Using Flow States to Move from Anxiety and Depression to Optimal States of Thriving
Carol Kershaw and Bill Wade
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Anxiety and depression have been difficult issues to find lasting cures. Around the world, the number of those who suffer with these afflictions grows each year. Traditional treatment paradigms have explored improving cognitions, developing insight, resolving trauma, and balancing neurotransmitters. While psychotropic medications and psychotherapy have been helpful, many people find themselves on cocktails of medicine and have a history of utilizing many therapeutic experiences without enduring change. The clinical imperative is to shift symptom patterns into solution states that reflect emotional regulation mastery (Rossouw, 2014).
Habitual negative mental states often rigidly pattern and evolve into a personality trait over time.
When clients are in negative states, it is difficult for them to rebound from the sudden insults of life, and they can lose their internal locus of control. It becomes challenging to rationally perceive options in a difficult situation (van der Kolk, 2014). Habitual negative mental states often rigidly pattern and evolve into a personality trait over time. Life challenges, including the onset of illness, loss, trauma or chronic stress, can result in “action immobilization”. The fight/flight/freeze/faint response blocks a neurological reset so that one’s sense of perspective freezes and confusion reigns. It is as if a person is living in the past by repeating the same mental habits and mindsets learned long ago of rumination, depression and anxiety, and avoiding risk each day.
With the explosion of neuroscience discoveries over the last 20 years, mental health is evolving a new paradigm stemming from the neuro-revolution in psychology that views anxiety and depression from a new perspective. Rather than focusing on imbalanced neurotransmitters and cognitive symptoms, which keeps people stuck in the past, perceiving these issues in terms of the brain’s neuroplasticity and its electrical functioning provides new intervention tools (Doidge, 2015). We now know that brain cells are in constant electrical communication and that the brain has enormous potential to heal, change, grow and develop throughout life. The process of creating new cellular connections becomes a source of healing. These connections can be intentionally strengthened or weakened with attention. By using competitive plasticity to override a natural tendency to ruminate, running anxious or depressive movies in the mind, the brain can be taught to use the same internal visual system to change states, condition them, and change the mental theater by using competing states. This is the process of using the mind to change the brain (Doidge, 2015; Kershaw & Wade, 2012).
The new focus in psychology is on understanding brainwave patterns that affect mental and emotional health, mind states and personal narrative. When inner states shift toward the positive, thought patterns improve which “turn on” previously inactive brain circuits. Then the task is to learn how to shift and train attention to stay in desired mental states for longer periods of time—once clients understand how to develop this mental flexibility, changing their personal problem narrative is easier. Due to the brain’s ability to form new connections (neuroplasticity), neuroscience discoveries are showing that the brain can be rewired to stay in happiness and calm for longer periods of time (Schwartz and Gladding, 2011). The key is to build a better brain through specific training that move us from living in survival states to higher level mental states of self-compassion, generosity, flexibility, warmth, and belly-laugh humor. These higher mental states often need to be activated by the clinician as well as inner resources of the client such as courage, persistence, facing fears, and following through on achieving goals.
The heart produces an electric field 600 times as large as the brain’s and extends farther outside the body.
This paradigm has its roots in the new science that examines the body/mind connection through the electromagnetic system of the brain and body. All cells give off electricity, creating a measurable electrical field that surrounds the body. An electroencephalograph measures the brain’s electricity, and an electrocardiogram assesses the heart’s electricity. Each organ system creates an electric field as well (Oschmann, 2000; Wisneski & Anderson, 2009). The brain emits a strong electric field that reaches outside the body. The heart produces an electric field 600 times as large as the brain’s and extends farther outside the body. Research from the HeartMath Institute (https://www.heartmath.org/) has demonstrated the impact of emotional states of anger, resentment, love, and compassion on the energy field of the heart: negative states, for example, lead to incoherent brain and heart waves, while love, compassion, generosity, and calm lead to coherent functioning (McCraty, Atkinson, Tomasino, & Bradley, 2009). As well as these inner states being reflected in the brain’s EEG, they are also reflected in blood flow, neurotransmitters, and body chemicals. Under stress, the brain resorts to functioning in higher beta states of anxiety that run around 23-35 Hz (Seo & Lee, 2010). Chronic stress often moves the brain into a dissociation from theta states of 4–7 Hz . This shift creates foggy thinking and sometimes frustration, disappointment, and depression (Jena, 2015).
A feeling of threat causes blood to pool in the center of the body and away from the extremities, so temperature lowers. Stress causes the brain to release cortisol, adrenaline, and epinephrine. Neurotransmitters such as dopamine, the feel-good and motivation chemical, are lowered, and the brain actually shrinks under these conditions. Balance can be restored according to how an individual pays attention to inner thoughts, feelings, and life experience.
