The Human Brain: Leading Experts On Preventing Cognitive Decline, Understanding Addiction, The Neurochemistry of Spirituality & The Mind-Body Connection

Dr. Andrew Huberman, Drs. Ayesha and Dean Sherzai, Dr. Anna Lembke, Dr. Lisa Miller, and Dr. David Spiegel are researchers exploring the mysteries of our most enigmatic organ. This compilation reveals how three pounds of tissue controls everything—from the vascular networks that determine cognitive destiny to the neurochemistry that drives addiction. Why 97% of Alzheimer's cases aren't inevitable, how dopamine traps us, what happens during spiritual experiences, and why hypnosis works. These insights offer understanding of the neural mechanisms that shape every moment of your existence. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors: On: High-performance shoes & apparel crafted for comfort and style 👉https://www.on.com/richroll Roka: Unlock 20% OFF your order with code RICHROLL 👉https://www. ROKA.com/RICHROLL Mint Mobile: Get your 3-month Unlimited plan for just $15/month 👉 https://www.mintmobile.com/richroll AG1: Get a FREE bottle of D3K2, Welcome Kit, and 5 travel packs with your first order 👉https://www.drinkAG1.com/richroll Rivian: Electric vehicles that keep the world adventurous forever👉https://www.rivian.com Check out all of the amazing discounts from our Sponsors 👉 https://www.richroll.com/sponsors Find out more about Voicing Change Media at https://www.voicingchange.media and follow us@voicingchange Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Rich Roll?

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• 1:05Speaker 01

  The major evolutionary advantage we have as humans is this big brain on the top of our bodies, but it doesn't come with a user's manual.

• 1:12Speaker 02

  It can consume up to 25% of the body's energy. So just imagine the amount of work that it does.

• 1:19Speaker 03

  The nervous system is responsible for sensation, perception, feelings, thoughts, and behaviors.

• 1:24Anna Lembke?

  In your brain, there's a balance. When we experience pleasure, the balance tips one way. When we experience pain, it tips the other.

• 1:32Lisa Miller?

  There's nothing as protective against addiction as a strong, personal spirituality. Can we watch that in the scanner?

• 1:49Rich Roll?

  Hey, everybody. Welcome to the podcast. Every thought you have comes down to three pounds of tissue sitting inside your skull. But it's also fragile. In this special episode, top experts break it all down by breaking down our brain and how it really works. Up first is Dr. Andrew Huberman.

• 2:13Rich Roll?

  Maybe we could start with, you know, how you think about the brain specifically. Like, what is the brain? What does it do? What does it not do? You know, it helps us survive. It's our portal into trying to make sense of the world. Like, what's the starting point in the discussion around the brain?

• 2:30Speaker 03

  Yeah, so the brain and nervous system, which, so it's like brain, spinal cord, connections with the body and back end. I don't distinguish between brain and mind. I think that's like an 80s discussion or earlier. And I think it would take us down the wrong track. So, brain or mind, to me, is interchangeable. Mind-body is kind of interchangeable because the brain is connected to the body and the body's connected to the brain, right? If I, you know, pinprick my hand and it hurts, my brain registers it where it happens. It's kind of an irrelevant discussion now. I think we really need to just appreciate that the nervous system is designed to orchestrate all the processes in the body, not just thinking and not just behavior. It really can be divided into five things. So, there's sensation.

• 3:14Speaker 03

  And sensation is really bound or restricted by the receptors in the body. So, receptors in the eye that perceive photons, light energy. Receptors in the skin that perceive pressure, you know, touch receptors. Smell, taste, hearing, et cetera. And the interesting thing about sensation and the fact that the nervous system needs to pay attention to sensation is it's non-negotiable. The nervous system of humans is designed to extract physical phenomenon from the universe that are non-negotiable, photons of light. I can't see in the infrared with my eyes. And I can't see ultraviolet light with my eyes. And I can't perceive that because I don't have the receptors for it. So, you know, other animals can perceive some of those things. But that leads us to the next thing, which is perception, which is which sensations

• 3:59Speaker 03

  are you paying attention to? So, all the time, you're sensing things. Like, right now, your feet are sensing the contact with your shoes, but you're not thinking about it until I say that. And then you shift your perception. So, perception is like the spotlight. So, the brain wants to constantly bring in sensation. It's non-negotiable what's coming in. It's just dependent on your environment. Perception is negotiable. You can control that. Because I just said shoes and you thought about your feet and there you are. Then there are feelings, which can be a little bit nebulous, but feelings are a link between our emotion and it generally invokes the body, sensations in the body and concepts in the mind of what those sensations are about. That's really what emotions are. Animals definitely experience them. I'm kind of appalled to think that 10 years ago, people like, do animals have emotions?

• 4:44Speaker 03

  Of course they have emotions, right? Because those are bodily sensations merged with some perception. So of course they do. And then there's thoughts, and thoughts are interesting because thoughts happen spontaneously. Think about like a web browser that's constantly giving you pop-ups. But thoughts can also be deliberate. So you and I can decide right now that we're gonna think about a plan for something, or we're gonna think about what's going on in the world. So thoughts happen spontaneously and that they can be deliberate. And then the final thing is behaviors and actions. So the nervous system is responsible for sensation, perception, feelings, thoughts, and behaviors. And what's interesting, we start to think about that as you're like, okay, that's a lot, but what is the nervous system really trying to accomplish? Like on any given day or at any moment, what's it trying to accomplish?

• 5:29Speaker 03

  And it's really trying to accomplish one thing, which is to take perceptions of the outside world and merge those with perceptions of the inside world, what we call interoception, and to link those in a way that's operating on our environment in the appropriate way. So what do I mean by that? So if I'm feeling anxious and I'm in a very calm environment, I'm gonna perceive that rapid heart rate and kind of feeling of agitation in my body as inappropriate for the moment, right? And my goal then, as an organism, is to adjust my level of what they call autonomic arousal or alertness down. If I'm at a great party, or I'm at a wedding, or it's a celebration, or I'm at a protest,

• 6:09Speaker 03

  or you know, then I might feel that my level of alertness is appropriate for my environment. So the nervous system is in this constant dynamic interaction with the outside world and trying to figure that out. One way this can be kind of conceptualized is there's an emerging idea that's kind of interesting about impatience. So we've all had the feeling of being impatient. Some people are far more patient than others. But if you've ever been in line at the store and you feel like something's going very slowly, you know, the person in front of you is taking a long time, they're doing some returns, and you're getting kind of impatient, maybe you're breathing in a mask and you're like, ugh, like you're, you know. What's the idea is that if you're getting a certain frequency of pulses from your body,

• 6:52Speaker 03

  and if those pulses are coming in quickly, like you're perceiving yourself, that interoception, quickly, it's like pulse, pulse, pulse, pulse. You're going to be more geared towards your internal representation. And then you're seeing what's going on in the outside world, and it seems like it's going very slowly. But there are other times when you're in line at the store, someone's getting some returns, and you're texting on your phone, or you've had a great day, you've had a great run, your family's in great shape, and you're fine. Why? Well, the frequency of those pulses, that interoception, is matched pretty well to your outside environment. And so impatience is really when your internal sort of metronome, tic, tic, tic, is not matched well to the external environment.

• 7:33Speaker 03

  There are other times when you're feeling like your internal metronome is tic, tic, tic, and you've got a million things coming at you through email or text, and you've got a bunch of things, and you're feeling overwhelmed and tired. Well, in either case, there's nothing right or wrong. It's just your body and your brain are trying to say, what's going on in the outside world, and how well matched am I to it? Right. So if you think about some of the sort of core practices of mindfulness and self-regulation of like focusing on breathing, or focusing on, you know, state of mind, a lot of that is trying to bring more awareness to your internal state.

