The Science of Impulse Control with Dr. Heather Berlin

Transcript

Bal Agrawal:
Good morning. Welcome to our webinar. I am Bal Agrawal, CEO, and founder of LifeWorx, and delighted to have you join our webinar today just about health and home. Health is what we are all about. We generally like to educate our community, and this is one of those webinars. A joke comes to my mind, simple that of all the things I lost in my life, I miss my brain the most. And I think that’s so true. We sort of forget about it, but it’s very important part of us. For those who are not familiar with LifeWorx, it is a home healthcare company with a lifestyle component into it. We serve greater New York. We have six offices and a team of 20 people in offices. Our core strength is to make sure that help at home is trusted, reliable, and skilled, and with good personality. So welcome Dr. Heather Berlin, whom we met about, I think on February 29th.

We had a event at Y. There were several attendees, I think there were 300 or 400, and she presented her work and it was very impressive and that’s why we are bringing to you Dr. Heather Berlin. Dr. Berlin is cognitive neuroscientist and assistant clinical professor of psychiatry at Icahn School of Medicine at Mount Sinai, New York, where she also completed her postdoctoral fellowship. She’s trained in clinical neuropsychology at Will Cornell Medicine in the Department of Neurological Surgery and completed her clinical internship at Behavioral Institute. Her research explores the neural basis of impulsive and compulsive psychiatric and neurological disorders with the aim of developing novel treatments. She’s also interested in the brain basis of consciousness, dynamic unconscious processes and creativity. Please welcome Dr. Heather Berlin.

Dr. Heather Berlin:
So this is the thing that I’m most fascinated by, this three pound piece of matter that basically is everything we are, every we’ve ever had, every feeling. It’s all encoded in this chunk of matter. And I became fascinated with this at a very young age. Basically it was around the age of five when I realized that I was going to die one day and I didn’t like that idea very much. So I thought to myself, well, even if I die, can I still have my own inner thoughts? Can I still have my consciousness so to speak? So I asked my dad the next day, where do my thoughts come from? Because I want to keep them when I die. And he said, they come from your brain. And I said, how? And he said, we just don’t know. And then I said, well, what can I be when I grow up to figure that out?

I want to keep my thoughts after I die. And he was a physician, so he said, I guess a psychiatrist. But that began my lifelong journey to try to understand the relationship between the physical mechanisms of the brain and how that relates to our subjective experience. Everything we think and feel from the moment we wake up till we go back into a deep dreamless sleep. But it’s a very complex piece of matter. So it’s made up of these little units called neurons. The brain has about 86 to a hundred billion neurons, which basically are information processing. It’s either on or off. It fires or not. They each have about a thousand to 10,000 synapses or connections. So there are about a hundred trillion connections in the human brain, which is more connections in the brain than there are stars in the Milky Way. So it’s a very, again, complex piece of matter and you can kind of think of it like an information processing system.

But what’s very interesting is that much of what’s happening in the brain is actually happening outside of awareness. We’re only conscious of a very small part of it. And it’s a myth that we only use 10% of our brain. We use all of our brain all the time, but we’re probably only conscious of a small percentage of the workings of the brain. But much of our behavior and the decisions that we make are being dictated by this processing that’s occurring outside of our awareness. And we often come up with these post hoc explanations about why we do things which don’t necessarily correlate to the real reason why we’re doing things. But I became very fascinated by not only what’s the neural basis of consciousness, but what is the brain basis of these unconscious processes that are dictating our behavior. So I began to study this in the lab and there are a number of ways you can look at this.
One of which is by presenting people with subliminal stimuli. So either you present stimuli very quickly so the person claims to not have seen it, but it will go on to affect their behavior. Or you can a subliminal message, which again, a person won’t claim to have seen but will go on to influence their behavior. So take a look at this image and can you see the hidden message here? And if not, I’m going to point it out to you. So in the bottom by the stems in the negative space, it says SEX. And then you can see there’s the birds on the left. You can see sort of the middle left and the bees down at the bottom. The flowers are kind of loving towards each other. Now once you see this, the word sex, you can’t unsee it, right? Something changed in your brain and that’s what we want to track.

So the physical stimuli hitting your retina, being processed by the visual parts of your brain, that physical stimuli remains exactly the same. But what changed was your perception, the inner workings of your mind. And that’s what we want to track, what change in your brain from the moment you saw it versus when you didn’t see it, and this would’ve gone on even if you didn’t see it to actually affect your behavior. So if I would’ve given you tests after you’d be quicker, let’s say to recognize sexual stimuli, so you would be primed so to speak, and it’s not just in the visual domain, we see this in the olfactory domain. So for example, we’ve given, there’s studies that have people do a kind of pseudo test, which isn’t the real test, like fill out a form and then at the end of it, they would get cookies for dessert as a reward.
And then there’d either be no smell in the room or a lemon cleaner smell in the room, and those who had the lemon cleaner smell in the room were much more likely to clean up their crumbs after they ate the cookies. Or if you’re in a competition task, if one person has a briefcase in their view versus a backpack, they’re more likely to behave competitively. Another study showed that if you were taking a subject to the lab along the way, you said, oh, I’m holding these books. Can you just hold my cup of coffee for me? And it’s either a warm cup of coffee or a cult iced coffee. Then they go into the lab, they read a scenario about a person which is basically a neutral describing ’em in a neutral way. And they say, can you describe this person with adjectives? If they had held the hot cup of coffee, they were more likely to describe them as being warm and friendly versus colder or distant if they held the cold cup of coffee.

