to them, sitting with you. 3. When the feelings of empathy, compassion and love are steady enough, shift gears a bit and remember a moment when you were facing your own difficulty, an "Ouch; this is tough; this hurts." However big or small, let yourself feel the pain of your own pain for a moment. 4. Then return to the feelings of warmth, concern, goodwill you felt for the person or child or pet you were first "feeling with." Without changing anything, simply re-direct this flow of empathy, compassion and love for them to yourself. Let yourself receive your own care and concern, you own empathy and compassion for your own pain, for whatever has happened, whatever you've done or failed to do, at any age or level of your psyche that needs to receive it. You may express this feeling toward yourself in words, "May this suffering pass…May things resolve for me….May I feel less upset over time." 5. Let yourself take in feeling understood and nurtured. Let your own heart relax into a more peaceful sense of understanding, compassion, and forgiveness, letting the self-compassion soak in and settle in your body. Let it re-wire your sense of yourself in this very moment. 6. Reflect on your experience of this exercise. Notice any sense of openness or approach to your own experiences now. Notice if this approach stance opens up possibilities for change and resolution of the difficulties that have concerned or hurt you before. As you cultivate an "approach" stance toward experience, you are creating more response flexibility in your brain, thus creating the conditions for more resilience. EXERCISE 9: CULTIVATING GRATITUDE: 2-MINUTE FREE-WRITE Take two minutes to write down things you're grateful in a stream of consciousness way. In addition to focusing on people, things, accomplishments, also focus on moments of positive emotions/behaviors - kindness, generosity, compassion, joy, awe - and notice what happens in body. This exercise can also be done as sharing at a family meal; great way to teach positive and pro-social emotions to kids. EXERCISE 10: GRATITUDE JOURNAL Gratitude journal; at the end of the day, especially in moving from gratitude for people and things and accomplishments to how these experiences make us feel. EXERCISE 11: GRATITUDE BUDDY: %These%days,%more%and%more%connection%with%other%people%happens% through%social%media.%In%rewiring%your%brain%for%resilience,%it's%truly%more%effective%to%find%ways%to%spend%time%in%the%physical%presence%of% other%people.%But%if%that's%not%possible%in%a%busy%life,%or%if%the%people%you%feel%close%to%live%a%great%distance%away,%connecting%by%phone%or%email%can%still%rewire%your%brain%in%a%positive%direction.%The%following% exercise%helps%you%make%the%most%of%those%connections%with%others.%%1.%Identify%someone%with%whom%you%would%like%to%share%your%experiences%of%positive%emotions,%to%broaden%and%build%your%resilience%repertoire.%Ask%this%person%to%be%your%gratitude% buddy%or%joy%buddy,%someone%you%will%share%resilience%building%with.%%2.%Arrange%a%regular%process%for%checking%in.%Once%a%week%for%coffee?%Once%a%month%for%a%walk%in%nature?%Every%evening% by%email?%Experiment%and%discover%what%works%best%for%both%of%you.%%3.%When%you%check%in,%share%moments%of%the%positive%emotion%you're%working%with%-%laughter%in%the%midst%of%trouble%or%uncertainty;%contentment%in%the%midst%of%upheaval%and% change;%friendliness%in%a%hectic%day.%Recall%how%you%felt%when%you%experienced%the%laughter,%contentment,%or%friendliness;% notice%how%you%feel%now%as%you%recall%it.% %4.%Listen%to%your%buddy%checking%in:%notice%how%you%feel%hearing% her%experiences.%It's%most%helpful%when%this%sharing%stays%open%and%receptive,%and%focused%on%the%positive%emotion;% this%is%not%a%time%for%giving%advice%or%solving%problems.%%5.%Notice%how%you%feel%after%checking%in.%Take%in%the%good%of%the% experience%to%reinforce%the%rewiring%in%your%neural%circuitry.%%6.%Thank%each%other%for%the%positive%experience.%You%can% notice%the%positive%emotions%continuing%as%you%schedule%the%next%time%to%check%in.%EXERCISE 12: CARRY LOVE AND APPRECIATION IN YOUR WALLET 1. Identify a group of people who all know each other-your coworkers at the completion of a project, your monthly book club or golfing buddies, family members at Thanksgiving-and suggest everyone send a card or email to everyone else in the group with a sentence or two acknowledging something they appreciate about that person, something positive and true. You can simplify this exercise, if you are comfortable doing so, by asking ten people you know-friends, coworkers, or neighbors, even if they don't know each other-to send you a card or e-mail with a simple phrase or sentence of appreciation. (You may already collect comments like this if you write down what people have written on birthday cards or congratulatory cards.) 