THE THREE RULES OF BRAIN CHANGE - Four Ways to Click: Rewire Your Brain for Stronger, More Rewarding Relationships (2015)

Four Ways to Click: Rewire Your Brain for Stronger, More Rewarding Relationships (2015)

Chapter 3

THE THREE RULES OF BRAIN CHANGE

By now it should be clear that we are not as psychologically independent and separate as we’ve been led to believe. For better or worse, relationships reach deep inside our brains to shape how we feel, think, and react.

Ideally, our relationships are healthy and help us feel great—Calm, Accepted, Resonant, and Energetic. So great, in fact, that we crave more relationships, and we knit together a network of people who help us mature into even greater relational complexity. If that doesn’t sound like you, well … welcome to the club, my friend. In a world that dismisses our biological need for warm, human connection, most of us have suffered through some pretty bad relationships or felt the chill of isolation. That means our brains have suffered, too. Instead of feeling Calm, Accepted, Resonant, and Energetic, you might feel any or all of the opposite: irritable, rejected, bewildered, and tired. You might even have the sense that you’re just not good with people, or that you weren’t built to enjoy relationships.

There is another perspective that needs to shift, and this is the idea that a history of difficult relationships can be traced to a fixed, unchangeable flaw in our personalities.

This is untrue. Both our genes and the environment will, over the years, write particular relational patterns into the brain—but they are not necessarily written onto our souls. It can be helpful to see these problems as nothing more than electrical impulses that, instead of following the four C.A.R.E. pathways for healthy relationships, go off track. With understanding and effort and support, it is possible to redirect those wayward impulses. We can shrink undesirable neural pathways that undermine our relationships and strengthen other pathways that are more beneficial. We can even grow neural connections that are completely new. These new or healthier pathways can help us do what we are designed to do: enjoy satisfying relationships in which we can grow.

Neurology Does a 180

Sally, a client who initially came to me because she had developed a habit of lying to her boyfriends, is a good example of how an adult can learn to change her brain, and how relationships are a vital part of that change.

My mother used to say to my siblings and me, “Why lie? The truth is far more interesting.” This was not the case with Sally. Real life was almost never as interesting as her lies. If Sally didn’t feel like going out on a Saturday night, she’d tell her boyfriend that she was going on a weekend trip … to London. If she was running late for a date, she’d say that her tires had been slashed. There were other kinds of lies, too: if Sally’s boyfriend liked action movies, Sally—who preferred foreign films—would pretend to like them, too. Did Sally want to help her boyfriend finance a car? Let him move in without paying rent? Of course she did!

Flexibility is essential to relationships, perhaps especially romantic relationships. We have to be able to imagine each other’s experiences of life and compassionately negotiate our different needs. But Sally was a relational contortionist who twisted herself like a pretzel to fit the desires of whatever man she happened to be dating. She wanted men to feel that she could perfectly suit their needs—that she would never be disagreeable, would never be late, and would never want to do anything different from what her boyfriend wanted to do. Sally’s lies weren’t just lies; they were her strategy for staying connected in her romantic relationships. They were also a source of dopamine, the neurotransmitter that creates a sense of pleasurable energy. When she told a whopper, she felt a rush of excitement—would she get caught this time?—as well as anticipation of tenderness from her boyfriend as he heard of her latest tragedy or her willingness to support his plans. But Sally’s romances came to a predictable end: within a few months, she’d told so many lies and hidden so much of herself that the relationship was unsustainable. Sally came to me because she wanted to stop this pattern. But after more than a decade of advanced lying, could she change?