Another element in the new paradigm comes from a concept called state-dependent memory and learning, which was first proposed by Donald Goodwin and colleagues at the Washington University Department of Psychiatry in 1969, and in the research from neurofeedback over the last 20 years. Goodwin and his colleagues conducted a research study focusing on memory and alcohol (Goodwin, Powell, Bremer, Hoine, & Stern, 1969). They asked a group of college student volunteers to drink to inebriation and then memorize a list of nonsense syllables. Upon sobering up, the researchers asked the students to repeat what they memorized, which they failed to do. Without allowing them any time for review of the words, the researchers required their subjects to become drunk again. This time the students easily repeated the list of words. The results of the study demonstrated that information is encoded in a state of mind. When needing to recall learned material, or an emotional resource like feeling confidant, an individual must re-enter the same state of mind in which it was learned or experienced (Goodwin et al., 1969). Therefore, in order to access the mind’s ability to come up with generative solutions and overcome depression and anxiety, a change in state of mind is required.
Research in neuroscience has discovered that neural pathways are laid down with experience, activate with habitual patterned thought, and shrink from non-use. The oft-quoted maxim that neurons that fire together wire together (Hebb, 1949) describes the establishment of neural pathways. Neuroscience has since contributed an additional maxim—neurons that fire apart, wire apart—meaning that when we change an activity or develop a new way of thinking, different pathways emerge. Accepting negative feelings are important to mental health. But, rather than regularly running Stephen King-type horror movies of the mind, positive mental states that are practiced lead to more positive behaviors connected to an imagined future that clients want to create.
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Neurofeedback technology has contributed immensely to the new paradigm by demonstrating that practicing certain states of mind with feedback allows a client to improve brain function. This improvement manifests as greater happiness and less reactivity to life events. It is as if the brain receives an upgrade.
In a fairly short treatment time of 20 to 40 sessions, neurofeedback has been shown to dissipate depression and anxiety, increase focus, raise IQ, and improve clarity and awareness (Chapman & Chapman, 2013). It is a brain training that works by inhibiting those frequencies that are above a therapeutic threshold and reinforcing those frequencies that are below a therapeutic threshold. During treatment, a client is hooked to a specialized computer via electrodes and plays a video game by staying in the mental state that will run the game. If the client stops being in that state, the game stops running. Over time, the client learns how to pull up the appropriate state independently from the neurofeedback system when needed.
Deep-state training with alpha/theta frequencies has allowed clients to overcome alcohol and drug problems, post-traumatic stress disorder (PTSD), and have transformative experiences. When clients learn to raise theta (deep meditation frequency) over the other frequency amplitudes, quite profound experiences often occur. Creative solutions to problems seem to suddenly flash into mind; perspectives on problems may shift to a bigger picture, and compassion toward the self and others increases.
This deep state allows the brain to release a neuropeptide called anandamide, a Sanskrit word for bliss. Anandamide has a similar chemical structure to marijuana and seems to be important in the body’s healing system for both emotional stress and physical illness. Just as the body has a stress system, it also employs a theta healing system which may point toward a new frontier in psychotherapy and medicine (Wisneski & Anderson, 2009).
Distinct ranges of frequencies and amplitudes reflect inner states. These states are composed of brain frequencies measured in Hz (cycles of electrical activity per second) that can be recorded on an encephalograph and evaluated with a quantitative EEG. This assessment of brain function compares each client’s EEG data with norms based on gender and age and reveals areas where the brain may be over- or under-aroused. How things are being perceived can be gleaned from a quantitative EEG (Demos, 2005).
All of the ranges of frequencies can be considered in determining a client’s mental states that can be both troubling and helpful. Several have been identified. Gamma is the highest beta frequency, ranging from 35–70 Hz and above, and is associated with enlightenment experiences of transformation. These waves are correlated with a “super consciousness,” awareness, and more love and compassion. Synchronous bursts of 40 Hz organize the brain and develop mental sharpness. High beta operates from 21–34 Hz and often reflects anxiety. Mid-range beta runs from 12–20 Hz and activates with cognitive tasks. Sensory motor rhythm is recorded from 12–15 Hz and is the brain’s most stable frequency. Alpha shows up at 8–12 Hz, with 10 Hz being natural alpha and used for self-comfort. This is the state where love, forgiveness, creativity, and compassion reside. Interestingly, with chronic alcohol overuse, this frequency disappears and a person may develop more anxiety. Theta resonates from 4–7 Hz and is a deep meditation state. Delta reflects the slower frequency that is found in sleep but tends to rise with high stress or changes in hormonal levels and manifests as foggy thinking. The brain manufactures all of these frequencies day and night but depending on the task or time of day, one range is more dominant.
Humans move through many states each day that create our frames of perception and are connected to patterns of behavior. These different states result from electrical and chemical changes in the brain. Jim Grigsby and David Stevens (2001) suggest that our states lead us to behave in certain ways. Thus, if clients can learn to intentionally shift states, they have more flexibility in living.
A variety of activities can alter states. Where a person places attention, inner reactive movies and perceptions, posture and breathing, the language used to describe events and interactions with others can all shift inner states; even the act of moving the facial muscles into a smile shifts states. When one pets an animal, the brain releases oxytocin and the mental state shifts; when listening to music, dancing, singing or exercising, the mental state shifts.