2. Assemble the comments sent to you into one piece of paper you can fold and carry in your wallet or tape to the bathroom mirror. Read through this list of emotional nourishment at least once a day for thirty days-a month of steadily resourcing and taking in the good. 3. Each day, after you read through your list, notice how you feel about yourself as you take in and savor the appreciation. Notice where you feel any warmth or glow in your body from reading the list. 4. Set the intention to return to this warm glow of self-appreciation as you move through your day, checking in with yourself periodically. Pause and remember the list (look at it again if you need to) and recall that self-appreciation. 5. At the end of the month, reflect on how reviewing your list of appreciations every day has strengthened your resilience in coping with the new, the difficult, the stressful or hurtful. You may add to the bottom of your own list an appreciation of your growing capacities to create resilience for yourself. This practice is especially helpful at times when your sense of self-worth is being challenged. You're using your own emotional intelligence to create a resource of support as you remember the appreciation of other people. Practices of self-appreciation have been shown to diminish bouts of anxiety and depression. Taking in the love of others and cultivating love for ourselves activates the release of oxytocin, creating the calm in the body and enhancing the neural receptivity in the brain that allows us to learn more resilient strategies of coping. It also provides all the benefits of cultivating positive emotions: putting the brakes on negativity and deepening the wellsprings of optimism, connections to others, resilience, and fulfillment. EXERCISE 13: Taking in the Good %1.%Practice%noticing%moments%of%kindness%and%understanding% as%they%happen%in%your%day,%in%the%moment%or%in%memory.%For%instance,%someone%lets%you%cut%in%front%of%him%in%line%at%the%corner%deli%when% you're%desperate%to%get%change%before%the%meter%maid%tickets%your%car.%Someone%notices%that%you%picked%up%the%trash%left%by%a%park%bench%and%smiles%as%you%walk%by.%A%colleague% stops%you%in%the%hall%to%say%"Good%job"%after%a%presentation%or%offers%you%a%handful%of%cherries%from%her%lunch.%A%new%neighbor%brings%you%homemade%lasagna%after%you've% spent%six%hours%moving%into%a%new%apartment%in%the%pouring%rain,%and%then%checks%the%next%morning%to%make%sure% you're%okay.%%2.%Let%the%experience%register%in%your%mind%and%body,%drop%into%a%felt%sense%of%it;%a% warmth,%a%relaxation,%an%opening% Savor%the%experience%for%10]20]30%seconds.%Notice%how%this%moment%makes%you%feel:%perhaps% acknowledged,%included,%or%happy.%Notice%what%fills%your%heart:%perhaps%gratitude,%joy,%peace.%%3.% Anchor%the%experience%in%a%physical%cue,%touching%your%thumb%and%forefinger%or%holding%the%thumb%of%one%hand%in%the%other%hand,%to%be%able%to%use%the%cue%to%remember%the%felt%sense.% %4.%You%can%reinforce%the%taking%in%of%the%good%by%telling%supportive% friends%about%this%moment%later,%or%by%imagining%telling%your%circle%of%support.%You%can%remind%yourself%again%through%journaling%or%in%an%end]of]the]day%review% of%"three%good%things%I'm%grateful%for%today."%This%repetition%reinforces%the%encoding%of%the%event%in%your%neural%circuitry;%you%can%draw%on%it%again%and%again%as%nourishment% for%your%inner%base%of%resilience.%EXERCISE14: EATING A RAISIN MINDFULLY Please take 3-4 raisins in your hand, hold them, don't eat them, pass the box to your neighbors. Hold three or four raisins in your hand. Notice any reactions to holding the raisins, looking at them, not eating them yet. Notice the color, the texture of the raisins, the lightness of them in your hand. Notice what happens as you lift one raisin to your mouth; notice any change in your experience. Notice what happens when you roll one raisin around in your mouth without biting into it yet; notice the texture; notice your tongue moving the raisin around. Then, notice what happens when you bite into the raisin; notice your experience of taste, smell, sensation in your mouth. Chew the raisin slowly, then finally let yourself swallow the raisin. Notice your experience as the experience changes. Now, put the remaining raisins in your mouth; again notice your experience as you play with, chew, swallow the raisins. Notice your experience after the raisins are gone. EXERCISE 15: Noticing and Naming to Create Options One of the things we gain insight into with mindfulness practice, as we notice and name, are patterns of our experiences as patterns. Mindfulness allows us to be present, in the moment, to the experience that is happening in the moment, reflecting on experience in the moment as the experience that is happening in this moment. With practice, we can notice any thought as a thought, any pattern of thoughts as a pattern. We can notice any feeling as a feeling, any cascade of feelings as a cascade. We can notice any state of mind, even multi-layered, richly complex (torturous) states of mind as a state of mind. We can notice any process of the brain - planning, organizing, evaluating - as a process of the brain. We can notice any story that we've told ourselves since we were five, or twelve, or since we got married, or since we got divorced, since we became a psychotherapist and wished we'd become a welder instead, as a story. We can know that any view, no matter how forcefully compelling or stubbornly held in this moment, is not - does not have to be - true in all moments. We can see clearly that sometimes I think this way, sometimes I don't. I'm thinking or feeling this way now, but I wasn't ten minutes ago or yesterday. We can realize that what we're seeing is not the ultimate truth but are tracings, or the entrenchment, of patterns of neural firing in the brain. %1.