• 8:12Speaker 03

  But what our brain is normally doing when our eyes are open and we're interacting in the world is we're constantly trying to update our internal state to match external demands of the world. And this hargens back to a, you know, like a really early design of all nervous systems, which is how do you take an organism that needs certain things, food, water, mates, reproduction, shelter? How do you move that organism? How do you create a system that will do that in best relation to the environment? And so what Mother Nature has done is designed a system, a series of systems. Let's just take agitation and stress for one. If an animal or a human is very thirsty, you feel kind of agitated, you might get up and get a drink of water. If you're very thirsty, it can put you into a state of panic.

• 8:57Speaker 03

  If you're extremely thirsty and water is a limited resource, you might even result to violence to get it. Or negotiation of some sort that you wouldn't if you were calmer. So the stress and agitation were designed to actually mobilize the body to take us in the direction of something that's adaptive. So you can start to see these kind of core elements of what the brain and nervous system do. Sensation, perception, feeling, thought, and action. And this constant challenge of trying to match our internal state to the external real estate, the outside world. And you start to see that the sensations that we call stress, or impatience, or calm are really the result of those attempts that the nervous system is trying to perform.

• 9:40Rich Roll?

  That's a lot to take in and super interesting. And it, you know, it's prompting in me, this, you know, attempt to try to wrap my head around what within the brain is mutable, which is kind of, you know, what your work is all about versus what is immutable. Like you were talking about thoughts, like pop up windows on a browser. You know, sometimes our brains are just doing what they do and that there are things that we can do, like mindfulness and breath work and the practices that you're talking about, hypnosis, which is another thing that you're, you know, involved in, to help, you know, help us like take better,

• 10:19Rich Roll?

  manage better that process to kind of take the reins and be more in charge rather than be prey or victim to these kind of things that just occur without our conscious awareness.

• 10:32Speaker 03

  Well, I think that, you know, in terms of value of understanding the nervous system and where it can be steered, it's absolutely clear that the nervous system can change in response to experience. So this thing we call neuroplasticity is really that. It's the brain's ability to modify itself in response to experience. And I think it's important to understand that from birth till about age 25, the brain is extremely malleable. Kind of almost passive way where kids are exposed to things and the brain is just wiring up. I mean, the brain is really designed to adjust itself in order to be in concert with its surroundings. And to optimize that, just the way we described a minute ago.

• 11:09Rich Roll?

  Like the way that a child can learn a language very quickly or play the guitar or something.

• 11:14Speaker 03

  Yeah, without an accent, you know, three languages without an accent. It's remarkable. And trying to do that after age 25, it's very challenging. And so the the brain is basically designed to be customized in the early part of life. And then to implement those algorithms and that circuitry for the rest of your of its life. And so the brain can change in adulthood. And it can change, provided that there's an emphasis on some perceptual event. So in other words, if you want to change your brain as an adult. Let's say you want to be less anxious, you want to learn a new language, you want to be more functional in some way presumably. The key thing is to bring focus to some particular perception of something that's happening during the learning process.

• 11:59Speaker 03

  And the reason for that is that there's a neurochemical system involving acetylcholine. And it comes from these two little nuclei down in the base of the brain called nucleus basalis. All day long, you're doing things in a reflexive way. But when you do something and you think about it very intensely. Acetylcholine is released from basalis at the precise neurons that were involved in that behavior. And it marks those for change during sleep or during deep rest later. So for people that want to change their brain, the power of focus is really the entry point. And the ability to access deep rest and sleep. Because most people don't realize this, but neuroplasticity is triggered by intense focus. But neuroplasticity occurs during deep sleep and rest.

• 12:43Speaker 03

  And we can talk about how to optimize those different brain functions. One of the things that's really important, also to think about how the brain works in terms of plasticity and all this stuff is what the brain really wants to do is also pass as much of what it does often reflexive behavior as possible. So when we're talking about focus, I think it can get a little bit vague, but it might be useful thing about like, what exactly is focus and what triggers plasticity? So the brain loves to be able to just do things, pick up coffee cups and drink and walk and talk and do things and not put much energy into it. When we decide to focus, what the brain really does is it switches on a set of circuits that involve the frontal cortex and nucleus basalis and some others.

• 13:25Speaker 03

  And it's trying to understand duration, how long something's gonna last, path, what's gonna happen, and outcome, what ultimately is gonna happen. So duration, path, and outcome. You know, the events of early 2020 are a good example of this. One of the reasons why it's so exhausting to be alive in 2020 is because we are now having to pay attention to duration, path, and outcome. How long is this thing gonna last? When are, you know, when are they gonna open up all businesses? Did I touch that door handle? Does it matter? Right. Who are the experts? Are there any experts? You know, there are a lot of questions, whereas normally, we can just move through life without having to do all that analysis. So if it's a simple example, like trying to learn a new language, or a new motor skill,

• 14:09Speaker 03

  or a new way of conceptualizing something, maybe somebody's in a therapeutic process and they're trying to work through a trauma or something like that. Duration, path, and outcome is built into the networks of the brain. We can do that very easily, but it takes work. And it almost has a feeling of underlying agitation and frustration. And that's because the circuits that turn on before acetylcholine are of the stress system. So when you or I decide we're gonna learn something and really dig in, norepinephrine, which is adrenaline, is secreted in the brainstem and in the body, and it brings about a state of alertness. Then our attention, which is mostly a diffuse light, is brought to a particular duration, path, and outcome analysis. This would be thinking about what somebody is saying. What are they really trying to say?

• 14:53Speaker 03

  A hard passage of reading, a hard, you know, set of math problems, you know, a challenging physical workout. When you do that, these two systems have to work very hard and the adult brain doesn't really want to change the algorithms it learned in childhood. But if you do those two things, you have alertness and focus. The acetylcholine and the norepinephrine converge to mark those synapses for change. And so the way to think about neural plasticity, if one wants to change their brain, is bring about the most intense concentration you can to something and then later bring about the least amount of concentration of that thing. So I'll talk about that in a second, but there were some studies that were done at Stanford

• 15:34Speaker 03

  by a guy named Eric Knudsen that showed that plasticity in the adult brain, any age, can be as robust as it is in childhood, as fast and as dramatic. Wow. Provided the focus is there and it's all contingent on this acetylcholine molecule coming from nucleus basal. So you say, well, how do you do that? Right. How do you get it? Exactly. Well, I've got friends that chew Nicorette, thinking that's going to get them there because Nicorette is a nicotinic acetylcholine agonist. But that's going to globally increase acetylcholine. So I always tell them that's not the right approach. The right approach is to bring as much focus to a behavior or to a thought or to an action pattern. And there has to be a sense of urgency.

• 16:16Speaker 03

  So what Knudsen lab showed and another lab at UCSF, Mike Merzynik's lab showed, is that if there's a serious contingency, like in order to get your ration of food each day, you have to learn this thing, the degree of plasticity is remarkable. Right. But if there isn't an incentive, it just isn't going to happen. So these circuits in the brain that mother nature set up are designed to be anchored to a real need. And people always say to me, well, should I do something out of love and a real desire to learn or should it be out of fear? But either one works. The sense of urgency is just acetylcholine. It's norepinephrine. That's all it is. It doesn't, the brain doesn't have a recognition of whether or not something is pleasureful or not until later.

• 16:58Speaker 03

  Once you start accomplishing your goal, the reward systems like dopamine start kicking in. But I think if people are interested in modifying their brain for the better. At least some, you know, top contour understanding of how urgency and focus must converge for that to happen can be useful. Because I think there's a lot of attention paid to whether or not something feels like flow, or whether or not I see what I call highly desirable.

• 17:22Rich Roll?

  Right.

• 17:23Speaker 03

  Or whether or not you can, you can eat a plant out of the ground that will magically put your brain into a state of plasticity. And the answer is yes, such plants exist.