So that information is getting in through all of our senses, tactile, factory, visual, auditory, and it affects our behavior, it affects our judgments, and it’s happening all the time. This is a recent ad that I saw in Parents magazine, which I think was sending the wrong message. It really went to press, I dunno if you can see it, just look at the top right, parents magazine, it’s not quite. Anyway, so this would’ve gone on and maybe influenced people in interesting ways. Here’s another one. So I want you to take a look at it and see if you can see the subliminal message here.

Just take a second. So I hope what you all saw was the nine dolphins in the negative space, right? Probably not. But so what’s interesting here is that children tend to see the nine dolphins right away. Adults see the naked man embracing the naked woman. And that’s because what we perceive in the world is context dependent. Depending on what we’ve been exposed to in the past, it helps construct our perception of stimuli coming in. So what we see, what we perceive doesn’t necessarily correlate with reality. Our brain makes it, it’s a constructed sort of hallucination. Like some people say we’re hallucinating all the time, but it’s just a kind of controlled hallucination. Here’s an example. You can see these visual illusions like where a brain makes approximation. So if you look at square A and B, they look as if they’re different shades of gray, but actually they’re physically exactly the same shade.
So it’s the shadow illusion. And because B is surrounded by dark squares, A is surrounded by light squares, our brain makes these approximations and it lightens up square B darkens, square A. But if I show you it like this, you can see that they’re actually physically exactly the same Again, it’s very hard to even knowing that no matter how many times you look at that first image, you’ll still see it in a different way because our brain is using these heuristics, these shortcuts all the time. And if you remember this dress phenomena that happened online a few years back where people saw the middle dress and some people interpreted that as being a blue and black dress and others white and gold. It was obviously blue and black, and that’s because there was light hitting it. There was some ambiguity and some brains interpreted it and darkened it up and others lightened it.

So there’s this quote from this song, this gorilla song they say, you don’t see with your eyes, you perceive with your mind. And I really like that line because it’s exactly what it is. We’re just creating a reality within our minds that doesn’t necessarily correlate with the actual physical reality. So in the lab, we can use these kind of bi stable images where for example, if I primed you with words like youthful, vigorous, you might see the young woman looking away and you can kind of see her eyelash, her nose and her chin. If they give you words like elderly wise, you might see the older woman sort of looking down and you won’t see them both at the same time. It’ll flip back and forth in your mind’s eye, and that’s what you want to track. What’s the neural correlates of your perception? So what’s happening in your brain?
Again, the physical stimuli is staying exactly the same, but we want to see what neurons are fine when you perceive the old woman versus when you don’t. And what’s changing in your brain? What’s the neural correlates of your perception? And what we find is that what correlates with what you’re perceiving at any given moment are these coalitions of neurons. They start firing together, firing in sync. You can kind of think of it like a parliamentary election in your brain. It’s sort of a Darwinian competition between groups of neurons. And when a certain group fires together, they sort of come into power. And that’s what you perceive at that given moment. If you attend to something, it can stay there longer until the next coalition of neurons comes into power, and that’s what comes into your consciousness. So it’s this ebb and flow of conscious perception, but I liken it to a Twitter feed.

That’s actually what this chart is. So basically it’s like if enough people are tweeting about something, it starts to trend in our global consciousness. So you can think of each tweet is like a neuron firing and enough neurons fire together. It comes up into our conscious perception, but it’s not all happening at one place in the brain. It’s happening in these distributed networks across the brain. So this looks right complex, and don’t worry, I’m not going to get into all of this, but this is simply just a neural network in a bird brain. So you can imagine how hard it is, how complex it is to track these networks in the human brain. But what brings these neurons together, the way they communicate is not that they’re all firing at the same rate, that would be an epileptic seizure, but they’re firing in coordination, kind of like each one is an instrument in the orchestra when they’re all playing together a symphony.
You can also think of it like a wave and a crowd, not each person is like a neuron. They’re not all standing up and sitting down at the same time, but they’re doing it in coordination, in sync, and that’s what links up these neurons together. Now, there’s several different theories about the neural basis of consciousness, but the ones that have sort of gained the most traction are two of them I’m going to mention. One of them is called the global neuronal workspace theory of consciousness. But in layman’s terms, we kind of call it fame in the brain. So what it’s saying is that when something catches on the brain, it starts to cascade throughout the brain, it comes into consciousness. So in this case, you can see, and this is a lateral view of the brain. So a side view the back of the brain when they’re giving people stimuli that’s subliminal.

