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

Chapter 9


As I write this chapter, there is a trend toward reality TV shows featuring people who demonstrate how to survive by yourself in the wild. You can learn some pretty interesting things from these shows: how to make a meal from frozen yak eyeballs, and how to use your pants as a flotation device. Most of all, the hosts impress on us, is the importance of physical fitness and adaptability. You’ve got to be able to leap over boulders. You’ve got to be strong enough to build a snow cave. Sometimes you’ll have to run from wild pigs.

I love these shows. They’re fun. But I can also see that the trend toward survival TV reflects our attitudes about separation, that surviving on your own is the truest, most elemental human situation, and the ultimate test of your maturity. Physical survival is an extension of how we see the social waters: menacing, competitive, best navigated with a knife clenched between your teeth and a wary eye out for crocodiles.

Throughout this book I’ve tried to demonstrate an alternate way of thinking about our capacity for psychological maturity and growth. How our brains are designed to use relationships to help them grow and stretch and change. How those same brains contain neural pathways that can flourish only when given input from healthy relationships. How we mature, not by stepping away from other people but by moving into greater relational complexity. So maybe it won’t be surprising that I’m offering a different way to think of fitness as well. I want you to begin thinking about a brain that is physically fit—a brain that, like a survivalist’s body, can remain strong and flexible, and can adapt to changing conditions. Maybe not the conditions of an active volcano in a Pacific archipelago, but the relational terrain that changes as you meet new people, as technology creates different ways of interacting, as your own growth changes the nature of your relationships. At the beginning of this book, I compared relationships to a magician’s interlocking rings. The acts of coming together, overlapping, moving away, and integrating what you’ve learned, require you to stay light on your feet, mentally speaking. For this, your brain needs relationships—but it also needs to stay physically fit. It needs to conduct electrical impulses with efficiency. It needs to grow new blood vessels and neurons. It needs to rest and recover.

Below are nine ways to keep your brain in shape for great relationships.

1. Drink Water.

At my neighborhood pool, there is a rule that if you hear thunder or see lightning, everyone must immediately get out of the water and remain out for thirty minutes. Every summer, the neighborhood children complain that their happy pool time is interrupted for what to them appears to be no good reason. They don’t realize that this rule is lifesaving. The free ions, salts, and other minerals and metals that are found in water are highly efficient conductors of electricity. If lightning hits the water, its current travels almost instantaneously through the pool.

The same principle operates in your brain, which uses electrical currents to send its signals from one nerve to another. These signals include the impulses that zip from neuron to neuron along the smart vagus and eventually to the sympathetic and parasympathetic nervous systems, sending your autonomic nervous system accurate data about whether to stand up and fight or sit down and relax. Signals along the mirroring system let you have the imitative responses that produce an almost instant reading of another person. To do this and other complex, fast relational computation, your neurons need to be plump and well hydrated.

The Institute of Medicine of the National Academy of Sciences recommends that women have a total intake of 91 ounces of water per day; men should get 125 ounces daily. We get about 20 percent of these water needs through food, however, and most of us will do just fine by drinking whenever we’re thirsty, or by drinking enough to produce clear or pale yellow urine. Caffeine and alcohol are diuretics, so if you consume these, you’ll need to drink extra water to compensate. Also drink extra water if you exercise for more than an hour in a day.

2. Exercise Your Brain as Well as Your Body.

If you currently exercise to improve your stamina, shape your body, or save your heart, you are already ahead in the brain game. It’s been known for a while that exercise gives you the so-called runner’s high by increasing your endorphins, the natural morphine produced in your brain. But exercise does far more. Regular exercise increases key neurotransmitters like serotonin, dopamine, and norepinephrine, all of which support your mood and energy level. It also increases a recently discovered neurochemical called brain-derived neurotrophic factor, or BDNF, which improves your rate of learning. In his book Spark: The Revolutionary New Science of Exercise and the Brain, John Ratey, a clinical professor of psychiatry at Harvard Medical School, documents a novel physical education program called Zero Hour. Created in the Naperville, Illinois, school system seventeen years ago, Zero Hour has kids perform aerobic exercise at 80 to 90 percent of their maximum heart rate before the day’s classes begin. The effects on learning have been dramatic. The district consistently ranks in the state’s top ten for academics, despite spending significantly less per student than the state’s other top-performing districts. One reason for these results could be that there is more electrical activity in the brains of fit children than in sedentary kids. Another is BDNF. Ratey writes, “BDNF gives the synapses the tools they need to take in information, process it, remember it, and put it in context.”1 Exercise also increases an important chemical, vascular endothelial growth factor, that supports the growth of blood vessels in organs and tissues throughout your body and brain. More blood vessels means more blood flow and more blood flow means more oxygen and nutrients sent to your brain cells. In Ratey’s words, “exercise prepares neurons to connect, while mental stimulation allows your brain to capitalize on that readiness.”2

To stimulate neurotransmitters, BDNF, and vascular endothelial growth factor—and to sharpen mental acuity in general—it is better to partake of cardiovascular exercise than to lift weights or do yoga. It appears that the crucial factor is getting your heart rate up and keeping it there. Ratey suggests performing cardiovascular exercise at these levels:

Two days each week, exercise at 70 to 75 percent of your maximum heart rate (so that you are sweaty and somewhat breathless) for 30 to 60 minutes; and

Four days each week, exercise at 60 to 65 percent of your max heart rate (you’re still sweaty at this level, but you can talk fairly easily) for 30 to 60 minutes.3

I know. It’s a lot of exercise, more than the amount recommended by the Centers for Disease Control to maintain physical health. If you struggle to get going, leverage the benefits of human interaction. A Stanford University study found that when people received a phone call about their workouts every two weeks, subjects increased their exercise amounts by 78 percent.4 And the department of kinesiology at Indiana University discovered that couples who worked out separately had a 43 percent dropout rate in an exercise program, while only about 7 percent of couples who exercised together dropped out.5 Remember that relational dopamine is a great way to melt old neural pathways and create ones that lead to new, better habits.

3. Get Omega-3 Fatty Acids Through Food or Supplements.

Some people call the brain “gray matter,” but if you look at a picture of your brain, you’ll see that it actually looks whitish. The source of that white color is fat—and a fatty brain is a very good thing, because it speeds the transmission of electrical signals. Omega-3 fatty acids in particular are an essential component of cell membranes. They also help replace damaged brain cells by promoting the growth of new neurons, and they may be protective against anxiety and mood disorders.6

There are three types of omega-3 fatty acids: EPA, DHA, and ALA. While all three are good for your body, only EPA and DHA can cross the blood–brain barrier and nourish your brain cells. Perhaps the easiest way to get EPA or DHA is from natural sources such as salmon, herring, or tuna. Eating these fish two or three times per week will boost your brain functioning. For the non-fish-eater, taking a daily supplement of EPA or DHA is a great alternative and can be found in most local pharmacies and grocery stores.

You’ll also need antioxidants. When your body metabolizes fatty acids, the by-products include free radicals, which can build up and disrupt protein and lipid development—and damage your DNA. The buildup of free radicals is referred to as having a high load of oxidative stress. Antioxidants like vitamins C and E can bind to the free radicals and lower this stress. It’s best to get your antioxidants from brightly colored fruits and vegetables, but you can also take a supplement if necessary.

4. Wear a Helmet When Putting Your Brain at Risk.

Daniel Amen, a psychiatrist who has pioneered the use of brain imaging with single photon emission computed tomography (SPECT) to help diagnose and treat mental illness and brain injury, describes the texture of the human brain as similar to medium-firm tofu. If you have ever cooked with tofu, you will realize that this comparison is not reassuring. Even though this tofu sits within the hard human skull, the skull has a number of peaks and valleys that form sharp edges. When your head is hit with something—whether a soccer ball or the windshield of a car—and the tofu is jostled within the skull even a small amount, it can sustain significant injuries. The resulting brain bruise, usually referred to as a concussion, can have detrimental effects months and even years after the initial injury.

As a mom and a psychiatrist, I am thrilled that my son did not want to play football, a game that puts your brain at risk during every play. Additionally, I frown on bouncing the ball off the front part of the skull in soccer. The prefrontal cortex is simply too precious and too important in regulating executive functioning and impulse control to have it hit over and over again. For this same reason, I recommend helmets for anyone participating in contact sports; motorcycle and bicycle riding; skateboarding, skiing, and snowboarding; and under any condition where it is possible for you to bang your head.

5. Spend Time in the Sun.

One of the easiest things you can do for your brain is to spend time in the sun. The sun’s rays don’t simply bounce off your skin (or fry it). They actually have an integral role in supporting your health. Those long summer days we all look forward to after a dark winter actually improve blood flow in your brain and help regulate key neurotransmitters, serotonin and melatonin. Serotonin helps to maintain a positive mood and a focused, calm outlook on life. It’s also a precursor to melatonin, which—aside from physical benefits like helping the body counter infection, inflammation, autoimmune responses, and even cancer—assists with the onset of sleep. Sleep, as you’ll see in a moment, is critical to healthy brain functioning. Sunlight also increases vitamin D levels, which affect both your mood and memory.