Common methods of addressing a problem like Sally’s include the “you need to have more self-control” school of thought, which draws on the old separation-individuation model. The general idea is that Sally has to get a grip on herself and stop doing things that undermine her relationships. If she feels the impulse to lie, she should simply ignore that impulse, even if she has to white-knuckle her way through it until the temptation passes. There is some wisdom here, because self-control is an essential element of change. But this approach doesn’t account for the complex role of relationships in Sally’s problem, or the way that lying had become wired to the dopamine reward system in her brain. The self-control approach also doesn’t take advantage of neurological methods of brain change. (For example, the neurochemicals produced by healthy relationships can help melt pathways for bad habits and solidify new pathways that are more desirable.) Not to mention that the self-control approach leads to a classically depressing circle: if Sally feels that the measure of her maturity is the ability to stand alone and control herself, she will feel like a childish failure if she gives in to temptation and tells a lie. Then she’ll seek comfort in her most reliable source of dopamine—namely, telling some really impressive lies in order to elicit excitement and love.

Then again, some therapists might try to help Sally break her lying habit by looking at her present and past relationships. A psychodynamic therapist would probably try to understand her family history, for example, and talk about how Sally’s parents had never accepted the true, real Sally—they’d preferred the false version she’d learned to present to them. There would likely be a lot of discussion about how she tended to choose boyfriends who were a little too comfortable having a woman meet all their needs. Most of all, there would be a big dose of understanding acceptance. These are wonderful qualities to bring into a healing, therapeutic relationship. However, they are not always enough to bring about brain change, and even when they are, that change can be a long time coming. Although I suspected that Sally’s lying was connected to the nature of her past and present relationships, I worried that traditional talk therapy would not be enough to help her dig out of this entrenched habit.

Why are we stuck with only these two options—self-control and therapeutic acceptance—for changing habits and relational patterns? One reason is that most people, even therapists, aren’t aware of the neuroscience of connection. Another reason is that for centuries, the brain was seen as fixed and unchangeable. Yet there is overwhelming evidence that the brain can change—that it is, in fact, always changing.

Your Brain Is Alive

Until recently, scientists could not actually see the brain or measure its components. Tucked away neatly inside the skull, its nature has been hidden. Scientists who were unable to witness the brain in action have struggled over the centuries to create models and theories to explain its enormous capacity. The brain has been compared to a chest of drawers with many discrete compartments; to a filing cabinet with folders that can be opened and closed; to the Wizard of Oz, controlling the city from behind his curtain; and to a supercomputer, endlessly performing operations along its circuits. All these analogies are to essentially inorganic, mechanical objects. These objects aren’t alive. They don’t grow and they don’t change.

For the most part, scientists believed the same thing about the human brain, with one exception: childhood. It was believed that childhood was the only time that the brain could grow and adapt. A child soaks up signals from the internal and external environment and—for better or worse—the child’s brain adapts to that environment. In a case that Antonio Battro documents in his book Half a Brain Is Enough: The Story of Nico, doctors removed the right lobe of a boy’s brain in an attempt to treat his seizures. Despite Nico’s loss of crucial brain tissue, he developed virtually without deficits. He developed not just the kind of functions associated with the left side of the brain, but musical and mathematical abilities as well—even though those functions are usually controlled by the brain’s right side. Battro explains that the traditional explanation for how the boy’s brain could compensate when half of it had been removed was that a child’s brain is still developing during childhood.1

The old belief was that this kind of extreme compensation for a brain deficit or injury was possible—though rare—only while a child is still growing. As a child moves into puberty, scientists believed, the brain becomes fixed in place and no outside pressure can reshape it. No more growth, no more adaptation. At that point, if something from the outer world does damage the brain, that damage is mostly irreparable. To take a psychological example, children who grow up with unattuned, uninterested caregivers develop brains that result in behavior patterns reflecting hopelessness. According to the old model of brain development, such a child’s only hope is early, caring intervention to reshape the brain. Without it, the child’s emotional fate is sealed. Other physical and emotional traumas could carve their signatures into the young brain, too.

In an extension of the brain-as-hardware metaphor, it was also believed that the brain’s destiny was to break down. Little by little, as it took the hits that befell it over the course of a normal lifetime, the brain’s components would rust and short out. Or it could suffer a spectacular crash, with large parts of the brain going dark as the result of an accident, infection, or stroke. In this view, cells in the central nervous system are like pieces in a set of antique china; if you break one, there is nothing to do but sweep up the broken pieces and carry on as best you can with whatever is left intact.