Before you saw the word sex for example, it’s activating the primary visual cortex in the back of the brain, but it’s not coming into consciousness yet. As it starts to come into consciousness, you start to activate the secondary visual processing areas like going forward through the brain. Finally, it activates the prefrontal cortex and then you get these feedback loops to the back of the brain, and that’s when the image comes into conscious perception. But the thing is that even when it was only activating the primary visual cortex and you weren’t consciously aware of it, again, it can go on to affect your behavior. Another sort of very well-known theory of consciousness is something called the integrated information theory of consciousness. And this can get very complex, but basically what it says is that any system that has a high degree of integrated differentiated information will have the property of consciousness.

So that consciousness is a fundamental property of the universe like gravity. So any system that has it, the brain happens to be one of the systems. And when I say integrated, I mean that if one neuron fires, it affects the one, the ones next to it not integrated would be the pixels on your phone. If one goes out, it’s not going to affect the one next to it. But what’s interesting about this theory is that it’s pans psychic in that it says it doesn’t have to necessarily be a brain, it’s any system. The brain happens to be a system that has a high degree of integrated information, but other systems that have that property would have some degree of consciousness. And so therefore there’s a lot of debate and it’s very controversial, but there is definitely evidence supporting this theory as well. So the last thing I kind of want to mention just about in terms of an overall general overview of the brain is that you can even think of it as these two basic systems in the brain.

So you have these evolutionarily, older sub-cortical parts of the brain, the limbic system you can think of that your reptilian brain, Freud might call it your IT impulses. It’s looking for immediate pleasure and avoidance of pain. So it’s sort of like risk taking and you get ahead of dopamine when you get a reward pleasure seeking. And then you have the more recently evolved prefrontal cortex. Now humans have the largest percent of prefrontal cortex compared to the rest of the brain than any other animal. And that’s kind of the control system of the brain, we call it. It’s involved in executive function. So self-control, Freud would call it your super ego. So the limbic system gives you this go signal. It’s like the accelerator, go eat that piece of chocolate cake, I want it now, the prefrontal cortex kind of thinks about the future consequences of those actions.

It’s like the brake system. It weighs them against what your desires are and it kind of helps you make a more adaptive decision. Maybe I shouldn’t eat that piece of chocolate cake now because I don’t know, I’m on a diet and I want to fit into this new outfit or something. So these two systems are kind of working together to help us make adaptive decisions. But the problem is that if there’s either too much activation coming from the limbic system like overstimulation, it can override the brake and you can become impulsive or if the brake system is broken, so the prefrontal cortex is either damaged or has under activation, again, it doesn’t allow you to modulate your impulses and people start engaging in more risk taking risky behavior, which can have negative consequences. And finally, if the connections between these two systems are kind of broken down, you can also see impulse control disorders in those situations.

And we see it with neuroimaging. This was a pet study that was done, which basically people just simply had to imagine a neutral scenario or imagine an aggressive one, and simply imagining aggression actually decreased activation in their prefrontal cortex, implying that they might actually go out and be more aggressive. So it can be very affected in many ways. And then of course, having a brain lesion in the prefrontal cortex. This is the classic case of finna gage in the 18 hundreds, a metal tamping, he was working on the railroad, there was a spark of dynamite, and this tamping iron went straight through his prefrontal cortex and it completely changed his personality. He went from being a mild mannered man to being impulsive and aggressive. And this was the foundation of the idea that this part of the brain is involved in impulse control, is involved in personality.

In a more recent sort of modern Phineas day case, this is a patient who in his sort of mid forties started developing pedophilia like symptoms, collecting child pornography. And he was actually living with his young stepdaughter in his home and they took him out of the home and they were going to put him in jail. And also it’s very rare to just start developing these symptoms that late in life. And he started getting these severe headaches and they went to the hospital, he did an MRI, and they found this huge tumor in his prefrontal cortex, and he literally had said, it feels like the pleasure principle is overriding me. So they removed the tumor and his symptoms went away and he was allowed to return home. Everything was fine for about a year. A year later, the symptoms came back and sure enough, the tumor had grown back.

So a lot of neurosciences about correlation showing that certain parts of the brain are active during certain thoughts or behaviors, but in this case we’re talking about causation changes in the brain that are directly causing changes in personality. And we also see this in psychiatric patients. So another condition I study is called that has impulse control problems is borderline personality disorder. So the classic is like glen close and fatal attraction, if any of you guys are old enough to have seen that. But this is where patients have a very unstable image of themselves. They have emotional swings, impulsive reckless behavior, impulsive sexual behavior, shopping, sprees, those kinds of things. And what I found in my research is that actually they have problems with a part of the prefrontal cortex called the orbital prefrontal cortex, and they act a lot like patients who have brain lesions to that part of the brain.

The thing is with psychiatric patients, if there’s no clear lesion in the head, it’s more of a neurochemical imbalance that is affecting these parts of the brain. And what’s interesting is it’s not just about under reactivation of the prefrontal cortex that can be problematic and cause impulsive behavior, but overactivation is also problematic too because that can lead on the opposite end of the spectrum to things like obsessive compulsive disorder. So we kind of think of it like a spectrum where you have impulsivity on one end and there’s decreased prefrontal cortex activation and kind of risk aversion on the other end, which is overactive activation and sort of rumination and anxiety. So you can think of the, well, I think of my husband who’s an artist, a rapper on the more impulse end, and I am on the more risk averse, sort of more overcontrolled end, which is a nice balance I guess. But if you can sort think about the different psychiatric disorders, so you have on the risk averse and you have things like OCD and anxiety and anorexia like overcontrolled, and then you go over to the other end of the spectrum as pathological gambling, borderline personality disorder, antisocial personality disorder, and those kinds of disorders.