%Imagine%you're%walking%down%the%sidewalk%of%a%busy%street%in%your%neighborhood.%You%notice%a%friend%walking%toward%you%on%the%other%side.%You%wave%and%call%out%"Hello!"%but% the%friend%does%not%respond.%Notice%your%own%split]second%reaction%to%that%lack%of%response:%a%contraction%in%your%body,%a%drop%in%energy.%Notice%whatever%thoughts%might%begin% to%cascade%in%response%to%your%body's%reaction.%Maybe%you%think,%"Hmm,%that's%unusual.%I'd%better%try%again."%Or,% "Whew!%He%has%a%lot%on%his%mind.%I%wonder%if%I%should%even%bother%him?"%Notice%any%reactivity%to%those%thoughts.%"Gee,%he%seems%a%little%stuck]up%today."%Or%"Oh,%no!%What%have%I% done%wrong?"%Notice%whether%your%thoughts%follow%a%pattern%that%you%have%noticed%before,%such%as%feeling%bad%about%yourself%or%wanting%to%reach%out%even%more.% %2.%Now%imagine%that%your%friend%sees%you%and,%on%his%own,% waves%and%calls%out%"Hello!"%to%you.%Again,%notice%your% own%split]second%reaction%to%his%connecting%with%you:%maybe%a%smile,%an%uplift%of%energy.%Bring%awareness%to%any% shifts%in%your%body,%notice%any%shifts%in%your%thoughts:%"He%noticed%me!"%Or%"I'm%glad%we%weren't%disconnected%after% all."%As%you%reflect%on%your%experience,%notice%whether%your%thoughts%follow%a%pattern%that%you%have%also%noticed%before,%perhaps%of%relief%or%gratitude.% %3.%Take%a%moment%to%name%the%reactions%and%the%patterns%you%discovered,%with%compassion%for%any%reactions%that%may% have%been%triggered%by%the%noticing.%With%every%moment%of%practice%in%noticing%and%naming,%you%are%strengthening%your% prefrontal%cortex.%And%by%pausing%to%do%this,%you%are%conditioning%your%brain%to%create%choice%points,%giving%yourself%the%chance%to%respond%with%more%flexibility%and%choose%a%different% response%the%next%time.%EXERCISE 16: RELAXING THE SELF INTO NON-SELF One of the most important constellations of patterns we can observe and gain insight into is the "self" - the constellation of thoughts, feelings, behaviors we and others come to identify as "me" or "I". This "I" is seen in traditional mindfulness practice as ever-changing, ever-unfolding, nothing fixed or permanent when thoroughly unpacked as a "mental content." With steady practice, mindfulness begins to penetrate the "substance" of our personal self, much as modern physics has been able to penetrate the "substance" of any material object. Modern physics has probed the reality of nature to discover there is far more space between atoms, and particles of atoms, than there is "stuff," a vast spaciousness in the densest of matter, paralleling the vast spaciousness between the stars in the galaxies. Similarly, the practice of mindfulness allows us to begin to experience a similar spaciousness between the thoughts and judgments and reactivities of our "self" and experience more of the flow, the possibility of shift among all the "stuff." We begin to experience a flow between the "objects" of our awareness. We get unentangled from the entire commentary about self as self. When we loosen our grip on the "stuff: of our "self", we relax directly into an experience of openness, clarity, calm. With practice, this drop can happen within a breath or two. This new "object" of our awareness - non-self - is called true nature in the Buddhist tradition, but it is a universal phenomenon called presence, essence, the sacred in other traditions. 1. Sit comfortably. Allow your eyes to gently close. Focus your awareness on your breathing, gently in and out. Focus your awareness on your breathing, and then notice your own awareness of your breathing. Awareness allowing you to know you are breathing. 2. When that awareness of your breathing is steady, begin to notice the breathing of the people around you, no need to do anything, just noticing other people breathing as you are breathing. And noticing your awareness of that. Expand your awareness a bit to know that all the people in this room are breathing; become aware of everyone here breathing together, and become aware of your awareness. Expand your awareness more to include people you know, who are not in this room, and you know they are breathing in this moment, too. Notice your awareness of your awareness of everyone breathing. Expand your awareness to include people you don't know, outside this room, perhaps elsewhere at the conference, elsewhere in Washington; become aware of all kinds of people breathing, breathing together. Notice your awareness of your awareness. 