No one believed that brain cells might be able to repair themselves or regenerate, or develop new connections among themselves. This depressing neurological “fact” had serious consequences for people who had injuries or illnesses that affected the brain. Until about fifteen years ago, it was standard for rehabilitation hospitals to aggressively treat people in the first few weeks or months after their injury, but once the brain swelling subsided and improvement plateaued, it was believed that nothing more could be done. Rehabilitation meant learning how to compensate for whatever deficits you’d developed. If you injured your visual cortex (the part of the brain usually associated with vision), it meant you had cortical blindness, period. If you lost function of your left arm, that arm would forever hang limp. Rehab therapists would teach you how to get around without seeing or how to get your groceries through the front door while using only your right arm. And if you had difficult relationships as a child, it was assumed that these relationships left an indelible scar on your capacity to connect.

Fortunately, this view of the brain can be now placed in the medical-history archives, filed away with other outdated ideas like bloodletting and black bile (the “humour” that Hippocrates thought caused cancer and other illnesses). Although the brain still needs protection, and I don’t recommend knocking it around, your brain is not quite the fixed, fragile object we once thought it was. As you’ll see throughout the book, you can use the rules of brain change to solve problems, repair your C.A.R.E pathways, and strengthen your relationships.

Brain Change Rule Number 1: Use It or Lose It

A friend of mine developed tinnitus, a disorder in which your nerves “hear” a sound that is not there. She described the sound as a high-pitched noise that stayed in the background during the day, when she was distracted by work or her kids. When she lay down to sleep at night, however, the noise seemed to get louder. With fewer other sounds to compete with the noise, nighttime became a nightmare. After a few months she was chronically sleep deprived; eventually, she was depressed. Then her doctor told her about a new treatment, one that would use a principle called competitive neuroplasticity to weaken the area of her cortex that was producing the phantom sound. The treatment was time intensive: for a couple of hours a day, the doctor had my friend listen to music she loved but from which the pitch that matched the ringing sound was deleted. After the treatments, her tinnitus was dramatically reduced and no longer interfered with her ability to sleep at night. Slowly, her life regained its old, normal hectic form.

If you’d had tinnitus several years ago, you would have been told that it was untreatable. It was in 1997 that a surge of discoveries about the brain began, discoveries that led straight to this treatment for tinnitus, along with therapies for other disorders that originate in the nervous system. These are treatments that let us rewrite our brain pathways. They are becoming more familiar in certain settings, especially the rehabilitation hospital and the occupational therapist’s office. In other settings, including the psychotherapy office, they are not familiar enough. When your relational pathways aren’t working in the way you’d like them to, it is possible to change them.

The watershed event in 1997 was a study by Peter Eriksson, a Swedish neuroscientist who proved that the adult human brain can grow new neurons. Until then, it was thought that the adult brain was like hair on a balding scalp: although it was natural to lose neurons as you aged, and not necessarily a sign of disease, you could never grow new ones. Eriksson’s discovery had many implications, but one of its greatest effects was to throw open a door onto a new field of research. This field is called neuroplasticity; the idea is that the adult brain can be remolded and reshaped, much the way a soft plastic polymer can be pulled and pushed into shape. Suddenly, the hardware metaphors for the brain no longer fit the known facts. The brain is not fixed. It is more versatile and more resilient than anyone ever guessed. It is more alive.

Neural pathways are constantly responding to their environment. When you stimulate a brain pathway repeatedly, it grows stronger. It grows more myelin, allowing electrical impulses to travel faster along its length. More branches develop, making the path wider. (Seen through a microscope, a well-traveled neural pathway has so many branches that it looks wild and bushy, like Einstein’s hair.) Brain pathways also compete with one another for space, so as you use a particular pathway more and more frequently, other pathways die off. This leaves fewer alternative pathways for the brain’s electrical impulses to travel. Instead of dispersing themselves along several different smaller paths, more impulses run together along the well-traveled one.