Then the question is, so given all of this, how much control do we really have? If our brain is dictating how we behave in many ways and we see that people can neurochemical imbalances don’t have the same capacity for control, how much free will do we really have? And according to the philosophical Cartesian definition of free will, it is that if everything in the environment, if everything was exactly the same, we could have done otherwise. So that means not only everything, the environment was the same, but if every neuron firing in your brain was firing in exactly the same way, you could have made a different decision, that would mean that there has to be some sort of ghost in the machine. There has to be something other than the neurons firing that’s like controlling the puppets, so to speak. But according to neuroscience and studies that were started going all the way back to the 1980s, our sense of free will is basically an illusion.

Now, this was the original study and this was done in 1983 by Benjamin Libert where he basically just had patients or subjects look at this little dot going around this clock and say, you can press this button to advance a slide whenever you get the urge to do so. But just remember where that little dot was on the clock when you first got that impulse to do it, your intention to move not even doing the actual movement because that takes a little time. And what he found, and he measured brain activation with EEG, and what he found is that the person had something what’s called a readiness potential. So you can see this sort of activation gearing up, gearing up until you get to this point. W, which is the point of when the person claims they had the awareness of their own intention to make a movement, and then you had a few milliseconds later, they actually make the action, but about 350 milliseconds before they even have the intention.

You see this building up of brain activation. So in the sense the brain was already gearing up to make this decision, and then there’s just a point at which you get this inclination like, oh, I feel like moving now. And then you make the move. So it’s kind, the brain is deciding first and you’re the last to know about it. Now, people didn’t like this very much. Also, they actually could see it in more modern studies using FMRI that you say to a person, go left or right, and they could record brain activation and predict up to 10 seconds before the person was conscious of their decision to go left or right, they could predict with great accuracy whether that person was going to decide to go left or just based on their brain activation. So again, people didn’t like this and they said, what about free?

What about in those seconds between when you have the intention, but before you make the actual action, do you have the capacity to actually stop that behavior? Maybe that’s where the free will part comes in. But then of course another study which looked at that found that even the decision to inhibit has these anti sentence brain activation. So you really can’t get out of this cycle. It’s really the brain making the decision and our conscious awareness of it coming after the fact. So then when people hear this, they say, well, oh, so does that mean that I can just sort of go out and murder someone and it doesn’t matter because I have no free will? And the answer is of course no. Because even though we don’t have free will in this sort of classic Cartesian sense, we have the capacity for self-control now it’s an evolved capacity, so other animals have it, and as long as a brain is healthy and has the capacity to have control over itself, we hold that person responsible for their actions free will.

The illusion of free will is useful though because we see that there are studies which show that when you tell people that there’s no free will, then you give them a test, they’re more likely, for example, to cheat on an exam or to behave unethically if you’ve just told them they don’t have free will. So it is an important illusion to have in that we live in a social society and we have to be accountable to each other. So the feeling of having free will is that in terms of the legal issue, again, we hold people responsible for their actions to the extent that they have an intact brain that’s capable of having self-control, meaning of controlling itself. And that’s actually why we don’t hold children as responsible for their actions as we do adults. Because the prefrontal cortex, the control center of the brain isn’t fully developed until about the age of 23 in women, 25 in men.

It takes a little longer for men. So a five-year-old doesn’t have the same capacity for self-control as a 25-year-old. So when they commit a crime, we hold them less responsible for their actions. But this is also why certain times of life are very difficult, like a teenager. A teenager who acts out impulsively and takes it is reckless. Not only do they have a premature prefrontal cortex, they also have a hypersensitive limbic system. So that limbic drive is kind of an overdrive, plus you add in the hormones and it’s kind of the perfect storm for risk taking moodiness, poor impulse control. So any of you have teenagers to take that into account. Some of it, it’s their brain, they’ll grow out of it. Hopefully. There are individual differences as well in terms of how much impulse control people have. And this can be based on genetics and just the way their brain has been formed.

So this classic marshmallow tests, which has been controversial as of late, but this was done by Walter Michel in Columbia the 1960s. He took gave children around the age of three to six. He said, you can have one marshmallow now or you can wait and have two later. And then he just left the one marshmallow in the room and walked out of the room and just had the video camera on, see what happened. So some of them, as you can see, just waited very patiently and were fine. Others, they just couldn’t take it. They lost control and had to eat it. There’s some funny videos though of some like one girl just kind of smelling it and licking it, but trying not to eat it. But then they followed up these kids and they looked at them later in life and they also gave them a whole bunch of other different measures and this first stage of the study, and they found that the biggest predictor of future life success was just basically if they could pass this marshmallow test, if they could withhold their gratification for immediate pleasure.