3. Expand your awareness to include people all over the country, all over the planet, all breathing. Expand your awareness to include all living creatures, breathing, breathing in the parks, the forests, underground, in the lakes and rivers, in the oceans, the sky. All sentient beings breathing, breathing together. And notice your awareness of your awareness of the breathing. Expand your awareness to include all forms of existence, some breathing, some not. 4. Expand your awareness beyond our planet to all the forms of existence, and the space between the planets and stars. Expand your awareness out as far as you can imagine; and notice your awareness of your awareness expanding. 5. Now bring your awareness back to being aware of sitting in this room, in this moment, breathing, hearing my voice. This relaxation into spacious awareness is what allows intuition, creativity, new possibilities to emerge with an authentic truth sense, this is right, this is true, this is home. Being in the beauty and splendor of nature and wilderness, being in awe, will open up the spacious awareness, too. It is the mature pre-frontal cortex that allows us to toggle back and forth between these two networks of self and non-self. Meaning a mature pre-frontal cortex is what allows us to be self-aware; to accomplish the developmental task of developing a functional personal self and remaining aware of that self and feel safe enough to "let go" of that self into a more spacious consciousness as well, a more flexible neural receptivity that allows us to re-wire different patterns constellating the personal self more easily, should we choose to do that. EXERCISE 17: DEEP LISTENING I first learned this exercise from Jon Kabat-Zinn, developer of Mindfulness Based Stress Reduction. This exercise is done with a partner. Decide who will be speaker first all the way through and who will be the listener first all the way through. When you have each answered the repeating question fully, you can switch roles so you each get the benefit of practicing listening and being listened to. The listener will ask the speaker a question (samples below); the speaker will answer as honestly, as thoughtfully, as they can. The listener listens silently, though attentively and appreciatively. The listener then simply says "Thank you for letting me know that." And asks the same question again. The speaker drops a little deeper into their own inner truth and answers the question again from a different angle or from a deeper level of understanding. The listener listens as before, and when the speaker is finished, again says. "Thank you for letting me know that," and then repeats the question again. The speaker answers the repeating question for as many rounds as they are still discovering new understandings or feelings about the question. When the speaker is done (and thanks the listener for listening), the two of you switch roles. When you have both completed the rounds of listening and being listened to, you can de-brief, sharing what you noticed about your experience in each role. Sample questions. How do you best care for yourself? How do you love and accept yourself.? EXERCISE 18: See Yourself as Others See You Settle comfortably in your seat, allow your eyes to gently close, focus your attention on your breathing, rest comfortably in the simple presence of awareness. When you're ready, let yourself become aware of how you are holding yourself in this moment, are you kind toward yourself? Are you uneasy with yourself? Are you feeling critical of yourself? Just noticing, just awareness and acceptance of what is, without judgment, or if there is judgment, noticing that. Then, when you're ready, bring to mind someone in your life whom you know unconditionally, genuinely loves you. They love and cherish you; your very being feels safe in their presence. (This sounds like a repeat of the first exercise; keep going.) It could be a teacher or dear friend, could be a partner or a child, could be your beloved dog or cat. Could be a spiritual figure - Quan Yin or the Dalai Lama, your own Wiser Self. Someone who simply accepts you as you are, and loves you. Imagine yourself being with them face to face,. They are looking at you with such acceptance and tenderness, such love, such joy. Feel yourself taking in their love, their acceptance of you. Now imagine yourself being them, looking at you, looking at yourself through their eyes. You - being them - seeing yourself as they see you. All the love and openness, feel that as them toward yourself. Now come back to being yourself, you are in your own body again, experiencing them looking at you again, with so much love and acceptance. Feel yourself taking in their love, their acceptance. Let the love deeply into your own being. Feel it in your body; set the intention to remember this feeling any time you need to. RE-CONDITIONING 