The Power of Rituals: Managing Imbalance through the Endogenous Opioid System

1. The Daily 5 Pathophysiology, Mental health and Addiction Rituals protect us from dangers of imbalance Kim Bevill www.kimbevill.com

2. When neurotransmitters enter the synapse…we feel it. When “feel good” neurotransmitters are released by our endogenous opioid system - Immediate mood correspondence - Relieves stress - Boosts our immune system - Pain relief - And too many other cool things to list here

3. Endogenous opioid system Activity and neurotransmitters manage all pain and rewards …Involved in social and emotional processing Daily events trigger this area for feelings of reward like calmness and amusement Manninen et al 2017

4. Activity here relieves emotional & physical pain ...and improves immune system Anterior cingulate cortex activation brings pain relief   (Caruana, 2015) …as do properties of alcohol and drugs like painkillers, marijuana, heroine, cocaine, etc. nicotine and tobacco  food binging, cutting and other unhealthy behaviors EXACT area active during state of happiness (Caruana, 2017)

5. Oxytocin, dopamine, endorphins regulate …our regular daily life increases activity in opioid system during stressful or social stimuli • impacts our amygdala and hypothalamus Regulation is extremely important to calm stress response - Increased oxytocin during/before positive social interaction calms all anxiety-related behavior “stress” and aggression Neuman, 2008

6. Quantity of opioid receptors • Predicts addictive behaviors • Predicts romantic connection • Predicts laughter in a social setting • Promotes resiliency and well-being in general We are born with an amount of receptors (some inherit more, some less) and our daily life impacts the number of receptors (like use of substances) Dunbar 2018

7. Everyday life creates chemistrythe opioid system …reward system 1. Sleep 2. Food 3. Activities 4. Thought process 5. Purpose 5 Daily Rituals Without them… we self-administer with substances

8. One night of disturbed sleep (8HRS) Hormones in craving in all addictions are ENHANCED SIGNIFICANTLY because there is a decrease in leptin and increase in ghrelin! • When leptin is low (no feeling of satisfaction) • When ghrelin is high (triggers craving and binge behavior) …rate of relapse is over 70% at 30 days • One night of disturbed sleep increases ghrelin the next day (and decreases leptin) Increases inflammation • Worsens and causes symptoms associated with mental illness • Inflammation hampers brain’s ability to perceive reward…sets us up for using substances to satisfy the opioid system • Increases belly fat

9. Even ONE extra hour of sleep increases discipline for users Method? 10 minutes of meditating  (Click here for a 10 min meditation) - This resulted in an increase of ONE HOUR …Impervious to relapse!    Decreased by 70% McGonigal 2012, Britton et al 2010

10. Those who slept only 6 hours had MUCH less willpower Frontal cortex function is compromised • Yellow areas (6hrs) show how underactive • Red (8hrs) is overactive (controls impulses) …When underactive the brain doesn’t “remember”…To consider long term goals Sleep deprivation is main way to interfere with discipline or self-control

11. 2. Food…brings chemistry Low levels trigger addictive behaviors Too high levels change hormones (can trigger unhealthy behaviors)

12. Food triggers opioid system • Protein: “becomes” dopamine and norepinephrine • Carbohydrates: “becomes” serotonin (refined and natural: sugar, fruits, veg, bread, pasta) • When serotonin is low you feel depressed, act impulsively, and have intense cravings for alcohol, drugs or sweets • Low blood sugar: feelings of suicide, highly reactive , easily frustrated, craves bread, pasta, cereal, emotionally overwhelmed, depressed  • Processed foods (simple carbs) crash healthy chemistry • Fats improve neural transmission for cognition

13. The right levels allow us to control ourselves • Puts the brakes on impulses (more bread, or mean words or actions) • Low serotonin results in irritability, feelings of isolation, depression • Low levels is feel bad Your brain values balance! If level gets too low it will open up receptors, or crave!

14. Without protein (energy) we will self-administer • Caffeine • Chocolate • Alcohol • Marijuana

15. Receptors want more substance (chemistry) • Some brains are normally in a state that wants more (called upregulated state) and to compensate, they have more beta-endorphin receptors than normal (predisposed to addiction) …their brain “overreacts” to any substance that evokes an opioid system response • For example: babies born into a family who manages “substance usage” or born to a mom with a stressed pregnancy Brain likes the extra serotonin and complains if cut off and the more we do it, the more it needs

16. Omega 3 fish oil (DHA and EPA) • Helps cravings, lowers blood pressure • Helps symptoms of Attention deficits and dyslexia • Prevents and even “treats” depression • Increases creativity and innovative thinking • Improves symptoms of asthma • Causes weight loss…17% less likely to be obese 2,000 to 5,000 mg lowers inflammation …improves endogenous (internal) opioid processing

17. 3. Activity… • Fitness improves academics, mental health and wellness • Physical activity and PLAY improves academics, mental health and wellness …PLAY reduces the risk of depression IN ADULTS too McKercher et al 2012

18. One Activity is superior Play and recreation have a significantly greater impact on happiness…because of the “present time” and feelings of enjoyment increase serotonin, dopamine, beta-endorphins! • Outdoor activities boost the benefits even more. • Time in the sun lowers melatonin levels to allow for falling asleep quickly and staying asleep • Physical activity 3 times a week (for fitness, weight lifting is best) increases neurotransmitters that activate the opioid system (but does not impact levels of well-being and life satisfaction and happiness as does “playful” recreation)

19. Increased bloodflow helps relievepain Low levels of blood flow (depression) prevents focus, memory, thinking Increased flow increases activity in opioid system