And that correlated with a career success, marital status, body mass index, a whole bunch of measures. And really what this is is a measure of executive function of prefrontal cortex function. And you can see how this scales out because the more control you have over delayed gratification. So for example, you’re studying in college, okay, I’m not going to go out with my friends to the party tonight. I’m going to withhold, I’m going to stay home and study because I have a greater future goal. Those kinds of abilities lead to things like job success and the rest. So all this being said, we think, okay, it’s really good to have control, but at another level, sometimes not having that prefrontal cortex control can be good if it’s in a kind of controlled way. For example, children don’t have as much control, but they also don’t have that filter system in place and they tend to be more creative.

They can think outside the box. They haven’t kind developed those structures fully yet. They also have, they’re a little bit less, less rumination. So there’s some positive aspects to having less activation in the prefrontal cortex, but particularly, particularly I think this freedom that comes with unrestricted thinking and this creativity. And I started to become very interested in this for clinical purposes. I have patients who are struggling and they have this overactive prefrontal cortex and the anxiety and the rumination and the kind of too much self-awareness. And I thought, are there ways in which we can help people temporarily decrease the prefrontal cortex activation? This can be very therapeutic. You can kind of lose your sense of self. You can be in these sort of creative flow states. And then I got very interested in of all things freestyle rap, because this is also a state in which you’re being very spontaneous.

It’s improvisation. You have to in the moment be fully aware. We talk about mindfulness being present in the moment, your mind just not thinking about future consequences or worrying and ruminating. And I got curious as to what’s happening in a person’s brain when they’re in one of these creative improvising states. And I used freestyle wrap as an example of that, and I’m going to show you a little clip right now of what I mean by freestyle wrap. It’s in the moment, it’s spontaneous. They have to make it up on the spot. It has to rhyme, it has to stay on beat. So it’s almost like for it’s free association, you don’t have enough time to think. You just have to, what’s the next word that comes to your mind? I’m going to show you a little sample of it. So this is a wrap and the first part is memorized, and then he’ll go into the freestyle wrap and you can see it in real time. So here we go,

Baba Brinkman:
Performance feedback, revision. See, the genes are like a text with a hundred thousand pages and revisions occur in the random changes that come from mutations. And when they see the light, that’s the performance, that’s the phenotype and natural selection, that’s the feedback side. That’s about who survives and whose gene catch rise in the next generation. Yes. What I’m saying is that a performance like this is the best illustration for the way that the performance is necessary to change the words which have, which to drawing. In fact, I just did that. When you fail to react, because any line can change and mutations occur when I improvise on stage because up until this moment, everything I said was up the page, but now it’s for me to switch it up and do a little freestyle section. I’m going to try to make a specific so that I can detection. Yes, I might be a bit of a tough to follow with the Hammersmith Apollo. That’s S, but I’m a massive ale of science. That’s the way that goes improvising into just come with these three. Simon found some nice stuff in my rhyme for the Bible code. He’s been analyzing them. I’ve been jumping them up, but I’m kind the best at this aist. What I understand, the things that they’ve been expressing like every human being on this planet is relatives, which means every relationship is relatively in which this couple demonstrates. Excellent.

This is what you call agnosticism rationalism. All these critics have liberal evolution. Some people might try to, that’s not because ideas are, that’s the difference right here.

Dr. Heather Berlin:
So you can see there when he’s freestyling, it’s kind of like this free association. Now, this rapper, his name is Baba Brinkman, and full disclosure, he’s actually my husband. So I was able to get him into the scanner and take a look at his brain when he was rapping. So I had him do memorized wrap and then I compared it to the brain activation when he was doing an improvised wrap to look at the difference. These are some actual images of his brain. This is just the neuroanatomy. As you can see, he has a very healthy prefrontal cortex, which is nice. I like that nice large prefrontal cortex. If you can see that part up at the top there, that’s sort of black, that’s missing. That’s the part of his brain that has to do with listening. If you’re married, you’ll get that joke. And this is based on some preliminary research that was done on a group of rappers.

But you can see this is the difference in brain activation between the freestyle and the memorized. And you can see the areas in blue that’s a part of the brain called the dorsal lateral prefrontal cortex. And that has under activation, it’s sort of turned down, and that’s the part of the brain that has to do with your sense of self, your self-awareness. So your ego is kind of turned down. It has to do with kind of filtering your behavior to make sure it conforms with societal norms. And that’s turned down. So it’s sort of the filter is turned down, so it allows for this free flowing thought. Anything goes. And that’s what creativity is about. And that’s also why artists often say it feels like it’s flowing through them when they’re creating because their sense of agency is turned down. But the moment you become too self-aware of your performance, you turn that do lateral prefrontal cortex back on and you kind of lose the flow state.

So that’s like the death of any performing artist is if you start thinking or if I’m talking like, oh, what are they thinking? How do I sound? How then you kind of switch that off and you lose your flow. Now people associate this flow state with very positive emotions. They strive to get there, but we also see it with jazz improvisation as well. You get decreased dorsal lateral prefrontal cortex. Now the areas in the sort of yellow orange, that’s the medial prefrontal cortex, and we find that that has to do with the internal generation of ideas. So it’s being generated from within but without a filter. So you can make novel associations between ideas, anything goes, and this allows for creativity and again, associated with very positive emotions because the rumination is turned down and your sense of self-awareness and your inner critic is turned down.