But if neurons are starved of stimuli for long enough and if your brain does not sense a demand for their use, they can wither away. If you could look at the brain of a person who’s lost the use of a body part to amputation or paralysis, you’d see that the brain’s “map” no longer features roads and pathways for that part. The area those pathways used to travel is not empty, however. It is grown over by other, nearby pathways that are taking advantage of the abandoned real estate.

This is why the tinnitus treatment works. The competitive sound forces the patient off the old pathway so that it’s not used so repetitively; it also encourages a new, alternative pathway to grow. Rehabilitation specialists harness the use-it-or-lose-it rule with new protocols for stroke victims. Instead of merely teaching them how to compensate for lost function, they also will stimulate the neural pathways for the disabled body part by working it over and over.

The “use it or lose it” rule is also at work when people get stuck in relational patterns. You can see this when a long-married couple has “forgotten” how to talk about their problems without bickering and sniping: the neural pathways for these habits have, over the course of their marriage, become hardened and inflexible. Or when a woman always shows up with a date who drinks too much. For a person like this, there is probably a psychological tug of familiarity at work—maybe her parents had similar attributes—but there is a neurological factor, too. A neural track was laid down in her brain in childhood, creating a template that associates important relationships with alcohol. As she follows that template as an adult, and continues to follow it, she wears a neurological groove, replaying one set of preferences and behaviors over and over, until the alternative paths weaken from disuse. You also see “use it or lose it” when someone undergoes what looks like a significant change of temperament. A quiet person moves to a big city and becomes bolder; a selfish person undergoes a hardship and becomes more empathic. The changed circumstances force changes in the brain pathways.

Sally, my client who lied to her boyfriends, had a fast, strong neural pathway for lying that had been reinforced over years of repetition. Our work together would run in the same direction as the therapy for tinnitus. We wanted to intentionally weaken the path of her habit. At the same time, we’d stimulate some alternative pathways—relational ones—in the hope that they’d grow strong enough to compete with the old one.

Brain Change Rule Number 2: Neurons That Fire Together, Wire Together

The second rule of brain change is Neurons that fire together, wire together. Like people, neurons are stronger in groups. When neurons that are close to each other repeatedly fire at the same time, they will eventually link up and form part of a neural network or pathway. A neuron is made up of a nucleus, axons, and dendrites. Axons send messages toward other neurons, and dendrites receive other neurons’ messages. It’s as if axons and dendrites reach out from separate neurons and hold hands. (Their handholding is done across a gap called a synapse, into which neurotransmitters release chemical messengers that are passed from neuron to neuron.) In an immature nervous system, this handholding looks clean and simple. You can imagine that Neuron A holds hands with Neuron B, which holds hands with Neuron C—sort of like children playing a game of Red Rover. But with stimulation and the passage of time, neurons grow more axons and dendrites. They reach out to hold hands with many neurons, forming complex neural networks.

The direction that these pathways take, and their degree of complexity, is based partly on the DNA of the individual neurons. But the new field of epigenetics tells us that the expression of DNA is profoundly affected by the stimulation your neurons receive from the environment. DNA aside, your neurons and neural pathways are also directly shaped by environmental triggers. Consider the track that leads from the motor cortex of the brain to the right index finger. We’re all born with this track. As a child who is studying piano repeatedly stimulates that track, it grows stronger, with more axons and dendrites—that’s the “use it or lose it” rule in effect. But those axons and dendrites don’t simply wave around with nothing to do. They reach out and hold hands with other neurons; in “neurospeak,” they recruit neurons from nearby pathways. Brain scans of concert pianists show that the neural networks for their fingers are richly interconnected; the axons and dendrites of the relevant neurons have grown together so tightly that the whole hand operates as one unified part, rather than as five separate fingers plus palm and wrist. This interconnectedness results from the repeated stimulation of the different parts of the hand at the same time. Over the years, the hand’s neural network recruits even more neurons into its pathway. The nerve cells themselves will be slightly larger because they have each grown so many branches, but a thicker pathway also results from the pathway finding more and more friends, all joining into this neural network. If a pathway like this is used often enough, it will actually take up less physical space in the brain. This isn’t because the pathway is weaker. It’s because the pathway has become incredibly streamlined, and efficient, sort of like a flabby body that gets leaner as it grows stronger.