1. Anchor your awareness firmly in the present moment. You are safe here and now and will still be safe even when you retrieve a troubling memory of what happened back there, back then. 2. Focus your awareness on your positive resources: positive self-regard, self-acceptance. Trust your innate goodness, and evoke the wisdom of your wiser self. First, we consolidate a resource of positive memories - initial consolidation. Why cultivating positive emotions is so helpful to self care. The neural networks of positive states are firing - falling apart and reconsolidating in the brain naturally, so quickly we don't even notice the process. Be well resourced in your own goodness before beginning anything else. Draw upon your refuges and resources. 3. Start small! Work with a teaspoon of trouble, not a ton. Recall one small, specific relational instance when resilience went awry: * you were chosen last for the neighborhood softball team, and the sting of not being good enough lingers to this day; * you forgot to leave the car windows cracked when you dashed into the drugstore; you were delayed, and your new puppy in the backseat almost collapsed from heatstroke. * at your daughter's preschool, you blurted out the news of a teacher's cancer diagnosis in front of a group of parents. * you got a speeding ticket with a potential client in the car. * you were a little flip in your response to someone's money worries, responding with a quick slap on the back and a "Keep your chin up," and now they've ignored you for two weeks; Shame and guilt can carry such an intense charge that incidents like these may not seem at all small. If that's the case, just bring to mind the first moment or one small piece of the experience. When we deliberately focus our attention on a negative memory we want to resolve or dissolve, the focused attention causes the neurons constellating that memory to fire at every level - from implicit body-based and emotional memories to explicit cognitive thoughts. Neuropsychologists call that process "lighting up the network," making the old memory available for rewiring. 4. When this negative memory is vivid, bring to mind a memory of feeling genuinely seen and deeply loved and accepted by another person (or a pet), of being seen for real. Let yourself receive this love and acceptance and feel it in your body. 5. Hold both the negative memory and the positive memory of love and acceptance together in your awareness at the same time - simultaneous dual awareness. If this is difficult at first, toggle back and forth between the two, always strengthening the memory of love and acceptance. Focusing our conscious awareness on the second memory "lights up" the neural networks of that memory also. Now the neural networks of both memories are lit up simultaneously, held in a dual awareness. (This does take practice; this re-pair is how the brain re-wires.) As the paired memories are held in conscious awareness simultaneously, the networks fall apart and reconsolidate together. When the positive memory is strong enough (the "lake" of mindfulness, empathy and positive emotions large enough) the reconsolidation of the positive memory will trump the reconsolidation of the second more negative memory, re-wiring them together in a more wholesome way, often instantly, often permanently. 6. When this simultaneous awareness of the paired memories is steady, gradually spend more time focusing on the positive resourcing memory, strengthening the felt sense of love and acceptance in your body. After a moment, let go of the pairings and let your attention rest solely in the experience of self-love and self-acceptance. Take a few moments to savor the resting in this self-love and self-acceptance. 7. Reflect on your experience. Notice any shifts you experience from doing this exercise. Repeat this process of reconditioning as many times as you need to in order to fully dissolve the shame or guilt connected with a particular memory. The more often you practice this process with specific memories, the more you will be reprogramming those deep neural networks associated with toxic shame. As we intentionally work with the memories of feeling bad because of who we are (shame) or because of something we did (guilt), it's helpful to remember that implicit memories can feel completely true in the present, with no sense whatsoever that they are memories from the past. As we recondition, we pair explicit positive feelings of pride or of loving, caring acceptance, recognizing these as experiences in the present, with the negative toxic memories that we recognize as belonging to the past. This reconditioning can also happen in therapy; in healthy intimate relationships; with an attuned friend, a beloved benefactor, or a devoted partner; and in our imagination. Repeating this process strengthens the neural circuitry until the love and acceptance become the new normal. Our growing capacity to evoke and feel love and acceptance becomes the superhighway