• 17:31Rich Roll?

  Ah.

• 17:32Speaker 03

  But what's missing is the focus component. If that work is not done with a particular end goal in mind, you'll get plasticity. But you'll get plasticity in a kind of across the board. It's like learning a little bit of nine languages all at once is not going to make you speak coherently in any one of them.

• 17:50Rich Roll?

  Next, let's get into all things brain health with doctors Dean and Ayesha Sherzai.

• 17:58Speaker 02

  Um, you know, everybody talks about Alzheimer's and dementia as if it's a disease that just starts at one point, you know, you are diagnosed with Alzheimer's disease there. That's it. That's not the start. Right before that, you know, decades earlier, there is a continuous cognitive decline that people experience. And, you know, Dean and I go to different communities for talks and before all this pandemic. When you go into communities where, you know, their, their health literacy is lower, for example, they haven't had any resources, you actually experience the cognitive decline when speaking with individuals in their 50s and 60s before they even are diagnosed with Alzheimer's disease. And it's, it's scary and the numbers are scary. And we never address

• 18:43Speaker 02

  that. And it's not just brain health, you know, you, you, you hear about brain health all the time. You hear, you, you read great books, but it's that self that is under attack. It's that us, it's that us-ness, you know, it's, it's the sense of being aware and being present and being able to experience life. That is, we're being robbed of that.

• 19:08Rich Roll?

  Hmm.

• 19:09Speaker 02

  Um, you hear brain fog, you hear memory problems, but. Not being able to be present for each and every moment in your life, that's what's taken away from people and that's scary. And if we have a way of making people attuned, where we alarm them to listen, there is something that you can do, where you don't have to go through this. I think that would be a great opportunity and it's a great gift for us to be able to serve people that way.

• 19:37Rich Roll?

  Right. So, conventional medical wisdom, at least until recently, is or was that Alzheimer's is something that is going to be visited upon many, many people when they reach, I don't know, late 60s, 70s, something like that. It's basically a genetic predisposition. In more cases than not, it's a death sentence. There's not much we can do about it. We can't cure it. We can't prevent it. We can kind of maybe manage it with some drugs, but really, there isn't much that we can do. And we're working on a cure, but we aren't very close. So, how much of that is accurate?

• 20:19Rich Roll?

  And where does your work fit in to kind of upend that paradigm?

• 20:23Dean Sherzai?

  So, the genetic component, let's start with that. We know the genes that are involved in Alzheimer's. With new techniques like GWAS analysis and others, where you take large populations who have Alzheimer's and those that don't, you look at the genetic differences. We know about more than 30 genes that are involved in Alzheimer's. Of all Alzheimer's cases, the percentage that's driven by genes, 100% driven by genes, meaning that if they have these genes, they'll get it. And in genetic terms, it's called 100% penetrance, like Huntington's disease. If a person has the Huntington gene on that chromosome 4, they'll get it.

• 21:02Rich Roll?

  Right.

• 21:02Dean Sherzai?

  But the percentage of Alzheimer's cases that are like that is only up to 3%. The other 97% are affected by genes, but they are only risk genes, meaning that those genes increase your risk, but they're not a foregone conclusion. It doesn't mean that you will get it. The next highest risk gene is APOE 4.

• 21:28Dean Sherzai?

  About 2% of population has APOE4, is APOE4 positive. So if you have one of those genes coming from one parent, your risk goes up four times. If you have two, one from each parent, about 12 times. That number varies, but roughly, those are the numbers. So even if you have two genes, fully loaded with these bad genes, 50% of people get the disease. The other 50% don't get it. Why? And when you look at the data coming from Nigeria, where the population had higher proclivity for APOE, when they came to US, the disease went up. When you look at the studies that came from UK, which lifestyle increased your risk six times, even in lieu of APOE4, you realize, even with the higher genetic risk of APOE4,

• 22:13Dean Sherzai?

  lifestyle is a way bigger factor, by far. So all of the genes involved in Alzheimer's, except for those 3% or three genes, are all our lifestyle genes. How your lifestyle affects those genes, which means you have control over it. Even the most benign studies, the ones that had minimal effect, the MIND study and others. MIND study just looked at diet, very well-done study. Just a diet adjustment reduced your risk of Alzheimer's by 53%.

• 22:48Rich Roll?

  Wow.

• 22:49Dean Sherzai?

  And that was a watered-down version of the diet we think is optimal.

• 22:54Rich Roll?

  And how, how, how long would you need to be, you know, eating, eating in that certain way leading up to it?

• 23:01Dean Sherzai?

  It varies from person to person, their, their background, other things like if they had multiple head traumas, childbirth, like multiple variables. But in reality, if you're on that diet for several years, you continually reduce your risk. Like smoking, if you've smoked all your life and if you come off of smoking, come off of that bacon, come off of that, you know, well, then the more years you pass, I believe in smoking, it's after five years. Five to seven years, yes. Five to seven years, you're back to baseline. Right. Meaning that you're back to the lowest risk factor. So the longer you stay on a healthy lifestyle, which is exercise and all the things that we say, and especially if you do all of them, the reason I say all of them, coming back to our grandparents,

• 23:46Dean Sherzai?

  one of the elements is cognitive reserve, or what the term you and I love, idea density. You know, we say that if we have a musical band that's going to be called idea density. They had idea density, yes. It's a great, great concept. They both, both our grandparents had immense idea density and philosophers think, but they succumbed to Alzheimer's. Why? The other elements weren't taken care of. They had diabetes, cholesterol, high blood pressure.

• 24:14Speaker 02

  Quite sedentary, bad food.

• 24:16Dean Sherzai?

  Didn't exercise. Philosophers are not supposed to exercise for some reason. But, so you have to do all of it.

• 24:22Rich Roll?

  Right. So, we're going to get into these lifestyle interventions, but before we do that, let's talk about the brain more generally. We sort of think of the brain as this mysterious black box that is unknowable and something that sits outside of our body, right? Like, there's our body and then there's our brain, and these things don't really overlap. But in truth, brain health is really, it's about vascular health in the same way that heart health is, right? Like, we're dealing with, I don't know how many zillions of, you know, arteries that are going into the brain, you know, putting things into your brain and taking them out, et cetera.

• 25:07Rich Roll?

  And when you think about, you know, heart disease, we all know we're trying to not have plaque in our arteries and keep those pipes running clean, and brain health is really not that different, is it?

• 25:21Speaker 02

  That's very true. You put it beautifully. When you look at the brain, it's about three pounds, like jello. It's like hard jello when you hold it in your hands. And it's about 2% of your body's energy. And when you look at the tissues and the vessels, they're the same vessels that are in your heart and in your kidney and your body. I'm a vascular neurologist, so I teach a lot of Anatomy to medical students and residents about the vasculature of the brain. But basically, you know, you have arteries shooting from your heart, going through the neck. There's two major ones in the front, the carotid arteries and the vertebral arteries. And these are the major vessels that take blood to your brain. And there's just branching of these arteries. And somebody actually calculated this, but if you put the vessels in your brain end to end,

• 26:05Speaker 02

  it would span about 400 miles. So just imagine all these tiny hairline arteries taking in oxygen and nutrients to the susceptible areas of the brain for this incredible organ to function. And at any moment, our brain, as little and as small as it is, it can consume up to 25% of the body's energy. So just imagine the amount of work that it does. And if we don't address vascular health and if we don't really take care of it, it will succumb to disease. You know, we always say, and our cardiologists friends don't really like that, but we say the rest of the body is there to carry the brain.

• 26:48Speaker 02

  And it essentially comes down to the same pathological processes that affect the brain that also affects the heart, the kidneys, and the other systems as well.

• 26:56Dean Sherzai?