20. Play outperforms exercise • Emotional stability: social interaction, sleep, nutrition, mitigate stress • Because we feel in control of the activity, the power to be involved or not is most important, must be able to do the activity with “ease” • Individual control meant a sense of well-being (not controlled solely by coach or identified organizer) PE brings hope! Most reliable predictor is youth who have a positive reaction to “acute bouts of exercise” Cortis et al. 2017

21. Walking increases neurotransmitters and creativity

22. 4. Thought Processes

23. The 3 most important things Current neuroscience shows the following are CRITICAL for happiness and resilience (ability to maintain goals in adversity and manage to “substance use”) 1. Belief that you are in control of your life 2. Present time: do not think of past or future. Any event or life activity and thought process is on the current task. NO MINDWANDERING 3.Deliberate behaviors in the name of increasing feelings of happiness (Write 5 things DAILY that went right, made them thankful and happy)

24. 5. Purpose Provides the “neural” enthusiasm for living

25. Failure to work toward a purpose… Destroys the chemistry that allows us to make choices • The brain “needs” a goal: career, academics, role in a family etc.… • The desire to behave daily to pursue a goal stimulates the brain’s motivation centers Daily purpose ensures the neurology that ensures we “feel” life is worth living

26. Goal-setting • Make Goals • Relieves Stress • Avoid conflict • Assists anger management • Goal accomplishment = surge of dopamine • Goal accomplishment = improve self-image

27. 40 Behaviors that activate in the opioid system Increase dopamine, oxytocin and beta-endorphins that act as REWARD and Pain Relief and counter the effects of “life stressors” Stress triggers the amygdala…

28. Life triggers the amygdala! • Amygdala activation brings the fight or flight response  (cortisol and norepinephrine) Must have relief (or it is a trigger to use a substance)  • As little as 15 minutes of mindful or present thinking acts as an antidote …neutralizes the physiology Herbert Benson, Harvard Mind/Body Institute

29. Monitoring stress in daily life…listing On a scale from 1 to 10 list any and all things from your daily life that are “on your mind”  For example: • My Boss is a jerk (9) • My kids make me mad (10) • I got a ticket (10) • I have no money (10) Allows you to monitor stress and be aware of them as a trigger …only 12 minutes of stress results in seeking “relief”

30. Present Moment…control yourself from re-living past or worry about future in thoughts “Mindful activities” …10 or 15 minutes daily improve ability to discipline thought process Lowers blood pressure and heart rate Decreases inflammation and irritable bowel syndrome symptoms by 38% …because both are stress-induced states decreases belly fat and increases pain tolerance Brita Hoezel 2013

31. Stress triggers a hunt for reward in opioid system After only 12 minutes of a stressor (public speaking)…males and females looked for relief from the stress state (tried to find a friend) Males look for support and he is more willing to trust and share more Berger 2016 Females look for support from females and is more willing to share more (but not trust) von Dawans et al. 2019

32. Social bonding causes an increase in oxytocin, dopamine, endorphins • Which reduces activity in the amygdala (lowers anxiety) • Also increases social “ease” and interaction Pearce, Dunbar et al. 2017

33. Play • Relieves stress, increases dopamine, serotonin, endorphins • PRESENT TIME / MINDFULNESS Jaak Panksepp, 2012

34. Meditation • The minute you bring your focus to a point of your choice (breath, our counting backwards, etc) the amygdala “calms!” • Focusing for 10 to 15 minutes is therapeutic

35. Yoga controls PTSD and Anxiety As little as 30 minutes Decreases anxiety and increases calm Decreases depression Relieves anger, hostility Improves fatigue Even decreases seizures for epileptics

36. Exercise…20 minutes Increases serotonin, dopamine, beta-endorphins, neurotropic factors, blood flow Lowers cortisol levels, lowers depression and anxiety Daily walking for 20 as a habit is perfect

37. Sitting in a dry sauna • 4 times a week for 15 minutes …decreases inflammation, improves cardiovascular function, decreases chance of stroke, delays symptoms of dementia AND DEPRESSION (…infrared sauna doesn’t)

38. Reading something you choose • Reduces stress levels by 68% …After only 6 MINUTES

39. Viewing 7 photos of a puppy or kitten Increases blood flow and improves attention to task Subjects improved video-game performance by 44%

40. Meaningful Relationships Family or Friend or Coworker IS THE MOST POWERFUL! 6 people “you trust” outside your home…increase your lifespan by up to 7 years!

41. The Perception of trust Belief in social support (by loved ones) increases opioid response

42. Partner mitigates pain… Photo of partner…reduced pain -1.01 v. stranger .22 Masters, 2009

43. Photo of loved one…increases pain tolerance Looking also changes negative mood to positive! …in under 30 seconds Hiroshi Nittono ‘12

44. Hugging or any supportive touch

45. More friends…higher pain threshold Pain tolerance predicts social network size Subjects hold a 90 degree “wall sit” held on average (24 to 396 seconds)

46. Eating with other people “Communal eating” has significant social and individual benefits…dinner is most beneficial • Higher rates of happiness • Higher levels of satisfaction with life • More trusting of those eating • More likely to be engaged in the community • Have more friends they “can depend on” Eating leads to bonding: more people, more laughter (can be tricky for someone who “uses”) Dunbar 2017

47. Talking about “important topics” • Increases dopamine in left hemisphere • Sharing increases feelings of closeness and trust

48. A “deliberate” behavior to make another person happy

49. Emotional storytelling • Increases opioid system response • Increases trust and bonding

50. EMDR…calms responsive amygdala A trained professional is necessary • Eye movement Desensitization Reprocessing • Simple eye movements spaced in between brief periods of reflecting on a trauma/ grief/ loss UNPARALELLED effectiveness in psychology today