So I believe the eminent philosopher/rapper, Eminem, had it correct in his song when he said, you have to lose yourself in the music the moment you own it. You better never let it go. By the way, that’s my rapping. We also see it not just during creativity, this pattern of brain activation in this kind of flow state, but we see it during certain types of meditation, hypnosis, daydreaming, and during REM sleep, when you lose your sense of self and time and place, and it’s associated with very positive emotions. And again, people really strive to get to these states. We also see a similar pattern of brain activation during where you get this medial prefrontal cortex deactivation or activation and the posterior cingulate activation. And we see that during meditation and also when people take psilocybin, which is a psychedelic, these are like magic mushrooms, and this is affecting what’s called the default mode network.
Again, that’s sort of the place the pattern of activation in your brain when you’re having this inward looking thoughts. So you’re either daydreaming, but you’re internally focused versus externally focused. And this study actually looked at the connectivity in the brain during psilocybin. They gave them placebo and then psilocybin and with the placebo, this is a sort of sketch of the connectivity of the brain, so the shorter, smaller, closer lines or connections that are closer together. And the longer lines are about communication in the brain at longer distances. But this is what you see during psilocybin. So there’s this hyperconnectivity in the pathways. You have a wider repertoire of possible brain states, so it’s like the filter has been taken off. You also can look at something called signal diversity using this imaging technique called meg. But this is looking at psilocybin ketamine, which is now being used to treat depression and LSD. And you can see the areas in red show the higher signal diversity compared to placebo. And that again means that there’s a larger repertoire of possible physical brain states. And this can vary. This plausibly is what underpins the psychedelic experience when you have a blending of a senses and the illusion of the ego and you become very sort of imaginative, and we think it has to do a bit with this hyper connectivity and the higher signal diversity.

Finally, I just want to talk a little bit about the future of the brain. So as we understand the brain, it also allows us to influence it in more direct ways. So I want to talk just a little bit about what’s currently available with these brain computer interfaces and the ways that we’re basically learning to change ourselves with the push of a button via neural implants. So some of the implants that I’ve worked with, it’s something called deep brain stimulation. And what they do is they implant these, it’s called minimally invasive surgery, but you implant these two little small electrodes deep in the subcortical parts of the brain. They’re connected under the skin with a wire that’s connected to a battery pack, same company that makes pacemakers and they’re implanted in the chest wall. And this is being used right now. It’s been used for a long time to treat Parkinson’s disease, and now it’s moving into being used to treatment resistant. That means nothing else has worked, but very severe treatment resistant depression and obsessive compulsive disorder. So this is what the electrodes look like. You can see they’re very small. There’s four different contact points. So you can play around kind of what works best, and I’m going to show you the effects of implants when they’re turned on for the first time in a patient with Parkinson’s disease. And you can really see the immediate effect. So it’s another video, hold on.

Patient:
Okay, so we’re here for the initial programming session. You’ve got both sides of the brain put in bilateral stimulators, and here for the initial session, this what I can get my fat fingers to hit the button. There we go. See how that feels? How do you feel? Excellent. Try tapping both your fingers for excellent. Alright. Feels pretty good. Okay, good.

Dr. Heather Berlin:
Excellent. So it’s pretty amazing the effect. And what’s interesting is they have to be turned on the whole time. As soon as you turn them back on, the symptoms come right back. But in treating depression, amazingly, 40 to 50% of people with untreatable depression. So they’ve tried every medication they’ve, they’ve tried ECT electric shock therapy, but 40 to 50% get about a 60 to 70% improvement. And the same thing with obsessive compulsive disorder. And in the long-term follow-up studies, they found that with depression, people with the implants, the effects are still robust after about eight years after the implants. The only thing is that every four or five years you have to change the batteries, the battery pack, which is a minor procedure. So this is some of the applications. And so depending on the disorder, the place of where it’s implanted varies depending, even with the psychiatric illness where we implant them for OCD treatment is different than when where we implant them for depression versus Parkinson’s.

But you can see here the variety of applications that this technology is being tested out on. And now it might sound pretty dramatic like this is psychosurgery, but the alternative, say for treatment resistant OCT was to actually go in and lesion that part of the brain. And then if it doesn’t work, you have permanent brain damage. But in this case, it’s reversible, it’s adjustable. If it doesn’t work, you can just turn them off, you can remove the implants and you don’t get brain damage. The other thing is that when we’re in the or, we actually wake the patient up in the surgery so we can make sure that it’s working and that they’re in the right place. And in many cases you can see a response immediately right away they kind of light up. And so I’m going to show you a little video of a patient in the OR when they first turn on the electrodes.

So it’s pretty amazing. And again, now we’re going from correlation to causation, right? We’re going directly stimulating the brain to manipulate emotions. So be nice to neuroscientists. We have our finger on the button. No, but it’s very dramatic that we can actually modulate people’s emotions in such a direct way. And it’s not only these neural implants are not only being used to stimulate parts of the brain, they’re also being used to record from different parts of the brain. So this is a brain computer interface. It’s a micro electrode array that detects brain signals where ever it’s implanted and then it can translate via a computer, send that information to a computer and then translate that information into machine instructions that can basically allow you to, for example, control a robotic device or robotic arm just with your thoughts. So if you implant this in the premotor area of the brain, those signals, again, the thoughts get recorded thinking I want to move my right arm, but let’s say you’re paralyzed and you can’t, and then your thoughts will move a robotic limb.