  In fact, recently, there was a publication by Dr. Hacinski from Canada. And he summarized the concepts, but the vascular factors actually predate, you know, the popular thing that we hear amyloid plaque and vascular pathology predates those things. With the newer tools, with newer, more sophisticated MRIs, you can see 20 years earlier when somebody starts having some pathology.

• 27:24Dean Sherzai?

  And the microvascular disease started way earlier. So if we take that into consideration, that in your 20s, 30s, 40s, you know, the things you do isn't going to just avoid Alzheimer's. And we think absolutely for a great majority, 90% plus, you can avoid Alzheimer's. But more importantly, sustain cognitive capacity and grow cognitive capacity.

• 27:48Dean Sherzai?

  We know that we don't use the full potential of the brain. And in fact, as we get older, one of the areas that's affected the most is focus. For two reasons. One is the focus center shrinks, as well as the fact that we are overwhelmed. Multitasking, which we say, there's no such thing as multitasking. It's doing multiple things badly.

• 28:06Rich Roll?

  Right.

• 28:06Dean Sherzai?

  It just accumulates and accumulates. But if you manage and control focus, you can actually grow your cognitive capacity as you get older. That's our goal, because if you do that, if we've addressed the, this is critical. If we address the vascular factors and the fact that we can grow the brain, we can hit all these communities that are now devastated with cognitive decline. And we see them all the time.

• 28:31Rich Roll?

  Right, so neuroplasticity then becomes a function of vascular health.

• 28:36Dean Sherzai?

  Absolutely.

• 28:37Rich Roll?

  Yeah, super interesting. When we think of, again, back to the kind of heart analogy, we think of plaque buildup in terms of deteriorating heart health. With brain health, it's amyloid plaque, right? Which is different, but kind of the same, like it's blocking these passageways. And that's ultimately what leads to stroke.

• 29:02Dean Sherzai?

  Correct. So with stroke, it's after scrotic plaques. It's different. Amyloid actually accumulates outside of the neurons and stops the communication between the neurons. So it's a little different.

• 29:15Rich Roll?

  In between the neurons.

• 29:16Dean Sherzai?

  In between neurons.

• 29:17Rich Roll?

  Right, okay.

• 29:18Dean Sherzai?

  The neurofibrillary tangles, which is the tau, is inside the cells. There are two things happen. One is the amyloid plaques and the neurofibrillary tangles. They're connected in many ways. We are learning more and more. The neurofibrillary tangles are really interesting. There are these scaffoldings that hold the microtubules inside the cell steady. The microtubules are, it's almost like we're doing, we just got the Oculus. And I was doing the, and it's a crazy thing. We're doing the roller coaster thing. And you see this roller coaster throughout the planet go. And the microtubules are these pipelines throughout the cell for transport, for structure and everything. And the tau molecules hold them together.

• 30:02Dean Sherzai?

  All of a sudden, they get phosphorylated and they come off. And then you see these scaffoldings fall apart and clog together. So for many years, we've thought that that's a separate process. It's a genetic proclivity, and there is. There are those 3% variety. But we know that inflammation also attributes to that. Multiple traumas to the head, infections, multiple pathways to trauma, oral hygiene and all of that, as well as vascular factors. So, wait a second. So if vascular factors and inflammatory factors are contributing to even those tau and amyloid co-factors, we have control over those.

• 30:42Rich Roll?

  Right, right. Yeah, so that's amazing.

• 30:47Dean Sherzai?

  Yeah.

• 30:47Rich Roll?

  Like, just the realization that we do have some domain over this thing that we've always kind of thought of as just looming out in the distance, and it's either gonna happen or it's not gonna happen.

• 30:58Speaker 02

  Oh, absolutely. Just understanding that our day-to-day habits affect those small little arteries in our brain. You know, when you have sustained damage to the arteries, or sustained attack, let's just say, you know, an attack to the system. So the body and the brain especially is constantly trying to revert any damage. You know, we have damage control mode and we have a thrive mode. And the goal is to be more in the thrive mode rather than damage control. And the damage comes from, say, for example, vascular damage comes from sustained high blood pressure. You know, blood pressure is one of the most important risk factors for so many chronic

• 31:42Speaker 02

  diseases that we're dealing with. When we have uncontrolled blood pressure, the small blood vessels in our brains, they essentially collapse on themselves. And on MRIs, what we see is these patterns called white matter disease. White matter disease is when there is damage to the blood vessels, and so those parts of the brain are inflamed, or they don't really function very well. A lot of times, they were called nonspecific white matter disease, but we're actually learning more and more about them. And they have been correlated with cognitive decline. They've been correlated with strokes. And we know that lifestyle factors can really alter them, can change them. Diabetes is another risk factor. Damage to the inner linings of the arteries can cause damage. And you know, there are parts of the brain that require, well, all parts of the brain,

• 32:26Speaker 02

  but specifically the ones that are responsible for, say, for example, encoding memory, the hippocampi, or the frontal lobe where the judgment sits, or, or the emotion centers. When they, when the damage, when the blood vessels are damaged in these areas, we really can't function anymore. And that's when you see cognitive decline.

• 32:49Rich Roll?

  Okay, up next is Dr. Anna Levkey.

• 32:53Rich Roll?

  Well, let's talk about the, the neurochemistry of addiction. Walk me through what's happening in our brains and the role that dopamine plays in all of this.

• 33:02Anna Lembke?

  Yeah, so dopamine is a neurotransmitter, which means that it is the molecule that allows the electrical signal from the presynaptic neuron to be communicated to the postsynaptic neuron, because there's a little gap called the synapse between those two neurons. So neurotransmitters allow fine tuning of those electrical signals. And dopamine is the most important neurotransmitter involved in motivation and reward. And the fundamental difference between things that are addictive and those that aren't is that things that are addictive release a lot more dopamine. So we have dopamine firing in our brain that occurs at a tonic baseline. And when we do something that's rewarding or pleasurable, we get a little rise in dopamine levels or a spike.

• 33:47Anna Lembke?

  So for example, chocolate increases dopamine levels about 50% above baseline. Sex is about 100%, nicotine is about 150%, and things like methamphetamines are 1,000%, partially because of their, their specific mechanism. But the fundamental way that I explain to patients and medical students, and now in my book, about the neuroscience of addiction, so that they can really understand what's happening in the brain, is I say that really, you have to imagine that in your brain, there's a balance, like a teeter totter in a playground. When we experience pleasure, the balance tips one way. When we experience pain, it tips the other.

• 34:30Anna Lembke?

  But one of the fundamental rules governing that balance is that it wants to remain level. So with any deviation from neutrality, the brain will work very hard to restore a level balance, or what's called homeostasis.

• 34:45Anna Lembke?

  So for example, if I do something pleasurable, like eat a piece of chocolate, I get a little tip to the side of pleasure, a little release of dopamine. But no sooner has that happened than my brain adapts to that phenomenon by down-regulating my own dopamine receptors, down-regulating my own dopamine transmission. And I imagine that is these little gremlins hopping on the pain side of the balance to bring it level again. But the thing about the gremlins is they like it on the balance, so they stay on until the balance is tipped an equal and opposite amount to the side of pain. And that's called the opponent-process-reaction, the hangover, the come-down, the actor-effect. Now, and in my case, that's that moment of wanting another piece of chocolate. If I wait long enough, the gremlin hops off and balance is restored.

• 35:30Anna Lembke?

  But if I continue to consume chocolate in ever-larger amounts to overcome the tolerance or the number of gremlins on the pain side, then I end up with enough gremlins on the pain side of my balance to fill this whole room. And I'm essentially in a dopamine-deficit state with a balance tilted to the side of pain. Now I have to keep using, not to feel good, but just to feel normal. And when I stop using, my balance tips hard to the side of pain. I'm irritable, I'm depressed, I'm anxious, I can't sleep. Those are the universal symptoms of withdrawal from any addictive substance. And that can last a long time.

