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

Chapter 6


Soothe the Dorsal Anterior Cingulate Cortex

Here’s how you feel when a relationship soothes the Accepted pathway:

In this relationship, I feel calm.

I can count on this person to help me out in an emergency.

In this relationship, it’s safe to acknowledge our differences.

When I am with this person, I feel a sense of belonging.

Despite our different roles, we treat each other as equals.

I feel valued in this relationship.

There is give and take in this relationship.

Afew years ago, one of my fire alarms started going off at random. I’d be in the kitchen or just walking down the hall when the alarm would sound; each time, my body reacted with a jolt of adrenaline and I’d rush through the house, looking for smoke. When I found nothing burning, I’d worry that an electrical fire was smoldering within a wall. Then one day I was so frustrated by the beeping alarm that I took the little box down from the ceiling and opened it up. Inside, I discovered a bug, cooked to a crisp. It had crawled into the alarm and caused a short circuit.

Having an overactive dACC is like having a bug crawl into your fire alarm. Remember the dACC? It’s that small strip of brain tissue that activates when you’re in pain. The Cyberball study at UCLA, the one where volunteers were gradually left out of an online game of catch, showed that the dACC fires when you’re physically hurt but also when you’re socially left out. As a species, we seem to be incredibly sensitive to being left out. Later studies using Cyberball showed that even when the volunteer subjects believed that the other players were part of a group they didn’t respect, such as the Ku Klux Klan, or when they were told that the other “players” were actually a computer program, research subjects still smarted from the rejection. It’s as if your nervous system understands that belonging to a group is crucial to your well-being; when you don’t feel a sense of belonging, your nervous system wants you to feel uncomfortable, even wounded, so that you can recognize that you have a problem and do something about it.

But if your dACC has become highly sensitized, it sends distress signals at inappropriate times, just like my fire alarm did. With an overactive dACC, you’re always worried about or running from social “fires,” never feeling safe in a relationship. The process leaves you feeling alone and abandoned. These feelings of estrangement feed back into the dACC, causing it to be even more active in sensing social rejection.

It took a while before I understood that my fire alarm wasn’t telling me that I had a fire; it was trying to tell me there was a bug in the circuit. It’s the same for people with highly reactive dACCs. It can be hard to identify what’s really causing your feeling of distress. Is it that people are excluding you? It could be. We live in a society based on social competition and on identifying the people who are “in” and people who are “out.” Both children and adults get rejected, judged, and jostled out of groups all the time. It hurts to be excluded, even if we pretend that it doesn’t. Just to make things harder for all of us, however, a feeling of social pain can also be caused by a bug in the system. It’s easier to identify this bug if you know what to look for.

I traced the feeling of a “bug in the system” with my patient Kara, but it was a long time before either of us could figure out what was going on. She didn’t talk about alarms or fear or pain (or bugs) at all. When Kara and I first met, she described feeling like a black hole was inside her. Sometimes the black hole churned like an active volcano; other times it felt like a dead, stagnant space. Always the black hole was with her, like a negative energy that drained her. Kara had spent much of her life in therapy, trying to extricate, reshape, and even befriend this deep, dark energy. Nothing had helped.

Kara understood from her years in therapy that this black hole had probably been formed in childhood, when she had experienced losses that were sudden and frequent. Her parents had been doctors who worked for a medical relief organization; they moved around so often that all friendships stayed fairly superficial. She could remember longing to be close with her parents, but for years the Vietnam War got in the way. Her parents were preoccupied by their relief work, the number of soldiers and civilians dying every month, and by their opposition to both the draft and the war itself. In Kara’s mind, her early years were a swirl of tension, grief, and being on the move, although nobody really talked about these issues with her. Then, when Kara was in elementary school, her much older sister died in a car accident in a foreign country. Her parents pulled away from their remaining children, emotionally out of reach, where they stayed.

Kara grew into a woman whose life looked pretty darn good, at least from the outside. For starters, she was the vice president of a real estate investment firm. She had married and divorced amicably, raising a son and two daughters on her own. She talked with her children frequently and was proud of their growing maturity and independence. Despite her stressful upbringing, Kara had stayed in regular, though not close, contact with her two younger siblings; in fact, she often organized vacations with them for the express purpose of fostering connections. She had a vast network of friends and dated occasionally. Despite Kara’s success and her connections, the black hole remained, and it ate away at her. She instinctively turned to her friends to give her relief from the bad feeling—and this worked, but only temporarily. Within an hour after she returned home from socializing, the black hole would reemerge.

“Relationships are like drinking salt water,” she told me. When I looked puzzled, she explained that she could drink and drink, but her thirst was never quenched.