In Sally, this rule of brain change—neurons that fire together, wire together—has created a complex, strong pathway for habitual lying. When she told a lie, she felt thrilled, like a kid on a roller coaster. Also, her boyfriend would become more understanding and sympathetic in response to the lie, and Sally felt comforted. All these feelings were recruited into a neural pathway that also became linked to lying. (More about neurons and dopamine, the feel-good neurotransmitter, in a moment.) Sally’s brain was like a pianist’s, except that instead of recruiting neurons into the pathways for her hand, it was the pathways for lying, excitement, love, and comfort that had become so rich and interconnected.

I wanted Sally’s brain to change which neurons were wiring together and firing together. This would be a little like asking a pianist to become a lacrosse player; in effect, Sally would learn to let one set of pathways wither while building up a completely different set.

Brain Change Rule Number 3: Repetition, Repetition, Dopamine

Almost twenty years ago, I attended the first conference on the neurobiology of post-traumatic stress disorder (PTSD), held in New York. I was on a steep learning curve regarding issues of trauma and abuse and was thrilled to hear many of the leading researchers in the field present their piece of the neurobiological puzzle. The results were fascinating. People suffering from post-traumatic stress disorder were found to have a dysregulated hypothalamic-pituitary-adrenal axis, too much amygdala activation, too much norepinephrine stimulation, and not enough cortisol production. I’ll spare you the rest of the terminology, but suffice it to say that the sum total of these alterations in brain chemistry is a very reactive, irritable person.

We all wanted to help people with PTSD, but at the time, treatments for the disorder were poorly understood and difficult to implement. One research group stuck out, however, because their treatment was working. Edna Foa, a clinician and researcher from the University of Pennsylvania, was getting better than usual results in a group treatment designed for women who had a history of abuse, even when compared to other therapists who were using group treatments. Conference attendees were puzzled by the results. At one point, someone mentioned that Edna was an “unusual woman”—apparently this was code for a warm relational style that was very different from the standard detached application of treatment protocols. But no one (including me) went as far as to say that the relationships she was forming with clients or that the patients formed with one another in group therapy may have been a factor both in the research and in the success of her standardized treatment.

I can look back now and see that in Edna’s program, the therapeutic and group relationship was likely a direct contributor to her success. The chemistry of healthy relationships enhances your ability to change your old patterns. Change is a form of new learning, and learning, at the microscopic level, is about making new neurons. We’re making new synaptic connections, too: when we learn, axons and dendrites are reaching out to different neurons. The structure of the brain is being altered.

It’s almost impossible for this neurological change to take place when you’re feeling cut off from others. Isolation is a stressful state for both your body and brain, especially when you sense that you’re being rejected or judged; your body reads it as a dangerous situation. It prepares you to answer the question, “How am I going to survive the next few hours?” As the sympathetic nervous system shifts into high gear, adrenaline races through your body, diverting energy to the large muscles in your arms and legs and helping your heart and lungs provide the oxygen that will fuel your body’s fight-or-flight response. At these times, your body doesn’t have the interest in or energy for building new synaptic connections for learning. It’s simply busy saving itself.