• 36:10Rich Roll?

  Back to the biochemistry of everything. Obviously, every substance has a different half-life, and the withdrawal from whatever you're doing is going to be different. But what's going on in your brain? You talked about the kind of seesaw and the way that dopamine operates. When somebody is withdrawing from a substance and they're kind of experiencing the pain that comes with that, what is going on? And what does it take to kind of get past that to the other side?

• 36:43Anna Lembke?

  So there's a distinction between acute withdrawal and protracted withdrawal. Acute withdrawal is essentially where the body manifests the opposite of whatever the drug does. So if you have been using a stimulant, then in acute withdrawal, you will be sedated. If you've been using a sedative, then in acute withdrawal, you will have physiologic restlessness. And that can last anywhere between a few days to a few weeks, depending upon the substance and its half-life, as you point out. But once you get through the acute physiologic withdrawal, I think what's underappreciated generally is that there can be this sustained protracted withdrawal that can go on for

• 37:23Anna Lembke?

  months and in some cases even years, which is primarily psychological symptoms. Again, irritability, anxiety, depression and insomnia, as well as craving. So this is like ruminative, obsessive thinking about wanting to use. And that can even be accompanied by sudden physiologic feelings, sweating, stomach cramps. But that's the piece that I, in my mind, I visualize the pleasure-pain balance chronically weighted to the side of pain because those neuro-adaptation gremlins have essentially camped out there. They like it there and they're not getting off.

• 38:03Anna Lembke?

  And that is what drives relapse, even after people's lives have gotten objectively better, right? They've gotten their spouse back, their job back, and yet, and then people see them relapse and they say, "Well, why would they do that? Everything was going so well." But if you put yourself in the mind of that person, what you would see is that every day they get up, they are anxious, they are irritable, they are craving. And that is what drives relapse. It's sort of that intense physiologic and psychological suffering, really.

• 38:35Rich Roll?

  Yeah, after the acute withdrawal, that protracted period where everything just feels gray.

• 38:40Anna Lembke?

  Yes.

• 38:41Rich Roll?

  Because you're so used to those dopamine hits.

• 38:43Anna Lembke?

  Yes.

• 38:44Rich Roll?

  And even though your life is getting better, in the back of your mind, you're just like, if I just do this one thing, like, I'll be able to write that paper.

• 38:52Anna Lembke?

  Yes.

• 38:52Rich Roll?

  Or get through this uncomfortable experience.

• 38:55Anna Lembke?

  Yes.

• 38:55Rich Roll?

  And I'm just gonna do it once. And that's the cunning, baffling, and powerful component here that mystifies the non-addict.

• 39:04Anna Lembke?

  Yes.

• 39:05Rich Roll?

  Because it leaves them just utterly confused as to why somebody would make that choice. But it's almost impossible to avoid.

• 39:15Anna Lembke?

  Yes.

• 39:17Rich Roll?

  Depending upon the behavior and the substance.

• 39:19Anna Lembke?

  Yes.

• 39:19Rich Roll?

  Obviously, some are more powerful than others.

• 39:20Anna Lembke?

  And what I've come to appreciate is that something strange happens to our perception of time when we're in that state. So we're in that state of craving and dysphoria. It really feels like it will never end. I mean, it will. In most cases, we know with sustained abstinence, the gremlins hop off, homeostasis is restored. But when we are in that state, it feels as if it will go on forever. Plus, as you said, we have a way to fix it, right? It's right there within reach. If we use again, we can relieve those feelings. So I think that's the combination of those things, the distorted time perception, that those awful feelings will never end, even though they will, and knowing that we

• 40:04Anna Lembke?

  can make ourselves feel better if we just use.

• 40:06Rich Roll?

  Yeah. And if you're telling the patient they're facing the prospect of possibly years of this.

• 40:12Anna Lembke?

  Right.

• 40:12Rich Roll?

  I mean, if they're coming off benzos or something like that, they're in for a very long, hard road.

• 40:17Anna Lembke?

  Yes, that's right. Fortunately, in my experience, most people who abstain for one month begin to notice improvements in mood, hopefulness, sleep. They might not be where they want to be, but they begin to see a little bit of light at the end of the tunnel. Not always, but that's the piece that then I really have to remind them of. And I say, remember how you felt when. And if you can just hang in there with recovery. With abstinence, you know, incrementally in small ways, you will get better. And I think that's an important function that I serve. Kind of a cheerleader and a reminder, because the hippocampus is tricky. I also think that's a major function of AA, right?

• 41:00Anna Lembke?

  That we go, I use the we pronoun. So I'm not a member of AA, but in my clinical work, I use the we pronoun because again, I think we're all broken and humbled in the face of this problem. So I'll say to patients, you know, remember how you felt then. Remember how you felt a little bit better. You've done this before, you know, you remember, you have the data from recovery. Hold that close and tincture of time alone will get you there.

• 41:28Rich Roll?

  Are there cases where that dopamine balance never again reaches some level of homeostasis?

• 41:36Anna Lembke?

  Yeah, so unfortunately, I think that that can happen. So for example, in the book, I think the case of Chris, possibly one of the things that happened to him was after so many years of opioids.

• 41:47Rich Roll?

  Suboxone.

• 41:48Anna Lembke?

  Yeah, that the only way, that his balance was essentially broken. It was stuck tilted to the side of pain. And the only way for him to feel normal is to be on, you know, what's called replacement therapy or opioid agonist therapy in the form of suboxone, which has sustained him feeling well now going on almost a decade. And I'm talking very, you know, he's doing great. It's not like he's just kind of trudging along. He's doing great.

• 42:15Rich Roll?

  And he's been able to maintain that level of suboxone at a base rate? Like he's not asking for more?

• 42:22Anna Lembke?

  No, no, and I do see that. I do have patients for whom, for reasons we don't understand, they do seem to develop tolerance, but not him. It worked immediately, it worked well, it restored homeostasis. He's re-engaged with life and he's interesting, at least somebody who never went to 12 step and never really got a whole lot of psychotherapy beyond, you know, what we do.

• 42:44Anna Lembke?

  But that's what works for him.

• 42:45Rich Roll?

  Yeah, so interesting.

• 42:50Rich Roll?

  What if I told you that all humans, all of us, are equipped with this innate capacity for spirituality? Well, here today to explore this fascinating and emergent science of spirituality is a woman who helped pioneer it, Dr. Lisa Miller.

• 43:07Lisa Miller?

  So, how do we put the spiritual core back in? Well, if it's a public school or the public square, it's minus religion. That can happen at home, but spirituality exists independent of religion. And how can we do that? Again, at home, the religious embrace of spiritual awareness is important for many families. Roll with it. Do that at home. But in a public school, we can strengthen the muscle of transcendent awareness, of spiritual values towards one another. And in fact, when we look in the MRIs at the neural correlates of the awakened brain, of all forms of spiritual practice, that which most correlates with a strong spiritual awareness is love of neighbor. Love of neighbor and service altruism, that can be part of every classroom.

• 43:49Lisa Miller?

  Circle time, whether we're five years old, or sophomore year by the locker. Of all people on earth, you were put next to your classmate who struggles with low EQ. Your classmate doesn't really know how to talk to people, your classmate maybe is a little awkward. Were you put there to bully her and make her feel horrible? Or were you put there perhaps as some form of inspiration or guide? Might you even be what I call a trail angel for her? We can recast who we are to each other as helpers and healers. Love, guided, held, and never alone. Can we show up that way for one another? And that can be taught in school. But the other things that need to be taught that are part of our natural awakened awareness are listening to our inner wisdom, that's hard data.

• 44:31Lisa Miller?

  And we need to reboot our capacity for transcendent awareness in a way that is inclusive, certainly constitutional, and in the language of life. And there are practices in the awakened brain for reawakening our brain, but we could do one if you want to do one.