Kara’s nerves were so frayed that we agreed to work on her Calm pathway to soothe her hypersensitive sympathetic nervous system. After a while, she felt brighter—but even a steady program of antidepressants, neurofeedback, and other exercises did not seem to change some deep, broken place inside her. The black hole was a useful metaphor for her pain, but I wondered what specifically in her neurological wiring kept this black hole perpetually intact.

Then something surprising happened. Kara was standing in the foyer of her center-entry Colonial, a house nestled in a neighborhood that had been home to centuries of American patriots, politicians, and business leaders. Waiters passed roast beef on toast points; from another room, she heard a pop and then a cheer as someone opened a bottle of Champagne. She was having a party for her colleagues and important clients. There, in her sparkling home, surrounded by history, celebrating with some of her favorite people, Kara understood for the first time that she did not feel that she belonged here. This feeling was familiar, but it puzzled her, because she knew that her own credentials were rock solid and that her friendships were real. Why would she feel this way? Moreover, she asked, why would this feeling bother her so much?

In an attempt to help her understand the particular pain she was feeling, I described the Cyberball research that tells us why it hurts to be left out. Naomi Eisenberger and Matthew Lieberman, who conducted the original Cyberball research, used the results of their experiments as the basis for SPOT, or social pain overlap theory. SPOT describes the “overlap” between the pain of being physically hurt and the pain of being left out. In our bodies, there is literally no distinction between the two. For people, being part of a group is essential, and being excluded is dangerous.

Kara’s insight at the party grew into a transformative concept that finally gave the black hole a definition. The black hole was, in fact, a deep sense of never belonging. She’d never felt that she truly belonged to any group. In her childhood, Kara’s family was disorganized at best and then, after the death of her sister, emotionally incoherent. Then she’d entered a mostly male profession, where she never felt that she belonged, and when she was married she never felt like part of her husband’s extended family. She moved to the East Coast but never quite assimilated into its clubby culture. She had always protected her children from knowing about the black hole; she was unable to share her full experience with them. On it went, this feeling of exclusion.

The next surprise happened when we talked about whether this view was accurate. Did she always feel left out, or was there anywhere in her life now where she felt comforted and like she belonged? Her answer was quick and clear. Kara’s two Burmese cats, Wellington and Sealy, were constant, warm, loving creatures who made her feel far better than people ever could. As she described her cats, she could feel the dark hole getting smaller and smaller.

There was another time when Kara felt like she belonged: whenever she was with her brother, Max. The two of them shared a familiar style of wit and good-natured teasing that was “home” to her. Her relationship with her sister, Charlene, was sometimes strained by their different life choices, but their time together also had this “home” feeling. Kara explained this realization of belonging with her brother and sister like this: “There’s a feeling of ‘Oh, I really do belong with these people.’ There’s an illusion that I don’t belong with my brother or my family, but I do.”

Kara suffered from a bug in her neurological alarm system. Her early childhood experiences of being left out had caused her dACC to become oversensitive. Even when she was included, her brain zapped her with painful messages of social exclusion. Understanding that her black hole had a name—it was the feeling of not belonging—and that it had a neurological cause gave her tremendous relief.

All her life, Kara had suffered from a social catch-22. She needed healthy connections to heal her sense of not belonging, but when she reached out to friends, her overactive dACC would give her another zap of pain. In effect, Kara’s brain would say, “See? Here’s another person who doesn’t really accept or like you.” Zap! Her attempts to shrink the black hole were actually feeding it. The fact that her friends actually did like and accept her didn’t matter to Kara’s dACC.

For Kara, the solution was to identify where she already felt accepted and to go there whenever the black hole made itself known. Instead of calling friends or making dinner plans when she felt bad, Kara would curl up on the couch with Wellington and Sealy. She’d pet them and they would flip over onto their backs so that she could rub their bellies. Or she called her brother. This was not necessarily an obvious set of solutions, because cats, however warm and wonderful, don’t have the same potential for conversational intimacy that people have. And Kara was not as close with her brother as she was with some of her friends. But when it came to healing the black hole, none of that mattered. What mattered was that in these relationships, the feeling of belonging was unquestionable. It was simply there. The relationships calmed her Accepted pathway—for Kara, it was like putting an ice pack on her red-hot dACC.

How a “Bug” Gets into Your dACC Cortex

I’ve been talking about a “bug in the system” of people with overactive dACCs, but of course it’s not a real bug. What’s more, the so-called bug doesn’t crawl into your brain at random. Something happens to create this effect of an alarm system that’s yelling out the message I’m being left out!, even when people want to welcome you in.