of resilience; old shame and guilt become the country backroad we don't have to go down anymore. EXERCISE 19: WISHED FOR OUTCOME 1. Sit comfortably in your chair. Focus your attention on your breathing, breathing calmly and deeply into your heart center. (Hand on the Heart is just fine, too.) Call to mind a particular moment of ease and well-being. Or a particular sense of your own goodness. Or a particular moment when you felt safe, loved, connected, cherished. Or specific people who love you, who believe in you. Remember one of these moments in as much detail as you can, in as many levels of your body-brain as you can - a visual image, the feelings that the memory evokes, where you feel those feelings in our body, any thoughts you have about yourself now as you remember the sweetness of that moment then. Let yourself savor this moment in a mindful and compassionate "holding" of the memory. 2. When you feel bathed in the good feeling and are still anchored in the larger awareness of safety in the present moment, call to mind a moment of experience when things went awry between you and another person, however slight or terrible, a hiccup or a hurricane. (But chunk down the terrible to one little bit of it. Start with a small storm and work up to the hurricane.) As you go back into the memory of that moment, imagining what was happening then quite vividly, remain in your observer role rather than getting sucked into the experience again. Evoke this memory to light up all the neural networks - visual images, body sensations, emotions, thoughts or beliefs at the time. Memories of what you said and did, what someone else said or did; who else was there; how old you were and how old they were; what you were wearing and what they were wearing, Maybe you wish you could have said or done something differently at the time, but didn't. Maybe you wish someone else had done something differently at the time, even if that could never have happened in real life. Remember the moment, the feelings of the moment, in as much detail as you can. 3. Then, in your imagination, begin to visualize a more positive wished for outcome. What you wish could have happened differently. What you would have said or done differently. What the other person could have done differently, even if this never could have happened in real life. What someone else not even in the original scenario could have said or done. Perhaps you even wish none of this had happened at all. You can imagine what would have happened if this event hadn't happened. Imagine the new scenario in as much detail as you can. Let the new story unfold as you would have wished. You are creating a scenario that completely disconfirms or contradicts what happened before. 4. Hold the two scenarios in your awareness at the same time. You don't have to do anyting here; your brain knows how to do this on its own. It's its own mechanism. (Or toggle back and forth between them, always refreshing the newer, more positive scenario to be stronger.) After a few moments, "let go" of what happened before and just rest your attention in the new scenario. Let your mind play out this new scenario, and then notice how you feel now. Notice any emotions or thoughts or beliefs about yourself that come up now, and if they are more positive, resilient, let them soak in. Then bring your awareness back to the present moment. This technique does not change what happened, but it does change our relationship to what happened, especially if the positive memory directly contradicts or disconfirms the negative memory. It doesn't re-write history but it does re-wire the brain. No one promise this experiment will work right off the bat. This is how we re-wire trauma. EXERCISE 20: HONORING GOODNESS IN SELF AND OTHERS [I first learned this exercise from Jack Kornfield at Spirit Rock. Joanna Macy also teaches it. And I've incorporated an adaption I learned from Kristin Neff.] 1. Invite a friend to do this exercise with you. Sit across from each other so that you can gaze comfortably at your partner. Decide who will be A and who will be B. Do the entire guided meditation together in a spacious silence. 2. Both of you simply gaze into your partner's eyes for a moment, then both of you gently close your eyes. A's re-open your eyes, and let yourself imagine in your partner the nobility of her true nature, the innate goodness and radiance of her being. Silently wish her well, sending her expressions of loving kindness: may you know the deepest happiness; may you have ease of mind and heart. B's, let yourself receive the loving kindness your partner is sending you. Let yourself take in the kindness being offered. 3. A's close your eyes; both of you reflect on your experience of giving and receiving loving kindness. 4. B's open your eyes. Let yourself imagine in your partner the nobility of her true nature, the innate goodness and radiance of her being. Silently wish her well, sending her expressions of loving kindness: may you know the deepest happiness; may you have ease of mind and heart. A's, let yourself receive the loving kindness your partner is sending you. Let yourself take in the kindness being offered. 