• 44:46Rich Roll?

  Yeah, we can do it.

• 44:47Lisa Miller?

  You want to do it? Great. Okay. This one, I want to honor my teachers, as I think, as in many traditions. This was taught to me by the late Gary Weaver. And I've done this exercise with thousands of people, none of whom have ever felt offended because it's in the language of life. And I do this with the US Army, and I do this with people on Wall Street, and I do this in homeless shelters. I do this everywhere.

• 45:10Rich Roll?

  All right, let's do it.

• 45:11Lisa Miller?

  Let's do it. Okay. I'm going to invite you to clear out your inner space, five breaths, and then we'll do about a 90-second visualization. Five breaths.

• 45:24Lisa Miller?

  I invite you to set before you a table. This is your table.

• 45:30Lisa Miller?

  And to your table, you may invite anyone, living or deceased, who truly has your best interest in mind. Anybody living or deceased who truly has your best interest in mind. And with them all sitting there, ask them if they love you.

• 45:53Lisa Miller?

  And now you may invite your higher self, your true eternal higher self, the part of you that's much more than anything you've done or not done, anything that you have or don't have, your true higher self,

• 46:10Lisa Miller?

  and ask you if you love you.

• 46:14Lisa Miller?

  And now finally, you may invite your higher power, whatever word that may be, however you know, your higher power,

• 46:25Lisa Miller?

  and ask your higher power

• 46:28Lisa Miller?

  if they love you.

• 46:31Lisa Miller?

  And now with all of those people sitting there right now, what do they need to share? What do they need to let you know? What do you need to know right now?

• 46:46Lisa Miller?

  And when you're ready, I invite you back.

• 46:49Lisa Miller?

  This is your counsel, and they're always there for you. Who shows up may change, depending on where you are in your road of life. And you can ask them different questions, depending on where you are in your road of life. But your higher self, your higher power, and those who truly have your best interest in mind, this is a form of deep awakened awareness. This is the deep loving consciousness that flows in and between us and through us. And we are built to be able to see and know this level of love and relationship.

• 47:25Rich Roll?

  I want to talk about the areas of the brain that get lit up,

• 47:28Lisa Miller?

  Yes.

• 47:29Rich Roll?

  that get turned off and all of that. First of all, constructing the study, like, how do you come up with what the study is going to be? And then you're putting people into the FMRI's. We should talk about what an FMRI is and what it can tell us and what you discover about these different areas of the brain and how they're impacted by cultivating the awakened mind, the awakened brain.

• 47:53Lisa Miller?

  That is an elegant way to ask the question, and I can't wait to respond to it. So, using the lens of epidemiology, it was clear that those threads of lived human spirituality, which are protective against addiction, which are part of our strengthening and deepening in the path of recovery and renewal from trauma or depression, were this sense of transcendent relationship, the capacity to perceive transcendent relationship and that that might be shared. So, knowing that through the lens of epidemiology, there was something heritable built into us, a form of spiritual awareness, that had such a huge impact on our health and wellness.

• 48:38Lisa Miller?

  It seemed that we could try to operationalize that dimension as a task in the MRI scanner and live-action watch people engaged in a deep transcendent relationship. So, that's what we did. We sat around the table for 18 months and used previously validated ways of working in MRI studies to come up with an in-scanner task that represented that thread that had been identified over 10 years of epidemiological work. And here's how we worked. Together, the Spirituality Mind Body Institute, my institute, together with Mark Patenza and Rajida Singh at Yale, together, literally, for a year, we sat around and figured out the method and then for another six months, operationalized it. And here's how we did it.

• 49:23Rich Roll?

  18 months, just to devise the experiment?

• 49:26Lisa Miller?

  Yes. Because the most meaningful part of a research study is the question and its method. This had never been done before. And in fact, scientists had said, you can't operationalize spirituality. It's too broad and vast. And that's where using multiple levels of inquiry, bringing a finding from epidemiology into an MRI scanner, allowed us to make progress, as well as working between labs. You know, the Manhattan Project didn't have one guy or one woman's lab. Sure. It's collaboration. So Regina Sin had found, over 15 years, that when we tell a story, a memory, in a way that's very palpable and rich, and has lots of sensory points, real anchors in it, to

• 50:10Lisa Miller?

  bring us back in time, we elicit the same neural correlates as if we were there, plus memory. And Marc Patenza, working with Regina Sin, had become one of the leading experts around addiction. And he had found that the addiction loop in our brain, the insulin striatum, is the same, whether we are addicted to alcohol and drugs, or pornography and the internet, or gambling, it's the same, I've got to have it, right? So they had worked together, Regina and Marc, in the past, developing this in-scanner task when it came to craving, when it came to telling stories of addiction, hungry, and I need to have the drug, I need to have, I've got to get to Vegas, I've got to have this, you know, roll of the dice.

• 50:50Lisa Miller?

  Well, when I approached them, I said, you know, we know from epidemiology that there's nothing as protective against addiction as a strong personal spirituality. Can we watch that in the scanner? And of course, as open-minded, creative scientists, Marc and Regina were thrilled. We sat down for a year and a half, and we took the following question, after a year and a half of inquiry, to 18 through 25-year-olds. We said, "Tell us a time when you felt a deep connection with your higher power." Some people say God, Jesus, Allah, Hashem. Some people say the universe, or oneness with all life. But tell us a time where you felt a deep connection with a deeper, deeper presence

• 51:35Lisa Miller?

  of life that was loving and guiding. Nobody was confused, 18 through 25 year olds in New Haven. A lot of them were Yale students, a lot of them were agnostic, some spiritual but not religious, some not friendly to the whole idea of religion. Nobody was surprised, everyone had an important experience, everyone.

• 51:53Rich Roll?

  And how many people, what was the population size?

• 51:56Lisa Miller?

  Well, okay, so in order to, you know, in MRI studies, there's often very small samples. You can publish a study with like 10, but we had about 30 people who went through every phase of this study. And in this study, whether they were Christian, Catholic, Jewish, Muslim, Hindu, spiritual but not religious, no matter what their background was, the same neural correlates ran as they told us that narrative.

• 52:20Rich Roll?

  And what is a neurocorrelate?

• 52:23Lisa Miller?

  So as they, as, we wanted to be very precise. We literally knew at what point in their study they felt this unit of experience. So we had them tell their stories. This is part of Rejudicens method over 15 years. Tell the story, tell it again while it's audiotaped, play it back in earbuds in the MRI machine while the FMRI is running, so that we can pinpoint to the T what neural correlates are seeing, what happens in the MRI as you say this specific little passage in your story. And right at the point where the young adults would say, "I'm walking down the street, I'm completely depressed, I've just been turned down at

• 53:08Lisa Miller?

  five out of six medical schools, I'm such a loser, I'm never going to be a doctor like my mother." But then suddenly I see light in the leaves and I know that God has a plan for me. Or suddenly I see light in the leaves and I know that life is buoyant and I will be a healer in the way I am intended. Or suddenly I see light in the leaves and I know that there's a path for me greater than anything I know yet, that aha, the reshuffling of meaning that is illuminated and speaks to a true part of myself. Right as that part of the narrative is told, we saw.

• 53:42Lisa Miller?

  Coming up online, four major components of what we're calling the awakened brain. The first is that quieting, I'm such a loser, quieting the racket. The default mode is powered down. Now, that you can do through mindfulness. That's simply getting present.

• 53:56Rich Roll?

  That's the network of rumination.

• 53:59Lisa Miller?

  Exactly.

• 54:00Rich Roll?

  Right.

• 54:01Lisa Miller?