And this technology has been used. So for example, this is a quadriplegic patient who she used her thoughts with this implant to move this robotic arm and took a sip of coffee for the first time in years. As you can see here, people can control a cursor on the screen. People who are completely paralyzed and can’t communicate anymore can use their thoughts to move a cursor on a screen that has an array of letters. And then they can think about closing their hand to click on the letter and they can click out, type out a message and communicate that way. It’s amazing. This is a more recent study also that they implanted this electrode array and this man was completely paralyzed. He was in his twenties and they implanted it over the motor cortex and it controlled this robotic exoskeleton. And he simply thought about moving his arms and his legs and walking, and that controlled this robotic skeleton, and he could walk with this device.

So these technologies are just going to be improving and getting better. Over the years, Elon Musk developed something called Neuralink, which he’s working on now, where it’s this thin mesh electrodes that supposedly are going to be so easy to just, you can almost inject them into the brain and then they will mesh with the brain cells themselves making us kind of cyborgs in a way. And these simple electrodes implants are kind of like the model T four of what’s coming. They’re the very early stages. But as our understanding of the brain increases, so will our ability not only to treat disorders, but also to design cognitive enhancements and brain computer interfaces that can potentially improve our brain’s processing speed, our memory capacity, modulate our emotions, even decrease our need for sleep. And so of course, there’s going to be ethical considerations. Who can afford these implants?

I mean, they would be at such an advantage. Is it going to be kind of cosmetic like Botox for the brain, or is it going to be something like performance enhancing drugs where either everybody has to have it or nobody can have it because it would just create such a schism between the haves and the have nots. And what if someone can hack into your neural implant and control your thoughts and your behavior, which is not unheard of. I mean, now we have them in mice and we can, using an iPhone, I can control a mouse in a lab by clicking, controlling it from remotely, by controlling their neural implant. So today these questions are kind of academic debates, but I think my children will most likely be confronted with these issues firsthand. And then it’ll be a question of, as we sort of merge with technology, we will be these sort of cyborgs and what will it mean to be human, right? There’s the silicon chip thought experiment where it says, if you replace one neuron with a silicon chip that can do the same exact thing, are you still, do you still feel pain? Are you still conscious? What about two? What about three? What about four? At what point are you still you? At what point are you still conscious? And this is really bringing up issues about identity in terms of who are we?

I think our brains are basically sculpted like clay throughout our lives. Our genes provide the raw material as well as a few preformed contours. And as our neurons are kind of wired up as we’re developing as children, the clay sort of hardens, but never completely. So there’s always room for change. And a baby’s actually born with billions of neurons and trillions of connections that are actually eventually pruned away. We’re born with more neurons than we need, more connections than we need. And the most salient ones are kind of rein instantiated, they’re strengthened, and the other ones kind of die off as we develop our personalities. So I think identity in a way is like information. It’s a matter of differentiation of defining ourselves by what we’re not and what we do and don’t reach for. That was my son years ago reaching for do. It was not plugged in. I mean, he wasn’t going to turn on.
But I do think as we think about these AI systems, one question is going to be, are they going to be conscious like us? And to know that we really need an overarching theory of consciousness, for example, to know, does a bee have it? Does a fetus have it? Does an AI program have it? Does the internet have it? And this will matter because for example, I can kick my refrigerator, but that’s fine if it’s not conscious, if it doesn’t feel pain. But if it could feel pain, if it did have subjective states, there would have to be laws in place that we can’t kick it. And we see this in kind of sci-fi now. It shows like Westworld and a film called Ex Machina where we build these AI systems that eventually start feeling and thinking on their own. And we have to really know, are these things going to actually feel pain?

They might say they can feel pain, but can they are not? And we won’t know until we have an overarching agreed upon theory of consciousness. So the more I learned, the more I realized just how little we still understand about the neural basis of consciousness and of unconscious processes. So we’re still, we know more than we did, but we’re still in the early stages of understanding the brain and how it relates to subjective feelings. But what we can do with the knowledge we have so far is we can try to basically understand ourselves. We can look inward and try to understand our own unconscious motivations, desires, drives, know thyself. And that’s a lot of what psychotherapy does. It tries to bring into awareness our unconscious processes so that we can understand ourselves better and live more in line with our long-term goals and be happy.