5. B's close your eyes; both of you reflect on your experience of giving and receiving loving kindness. 6. A's open your eyes. Imagine what human sorrows your partner might have experienced in her journey, what losses, what griefs, what pain of the human condition. Silently begin to send her expressions of compassion: may you be safe from inner and outer harm; may you be free of suffering, from all causes of suffering, from causing any suffering; may your sorrow ease; may your sorrow cease. B's let yourself receive your partner's compassion for your sorrow and suffering. Let yourself take in the care and compassion being offered. 7. A's close your eyes; both of you reflect on your experience of giving and receiving compassion. 8. B's open your eyes. Imagine what human sorrows your partner might have experienced in her journey, what losses, what griefs, what pain of the human condition. Silently begin to send her expressions of compassion: may you be safe from inner and outer harm; may you be free of suffering, from all causes of suffering, from causing any suffering; may your sorrow ease; may your sorrow cease. A's let yourself receive your partner's compassion for your sorrow and suffering. Let yourself take in the care and compassion being offered. 9. B's close your eyes; both of you reflect on your experience of giving and receiving compassion. 10. A's open your eyes. Imagine what human joys your partner may have experienced: what accomplishments and competencies she might have achieved; what blessings of abundance and love she might have experienced. Silently begin to send her expressions of sympathetic joy, happiness for her happiness: may you fully delight in your delight; may you feel your joy deeply. B's, let yourself receive your partner's joy in your joy. 11. A's close your eyes; both of you reflect on your experience of giving and receiving compassion. 12. B's open your eyes. Imagine what human joys your partner may have experienced: what accomplishments and competencies she might have achieved; what blessings of abundance and love she might have experienced. Silently begin to send her expressions of sympathetic joy, happiness for her happiness: may you fully delight in your delight; may you feel your joy deeply. A's, let yourself receive your partner's joy in your joy. 13. B's close your eyes; both of you reflect on your experience of giving and receiving compassion. 14. A's open your eyes. Begin to express wishes for your partner for calm abiding and equanimity: whatever happens on your journey, may you perceive and respond to it with a calm ease of mind and heart; may you have deep inner peace. B's let yourself receive your partner's wishes for equanimity and calm abiding for you. Let yourself take in the calming energy of her well-wishing. 15. A's close your eyes; both of you reflect on your experience of giving and receiving wishes for equanimity and calm abiding. 16. B's open your eyes. Begin to express wishes for your partner for calm abiding and equanimity: whatever happens on your journey, may you perceive and respond to it with a calm ease of mind and heart; may you have deep inner peace. A's let yourself receive your partner's wishes for equanimity and calm abiding for you. Let yourself take in the calming energy of her well-wishing. 17. B's close your eyes; both of you reflect on your experience of giving and receiving wishes for equanimity and calm abiding. 18. Then both of you take a moment, eyes still closed, to simply noticing whatever is going on for you right now: awareness of your inner experience, and awareness of your awareness. Notice and reflect on any changes in your inner, subjective sense of self. You may notice a sense of spaciousness, less defensiveness, more openness. EXERCISE 21: WIRING IN CURRENT CONFIDENCE FROM PREVIOUS COMPETENCE 1. Identify areas of your life where you would like to have more of the feeling of "Sure I can!" They might include returning to school after thirty years in the workforce, buying into a franchise, or facing an empty nest when your youngest child has moved away. 2. Identify three moments in your life when you actually had that sense of "I can!" in your body - a visceral sense of confidence arising from a moment of competence. Reflect not so much on what you did, because that will change with circumstances, but on how you felt when you realized that you had done it. Remember, we're talking moments here, not major events: opening a stuck jar lid for your mom, intuiting which way to turn to find the train station in a strange city, knowing just what to say when your child experienced a disappointment. Modest but genuine successes can mean just as much for rewiring the brain as those that are more dramatic. 