  Right. Now, very often, because we have a hungry culture, many people are taught mindfulness, to get present, and it's helpful, but it only stops there. It only gets us present. When in fact, what then is potentiated is that we are at a threshold to cross, for being present, into a state of awakened awareness. It's mindfulness plus, it's crossing into. And the next three loops are first and foremost, just as we were held as children in our parents' or grandparents' arms, we feel loved, we feel held, the bonding network is engaged, and we are aware that life itself is holding. The next is the parietal.

• 54:40Rich Roll?

  That's the frontotemporal.

• 54:41Lisa Miller?

  Yes, yes, exactly. Right. So that was the, um, yes, that was the article. And in fact, that, well, I'll tell the whole story. Then, the next piece to come online is the parietal. It puts in and out hard boundaries. So just as there's a sense of discreet and specific experiences, you have your path, you live in California, you have your family, you look like you, and I live in Connecticut, and I have my family. We are distinct, we are magnificently diverse, we are different, and at the same time, there's a deep communitative experience, a common human heart. The parietal puts in and out hard boundaries so that we can toggle between a sense of difference and common love, common felt being. And then the final piece, which is...

• 55:25Rich Roll?

  But just to put a finer point on that, reduced activity in the parietal lobe allows the influx of this sense of commonality among all. Is that right? Is that fair?

• 55:38Lisa Miller?

  That we are connected.

• 55:39Rich Roll?

  Right.

• 55:40Lisa Miller?

  Or one. Exactly. And then finally, this is of particular importance to innovation, to decision making. The Army's really championed this dimension of awakened awareness. We move from a narrow, top-down dorsal attention network. Tactical, strategical, we've got to get out the red door. We've planned, we're prepared, everybody's trained, we're going out the red door. But today, here, live, the red door's jammed. We can't get out. That's a metaphor, of course, for life. Everything was in the bag, A plus, B plus, C. Of course, it was me who was going to be promoted. And then they what? They brought in somebody? Or A plus, B plus, C. You know, I was the one. It was my turn to be quarterback. It was my turn to be on the varsity football team. And what? I got cut?

• 56:24Lisa Miller?

  So it all didn't add up. The red door stuck. And because the red door stuck, we shift in a state of awakened awareness from the top-down, narrow, bowling alley perception of the dorsal to the bottom-up ventral attention network. We have a much broader field of perception, far more information. And many people say that the right answer, the new possibility pops. The yellow door. Never would have seen the yellow door. But the yellow door leads to a landscape that was surprising, that could be magnificently, in the big sense of the word, prosperous. I meet the person who I am best friends with the rest of my life. I find a line of work I never dreamed of. I end up in a city that was so very much at home. The yellow door opens.

• 57:08Lisa Miller?

  And that possibility of bottom-up perception leads to a form of creativity and innovation the Army calls situational awareness that allows us to align with the way life really is.

• 57:20Rich Roll?

  You can see the whole chessboard as opposed to the one piece that you can't move the way that you want it to move.

• 57:27Lisa Miller?

  Yes, and your opponent played something you never dreamed, based on the books he'd play. That's why it's harder to play a bad opponent than a good one. But that's the real chessboard that's actually here now. And when we have actual alignment with the... What is life showing me now? What is the chessboard actually telling me now? We're able to make much better decisions.

• 57:56Rich Roll?

  Finally, Dr. Spiegel is the Associate Chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. And he's here today to share the science and the neurobiology behind hypnosis, as well as the many efficacious use cases for it.

• 58:13Rich Roll?

  You mentioned the mind-body connection, and I think that's a really important point in broadening our understanding of this world of hypnosis.

• 58:21Speaker 01

  Well, you know, you mentioned snake oil earlier. And one of the things that really troubles me, saddens me about the way hypnosis has been understood and treated is, you know, there have been a lot of problems with medications, too. You know, we have 60,000 opioid overdose deaths in the United States last year. Medications have their problems, too. And I'm a physician, I use medications, I'm not against that. But, you know, the major evolutionary advantage we have as humans is this big brain on the top of our bodies. It's connected to every organ in the body, but it doesn't come with a user's manual. And so, we don't take full advantage of what it can do.

• 59:03Speaker 01

  And we underestimate, we tend to think that the real treatments in medicine are ingestion, injection, or incision. You know, that the body is like a broken car, you just replace the part and everything will be fine. And otherwise, you're not really doing anything, you're just talking to the person. And I'll tell you, Rich, the day that really turned me around about this, I was a third year medical student at Harvard, I was in pediatric rotation. The nurse says to me, "Spiegel, your next patient is in room 342, and I'm following the sound of the wheezing down the hall." And there's this 15-year-old girl, redhead, bolt upright, knuckles white, struggling for breath, you could hear the wheezing, her mother's standing there crying. They had tried to use subcutaneous epinephrine twice, it didn't work.

• 59:48Speaker 01

  They were thinking about general anesthesia and starting her on steroids. And I didn't know what else to do. So, I said, "You want to learn a breathing exercise?" And she nods. And I had started a hypnosis course, and so, I got her hypnotized. And then I realized we hadn't gotten asthma in the course yet. So, I came up with a very clever idea. I said, "Each breath you take will be a little deeper and a little easier." And within five minutes, she's lying back in bed, her knuckles aren't white, her mother's not crying, and she's breathing almost normally.

• 1:00:19Speaker 01

  And the nurse ran out of the room. My intern comes to find me and I figure he's gonna pat me on the back and say, "Good job, Spiegel. What'd you do?" He said, "The nurse filed a complaint with the nursing supervisor that you violated Massachusetts law by hypnotizing a minor without parental consent." And you know, Massachusetts has a lot of weird laws, but that's not on the list. And her mother was standing next to me when I did it. So he says to me, "You're gonna have to stop doing it." And so, I mean, this, just observing that, I think, you know, "There is something here. There's something to this. The brain can really control what's going on in the body, even in rather extreme circumstances." So, they told me that it was dangerous. And I said, "You're gonna put her on steroids and put her under general anesthesia and my talking to her is dangerous?" And he said, "Well, you may not be able to follow her."

• 1:01:04Speaker 01

  And I said, "Well, I'll, you know, I'm in Boston. I'll follow her as long as it's necessary." And he said, "You gotta stop doing it." I said, "I'll tell you what. As long as she's my patient, I'm not gonna tell her anything I know is not true. So if you wanna take me off the case, go ahead, but otherwise, I'm not." So, there was a council of war among the, my intern, the resident, the chief resident, and the attending that weekend. And they came back on Monday with a radical idea, never been tried before. They said, "Let's ask the patient." And she said, "I like this," you know. And, and that, just that observation, that just something I said to her, that using this simple, straightforward, undangerous technique could produce such a radical change in such a short time, really hooked me.

• 1:01:49Speaker 01

  I mean, I, you know, I'd learned a lot, a fair amount about hypnosis, growing up, but nothing like this, where you see it happen. And, and that, I think, is one of the tremendous advantages right now, is that you will know very quickly whether it's gonna help you or not. Doesn't help everybody, but it helps a lot of people. And you can feel it right away, which is unusual among psychotherapies, even among medications. It often takes a while to, to feel the effects.

• 1:02:18Rich Roll?

  And what do we know and perhaps have yet to learn about what's going on neurochemically in the brain when you induce a hypnotic state? Like, what are the brain, what aspects of the brain are being turned on, turned off, etc.?

• 1:02:35Speaker 01

  We've been studying that for the past decade, and we've discovered some things that really begin to make a lot of sense. And one of them, and I'll talk first about neural function in the brain and then neurochemistry. One of the things that happens when somebody goes into a hypnotic state is that they turn down activity in the dorsal anterior cingulate, the salience network. The way to think about the cingulate gyrus is it's a bundle of nerves that looks like a C on its end here, and it goes under the cerebral cortex and over the limbic system. And this part here in the front, the dorsal anterior cingulate cortex, is part of the salience network. It's part of the brain that is a context detector, and it tells you, should I pay

• 1:03:19Speaker 01

  attention or not? And so if a loud noise suddenly happens, you startle and you go turn your attention to where it is. Social media is very good at using this. You know, they'll float something by you that sounds a little scary or threatening, and you suddenly, you know, detach from what you were paying attention to. That's the salience network. In hypnosis, you turn down activity in that brain region. And in fact, in another study, we looked at the prevalence of neurotransmitter activity in those regions, and you see more GABA activity in the anterior cingulate of people who are very hypnotizable. So they have more ability to inhibit. It's an inhibitory neurotransmitter.