States are emergent properties of the brain’s self-organizing system (Grigsby & Stevens, 2001). We can think of them as falling into three distinct categories (Bailey, 2001): executive, or problem-solving (What can I do with this experience or activity?); emotional/attachment, or connection (Am I loved?); and survival, or safety (Am I safe?). Each state or category accesses a different brain system: executive states access the prefrontal cortex; emotional states access the limbic system; and safety states access the autonomic nervous system.
Humans have a biological need to alter states. Every 90–120 minutes the brain moves into the ultradian rhythm that shows up as a down period of fatigue, a tendency to blank out, feel hunger, yawn, and a need to rest (Rossi & Nimmons, 1991). To maintain peak performance, it is best to honor these phases with a 20-minute period of relaxation. However, most people push through the fatigue with caffeine or sugar, which stresses the system and creates imbalance that can lead to anxiety and depression. As Jim Loehr and Tony Schwartz state in The Power of Full Engagement (2003, p. 31):
We are capable of overriding these natural cycles, but only by summoning the fight-or-flight response and flooding our bodies with stress hormones that are designed to help us handle emergencies. The long-term cost is that toxins build up inside us. We can only push so hard for so long without breaking down and burning out.
The result of inattention to this biological rhythm results in irritability, aggression, insensitivity to others, eating sugar and carbohydrates, and drinking alcohol to push through fatigue. What often results is chronic illness, relationship stress, anxiety, depression, and a full-blown acceleration syndrome, where life continues at increasing speed until something breaks down. Without a bioenergetic rebalancing by honoring human biology, life becomes more stressful and begins to lack meaning; and then health issues arise.
When people override their biological rhythms, problems tend to manifest from an inability to shift a range of frequencies (states) quickly. If a person cannot pay attention to a task at hand but stays in a sleepy mode, it could be a problem with a brain that cannot shift into beta. This hindrance frequently manifests as daydreaming and drifting attention while attempting to focus on cognitive tasks. Besides genetic wiring, the problem could be related to overriding the natural ultradian rhythm. A client who is highly anxious may have difficulty shifting into alpha for self-comfort and allowing the ultradian rhythm to occur. This person stays over-aroused and has difficulty winding down to regenerate energy. Leftover anger, and resentment toward those who have harmed them, serves to lower alpha until the client can fully forgive the past and themselves. However, unless the process is accomplished in a high alpha state (or deep state of mind), which occurs naturally in the down phase of the ultradian rhythm, the hurt returns (Hardt, 2007; Webb, Phillips, Bumgarn, & Conway-Williams, 2012). If the client feels ready, the therapist can facilitate this process by following a specific five-step protocol. First, encourage the client to access safety and security. Second, have the client develop a deep state. Third, the client can become aware of feeling anger toward someone who created a hurt or offense. The fourth step is to view the offender through the eyes of a compassionate adult self and to understand what may have led to the offense. The fifth and final step is to feel self-compassion and then feel compassion for the person who was responsible for the emotional pain.
While the client may not completely forgive the offender, this process is often a beginning of letting go of upset and rumination.
The following is a script that can be used.
- Place your feet flat on the floor and take a couple of nice relaxing breaths. Begin to feel a sense of comfort develop in your body. As a wave of relaxation moves over the body, notice any tension leaving, just like mist rising on a lake in the early morning. Now think of a geographical location where you feel a kinship, a sense of safety and security. It can be anywhere you have been, or a place you’ve seen in a picture that so caught your attention you couldn’t help but feel comfortable. It might be by the water, or in the country, or in the mountains—some amazing place that, when you think of it, you shift your mental state to comfort and calm. This is a place for which you feel such an affinity, it may seem like you once lived there. Feel and sense the experience of safety and security in your body, and hold that sensation in your memory. Notice your feet firmly on the ground, and the chair you are in that provides good enough support, and gently practice that feeling of safety by thinking about it now.
- Continue to carry that feeling with you as you relax even more. Go deeper inside yourself as the comfort deepens.
- Now think about the person who hurt your feelings and what was said. Feel the anger and hurt. Now take a deep breath and put those feelings aside by shifting attention to your breathing. Go in even more deeply as I count down . . . 10 . . . 9 . . . 8 . . . 7 . . . 6 . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . , and all the way down to the deepest level of comfort that you can reach.Knowing that a person can go deeper, allow yourself to float all of the way to the edge of sleep.You may notice this space inside of you now is without discomfort, only deep comfort. This is a place of immense self-compassion without any upset, resentment, anger, sadness, or anxiety. It is your inner sanctuary. Allow yourself to enter this sacred space where your true, wise, adult self resides.
- Now on your mental screen call up the person who harmed you and observe that person through your compassionate adult self who has deep understanding and empathy for what happened to that individual. Knowing that what occurred was not acceptable but that the person acted out of wounds from some past time, allow your deep understanding to emerge.