3. Focus on the sense of mastery those successes brought you. How does that remembered sense of mastery feel in your body now? Take in the feeling of "I did; I can" as a bodybased resource. 4. Try to bring that visceral sense of "I did; I can" into the present and apply it in the areas where you would like to feel this confidence more often. Even the slightest success at doing this reconditions your brain toward resilience. EXERCISE 22: DO ONE SCARY THING A DAY Whenever we're about to venture into something new - moving across the country, getting married again, taking on a new job, finally fixing the leaky showerhead - we can feel a hesitancy, a pullback within - a somatic feeling of "Uh oh! Strange territory! Don't know if I should be doing this!" - even though, consciously, we might very well want to forge ahead. Our resilience goes on hold. To overcome this somatic marker of "uh, oh!" we need to practice doing what feels risky or scary anyway. When we deliberately face our fear of doing something new, something that could possible go wrong or evoke deep doubts about ourselves as human beings, we come to the brink of that somatic threshold that would block us from moving forward or that would steer us back into the certain, the familiar, the comfortable. By choosing to face the fear and intentionally cross the threshold into action, we are deliberately choosing to evoke new experiences that would re-condition the signal anxiety in our nervous system. By pairing an old pattern of fear or block with a new more positive pattern of courage and action, we contradict the old - neural deconsolidation-reconsolidation at its finest - and we re-wire it. In your small groups of four, take a few minutes each to brainstorm what are some of the one scary things a day you could do when you return to your office, your life, on Monday morning. And how could experiences from today or this conference help you do them? EXERCISE 23: WIRING FOR RESILIENCE BY FINDING THE GIFT IN THE MISTAKE %Our%brain%rewires%from%the%experience%of%making%a%mistake.% When%our%choices%turn%out%to%be%problematic%for%ourselves%or%others,%we%can%learn%from%them%by%asking,%"What%did%I%not%see?%What% could%I%have%done%differently?%What%can%I%do%differently%now?"%As%the%neuroscience%writer%Jonah%Lehrer%says,%"We%turn%a%regrettable%moment%into%a%teachable%moment."%We%can%learn%to%find%the%gift%in% the%mistake%in%the%form%of%a%belief%that%"I%am%learning;%I%am%coping."%1.%Ask%a%small%(safe!)%group%of%friends%to%come%together%to%"look%for%the%gift%in%the%mistake."%%2.%Each%person%shares%common%mistakes%first,%the%sort%of%mistakes%that%anyone%might%make:%getting%distracted%and%running%a%red%light;%accidentally%deleting%all%the%emails%confirming% travel%reservations;%forgetting%to%enroll%in%a%health%insurance%plan%by%the%deadline%and%now%having%to%appeal.% Find%some%comfort%(not%judgment)%in%the%universal%imperfections%of%being%human.%%3.%Expand%your%sharing%to%include%mistakes%that%had%bigger%external%consequences%-%putting%off%going%to%the%doctor% until%"just%a%cough"%landed%you%in%the%hospital%with%pneumonia%for%a%week%-%or%internal%consequences%-%the%guilt%you%feel%because%that%hospitalization%caused%you%to%miss% your%daughter's%graduation%from%college.%%4.%Let%the%compassionate%reflection%of%others%in%the%group,%as% well%as%your%own,%allow%each%person%to%"own"%their%mistake,%discern%what%lesson%could%be%learned%from%it,%and%find%the% gift%in%it,%according%to%the%following%narrative:%this%is%what%happened;%this%is%what%I%did%to%survive;% this%has%been%the%cost;%this%is%what%I%have%learned;%this%is%how%I%can%respond%to%life%now.% %Even%if%the%gift%is%simply%a%deeper%intention%to%pay%closer%attention% as%we%careen%through%our%days,%or%to%be%kinder%to%ourselves%in%our%imperfect%humanity,%we%have%found%the%gift.%Exercise 24: LAUGHTER Workers who laugh regularly, long and hard, focus better, think more creatively, and problem solve better than co-workers who do not. People who laugh tend to be more efficient, more productive, and make fewer mistakes than their stressed out co-workers. Turn to a neighbor - how can you plan to build more laughter into your day, your life.


Highlights of prescribing information

HIGHLIGHTS OF PRESCRIBING INFORMATION (NSAID) or colchicine upon initiation of treatment) may be beneficial These HIGHLIGHTS do not include all the information needed to use ULORIC safely and effectively. See full prescribing • Cardiovascular Events: A higher rate of cardiovascular information for ULORIC. thromboembolic events was observed in patients treated with ULORIC tha

Tender for procurement of drugs and medical consumables

TERMS, CONDITIONS & SPECIFICATION FOR SUPPLY DRUGS AND MEDICAL CONSUMABLES FOR A PERIOD OF ONE YEAR Name of the District / Health Institution:_CDMO, NUAPADA (HEALTH & F.W. DEPTT., GOVT. OF ODISHA) Tel: 06678 - 223346 /223908/ 223118: Fax: 06678 – 223346/ 223118 Bid Reference No. 02/DMC/2011-12 LAST DATE & TIME OF RECEIPT OF BID DOCUMENTS : 13.10.2011 up

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