• 1:04:01Speaker 01

  It's one that is activated by anti-anxiety drugs. And there's greater ability there because of the higher prevalence of this inhibitory neurotransmitter to inhibit the salience activity. So it's one thing that helps you concentrate intently. You're less likely to worry about what else you might be thinking of or thinking about. The second thing that happens is higher what we call functional connectivity. That's if one region is active, the other region is active, that region is inactive, the other region tends to be inactive. Between the dorsolateral prefrontal cortex on the left, which is part of the executive control network, it's the part of my brain I'm hopefully using now as I'm describing this to you, and the insula, that's another part of the salience network that's a major

• 1:04:46Speaker 01

  mind-body pathway. So it helps your brain control what's happening in your body, control gastrointestinal function, control autonomic activity. And so you have a greater ability in hypnosis to control what's happening in your body, like that 15-year-old girl with her asthma attack.

• 1:05:05Rich Roll?

  Right.

• 1:05:06Speaker 01

  The third thing that happens is you have inverse functional connectivity. So when one region's active, the other is inactive, between the executive control network and the posterior part of the cingulate cortex. That's what we have called the default mode network, and it's a part of the brain that's active when you're thinking about yourself, when you're reflecting on who you are and what it means. It's a part of the brains where activity goes down in experienced meditators. And of course, part of meditation is to sort of detach from your self-ness, you know, to just experience things and not judge them or see what they mean for you. And that's a mechanism of dissociation in hypnosis. So we found that a lot of things that we know from the phenomenology of hypnosis are

• 1:05:49Speaker 01

  actually happening in specific regions of the brain that should control that kind of activity.

• 1:05:54Rich Roll?

  And is this the result of FMRI testing? That you've been able to discern all of this?

• 1:06:00Speaker 01

  Yeah, we've screened hundreds and hundreds of, thankfully cooperative, Stanford students, and picked out the ones who on formal testing are very high and very low in hypnotizability. We get, put them in the scanner, the highs and the lows, we give them hypnotic instructions, and we see what happens in the brains only of the high hypnotizables and only when they're in the hypnotic conditions. And that's what enabled us to observe what's going on in the brain.

• 1:06:28Rich Roll?

  And on that subject of hypnotizability, let's talk a little bit more about that. I mean, first, how do you determine whether somebody has a high receptivity to it? And secondarily to that, like, is that sort of a preset that people come into the world with? Is it malleable? Is it something that can be shifted with technique?

• 1:06:52Speaker 01

  We're doing some research now that adds to another body of research over the last decade or so, showing that there does seem to be a genetic component to hypnotizability. That particularly people with a certain polymorphism of the production of dopamine, a neurotransmitter that's prominent in the prefrontal cortex and throughout the brain. If they produce just enough, so this is an enzyme, catecholomethyltransferase, it's an enzyme that metabolizes dopamine. And if you're at a point where you don't metabolize it too quickly or too slowly, those people

• 1:07:36Speaker 01

  seem to be more highly hypnotizable. And related people, people with in general genetic commonalities, tend to be more similarly hypnotizable than people who are unrelated. And so there is some evidence that it may have to do with this genetic variation in neurotransmitter metabolism. But there's also evidence, Josephine Hilgard published a book called Personality and Hypnosis, where she looked at the early life histories of former Stanford students, of Stanford students, and found that higher hypnotizability was associated with one positive and one negative thing. Imaginative involvements, children who had been raised to have imaginative involvements,

• 1:08:20Speaker 01

  their parents read stories to them every night, they played games in their imagination, turn out to be more highly hypnotizable. But sadly, also children who have been physically and sexually abused are more highly hypnotizable. And it may be that it's a kind of protective defense mechanism if you're going through terrible experiences.

• 1:08:39Rich Roll?

  Right, because they developed the ability to disassociate when their brain was still malleable.

• 1:08:44Speaker 01

  That's exactly right. I had one patient who said, "I'd just go to a mountain meadow full of wildflowers when my father and his friends were abusing me." You know, that's the way she dealt with it. And so there's a developmental part of it, but the other part of the story... Is that most children are highly hypnotizable.

• 1:09:03Rich Roll?

  Right, that's what I was thinking because they're less calcified in their neuropathways.

• 1:09:08Speaker 01

  That's, that's part of it and because they're, for children, you know, knowledge and emotion and experience are all kind of one thing, you know, it's why work is play for kids, you know, it's a shame that we make them into little adults because they love doing whatever it is they're doing, they just get fully engaged hypnotically in a way and whatever they're doing and you call your eight-year-old in for dinner and she doesn't hear you, she's out doing whatever she does. In adolescence, when we develop what the psychologist Piaget used to call formal operations, where you kind of privilege logic over experience, many people lose to some degree that hypnotizability. And by the time you're 20, 21, the level you have is what you're gonna have 25 years later.

• 1:09:51Speaker 01

  And they did a study at Stanford in which they blindly retested students and at 25 years after they'd taken their psych one class and found that there was a point seven correlation between their original hypnotizability and the one they had at age 45 or 46.

• 1:10:10Rich Roll?

  Is that Zimbardo?

• 1:10:12Speaker 01

  Yeah.

• 1:10:13Rich Roll?

  That did that, yeah. I took psych one from him.

• 1:10:15Speaker 01

  Yes, you took, did you really?

• 1:10:16Rich Roll?

  I was not part of that cohort.

• 1:10:17Speaker 01

  You weren't part of that cohort? Did he, did he read the hypnotic susceptibility?

• 1:10:20Rich Roll?

  I mean, it was, you know, 30 years ago, I don't remember.

• 1:10:23Speaker 01

  Yes, that's right, you were there in the 80s, you were at Stanford. Well, you know, so what it suggests is that once you get into early adulthood, it's a very stable trait. It just doesn't change very much. And, and so some people who retain it, I think, have brains that have been, have grown into a relationship particularly between, and we've done some neuroimaging on this too, the dorsolateral prefrontal cortex and the anterior cingulate. And people, the students we studied who were more highly hypnotizable, had more functional connectivity between the executive control and the salience networks than the low hypnotizables.

• 1:11:04Speaker 01

  So when they thought about something, they tended to coordinate that with a part of the brain that says, is this worth thinking about or not? Whereas, and it's interesting, if you see really low hypnotizable people as adults, and I see a lot of them, they come to me, they wanna be hypnotized and they're not hypnotizable, they're very critical and, and they evaluate things carefully and they argue and they raise questions, which is all good. But it's a kind of non-hypnotic way of responding.

• 1:11:31Rich Roll?

  Right.

• 1:11:36Rich Roll?

  That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change, and The Plant Power Way. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and/or comment. And sharing the show or your favorite episode with friends or on social media is, of course, awesome and very helpful. This show just wouldn't be possible without the

• 1:12:18Rich Roll?

  help of our amazing sponsors who keep this podcast running wild and free. To check out all their amazing offers, head to richroll.com/sponsors. And finally, for podcast updates, special offers on books, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo. The video edition of the podcast was created by Blake Curtis and Morgan McRae, with assistance from our creative director, Dan Drake. Content management by Shana Savoy, copywriting by Ben Pryor. And of course, our theme music was created, all the way back in 2012, by Tyler Pyatt,

• 1:13:01Rich Roll?

  Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants.