Neuroscientist Dr Alex Korb shares his research on the effect of depression and gratitude on the brain and how to create an upward spiral to overcome depression.
What are the benefits of gratitude?

Alex Korb: Gratitude was one of those things that I was really surprised by when I was doing research for my book because I feel like you always hear about these happiness gurus who were talking about 'just think positive' or whatever like the Oprah's book club books, like 'the Secret', you just send your positive thoughts into the universe and it always just seems a little BS to me.

But then I sort of learned there's this whole area of research and scientific research about gratitude and even neuroscientists have been studying in the last few years about how it actually affects the brain.  It turns out that by intentionally focusing on the parts of your life that you appreciate or are glad are there or grateful for, it actually changes some key circuits in the brain.  It changes the dopamine system, it causes changes in the emotional circuitry in the brain and these are measurable effects that you can see with MRI a functional MRIi machine or with other other ways of measuring the brain.  That sort of convinced me. It's actually like it seems silly like, oh I'm just changing what I'm focusing on, but it actually has measurable effects on the brain.

One study I remember they asked people to think about happy memories, and this is I think just the way of feeling gratitude for the past, like the things that happened to you.   They're not happening right now, but it might be better than the present. Or you might have a lot of negative things that happen to you as well. But if you just shift your attention to the wonderful things that have happened in your life, they showed that there are changes in the serotonin system, in a key part of the limbic system.

So this key neurotransmitter system in part of the emotional circuitry in the brain simply by taking a moment to think about happy memories and that's just one example of how you can practice gratitude.

There's this other awesome study where they had people write gratitude letters.

So you think about someone in your life who did something nice for you, whether it's big or small, maybe a barista at Starbucks a few months ago who you know smiled and just made your day feel better and you just write a letter to them explaining what they did and why it meant so much to you.
And you don't even have to know who the person is because one of the cool things about this study is even if you don't send the letter to the person, you just write down explaining why you're so grateful and how it helps you.  It has beneficial impacts on your mood and stress levels that can last for several weeks or longer.
One of the studies that utilize this gratitude letter exercise had a a bunch of people going through psychotherapy for anxiety and depression and half of them they said okay you're a control group you do this control writing exercise and half of you you're going to do this gratitude letter exercise and they just did three letters like once a week for three weeks.
Three months later after they've gone through therapy they brought them back into the lab to do an fMRI experiment to look at their brain activity while they experienced positive events.

The people who had done the gratitude letter, even though that was three months ago, their brains reacted more strongly to grateful things.

It's reacted more strongly to positive information and gratitude which just sort of shows that sometimes thinking about the positive, it's going to help you feel better in the moment, but sometimes if you think about the positive and then take action to actually express that gratitude, it can have a longer lasting effect that actually changes the way your brain perceives the world.

So sometimes when you when it feels like everything is terrible, there's nothing good going on, well if you can intentionally guide your attention to the positive things and then express your gratitude in some way or take action to make it more relevant to you, then that's gonna change the way your brain perceives the world, make, it easier to notice and appreciate the positivity in the future.

How Long is Good to Focus on Gratitude?

It's different for different people but their brains are different but also it depends on how you are practicing gratitude.

So when I talk about practicing gratitude there's an example of thinking of positive memories or there's writing a gratitude letter or there's writing a list of things or maybe just thinking about the positive things in your life, and those are certainly going to have slightly different impacts.

There was a study where they had people write down five things every day that they were grateful for and it improved their mood and reduced their stress and they said well what if we just do it once a week but I had almost as big an effect as doing it every day I think because if you're doing it for a long period of time there's a possibility that doing it every day, well then it just becomes a chore or it's either the burden.

So yes it's having a positive effect because it's gratitude but then I feel like it's something I have to do like, taking time out of my day and so and I just sort of phone it in and so like ideally it would be the biggest effect is if you could do it authentically every day, but if you can't do it authentically every day then maybe it's better to do once a week.

So I think that's one of the things that's complex, like there's not just oh you do this it's gonna solve all of your problems and this is the  right prescription for everybody because there's positive effects and negative effects, same thing with exercise,  how much exercise should I do right?

On average the biggest antidepressant effect from exercise is if you do it three to five times a week for about 45 minutes of moderate intensity for at least 10 weeks.
Some people are 'I could never' and okay well that's just because that's that sort of optimal level to see it on a group level.
With exercise, gratitude, sleep hygiene and all these different changes is that, yes making these small changes are good but, also how you are thinking about these changes can sort of enhance their benefit or detract from their benefit.
So I would encourage people to practice as much gratitude throughout the day or try it once a day to see how that is.
It is helpful to sort of have a practice of gratitude where I sort of make it a little more formal and write it down because there are many times where I won't feel like thinking about something positive and if I don't feel like it, I'm not gonna do it.  Well then you're at the mercy of your emotions whereas if you realize that actions and emotions are separate things, then it's more powerful because I don't need to feel grateful in order to just write five things that I'm glad are a part of my life.
I don't need to be overwhelmed by a feeling of gratitude.  I'm glad I have running water and I'm glad I have my health and had lunch today.
Just the act of expressing your gratitude is helpful whether or not you feel grateful and a lot of times I think people over focus on their feelings but there are times where it's helpful, just when you're feeling grateful just go with it and enjoy and appreciate that.
Other times when you're just like feeling really stressed and anxious just trying to use a little cognitive reframing to say I'm really stressed about my job. I'm also glad I still have a job and so that's a way to use gratitude in the moment.
Although many people use it in an unhelpful way in that they're stressed about their job and then they sort of criticize themselves for being stressed because they're like I should feel grateful because I even have a job and like guess what?
You can feel multiple things at the same time. Your brain is very complex those are in circuit, so you could be stressed and angry and also grateful, it's just that the more that you focus on how stressed and angry you are, and how you can't control that, the more stress and anger you're
generally going to feel. The more that you are focused on 'I am glad I have a job it doesn't negate my negative feelings I'm just gonna just pay attention to this the positive fact for a moment and that will help me have more positive emotions and generally get my stress under control.'
Is Mindfulness Useful for Overcoming Depression?

Mindfulness is one of the things that helps us break out of being just controlled by our our emotions and our habits um the we like to think of ourselves as being very intentional like oh yeah all the things I do or because I want to do them or whatever, but like most of the stuff that you do is based on habit and it's often driven by a negative emotion or frustration or something and then like your brain's like oh I know how to deal with this this is I'm going to do what we always do which is you know eat a cupcake or I'm going to do whatever and like almost before you become aware of the emotion, your habit circuit is already starting to take care of it and then you're not even aware of it. So you won't necessarily be even aware that you're stressed, you'll just notice how much you're eating maybe after a week you're like pants don't fit as well.

Mindfulness is a way to re-program that. You can start to become aware of your actions being like oh I'm eating a lot more than I was last week or uh oh I'm feeling frustrated and I feel like I want to eat a cookie or cupcake.

That awareness is part of mindfulness, then it's realizing also that emotions and actions are different things. You could feel compelled to eat a cupcake in order to deal with the stress that you're feeling, but that doesn't mean you need to eat a cupcake or it doesn't mean you need to drink a beer, if you do that then you'll generally feel calmer in the short term immediately because that's the way that habit and emotion systems work in this complementary way and if you avoid that habit you'll generally feel more stressed which will make you succumb to that habit and mindfulness is a process of like being aware like yup really really feel like doing that and then your emotional circuitry is going to really try and get you to do that and like yep I really feel like doing it now and if you just recognize that, you can start to break the automatic link where this emotion automatically leads to this habit and you can then act intentionally to say yep i feel this well i'm gonna do something else or can't do anything about it just gonna sit with it and let it down right?

So having the self-awareness to recognize that hey the baby inside is getting a little bit cranky and it's time to take care of that a little bit, throw them a baba and hope things are okay.

As it relates to the baby example it's something like sleep training. Sleep training is something that it's sort of controversial sometimes in parenting but at some point, most people want to feel like they can put the baby down and leave the room and the baby's going to sleep at seven o'clock and they want to have to sleep with a baby in their bed or whatever. So you put the baby down and the baby's not used to that. They start crying and it's your natural instinct, 'oh my god I want to pick the baby up', but guess what the baby will never learn how to soothe itself or that it's actually okay.

There's nothing wrong, it feels like it's wrong because it's unfamiliar, but you teach it how to calm itself because it does this thing that's unfamiliar and uncomfortable and then it's okay.

After a few days of that it's like oh it's okay.

But if every time the baby is stressed oh my god something's wrong I need to do with it, well then you're trying to fix it every time is just going to continue the cycle so you need to be able to use your higher order areas to say

'ah it feels like there's something wrong, my baby is crying', but I know okay now I fed the baby and can see on the baby monitor that there's nothing happening it just is uncomfortable because it misses me and the only way I can get it past that is to just allow it to experience and it'll then fall asleep and then after a few days that it will be fine' and so that's the sort of approach that we need to take with ourselves.

If something really is wrong like oh baby's leg is stuck out of the crib or like yep I forgot to give them a bottle, if something really is wrong then you need to address that because otherwise that's ignoring something and the baby's gonna cry all night, but if there's not actually something wrong then just continuing to try and like fix it so that you feel better right away is just gonna cause more problems.

Mindfulness is sort of like the process of which you can sort of separate which is which, but based on our habits we're so used to doing things that we can't actually disentangle like is this something that's wrong that I need to fix or is this just a habit that I've fallen into that is just comfortable for me and I’m trying to avoid some feelings right

I wrote the upward spiral because I've been studying neuroscience for 10 or 12 years at that point and it was finally oh I understand now how all these different brain regions are contributing to why you feel stuck and anxious and depressed, but there's all these things that you can do to help reverse the course of depression and make yourself feel better and create an upward spiral and my first book was explaining all the science behind it and after that came out a lot of people having trouble applying it.

So I started offering personal coaching to help them apply it to their life because the individual person's life with all these different habits and emotions pulling you in different directions and having someone else can help guide you through that and then I from that wrote the Upward Spiral Workbook which is still based on practical stuff you can do.

After that came out last year when the pandemic hit and I was teaching my class at UCLA online I was like why don't I teach a class?

So I created a few courses create a short one on stress which I think is the one that you took and then created a bigger more in-depth course called the upward spiral core program which focuses on the key elements of the upward spiral and the most important ones to try and implement first and sort of helps you understand them and then we have live boom calls each week to try and help people problem solve and implement them in their lives for people who just want to pick and choose, do it on their own. That's why I wrote the book and then provide guidance and group support.

I like writing I also like teaching people and people like learning about this stuff in a live lecture so that was that's one of the things that inspired me to to do more because I'm really passionate about neuroscience and I want to help people and I feel really grateful that I have the opportunity to do that.

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