- Begin to really feel deep self-compassion directed to your mind and your body as if some energy were holding you in this sacred space, and now direct compassion and forgiveness to the person who harmed you. Now allow yourself to float on the edge of sleep for the next 5 minutes. When you are ready, follow the numbers all the way back . . . 1. . . 2. . . 3. . . 4. . . 5. . . 6. . . 7. . . 8. . . 9. . . 10. . . , and come back into the room.
Once the forgiveness process is complete, the therapist may observe less anxiety and depression in the client and more energy. Even physical energy may be enhanced. Two recent studies on forgiveness discovered that the “unburdening” effects included an increase in physical strength and the perception of undertaking a physical task seemed easier (Zheng, Fehr, Rai, Narayanan, & Gelfand, 2014).
Les Fehmi has researched how the mind pays attention and shows, by intentionally shifting mental states from narrow, fight/flight/freeze/faint (problem-focused) to diffuse and open (solution-oriented), how clients can learn to stay in states of thriving for longer periods of time (2006). He used neurofeedback with himself and discovered that, by increasing his alpha frequency (8–12 Hz), after a few hours of practice:
My muscle tone softened, and I moved with a new-found effortlessness and fluidity. . . . Anxiety evaporated. I felt extraordinarily present, centered, poised, open, lighter and freer, more calmly energetic and spontaneous. . . . Arthritic pain in my joints subsided and . . . I was more aware of the bigger picture and . . . I was in the zone and there was a feeling that I had come home. (Fehmi & Robbins, 2007, p. 31)
Fehmi developed the exercise of open focus, where attention moves from a narrow to diffuse perspective. By practicing this particular state, alpha increased in phase synchrony to a point where many parts of the brain were producing alpha in a rhythm of rising and falling at the same time. Later, he discovered how to create synchronous alpha by focusing on “space”. Asking the question, “Can you focus on the space between your ears or the space between your fingers?” immediately sent a client’s brain into synchronous alpha and a mental place absent of any anxiety, depression, worry, or concern. When there is no object on which to focus, the mind cannot create a narrative—and it is the story that keeps negative feelings activated.
Brain States of Over-Arousal and Under-Arousal
Negative states of mind occur in a variety of ways. Chronic states of over-arousal or under-arousal often emerge from insecure attachment patterns (Grawe, 2007). Problems with adverse states may also be a result of having difficulty shifting between emotional systems in the brain (Panksepp, 1998).
Panksepp (1998) identified seven emotional systems that activate with experiences or events, and these are proving to be the emotional foundations of personality, motivation, and the psychobiological systems underlying feelings and behavior. The seven systems are: Rage/Anger, Fear/Anxiety, Panic/Grief, Care/Nurture, Play, Lust, and Seeking or Curiosity.
When a person is stuck in over-arousal or under-arousal, or a particular emotional system, problematic life patterns evolve. An individual may become too aggressive, or passive, or stuck in a behavioral pattern that is inappropriate to the situation. Being stuck may lead to rigid or inappropriate cognitions such as I need substances to deal with life or I must micro-manage another’s behavior to be successful. The first pattern demonstrates difficulty with self-comfort, most likely from over-arousal, and the second may reflect an inability to trust others and oneself, often occurring from a pattern of insecure attachment.
Neurological exposure to repeated stressors can lead to hypersensitivity to those stressors. Through a process called limbic kindling, which is the tendency of the brain to become oversensitive to stimuli, multiple stressors experienced in war, through abuse, or in unstable environments lead to chronic sympathetic nervous system activation that reduces the body’s ability to regenerate. Over time, the body reacts with insomnia, anxiety, depression, increased oxidative stress, inflammation, gut flora dysregulation, and toxin build-up, which in turn causes more limbic kindling and could explain how chronic illnesses develop. As it becomes more difficult to suppress the fight/flight syndrome, clients need more than talk therapy to reverse the reaction. Their nervous systems must be retrained (Jason, Porter, Herrington, Sorenson, & Kubow, 2009).
Interventions with the Brain in Mind
Family dynamics affect each member at a psychophysiological level. Strategies that help lower over-arousal and raise under-arousal help family members develop more flexible behavioral patterns (Grawe, 2007; Holtforth, Grawe, Egger, & Berking, 2005). The therapist needs to help regulate the client’s nervous system while dealing with the accompanying narrative. An interpersonal biological perspective becomes an important consideration in intervention to reset an unconscious reaction.
Neuro-repatterning is a process of teaching the brain how to more effectively switch the different neural systems, as described by Jaak Panksepp (1998) and Davis and Panksepp (2018). Positive states of mind can be intentionally practiced and conditioned (Kershaw & Wade, 2017). Love and nurture shift anger and anxiety. Play improves depression and sadness. And curiosity turns down fear. For example, if the clinician asks a fearful client, “What is it about this issue that brings up fear?” the client turns off fear and shifts to curiosity to think about the question. By utilizing more positive emotional systems/states, others are given less attention.