In the sun-crazy days of my youth, people set up tinfoil boxes and slathered themselves with oil in an effort to bake themselves like potatoes in an oven. This practice ignored one of the eternal rules of health—moderation—and decades later, these men and women were developing skin cancers at an alarming rate. Suntan lotions and oils were developed to filter some of the more aggressive sun rays and protect the skin; then sunscreens gave way to sunblocks that can offer more than one hundred times your natural protection against the sun. Now we have a generation of people who aren’t getting enough sun, and who suffer from low levels of vitamin D. Once again, it all goes back to moderation. Try to get a little sunshine every day if you can. If you live in an area where that’s not possible, the recommended dose for people without a clear vitamin D deficiency is 600 to 800 IUs daily. People with a vitamin D deficiency should supplement with 2,000 units a day until the deficiency has been remedied. Your doctor should evaluate your blood levels of vitamin D during your regular checkup.

6. Get Enough Sleep.

Like getting an adequate amount of sunlight, getting enough sleep is a freebie—sort of. It’s awfully easy to stay up an extra hour to watch a show because, finally, the kids are asleep and this is “your” time. When I was in medical school, there was a clear improvement in status for the person who could stay awake the longest and still perform on a high level. I have vivid memories (or maybe flashbacks) of spending nights in the emergency room seeing patient after patient and guzzling Diet Coke after Diet Coke to stay awake.

Yet even small amounts of sleep deprivation can cause multiple problems in the brain and body, including poor concentration, drowsiness, impaired memory, impaired physical performance, a decrease in ability to do math calculations, and mood swings. “Your time” at the end of the night is much better spent sleeping. You might notice that when you actually get enough sleep, you have more energy and focus to get through the list of things in the day that are usually left to the end. Research also shows that even though you might get used to functioning with a sleep debt, your reaction time and judgment can still be significantly impaired. That’s because less sleep will create more irritable brain pathways.

Sleep needs depend on your age and, of course, on your own specific brain and body, but in general, adults need seven to eight hours of sleep a night (though a few people need as little as five or as much as ten), teenagers need roughly nine hours of sleep, and infants need a whopping sixteen hours of sleep per day. Remember, too little sleep creates a sleep debt that eventually has to be repaid!

7. Eat Brain Foods.

There is a connection between your gastrointestinal tract and your nervous system, and what you eat has a major impact on how your brain functions. The proteins, carbohydrates, and fats you eat become the building blocks for cells and neurotransmitters in your brain. Micronutrients, like vitamins and cofactors, are needed to run the little factories in your cells and produce energy. A balanced diet, including all of the essential food groups and plenty of fruits and vegetables, will make your body healthier and your brain work more efficiently.

But you can and should go beyond the traditional balanced diet when you’re focusing on brain health. The brain foods listed here have specific benefits to mental and psychological functioning. Blueberries help prevent oxidative stress; in rats, they’ve been shown to enhance learning. Avocados and whole grains help preserve blood flow to the entire brain, including its C.A.R.E. pathways. Beans deliver a regular stream of glucose to the brain, providing a steady (not wild or erratic) supply of energy. Freshly brewed tea is an ideal drink, because it contains the ideal amount of caffeine to improve focus, mood, and memory. Tea also contains small amounts of catechin, which helps regulate blood flow. Nuts and seeds contain vitamin E, which helps stave off cognitive decline. Dark chocolate pulls off a hat trick with endorphins to calm the body and brain, caffeine for focus, and antioxidants to fight free radicals. The final brain food is any fish that contains the omega-3 fatty acids I’ve talked about: wild salmon, herring, and tuna.

8. Use a Brain Training Program.

Most of us know to keep our brains stimulated with games and activities, but not all stimulation expands overall brain functioning. If you are routinely doing crossword puzzles to keep your brain alive and active, it is likely that what is increasing for you is . . . your capacity to do crossword puzzles. Posit Science, a company founded by neuroscientist Michael Merzenich, has designed the SAAGE protocol to describe the benefits that brain games should include:

S is for speed. As your brain ages, the speed of electrical transmission slows. A good brain activity should improve the speed of your thinking.

A is for accuracy. Brain games should improve how well you classify pieces of information.

A is for adaptivity. Brain games need to adapt to your specific and current level of functioning. If you are having an off day, the tasks should get a little easier. The last thing your brain needs is to play a game at which you are constantly failing; it’s not helpful for your C.A.R.E. pathways or your learning to stimulate the sympathetic nervous system unnecessarily.

G stands for generalizability, which refers to the ability for the program to improve real-life activities, not just the activity in the game (e.g., crossword puzzles).

E is for engagement. For adults to turn on their learning machinery, the nucleus basalis, novelty and attention are required; the reward system stimulates dopamine to help solidify new pathways. A game should engage the brain’s attention, reward, and novelty systems hundreds of times per training hour. These systems must be engaged for long-lasting brain change.7

For a list of brain-change programs that fit all the SAAGE requirements, visit

9. Find Stress-Reduction Techniques You Love.

Stress, and the stress chemicals it produces, can be remarkably toxic to your brain. But like most things in your body, there is a continuum of toxicity. Studies have shown that at mild levels, stress can actually help you improve your cognitive capacity. The release of adrenaline wakes up nerve pathways, allowing you to focus and concentrate better. As the stress level increases, however, the system turns on you—and the same chemicals that just a minute ago allowed you to focus more closely now cause you to feel anxious and panicky.

From an evolutionary perspective, the system makes sense. Imagine you are a caveperson, scanning the environment for danger. Being just stressed enough to stay alert and avoid spacing out is crucial to your survival. Off in the distance, you see a mountain lion on the prowl. The adrenaline simmers in your body and you remain attentive, but not reactive. After ten minutes, you notice the mountain lion seems to be stalking closer and closer to your cave. More adrenaline pumps through your nervous system and now your heart is starting to beat faster, your breaths are becoming shorter, your body is making the switch from scanning and evaluation to preparation for battle. If you are a cavewoman, a combination of adrenaline and the hormone oxytocin gives you the energy, focus, and wisdom to gather the other members of the clan and their children into a protective huddle. If you are a caveman, your testosterone and vasopressin rise, and you are thinking of tearing the mountain lion apart in order to defend your tribe.

Your stress response can be your friend and ally, helping you navigate a complicated and occasionally dangerous world. However, when we socialize humans to be autonomous and not turn to others to help buffer stress, we actively undermine the development of the neural pathways for connection. These neural pathways are an essential balance to the sympathetic nervous system and help keep it in check so that you are not in a state of high arousal all the time.

People who develop post-traumatic stress disorder from childhood abuse, domestic violence, or war live with a sympathetic nervous system that is running full blast much of the time, and this response is incredibly destructive. The cortisol released in an effort to counter the high levels of adrenaline can be toxic to the hippocampus, the area of the brain that stores memories. It can also help create a cascade of physical destruction, leading to the development of chronic health problems, from diabetes to autoimmune disorders. And of course, having an overactive stress response system makes it even harder to build healthy relationships.

For all these reasons, if you are spending much of your life in a culture that actively cuts off your C.A.R.E. pathways, it is essential that you balance the excessive stress response with some activity that reduces stress. Start by simply focusing on your breath throughout the day. When you are stressed, your breathing becomes more superficial and rapid, which leads to less oxygen to your brain . . . which can lead to more irritable neurons and ultimately more stress. So throughout the day, pause every now and then and focus on taking ten deep breaths. You will quickly feel the impact of increased oxygen to your brain. The beauty of this technique is that you can do it anytime, on the subway or at your desk, even in an annoying meeting with a colleague—and no one will notice.

Anything that reduces your stress can be a stress-reduction activity; here, you’ll find a list of suggestions for soothing a jumpy sympathetic nervous system. These are tried-and-true stress busters. The important thing is for you to pick something you can commit to, because balancing your autonomic nervous system is like everything else you are trying to change in your brain: it takes practice. Many people use meditation, yoga, and other forms of mindfulness, but if these aren’t for you, think of what does decrease your stress. If playing with your children at the end of the day allows you to feel safe and out of the stressful world, then build this activity into your day. If going for a run at lunch allows you to dispel the neurochemicals of distress, then make time for it. The goal is to counteract the ongoing stress that comes from spending much of your time in a culture that undermines your primary way to reduce stress: growth-fostering relationships.


As I’ve just noted, balancing your autonomic nervous system takes practice. So does strengthening all four of your C.A.R.E. pathways. Not only does it take practice to heal your connected brain, it is a practice, in the same sense that yoga or meditation is a practice. At first, learning to nourish your neural pathways for feeling Calm, Accepted, Resonant, and Energetic will feel awkward. It may feel as if you’re working against everything your culture has taught you about relationships—and, in fact, that’s exactly what you’re doing. But work on the C.A.R.E. pathways often enough and they will thrive. Soon, growing and sustaining healthy relationships will feel more natural.

It is time to send parents a new instruction manual for raising their children; it is time to send our children a new set of rules for interacting with friends and enemies; it is time to make our business leaders a new template for helping employees work cooperatively; and it is time to teach our world leaders how to guide their communities to fulfill their capacities to connect. We need an approach to human relationships that accurately reflects how interconnected we all are and nourishes our ability to use healthy relationships for richer, healthier lives.

It’s often said that a culture changes one person at a time, and that the only person you can change is yourself. But when you realize that we are not separated by strict boundaries, and that our relationships have a neurological life that unfolds inside the brains and minds of everyone we encounter, those statements seem too limiting. The minute you make a change in the way you relate to people—when you become less judgmental, more curious, less fearful, more accepting—you also make a shift in the places where you and other people overlap. When you improve your pathways for connection, the artificial walls that support the separation mentality melt away; those boundaries transform into rich areas of human interface, abuzz with growth and energy.

In other words, when a relationship changes, it quite literally changes the minds of everyone in that relationship. Your own transformation isn’t limited to yourself alone, because you are not alone. We live within one another.