For most of us, that something happens in childhood. In Kara’s case, her nervous system was formed at a time when her parents were unable to give her warm emotional acceptance. Children desperately need to be accepted and loved by their parents. The sights, smells, and feelings of a parent’s loving gaze and comforting hugs inhibit the firing of the child’s dACC, and the more often this happens, the more that the second rule of brain change—Neurons that fire together, wire together—can shape the neural pathways to make this effect even stronger. But when Kara would look into her parents’ faces, she didn’t see a loving, accepting expression. Instead, she got a preoccupied or vacant look. This is not as obviously cruel as neglect or abuse, but let’s be clear: it’s still a form of rejection. Worse, it was rejection by the people she most depended on.

Young Kara didn’t have the words for this painful experience, but over time she simply stopped expecting to feel anything other than left out. In effect, she learned that she was unworthy of loving relationships. As her therapy continued and the adult Kara thought further about the issue of belonging, she realized that whenever she started to feel a desire for more closeness to another person, she felt one of those zaps of pain. The pain carried a message: What are you thinking, Kara? You don’t get to feel close to other people! You know you don’t deserve it. What was this zap? You guessed it: a pain message that began in her overactive dACC.

The Relational Paradox

When Kara “heard” her dACC telling her that she didn’t deserve to be in relationships, she naturally pulled away from the other person. This meant that although Kara had plenty of friends, she wasn’t really close to any of them. Kara’s behavior with her friends fits into a pattern that relational-cultural therapists call the relational paradox. This happens when you’re convinced that your friends won’t tolerate who you really are, so you decide that the best way to be accepted is to leave a part of yourself out of those relationships. You think, If they knew about my insecurities [or past history, secret habits, or anything you believe would keep you from fitting in], I’d lose the relationship. Kara’s thoughts ran along the line of, If they knew that I don’t deserve to be in relationships, they would leave me. So, ironically, Kara tried to save her relationships by withholding her fears.

Of course, by hiding yourself you may preserve the friendship, but at a cost of feeling that you don’t legitimately belong, that if your friends could see who you truly are, they would cut you loose. The more you participate in the relational paradox, the more pain you feel, and the more sensitive your dACC becomes—which makes you want to hide and protect yourself even more.

You can start to dissolve the relational paradox little by little. I suggest you start by simply becoming aware of the times you hide yourself or pull back from relationships because you think you’re unworthy. This can take practice! Then you can send a soothing message to the place in your mind that feels vulnerable. You can do this by revisiting a positive relational moment, which I explain in detail here. If you have a reactive dACC, it’s useful to build a library of positive relational moments that involve a close and clearly accepting connection. Kara would say to herself, Hmm, I hear my dACC telling me I’m unworthy. Then she’d play a funny conversation with her brother over in her head.

Eventually, you’ll be able to see your current relationships with less bias. You can even try sharing some of your hidden self with the people who feel safest to you.

Relational Problems: A Package Deal

Kara’s relational assessment chart is interesting because it shows how one problem—in her case, an oversensitive Acceptance pathway—usually shows up in the company of other problems.

Kara’s C.A.R.E. Relational Assessment Chart

Here’s how Kara scores on the C.A.R.E. pathways:

Calm (add up scores for statements 1 through 7; maximum total score is 175): 94 (low)

Accepted (add up scores for statements 5 through 11; maximum total score is 175): 89 (low)

Resonant (statements 12 through 16; maximum total score is 125): 66 (low)

Energetic (statements 17 through 20; maximum total score is 100): 56 (moderate)

Kara’s Accepted score is her lowest number relative to the scoring range for each category. But her other numbers don’t look so great, either. She’s only a few points higher for Calm—and that score reflects the improvement she saw after using antidepressants and trying neurofeedback. She had some trouble reading other people, and this went hand in hand with a low Resonant score. She wasn’t able to perceive that others really liked her and wanted her to be part of their group. Her energy level was okay, but she tended to feel drained after social interactions, mostly because she felt rejected. It makes sense. Would you feel like dancing if your brain was telling you that you’re unwanted?

These kinds of chart results—with low to moderate scores across the board—are typical for people whose neurological wiring is dysregulated. One problem leads to another problem that makes the first problem worse, and so on. It’s almost impossible to know precisely where one issue begins and the other ends. If you head into a relationship with your guard up, certain that you won’t be accepted, it’s hard to feel calm or to project yourself in a such way that others can see the real you, and vice versa. Eventually, all your neurological pathways can suffer.

Fortunately, the reverse is also true. By improving one relational pathway, the others have a head start on getting better, too.