Bruce McEwen, researcher in neuroendocrinology and stress, says: “The healthy brain has a considerable capacity for resilience, based upon its ability to respond to interventions designed to open ‘windows of plasticity’ and redirect its function toward better health” (2016, p. 56).
In his book, The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity, Norman Doidge (2015) recounts how a pain physician was successful at eliminating his own intractable pain by turning on competing brain circuits to the ones that carry the sensation of pain.
Interventions are not only verbal. It may be the therapist’s empathic tone that triggers the nurture system and reworks attachment; or the therapist may use questions that create an internal search that triggers the nurture system. For example, if a client struggles with not feeling good enough, the clinician might ask, “If you were the most loving parent that ever existed, how would you respond to yourself?” Or the clinician might ask, “Do you remember how long you practiced being so hard on yourself?” and explore with the client what potential hurt occurred and what the triggers are to this pattern.
The therapist’s calm but engaged energetic mental state works to help a client move into an appropriately calm and more stable state of arousal through entrainment and interpersonal synchronization. The brain models itself after the most dominant frequency in the room, and the client may often replicate the inner state of the therapist by slowing the heart rate and unconsciously breathing in synchrony (Ferrer and Helm, 2013; Koban, Ramamoorthy, & Konvalinka, 2017). The therapist’s attentive, calm, focused state is one way of teaching a client to shift out of a problematic state to a more productive one. It is helpful to remember that “the success of an intervention depends on the interior condition of the intervener” (Scharmer, 2018, p. 252).
What may begin as a brain/body reaction is often made worse by the mind’s incessant review of an event. As such, other modalities such as hypnosis, biofeedback, neurofeedback, meditation, yoga, bilateral stimulation, audiovisual entrainment or a combination of these become useful interventions to retrain the nervous system. These modalities stimulate the alpha frequency to lower sympathetic arousal and open awareness from a more nonreactive perspective. Then the therapist helps the client deal with limiting beliefs, triggers to negative mental states, and life patterns that block life success.
Conditioning States with Other Technology
When the client can shift states of anger or fear by moving into curiosity about what is upsetting, the mental state often morphs into an access state, an open state of inquisitiveness and motivation where work on the beliefs, assumptions, perspectives, and life patterns take place with the aid of a therapist. With practice, higher states activate in terms of gratitude, love, appreciation, and self-compassion, and new patterns of being in the world emerge. These higher states occur with a practice of meditation, hypnosis, neurofeedback, mental training exercises and, over time, can be conditioned through a certain focus of attention. Evidence from studies with Buddhist monks meditating on compassion demonstrated the production of gamma, a high-beta frequency seen in transformative experiences. Gamma synchronization may offer an underlying mechanism for unlearning habitual conditioning and mental patterns as it increases happiness and brain processing speed (Berkovich-Ohana, 2017). Interventions that utilize this state find limiting beliefs dissolve. The research suggests that we need to rethink the process of learning.
From studies that teach expert performance in one day of practice with brain feedback, researchers found that the brain prunes irrelevant connections and strengthens the pathway to automatic proficient performance. Rather than the traditional idea that it takes 10,000 hours to become proficient, it is possible to quickly learn an expert state of mind. The same may hold true in learning stable emotional states (Berka, 2017).
Ruth Olmstead (2005) took a group of 30 children aged 6 to 16 years and exposed them to audiovisual entrainment using a device that produced binaural sounds and flickering light. Twice a week for 6 weeks, the students were given 35 minutes of gamma-wave stimulation. Participants put on headsets and light goggles and completed each session while reclining in a comfortable chair. She found a statistically significant gain in the participants’ speed of information processing and visual–motor coordination. The experiment demonstrated overall improvement in the students’ ability with numbers and short-term memory. The students also significantly increased their ability to focus and pay attention.
The researchers reported that the relatively low number of audiovisual stimulation sessions needed to improve cognitive abilities served as more evidence of its value in creating significant change (Olmstead, 2005). These studies and others (e.g., Norris & Currier, 1999) suggest that achieving brainwave coherence in the gamma range through audiovisual entrainment and other gamma-reinforcing interventions may be viable treatment modalities for improvement in attention and the ability to stay in more positive states for longer periods of time.
The new paradigm in psychology points to innovative ideas about how change occurs. By encouraging the brain to shift ranges of frequencies and activating those states, old patterns become interrupted. What this means is that because of neuroplasticity, conditioning positive mental states to treat problematic states results in lasting change. Alpha, and deep states of theta as well as flow states, have been shown to dissolve anxiety, depression, help people lose weight, and stimulate creative thought (Csikszentmihaly, 2005; Fehmi & Robbins, 2006; Hardt, 2007; Kershaw & Wade, 2012, 2017; Kotler & Wheal, 2017).
How a person pays attention is crucial to overcoming anxiety and depression. A narrow focus on a problem that occurs in a fearful state, or a wider focus from a broader perspective when observing possibilities, determines an entire lived reality. If we understand the habitual mental state that a client practices, the default state to which an individual returns after an elated or sad experience, we understand how the experience of life is created.
Clients with anxiety and depression can rarely change accompanying thoughts for good. Rather, when they discover how to shift high beta states (18–25 Hz) and practice calmer mental states of alpha (8–12 Hz) and theta (4–7 Hz), new patterns of thinking, feeling and behaving emerge. The easiest method is to slow breathing and heart rate. By exhaling and inhaling to the count of 5, the sympathetic nervous system relaxes.
The practice of these calmer states often leads to almost magical shifts in people’s lives by changing the perception of threats to challenges when the negativity bias is turned down (Lucas, 2012). Insights from neuroscience are helping clinicians rethink how to help clients achieve mental stability and control. The next step is learning the source code for accelerated life transformation: the flow state.
The state of flow was originally described by Mihilayi Csikszantmihalyi in Flow (1990). It has been defined more recently by Nakamura and Csikszentmihalyi (2009) as a state of optimal attention where there seems no separation between an activity and an individual. In his TED talk (2004) Csiksentmihalyi describes Flow as a timeless state of intense attention that -
leads to a sense of ecstasy, a sense of clarity: you know exactly what you want to do from one moment to the other; you get immediate feedback. You know that what you need to do is possible to do, even though difficult, and sense of time disappears, you forget yourself, you feel part of something larger. And once the conditions are present, what you are doing becomes worth doing for its own sake.
Csikszentmihalyi and Hunter (2003) list six factors as encompassing an experience of flow:
- present-moment concentration;
- merging of action and awareness;
- loss of reflective self-consciousness;
- heightened feeling of personal control;
- time distortion; and
- experiencing the activity as intrinsically rewarding or an autotelic experience.
It turns out that the state of flow is an antidote to anxiety and depression and a trigger to immense physical and mental well-being and creativity (Davis & Panksepp, 2018). From Panksepp’s laboratory findings, researchers found that rats love to play. They emit chirps of joy when having their tummies tickled, and they seek out play with others in states of flow. This social joy was discovered to change depressed rats to happy animals.
Siviy and Panksepp (2011) found that social play actually contributes to the development of frontal cortex brain regions, which are involved in planning and emotional regulation, all of which leads to more stable moods over time. It may be that social play is a helpful intervention for depression and anxiety.
The reason lies in what happens to the brain in flow. Arne Dietrich (2003) suggests that evidence from psychological and neuroscientific studies of dreaming, endurance running, meditation, daydreaming, hypnosis, and various drug-induced states finds that transient hypofrontality is the common denominator of flow states. This means that the key to change rests in this important new idea discovered in neuroscience imaging. Transient hypofrontality is the deactivation of the prefrontal cortex when altered states are experienced and particularly in states of flow. When the prefrontal cortex goes offline, it is impossible to experience any negative state or self-criticism. Whether a person is in a trance, a flow state, play, or in a meditative state, there is no access to worry, agitation, or depression.
States such as confidence, courage, persistence and optimism, learned early, occur in more positive and relaxed states of mind or in states of flow. Children often acquire resourceful states of confidence, courage, persistence and optimism early in life as they accomplish developmental tasks and athletic endeavors such as walking, hitting a baseball, doing a martial art, or learning any physical skill. As they learn how to control their own physiology, their self-confidence grows as well as the ability to face fears and recover from disappointment. These emotional resources can be called upon in adulthood by reviewing a memory of an event when one of these states was experienced.
If a client cannot access a positive feeling, the following exercise can interrupt a rigid state.
Attention and Negative States
In order to experience depression or anxiety, attention must be focused inwardly. When asked to think of something depressing or anxiety-provoking, usually an individual can call it up immediately by looking down at the floor. The focus of attention shifts to an internal experience by activating the visual system to run internal pictures or movies. Then, when the person is asked to look straight up at the ceiling and notice what happens to the feeling, the shocking experience is the emotion disappears. It is possible to shuttle back and forth from an inward focus to outward attention, and keep the feeling activated. However, when a person fully focuses on the ceiling, the affect disappears, and the inner narrative or movie stops running. We can only create a story when internally focused, and it is the never-ending negative story that keeps affect activated. As an exercise, this is invaluable to demonstrate the ability to shut off rumination or negative affect. Of course, the therapist needs to do more to deal with the pattern of rumination or depression.
Cycle of Flow States
The more flow states a person experiences, happiness increases (Csikszentmihalyi & Hunter, 2003). As Csikszentmihalyi (1990, p. 3) said: “The best moments in our lives are not the passive, receptive, relaxing times; [rather] the best moments usually occur if a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile.”
Herbert Benson, a Harvard psychiatrist, found that flow has a cycle to it with transitions through several brain-wave states. The first stage of flow is the struggle phase. When attempting to solve a problem, learn something new, or improve performance, there is a natural tendency to evaluate many different solutions. This stage triggers the beta frequency that causes stress hormones such as cortisol and norepinephrine to flood the body until the fight/flight response activates worry and anxiety. Stage two is the release phase where stress shifts to more relaxation, and alpha activates with the release of nitric oxide; this normally occurs when the mind is taken away from the problem. In stage three, the breakthrough of flow, theta and gamma frequencies rise and there is a release of dopamine and endorphins, pleasure neurotransmitters. Also released is anandamide (a Sanskrit word for bliss or supreme joy), an endocannabinoid that reduces inflammation and has a similar chemical structure to marijuana. Just before the breakthrough of the flow state there is a release of tension, and stress, anxiety and depression disappear (Benson, 2003). Stage four is the recovery stage in which the brain stimulates the delta frequency and releases serotonin and oxytocin. In this stage, a person enters new patterns of thought and emotions and releases healing power in the body for both physical and emotional transformation. Over time, with more flow states, daily life has more joy, contentment and empathy.
The U.S. military discovered the healing quality of the flow state for treating PTSD. In a project called Surf Therapy, the Navy in San Diego, CA, ran studies where returning war veterans experienced a program of psychotherapy and surfing for six weeks. By engaging the flow state over a period of time, anxiety trauma, and depression clear, allowing for a clarity of mind, access to more positive feeling states, and a more positive outlook on life (Bergland, 2015).
Another benefit of the flow state in therapy has to do with the endocannabinoid system. This system may be one of the most important systems involved in creating and maintaining health. There are endocannabinoid receptors in organs, bones, connective tissue, and skin. The body/brain releases endocannabinoids to aid our healing. The impacts of this system include mood regulation, appetite, inflammation, pain perception, extinction of traumatic memory, protection of nerves and brain tissue, bone growth, stress management, and gastrointestinal motility. According to one of the researchers who discovered this system, Raphael Mechoulam, the endocannabinoid system acts in every physiological system that has been researched (McPartland, Guy, & Di Marzo, 2014).
Some of the problems that can occur when the level of endocannabinoids is depleted are inflammatory bowel syndrome, migraine headaches, depression and anxiety, fibromyalgia, decreased appetite, and stress. In fact, there is evidence that a disruption to endocannabinoid regulation impacts the hypothalamic–pituitary–adrenal axis by increasing anxiety and depression (Bambico & Gobbi, 2008; Neumeister et al., 2013; Witkin, Tzavara, & Nomikos, 2005). Recent research into the endocannabinoid system also suggests there are lower cannabinoid levels signaling the pathophysiology of social functioning deficits observed in PTSD, major depressive disorder, and bipolar disorder (Witkin et al., 2005).
The bliss neuropeptide anandamide, released by the endocannabinoid system, can positively impact mental health. A study published by Neuropsychopharmacology found that anandamide treatment lifted depression in male rats with diabetes. When the rats were given a chemical that blocked anandamide, they became depressed again (de Morais et al., 2016). This neuropeptide in adults is released in states of flow and in a hypnogogic state hovering right above sleep. By taking a client into deep states of relaxation, anandamide is released, and often mood is elevated (Kershaw & Wade, 2012).
Therapists can use deep states to resolve trauma and resistant depression and anxiety by taking clients down to the deepest state above sleep. The brain begins to enter a dream-like state at around 3–4 Hz that stimulates dream images from the unconscious mind. As these are understood by the client, asking “What is your association to this image you received?” enables powerful life-guiding messages to emerge (Kershaw & Wade, 2012; 2017).
Brain Change Therapy Process
The therapy process involves three steps. First, the therapist identifies through collaboration with the client whether the problem is defined as a state of over-arousal (anxiety), under-arousal (depression), or a combination of the two, and when the client feels in a state of stability. Asking the question, “Under stress, are you likely to feel anxious, depressed, or a combination of the two?” reveals how the client’s nervous system operates. If over-arousal is a problem, interventions to reset the nervous system through conditioning calmer states are in order. If under-arousal is more prominent, interventions to activate the system are appropriate.
Once the therapist facilitates a state change, which can be observed by the client shifting in the chair, smiling, taking a deep breath, or other physiological changes, it is appropriate to empathically deal with the client’s narrative about the problem. Past influences and triggers for negative emotions that have been obstacles to life joy can be discussed, appropriately reframed, re-contextualized, and understood from a different perspective. This emotional process—therapeutically “held” in the resonance field between therapist and client with deep empathy—shifts the narrative to a story the client can accept and put in the past without an emotional charge. Rather than focusing psychotherapy on a repetitive archeological dig into the worst experiences from the past, we now know that focusing on mental state change followed by processing a client’s story, family history, and triggers to negative feelings has excellent results. Acknowledging the difficulty in a person’s story is important, but over-focusing on negative feelings is a way of unintentionally practicing them.
Second, the therapist teaches clients how to use the brain’s abilities to overcome anxiety and depression, which frequently occur together, through the process of neuro-repatterning, discussed above. Neuro-repatterning teaches the client how to inhibit rumination and depression by shifting the emotional system to one incompatible with the state that has triggered the troubling emotion and cognition. Grawe (2007, p. 92) said:
The task of psychotherapy is very often to inhibit something problematic because “getting rid of” or “eradicating” simply doesn’t work. This leads to a shift of the focus from that which is problematic to that which should be put in its place instead. Inhibition means, after all, to put another neural process in the place of the to-be inhibited process.
State change must occur frequently by the therapist using questions of curiosity. For example, asking “How is this person, place, thing, a problem for you?” shifts the state often from fear to open and interested analysis, and the focus of attention from internal to external, so rumination or depressive thoughts are more difficult to experience. Because the more a client reviews negative feelings, the better the person is at feeling the particular emotion, one of the goals of psychotherapy is to help clients stop practicing negative feeling states, and move attention to a mental state that is healing.
Third, a focus on intentionally activating the flow state to maintain optimal states of functioning for longer periods of time is discussed with examples of flow triggers from the client’s life that can be replicated. These would include aerobic and weight-lifting exercise. Research has demonstrated a positive correlation between muscle strength and brain health (Firth et al., 2018). Other flow experiences include painting, singing, gardening, as well as specific mental exercises.
The new paradigm focuses on helping clients develop and practice the whole brain state, a bilateral and symmetrical brain-wave pattern that often occurs in the flow state but also develops with any bilateral stimulation like EMDR (eye movement desensitization and reprocessing), tossing a ball from hand to hand, drumming or walking. The whole brain state increases communication between the left and right hemispheres of the brain, equalizes blood flow, speeds up the transfer of information across the corpus callosum, and diminishes the capacity to worry (Gaia, 2013).
What we are coming to understand is that the brain is not hardwired. It can be changed with mental training, aerobic exercise and better nutrition, which reduce brain inflammation that is often a factor in depression and anxiety. Calming the mind, and changing perspectives and perceptions actually create new neural pathways. When calmer states are practiced, they are more easily achieved.
Since emotional pain often comes from chronically reviewing negative memories, changing mental states through meditation, neurofeedback, or the mental practice martial artists and elite athletes use of moving away from past and future fears and into states of flow, prunes old neuronal connections and grows new ones. New thoughts create a new self-identity and create the move beyond negative experiences into a life lived in resilient thriving. When the brain consistently enters synchronous alpha, personal reality shifts with the development of psychological coherence, a state of stability, flexibility in thinking and feeling, and perceiving problem-solving options. This is truly neuroplastic transformation.
This article suggests a new psychotherapeutic paradigm that uses the human brain’s capacities. The ability to use attention flexibility and shift mental states allows new perspectives, generative solutions to problems and enhanced creativity. Through a process of neuro-repatterning, clients can activate the brain’s ability to interrupt negative patterns and create new ones that lead to life success.
In addition, accessing the state of flow shuts down fear, worry, rumination and anxiety. When clinicians intentionally encourage clients to engage in this brain state, the client opens new abilities in confidence, courage, joy, flexibility in thinking, and motivation in everyday life. Achieving this whole brain state is key to mastering life challenges and building a positive future. This brain state may be achieved through technology such as neurofeedback, audiovisual entrainment, or mental exercise, allowing people not only to overcome life challenges but to live in states of thriving for longer periods of time.
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I agree with the author’s premise that the goal of therapy must not be to simply weaken problematic mind/body states, but rather tonstrengthen optimal mind/body states such as “flow” states.
At the same time, it seems to me the author may overemphasize neurophysiology and underemphasize inter- and intramural-relational psychology, specifically as a consequence of interpersonal trauma and neglect.
Take, for example, the patient who holds stress in his gut. While this patient can relax some using “tapping”, they do better when they develop the capacity to intra-relationally soothe and protect, while in an hypnotic state, their “young child” mind/body state that previously held the psycho-somatic experience of neglect.
In sum, what does the author think about combining training in optimal neurophysiological functioning with intra-relational care of previously neglected, “young” mind/body states, thus integrating “neurophysiology” with relational “psychology”?
Ken Benau, PhD
Please note: In paragraph two, the phrase “intramural-relational psychology” should read “intra-relational psychology”.
Ken Benau, PhD
Thanks for your comments. Yes we agree. It is impossible to put everything in one article. In or practice over 35 years we did much interpersonal work with many interventions including hypnosis. Keeping in mind the notion that mental states are the basis for suffering and satisfaction, interventions with that in mind can be more effective. But of course there is the area of connection, love, and spirituality. An overarching belief we have us that humans have amazing abilities to heal and thrive!
Thank you, Dr Kershaw. Sounds like we agree that therapy benefits from addressing several aspects of experience, eg neurophysiological, intra-relational, spiritual, etc… And as you write, with an overarching belief in people’s resilience and capacity to heal and thrive (perhaps the most important factor of all).
Ken Benau, PhD
The assumption that “eradicating” is Simply impossible is in contrasto with the empirically confirmed findings of the Memory Reconsolidation Theory.
Thanks so much for your comment. If you read Grawe’s excellent book, in the quote you mention, we understand him to mean that clients cannot use cognitive interventions to eliminate a recurring negative state. And eradicating a symptom is definitely very difficult without using neuroplastic Interventions.