When you are in healthy connection, your physiology is soothed, and you have a higher capacity for learning. Although you need a small amount of “good stress” to arouse your nervous system and give you a little boost of energy (think of how a skilled coach can put just enough pressure on you—but not too much—to help you play at your highest level), you can’t effectively grow new synaptic connections unless you feel basically safe. Healthy relationships release a full cascade of chemicals that ease the way for learning. These include serotonin, which in certain areas of the brain has a calming effect, and norepinephrine, which has a focusing effect in small quantities. Oxytocin in particular appears to propel both relationships and learning. When you’re in love or when you become a new parent, oxytocin floods the body; in a literal sense, it makes you want to reach out to another person, to hold and touch them. In his book The Brain That Changes Itself, psychiatrist Norman Doidge describes the theory that oxytocin encourages brain change by melting away some existing brain pathways so that you have room for new ones.2 Again, this comes back to relationships—it allows us to change our old ways so that we can prepare for a different kind of life, one with a new partner or child. Oxytocin is released, although in smaller quantities, by friendships and other warm connections. If you want your brain to build a new pathway, you can speed along the process by enlisting oxytocin.

The neurochemical with the strongest capacity to encourage brain change may be dopamine, which is also released by growth-fostering relationships. I’ve already mentioned the dopamine reward system, which is so compelling that it creates addictions when dopamine pathways are connected to the wrong activities. By supplying your brain with a hit of dopamine from healthy relationships, you create a powerful connection between the activity you want to encourage and the body’s natural cravings. You’re offering the brain a reward for reshaping itself. Neuroscientist Martha Burns tells teachers to think of dopamine as the brain’s “Save button,” because when dopamine is paired with learning, the neural pathways associated with that new information are solidified and retained.3

For all these reasons, a healthy human relationship can be the biggest asset you have when you are trying to change. At the same time, a healthy relationship without repetitive stimulation of a new pathway may not be able to effectively compete for brain space with existing unwanted neural pathways and their troublesome behaviors. This is why a third rule for brain change, whether you are in therapy or trying to change without professional support, is clear: repetition, repetition, dopamine.

Putting the Three Rules into Action

A visual may help illustrate how to put the three rules of brain change to work. One of our recent winters in New England was a bear, with more snowstorms than I can remember since my childhood in Maine. During the third major snowstorm in a single week, my friend’s car became stuck at the end of our driveway, the back two wheels spinning helplessly on a patch of ice. Each time she stepped on the gas pedal, my friend’s wheels spun faster and faster. The pathway transformed from a slick of ice atop the snow’s surface to a deepening icy groove. The more she revved the engine, the deeper the car went, and the more stuck it became. This is what happens with habits and relational patterns. They may start as a small nuisance, but as the action is repeated over and over again, the neural pathway bulks up. The habit becomes entrenched.

When my friend’s car was stuck, she needed a new pathway. The tires needed to land on a different section of the driveway that was not on the patch of ice. To free the car, I created a different pathway by packing salt and sand down into the deep groove. The wheels found some traction on this new surface. The car lurched onto the clean side of the driveway, and she was able to drive away.

Changing your brain and your old habits requires a similar shift, away from a neural pathway that is undermining your health to a more desirable pathway that stimulates both dopamine (to help solidify new habits) and healthy interpersonal connection (to stimulate the connected brain, decreasing stress and isolation and improving learning). Some people like to imagine that they are setting physical roadblocks down on the unwanted neural pathway, to block the impulse from traveling through. Other people like to imagine that they are lifting up the impulse that is originating in their brain and redirecting it to another pathway, one that’s more pleasant. These images are an oversimplification of what happens in the brain, but this is an instance when simplicity has an advantage. When you feel yourself careening off into a bad habit, you might find that the habit’s pull is so forceful that it’s hard to remember what you need to do to change. But if you have a strong, clear image in mind, you are more likely to coax your mind into behaving differently.

Let’s go back to Sally, who needed to decide on roadblocks she might set up to divert her from lying to her boyfriend. There was no right or wrong answer, I explained. The first roadblock could be whatever allowed her to pause, for even a second, when she felt the temptation to lie. I encouraged her to be unafraid of taking very small steps, which are less overwhelming and easier to make than sweeping changes.

I had another recommendation to make. Many people come to define themselves by their bad habits or their failures; being able to recognize the bad habit as something apart from themselves is an important first step and can serve as a roadblock. Sally was able to set up a small roadblock on her lying pathway simply by recognizing the desire to lie as a way to change her physiology and make her feel better in the relationship. Her lies and the resulting knot of relational difficulties did not have to define her. Other people have set up similar roadblocks by saying things to themselves like “that’s just my crazy thinking” or “this is just my body telling me that it’s craving dopamine.”

When she paused and labeled the urge to lie as simply a bad habit and an ineffective way to feel closer in a romantic relationship, Sally was able to remember that she was more than the habit that had frustrated her for years. This left her the mental flexibility to call up other, more important images of herself as a successful professional, a culturally sophisticated adult, and a caring person. These were positive, rich relational images of good connections. By changing her focus, Sally literally changed the stimulation to her brain. The pause also allowed Sally to gradually recognize that the impulse to lie wasn’t really an impulse. It actually began much more gradually, when she was feeling lonely and starting to look forward to being with her boyfriend and feeling special, cared for. Her old relational templates did not allow her to linger in this state of positive anticipation, however. Almost immediately, she was flung into an intense fear of abandonment—a fear that her boyfriend wouldn’t like her if he knew how she felt. This fear inevitably led to a lie designed to keep him sympathetic and interested. Sally began to label those thoughts as a part of her habit and could see how these thoughts had been recruited into the lying pathway she now wanted to starve.

As she got better at identifying the thoughts that preceded the lying, she worked on picking her mind up and off its groove—and then moving it to a more positive neural pathway. When she was alone and craving connection, she’d try imagining a time when she’d felt authentically connected with her boyfriend. If this didn’t work, she might call him and say honestly that she missed him or that she felt low. Over time, she was also able to describe some of her lying behavior to a friend; they agreed that if Sally felt like lying, she would text the friend and tell her about it. One day Sally found herself conjuring up an old memory of a high school boyfriend who had adored her, no lying necessary. Each of these activities served as roadblocks and exercised healthier relational pathways. Although these pathways were withered from disuse, they were like desert plants that lie dormant but come back to life when they are given just a little water. When she engaged in these more positive actions, she felt the jolt of pleasure, the surge of dopamine.

Sally was not able to hold on to a positive image or activity every time she had the urge to lie, especially at the beginning of her attempt to change. Sometimes she ended up telling her boyfriend about how her grandmother had died, or how she had been mugged during her last trip abroad (all lies, including the trip). But as she practiced the skills for more honest relationships, this pathway strengthened, and it became easier to reroute her thoughts in its direction.

I want to stress that Sally had a long path ahead of her. It is not easy to change a very old habit, especially when you have as little experience with healthy relationships as Sally did. But it is definitely possible, especially if you have at least one safe relationship that will support you and your work. Unsurprisingly, Sally eventually broke up with her old boyfriend. I was worried when, within just a few weeks, she began dating someone new. Early in the relationship, a warning sign flashed. Sally moved into a new apartment, and he brought her a housewarming gift: a bottle of his favorite barbeque sauce to keep in her refrigerator. Sally and I talked about how confusing it was to receive a “gift” that was about him, not her. The next week, she explained to her new boyfriend that she appreciated the gift, but that she didn’t like barbeque sauce herself. We cheered this small success—because, actually, it wasn’t small. It was one of the first times she’d ever risked being honest this early in a relationship. To her surprise, her boyfriend did not mind that she had different tastes in condiments. Sally expressed her amazement to her friend, who had grown closer to her, and the friend reinforced the idea that a healthy relationship can tolerate different opinions and ideas. The combination of this safe friendship, along with regularly not lying, were literally rewiring Sally’s brain for honest connection.

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The takeaway message from this section of the book? Your brain can change, and most important for our purposes, your brain can change its patterns of relating to people. You can teach your new brain to be Calmer, more Accepting, more Resonant, and more Energetic—to bolster all four pathways that relate to growth-fostering relationships. That work begins with the book’s next section: the C.A.R.E. program.