Safety Groups: A Warning for People with Low Acceptance Scores

I want to alert you to a danger for people with low Acceptance scores: if you don’t feel like you belong anywhere, assessing your safety groups might be a painful exercise. If your groups don’t include anyone in the safest category, you might be tempted to think: Oh, look—here’s proof that I really don’t belong anywhere and there’s nobody who really likes me.

If you catch yourself thinking this way, stop!—and relabel this depressing idea as an inaccurate message from your overactive dACC. It may be true that you spend most of your time with people who are critical, judgmental, and unaccepting. You need to identify these relationships so that you can understand the damaging effects that they are having on your dACC and so you can start to repair the damage that’s already been done to it.

It can also be true that past experiences with feeling outside and outcast may have shaped your dACC so that it’s hard for you to feel like part of any group, even when people want to welcome you in.

Both issues—that the people you hang out with are judgmental and that your brain has trouble understanding that you are safe and welcome—can be true at the very same time. This is why sorting your relationships into safety groups is so illuminating. It can help you figure out which relationships deliver a lot of exclusion pain, and which relationships are more promising.

Like Kara, you might be surprised to find that the relationships you turn to in a time of crisis are the ones that actually make you feel the worst. This doesn’t necessarily mean that these friends or family members are cruel and excluding (although they might be). In Kara’s case, it simply meant that she had a fundamental, instinctive feeling of belonging with her cats and with her brother—and that these were the relationships that she could rely on to help her feel a healing sense of belonging.

Here’s how Kara’s safety groups shaped up, with a look at how she used the insight:

High relational safety group (75–100 points): None. This helped Kara further identify the cause of her “black hole” as a feeling of exclusion.

Moderate relational safety group (60–74 points): Her brother, Max, had the highest score and was the safest of all of Kara’s human relationships. Her friend Nina also made it into the moderate category, but Kara’s gut feeling was that she just didn’t have quite the same sense of belonging with Nina. This was a relationship that she could improve when she felt ready to share more of herself.

Low relational safety group (less than 60 points): Kara’s sister, Charlene; adult daughter, Suzanne; and her coworker Alex scored in the lowest group. Kara tried not to dump her problems onto her daughter, who suffered from bipolar disorder and was often extremely reactive herself. Kara loved Suzanne, but the relationship struggled. Kara could instinctively feel a sense of belonging with her sister—but she realized she had to proceed carefully. Charlene wasn’t entirely safe for Kara.

Alex was a tech wiz who ran the IT department at the bank. He often seemed emotionally cool. Kara wondered if he might even be on the autism spectrum. Kara concluded that her relationship with Alex did not hold much potential for acceptance and belonging, and furthermore she decided that this was okay with her. She didn’t need to feel a sense of belonging with everyone. When she was with Alex, she knew how to identify the discomfort she felt, and she could immediately say to herself, “Oh, well. I don’t feel accepted by him. Thank goodness I’ve got my kitties to go home to.” Eventually, she decided to focus on accepting Alex as he was, instead of wishing he could be different. As you’ll see, the judgments you make about other people can boomerang back in a way that heightens your own feelings of being judged. One way to calm your dACC is to let some of those judgments go.

Our Judgmental Culture Leads to Social Pain

Kara’s dACC had become overactive in response to her early childhood losses. But there are other ways that you can develop an overactive dACC. When a culture dictates that normal human development is measured by how separate people are from one another, everyone’s relational templates are distorted, and everyone’s dACC is reactive to some degree. To make matters worse for the dACC, we live in a hypercompetitive society that’s always asking the questions: Who’s prettier? Who’s more popular? Who’s a member of the “best” race, gender, religion, class, or sexual orientation? Who’s more competent? Who has achieved the most? Who’s got the best stuff? Who’s better?

To a large extent, our social groups are created around the answers to these questions. This happens so unconsciously that most of the time we’re hardly aware of it. Yet it has the effect of putting us all on constant high alert. A part of us is always scanning our surroundings, wondering where we rank against the people we see. Are we better? Are we worse? Imagine what it does to the dACC to know that we could be kicked out of our social group if we buy the wrong handbag or don’t get the right kind of job, or if we tell our friends that we’re gay or that we don’t agree with their politics. In this atmosphere, the dACC is constantly stimulated—and then it becomes more sensitive in response. The result: this primitive part of the brain is trapped in a vicious circle. The world looks dangerous; every encounter could potentially result in social peril. Then, in self-protection, the brain says, “Withhold yourself. Don’t expose who you really are. Take the other person down first if that’s what you have to do to stay safe.” And then the world does become more hostile in response to you.

This is exactly what happened to my client Nancy, a fiftysomething woman with stylishly tousled hair and a wardrobe of casual but expensive-looking clothes. Nancy wanted to be in therapy to talk about her relationships. She was worried that she was becoming more distant from her children and losing many of her friends. As we talked, she salted her conversation with judgments about the people she knew:

“Everyone can see that my friend’s son isn’t very smart. That’s why he has to go to the state school.”

“My daughter wants a promotion, but that’s hard to imagine. She’s so lazy!”

“Well, someone had to tell my aunt that she’s annoying.”

I have to admit: I wondered what Nancy would say about me when she left my office.

Nancy’s harsh comments were the effects of a lifetime of living with a highly stimulated dACC. Nancy did not have a traumatic childhood like Kara’s. But throughout her life, she and her family looked to “in” groups to satisfy a desire for belonging. Her mother in particular was highly attuned to how her children appeared to the outside world, especially to the people she wanted to impress. When she thought Nancy had gained too much weight or wasn’t doing well enough in school, she could be bitingly critical. By college, Nancy was so accustomed to criticism that a relentless chorus of judgment sounded in her mind: she was too fat, too dumb, not sweet enough. Then Nancy fell in love with a slightly older guy who was studying for his Ph.D. He was ambitious and handsome and from an educated family. Here was a desirable man, valued by the kind of people her family had always admired. The fact that such a man could love her quieted the critical voices in her head.

Nancy married this man and started a family. They were happy at first, but under the pressures of new parenthood, Nancy’s husband lashed out at her. She bought a new dress, and he told her she looked ugly in it. He fumed that she was a lazy mother who kept the children in diapers all day, when other wives were out working and contributing to house expenses. If Nancy tried to bring up a complaint about the way he acted, he turned it back onto her: “I don’t ignore the children. You’re the one who lets them watch TV while you pretend to get stuff done!” His attacks resonated with the words she had heard repeatedly as a child from her mother. Instead of making her angry, they confirmed her biggest fear: that she was unlovable. Her dACC pain pathways were being chronically stimulated and growing more and more reactive.

Plenty of people suffer damage to their dACC pain pathway as a couples relationship develops—whether the partnership takes on an abrasive tone or not. Falling in love is great for the dACC, as the two people pay extra-close, tender attention to each other. Although it’s definitely not healthy for a partner to be as spiteful as Nancy’s husband was, it is normal for the intense feelings of this initial phase to fade. If one of the partners has even a little bit of reactivity in the dACC, this normal pulling away may not seem just like a change in the relationship. It can feel as if the other person doesn’t love him or her at all. The dACC becomes even more stimulated, and feelings of judgment and abandonment cloud the relational picture. It becomes harder to see the other person more clearly. All relationships take work, but the ones that are really close can be the most difficult, because there are so many opportunities for distortion to occur.

Nancy coped with her feelings of inadequacy by trying to fit in with the best social groups in town. She always put forth what she considered to be the best version of herself and her family and hid what she believed were faults. This was the relational paradox at work: in an effort to belong, Nancy was hiding parts of herself. Only the perfect parts could show. Unfortunately, her only other strategy for lifting herself up was to put others down. It was typical for her to “honestly” describe their flaws: her friends were told when they were being ignorant, unstylish, or just irritating. Everyone who Nancy knew was subject to this judgment—even her children, whom she constantly compared to one another.

When I would point out that a statement she’d made sounded overly judgmental, Nancy’s face went blank, as if she could not imagine any other way to be. It was all she knew. Of course, her relationships suffered as friends, hurt by her insults, showed her the door. Eventually, Nancy’s relationships started to feel like land mines in a field to her, ready to blow any minute. And when they did, she felt hurt and judged and rejected . . . again. But she had trouble understanding the role of her own judgments in the explosions. There was no template in her mind for nonjudgmental acceptance, no alternative to piercing criticism.

From a distance, it might be tempting to wonder what on earth Nancy could be thinking. How could she believe that a constant drumbeat of criticism would draw her closer to her friends or her children? But that’s what can happen when the dACC soaks in an atmosphere of judgment. Judgment becomes the way it protects itself. Judgment becomes all that it knows.

Exercises to Soothe Your Acceptance Pathway

Social disconnection isn’t just painful. It can have serious health consequences. Science has long known that physical pain stimulates our stress response systems, and now we know that social pain is equal to physical pain. This means that chronic social pain leads to chronic stress, too—and there is an overwhelming amount of research documenting the negative effect of chronic stress on our minds and bodies. Stress dampens the immune system and increases the risk of cardiovascular disease, depression, headaches, diabetes, anxiety, asthma, and other conditions. People who live with chronic physical pain are at significant risk for health problems like these. So are people who live with chronic social pain.

Despite the link between social exclusion and devastating health problems, it’s hard not to keep the vicious cycle going. Like Nancy, many of us are unable to see an alternative to constant judgment. Or, like Kara, we’ve turned the judgment onto ourselves, and the message that we’re not good enough is so deeply written into our psyches that we don’t even realize it’s there.

The key to breaking the cycle is to become more aware of the cycle. It’s so easy to pretend that social pain doesn’t exist—that it doesn’t hurt to be left out, that we’re too grown up to feel bad when people are cold or rejecting. Both Kara and Nancy were perplexed by their suffering. They hardly had the words to describe what was hurting. That’s why I’m devoting lots of space here to something I call SPOT removal, a series of steps designed to increase your awareness of social pain. I’m also sharing a few other activities that I use for increasing self-acceptance and acceptance of the people who are your friends.

SPOT Removal

SPOT removal is a set of exercises I developed in response to what researchers call SPOT—social pain overlap theory, meaning that social pain overlaps with physical pain in the same brain region. These exercises will help you identify how strongly your brain reacts to social exclusion. They’ll also help you extricate yourself from the cycle of inclusion and exclusion that’s constantly being played out in our stratified, power-based society.

First, think of a time when you were excluded from a group or uninvited to a social event:

· What were your feelings and thoughts about being excluded?

· What did you do in response to being left out?

· As you remember this time, what sensations do you notice in your body?

· What story did you tell yourself to explain why you were excluded?

· How did the experience affect your connections to people other than the ones who excluded you?

Then put yourself on the other side of the table. Think of a time when you, or a group you were a part of, knowingly excluded someone else. Ask yourself the same questions.

The goal of these first two steps is for you to become more aware of the impact of exclusion on your body and on your relationships. When you exclude others, or when you judge others, you are perpetuating a system of inclusion and exclusion—the same system that feels so threatening to your brain. This game of “in” and “out” is damaging to everyone who plays it. Even if you are currently “in,” you feel, perhaps unconsciously, a sense of threat. On some deep level, you know that at any time your name could be called, and you could be the one who’s “out.”

I learned this lesson early in my career, when I was working in the psychiatric unit of a hospital where a clinician was being targeted by other staff members. The staff had some legitimate criticisms about the clinician’s skill. That was fine. Being able to review someone’s performance is critical to running an organization. But instead of giving her direct feedback, the staff turned on her. They made her the brunt of behind-the-scenes jokes and cut her out of the group. I’m ashamed to say that I participated. I was new and loved my status as one of the “included” doctors. A few short years later, though, I found myself on the “out” list. I was judged unfairly—just as I had unfairly judged my colleague earlier. Anyone participating in social inclusion and exclusion is in an emotionally precarious situation. Even now, when I think back to both those experiences as a young psychiatrist, my throat tightens and I want to hide. The experiences of excluding and being excluded are ones that can stay with you.

Repeating these two steps with a few different experiences of inclusion or exclusion will give you a better perspective on the revolving-door quality of this human dynamic. In, out, in, out. Zap, zap, zap, zap. Feel that? As you temporarily relive the stress of being left out, or the transient relief of being included when someone else is pushed aside, focus on all the feelings that arise. You may be surprised at their complexity.

Next, pick a time when you’ll be out in the world for at least thirty minutes. Bring a notebook or your phone and make a small notation every time you make a judgment about someone else or judge yourself in comparison to someone else. When you’re done, think about the messages that have been running through your head. Do you constantly think others are managing their lives better than you are? Or do you judge yourself as smarter and better than everyone else? Do you notice the weight of everyone around you, or their height, or the clothes they wear?

Judging immediately disconnects you from other people. In that moment, you can’t see what does or could exist between you; you can only see where you rank in the power structure. If you’ve ever had a highly critical, micromanaging boss, the kind who thinks he’s the only one with the “right” answers, you know what I mean. Every interaction leaves you feeling helpless, diminished, and angry! On the other extreme is the coworker who repeatedly apologizes for the work he’s done, always sure that he’s not good enough. He makes little eye contact in meetings; you can feel the shame he carries. The person who chronically judges others and the person who chronically judges himself base their interactions on old relational patterns and controlling images from the past. When you are in an interaction with someone like this, you may feel “unseen.” Judgments are like a thick layer of fog settling between you and the other person, making it nearly impossible for you to see each other clearly. Some of these old relational images come from childhood experiences, but others are absorbed from the fabric of society’s values. These are the “isms”: racism, sexism, heterosexism, able-bodyism . . . in a stratified society, there is an infinite number of ways to judge others. Not only do we learn to judge individuals as a way for us to get ahead, but we also learn to judge entire groups of people and even whole cultures in order to justify an unequal division of power. By noticing how often you make mental criticisms of yourself and others, you’ll become more conscious of the default program of judgment that runs in your head.

A way to decrease a chronically overactive dACC is to stop feeding it judgments. So again, find thirty minutes when you will be out in the world with others. When judgments pop into your mind, simply notice them—and then relabel them. Don’t judge yourself for having judgments! Just say, “Oh, that’s just my judging mind,” and then actively lift your thoughts up out of their neural groove and move them to a new, more positive track. Try thinking something more generous about the person you were judging, even if that person is you. Or think about a happier moment, like your child’s face during her birthday party or a relaxing afternoon you spent searching for stones on the beach.

When you take this step, you stop the revolving door of judgment in your mind. Active nonjudgments starve the neural pathways in your brain devoted to judging yourself and others.

This step is simple but not easy. The judging pathway isn’t going to simply concede defeat and step out of the way to let the new thoughts take hold. The judging mind is an agile foe, and the judging pathways are robust from years of development. Expect some of the other neural pathways that the judging path has recruited to jump in and tell you things like, “But really, that person’s hair is too long!” or “This SPOT removal thing is overly simplistic and a waste of time.” It is essential to continue to notice, relabel, and refocus. Only then will you distance yourself from judgment enough to see that it isn’t reality. Try this step for thirty minutes a day for two weeks, and you will begin to see the judging pathways diminish.

Challenge yourself to apply this technique in more complicated situations. Choose an environment that really pushes your hot buttons, like a political debate. There may be no place in American culture more judgmental than the field of politics (with the possible exception of fashion and beauty). Over the last couple of decades, opinions and judgments have become hair-triggered and hardened. This makes politics a great place to practice nonjudgmental acceptance. So regardless of your political beliefs, try watching a debate, or follow a political issue being argued through the media. When you feel a judgment coming on (“He’s an ignorant idiot!” or “She’s an elitist!”), see if you can notice it, name it—and then relabel it as the product of a judging mind.

Another challenging environment for most people is holiday dinner with the in-laws, whether or not politics comes up. So try to name and relabel your judgments next time you’re sharing a turkey dinner with relatives who drive you crazy. To paraphrase Frank Sinatra: if you can practice active nonjudgment there, you can practice active nonjudgment anywhere.

The goal of this more challenging exercise is not to strip you of your belief systems. Having well-developed opinions is essential to a full life. The goal here is to create a healthier dACC by cutting back on how often you feed it the unhealthy food of demeaning judgments. And by starving the dACC in this particular way, you take advantage of the first rule of brain change: Use it or lose it. If your dACC isn’t stimulated by judgments as often, it will lose some of its reactivity.

There’s another way that toning down judgments can heal your brain. Judging is the domain of the emotional right brain, which is trying to protect you from something it perceives as a threat. This is a well-meaning activity on the part of your right brain, but it is an ineffective relational strategy. When you’re judging, you’re not listening. And if you’re not listening, you’re missing out on one of the best ways to stimulate your smart vagus pathway and turn down the volume of your stress-response system. But if you’re not judging, you can listen more and feel calmer, and this, in turn, will make interacting with others much easier and judging others less necessary. As you listen, you may learn something new. Or maybe not; there is always the possibility that you will hear things that you don’t agree with. Fine. Honest disagreements happen in even the best relationships. If you can have a passionate argument without pathologizing the other side as sick or malicious, your relationships will be more durable.

Sometimes people question the steps of SPOT removal, wondering whether giving up judgment means that they cannot give or receive feedback about interpersonal actions and behaviors. Actually, feedback is absolutely critical to growth-fostering relationships. How can you grow without feedback? It’s instrumental in helping people see each other clearly and correcting behavior that undermines the relationship. But snap judgments and dismissive comments are very different from respectful conversation about what needs to be improved in a relationship. While both can be hard to handle, judgments are usually mean-spirited and designed to enhance your distance from the other person. Respectful conversation is in the service of the relationship. These conversations are in the category of growing pains; they are not fun to experience, but they are easier to bear because the pain isn’t being held by just one person. It’s being held within the relationship.

Judgments versus Feedback

What’s the difference between making a snap judgment and offering helpful feedback? It’s all about their intended effect on the relationship. Judgments set you and the other person further apart; feedback will, ideally, bring you closer. Here are some examples of both:



I can never get things right with you. You’re never happy!

I try to consider your experience of things, but I am often confused by your reaction. Can we talk about how each of us can become more responsive in the relationship?

You’re an undependable jerk for canceling our date last night.

Can I tell you something? We’ve been out on a few dates, and I like you a lot. But when you cancel on short notice, it feels as if you’re sending me a message that your schedule is more important than mine.

You’re lazy.

I’ve noticed that you tend to leave the room when it’s time to put the kids to bed. I really wish you would stay and help me.

Your political opinions are crazy! You’ve been brainwashed by the media.

We have different political opinions. Why don’t you tell me yours—and I’ll promise not to interrupt or try to change your mind. Then I’ll tell you about mine, if you promise to do the same for me.

What Are You Hiding?

Most people are hiding at least a few things—usually personal characteristics or beliefs or past experiences—from the people closest to them. Hiding who you are can make you feel safer, but only temporarily, because hiding produces follow-up thinking that goes, If they knew the real me, they would reject me. This is the relational paradox at work. In the hopes of being accepted, you don’t share who you are—and then you feel as if you’re always on the verge of being discovered and then rejected. You feel chronically unseen. What seems like a good, safe strategy for building relationships ends up activating your dACC pain pathways.

Ending this stimulation of your dACC requires some courage and at least one reasonably safe relationship. Begin by making a list of things you are hiding. Then choose your safest relationship and invite that person to perform an exercise in mutual sharing: you will both divulge one thing you’ve been hiding from others. The thing you are hiding is likely much more embarrassing or shameful to you than to the friend you are telling.

Here are some of the secrets, big and small, my patients have hidden from their partners, family, and closest friends:

· I lied and told my boss I got into a car accident because I didn’t want to go to work.

· My family is from Germany.

· I took a year off from school after flunking out of college.

· I had an abortion when I was seventeen.

· I was sexually abused as a child.

· I hate camping.

· I give lots of speeches, but I throw up in the bathroom before each one because I am so anxious.

· Some days I’m so depressed and anxious that I can’t get out of bed.

· Some days I really wish I didn’t have kids.

· When I was a little boy, the older kids chased me all over the football field and I was scared to death.

· My wife earns more money than I do.

The relationship will probably be closer after you’ve been more honest with each other. Unpacking old secrets can significantly decrease the pain of life.

Root Chakra Work

In the Hindu and yogic traditions, the seven chakras are the body’s energy centers, each located at a different point on the body and each governing a different psychological or emotional state. The root chakra, which sits at the base of your spine, right at your tailbone, helps you feel grounded and connected—to know that you belong in the world. You can try a very simple method of balancing this chakra by placing one palm over its area and another hand over your heart (the location of the heart chakra, which influences our sense of inner peace). You can do this while watching TV, meditating, or simply sitting and thinking. Over time, the bad feeling of exclusion will lift.

Compassion Meditation

Barbara Fredrickson, the director of the Positive Emotions and Psychophysiology Laboratory at the University of North Carolina at Chapel Hill, has spent her career researching love and acceptance. In her book Love 2.0, she describes what she calls “loving-kindness meditation” or “compassion meditation,” a practice that her lab has shown to increase self-acceptance, decrease depression, and improve relationships.

To practice compassion meditation, find a quiet and comfortable spot. Breathe in and out, finding a slow, deep rhythm. Say these phrases to yourself:

May I live in safety.

May I be happy.

May I be healthy.

May I live in ease.

Then send the same wishes to a friend:

May he/she live in safety.

May he/she be happy.

May he/she be healthy.

May he/she live in ease.

Using the same script, send the wishes to a neutral person, and then to someone you dislike. Finally, send the wishes to the world:

May we live in safety.

May we be happy.

May we be healthy.

May we live in ease.

As you sit quietly, breathing deeply, you are decreasing your nervous system’s level of arousal. You become calmer. When you send compassion to yourself and the world, you add a sense of warm-heartedness to that feeling of calm. You’re teaching the brain to pair these two states of being—to use the second rule of brain change by wiring the two sets of neural pathways together. If your brain has been wired for snap judgments, this exercise will show it how to find pleasure in good wishes.

When you meditate on oneness and on compassion toward yourself and other people, you’re enlarging—in a psychological and neurological sense—the knowledge that we’re all one. It’s remarkable to witness the change in people as they make a regular practice of compassion meditation. Over the weeks, its message begins to compete with the well-worn neurological pathways that insist I don’t belong. A different pathway, one that has been weak for a long time, begins to remind you that you do belong, and that we are imprinted on one another. We can hurt and heal one another. And one of the best ways for us to grow is within our relationships.