Resetting Your Behavior with Dr. Anna Lembke

the richest countries in the world are the countries that have the most suicide anxiety depression and physical pain the more we have a good life right lots of food lots of fun stuff lots of medicines to protect us from you know illness and pain we've clearly reached some kind of tipping point we're now essentially more miserable than ever and the question is why your solution to this modern problem and it's a modern problem that we all have is to one of the most findings in neuroscience in the last hundred years is that pleasure and pain are co-located by which i mean that the same parts of the brain that process pleasure also process pain and they work like opposite sides of the balance so when we do something that's pleasurable or reinforcing or rewarding that balance tips to the side of pleasure when we experience something painful like cutting our finger it tips to the side of pain but one of the overarching rules governing this balance is that it wants to remain level it doesn't want to be tipped for very long either to pleasure or pain and the brain will work very hard to restore a level balance or what neuroscientists call homeostasis it's really a biological imperative not just in our own physiologic symptoms but in the universe to go to homeostasis and that any deviation from neutrality is actually a form of stress in fact biologists define stress as a deviation in either direction and that's really the key the problem with modern life and one of the main problems with modern life is that we have too many pleasurable substances and behaviors and that is actually stressing us out it's literally stressful so when we do something just obviously pleasurable like i don't know having a beer or playing a video game or eating a piece of chocolate it depends who you are because people are different but in general those things are pleasurable to many people what we do is we get a little tilt to the pleasure side and we get the release of dopamine in our brains reward pathway which is this evolutionarily phylogenetically conserved very very old part of the brain that's been unchanged in our brains for just millennia and is also identical in other species all the way down to the lizard which is why it's sometimes called the lizard brain you know our evolution meant that we've piled a whole bunch of other layers on top but that part is exactly the same as it's always been and it's the part that gets us again to approach pleasure and avoid pain but here's really the key the way that the brain restores a level balance or homeostasis after this deviation to the pleasure side is to not just bring it level again but tilt it in equal and opposite amount to the side of pain and that's called the opponent process reaction and i sort of think that is these little gremlins that represent neuro adaptation hopping on the pain side of the balance but they like it on the balance so they stay on until it's tipped and equal and opposite amount that's that moment of wanting just one more video game you know another beer another piece of chocolate now if we wait a little bit because it's a powerful physiologic drive to reach for more if we wait the gremlins hop off that feeling passes and homeostasis is restored and we want homeostasis to be restored it's really important because it's fundamental to the resilience of this system because when the system is at baseline homeostasis it's sensitive right it senses new pleasures it's aware of potential dangers and painful things so we know to avoid them but let's look at what happens if we instead of waiting for those gremlins to hop off instead immediately reach for another beer another piece of chocolate another video game another major rule of this balance is that with repeated exposure to the same or similar stimuli that initial response gets weaker and shorter in duration and the after response gets stronger and longer so i think of that as sort of an arnold schwarzenegger type gremlin hopping on the pain side to bring it balance again so we need stronger gremlins right and essentially what's happening in the brain by the way with those neuro-adaptation gremlins is that we're down regulating our own dopamine transmission we're taking our dopamine receptors that are on the outside of our neurons and we're resorbing them into the neuron all of which is a way to accommodate this huge increased bolus in dopamine but again what ends up happening is now that opponent process reaction is stronger and longer so we go from you know shorter and weaker to stronger and longer on the pain side of the balance and that is the fundamental sort of paradox or vicious cycle that we get into especially when we're living in a world in which we have nearly universal ubiquitous access to highly potent highly reinforcing drugs and behaviors which don't just release a little bit of dopamine but a whole huge bolus and we're all surrounded by them all the time every day and over time what that means is that we're bombarding our dopamine reward pathway with way more dopamine than our primitive brains can handle and the result is that we end up with enough gremlins on the pain side of the balance to fill this whole room and they are now camped out there and that's called allostasis so we've gone from homeostasis to allostasis and allostasis is where our body has to accommodate and work very very hard to try to restore homeostasis and if it's unable to do that using the normal mechanisms it essentially changes our set point so now we've got those gremlins camped out there they're not leaving even when we wait a while they're camped out there our balance it's easier to tip it to the side of pain and it's really really hard now to experience pleasure and when we're not using we're in a state of anxiety universal symptoms of withdrawal from any addictive substance anxiety irritability insomnia dysphoria and craving for our drug this is the fundamental problem if you look at rates of depression and anxiety all over the world today they are going up skyrocketing suicide rates too also physical pain the richest countries in the world are the countries that have the most suicide anxiety depression and physical pain and this is by many different measures many different survey measures many different types of studies so clearly we have something very strange going on here where the more we have of the kinds of you know ideal things that we think would make a good life right lots of food lots of fun stuff lots of medicines to protect us from you know illness and pain we've clearly reached some kind of tipping point we're now essentially more miserable than ever and the question is why and i do think that the pleasure pain balance explains that because our primitive brains were not wired for an easy hyper convenient world we are suffering as a result of all of this access to these feel good things the first thing that we need to do is to cut out all of these feel-good substances and behaviors at least for long enough for essentially dopamine fasting right and whatever your source of dopamine is to cut it out for long enough now in my clinical experience in my practice because i have patients who come in seeking help for anxiety depression insomnia and the first thing that i will typically do is to have them cut out their feel good drugs and behaviors we are hardwired to approach pleasure and avoid pain and that's really at the heart of our dopamine reward system dopamine is not just about the reward it's also about the wanting and the motivation and it's relative dopamine so it's whether our dopamine is above or below tonic baseline that really is at the heart of this motivational cycle