And I think ultimately this leads to wisdom. And so wisdom is having experience and knowledge and good judgment. And with these AI systems, they might have consciousness, but will they have, I don’t know, creativity? Will they have wisdom? We just don’t know. But I started studying consciousness in order to find a way for my thoughts to survive death. But what I got instead was a feeling of awe that this three pound piece of matter gives us even the ability to ask these questions in an attempt to answer them. And so I think the question still remains, how does subjective experience arise out of matter? But the answer lies right in our brains. And the technologies of today allow us to peer even deeper into the brain than anything that was available when I was five years old. So I’m optimistic that maybe the next generation of neuroscientists might finally be able to unlock this great mystery. One is how can we access our unconscious to boost creativity? So it’s kind of a counterintuitive answer, but if you are creative, let’s say you’re trying to write or paint or make music, the worst thing you can do is sit there and be like, I need to be creative. Now, be creative. You’re basically turning on your prefrontal cortex and trying to force it. But what you really want to do is actually turn down the prefrontal cortex. So the best thing you can do is actually don’t think about it. Go for a walk, do something else. Let your unconscious do its work. It can process much more than your conscious brain. The consciousness has a limited capacity in terms of how many variables it can hold, and it can process, but the unconscious has unlimited capacity. So what you do is you consciously take in all the information and then you walk away from it.

People say, sleep on it, go for a walk. Our best ideas come out in the shower because we are letting the unconscious do its work and then come to the surface. This is when we have these moments of insight. And so the best way to be creative is to do nothing, is to actually, well take in the information. If you’re a musician, you have to learn the chords and the structures and all of that. But once you have the basics and it’s in your brain, let your brain do the rest, and it will come to you. The creativity will come.

Let’s see. Any questions here? So no questions. Yeah, feel free. Anybody to write in a question, just type Q and A and type it in. If not, I’ll just keep going with the pre-written questions. Can you speak about, oh, I see a question coming in. Okay, I’ll do this one. Okay, hold on. I’ll do this one. Hold. Could you speak about the connection of A DHD executive function and impulse control? So yeah, there is a connection there in that they’re all related to the prefrontal cortex. The thing with a DHD and why, it’s sort of again, counterintuitive that you give people with A-D-H-D-A stimulant as a treatment, you would think they’re already, let’s say hyperactive or they can’t pay attention. Why would you give them a stimulant? But what you’re doing is actually giving them a stimulant that stimulates the activation of the prefrontal cortex, and that’s basically stimulating the brake system.

So it’s turning the brake system on and allowing you then to actually inhibit and pay more attention the other. Okay, so how is your research helpful to families who care for the elderly or ill patient? So I think what’s really important, and I work with a lot of elderly people, especially with neurodegenerative disorders and things, but even without a neurodegenerative disorder, what we find is that there’s just a natural in the process of aging, decrease in the gray matter in the prefrontal cortex, so that older people can actually have less ability to control their impulses. And if you’ve noticed that sometimes, I mean, I remember I lived with my grandmother and she would just say whatever was on her mind to people, often embarrassing on me, but her filter was turned down. And I think it’s important to keep in mind that as the brain ages, sometimes the ability to inhibit becomes more difficult.
Memory issues occur again, not even just outside of a neurodegenerative disease, but normal aging, you have less memory capacity. So to kind of be sympathetic to that, when you are looking at a person, I look at people, I think about what’s happening in their brain. If I’m working with a teenager or an older person and take that into account, don’t expect them to always behave the way you think they should take into account that there are differences in the brain and that will affect their behavior.

Do you have any recommendations for how to combat anxiety naturally? Yes. So there are lots of ways to combat anxiety and cognitive behavioral therapy is one of the best techniques in something called exposure response prevention. What you do is you actually have people exposed to the trigger that makes them anxious and tolerate it. Over time, the brain habituates and it becomes less triggered by that stimulation. So for example, if you are, I’m just going to use a spiders for example. You’re very anxious around spiders. If every time you see a spider, you run and avoid it. Your brain never learns that. Actually, if you just sit there in the presence of a spider, nothing bad is actually going to happen because anxiety is about anticipation of a negative future consequence. But you have to retrain your brain to say, actually no, if you just are with a spider, nothing bad is going to happen. I mean, of course it’s not like a deli poison a spider, but, and your brain relearns that. So the worst thing you can do is avoid the things that cause your anxiety. The best thing you can do is actually sit with it, learn to tolerate it, and over time, your brain will be less triggered by those things that give you the anxiety in the first place.

Is it true? This is from, so those questions are from Amanda. This is from Mike. Is it true that the brain cannot distinguish between reality and imagination? And if so, is there a relationship to anxiety because of that? That’s a very interesting question. Okay. Not true. So basically whether you are looking at a beautiful, let’s say sunset, or you are imagining a sunset, if you actually look at the brain activation and the visual course X, it looks pretty similar. You won’t be able to tell the difference. An outside person couldn’t really tell the difference of whether you’re imagining that sunset, it’s being internally generated or it’s being externally generated, right? It’s coming in from externally. But there’s another part of brain that actually lets you know whether that perception that percept is being internally generated or coming externally. So we are aware of that. A healthy person knows whether I’m just imagining that or whether I’m actually seeing it.

But there are disorders in which that, or the brain that distinguishes internal versus external generation of stimuli is damaged. And so take schizophrenia for example. They can’t tell the difference. So they say, oh, I’m hearing voices, people are talking to me. But really it’s their own internal voice talking, but they’re putting it as it’s coming externally and they’re misattributing that. So what was the other part of that question? If it related to anxiety? Well, oh, it’s gone now. I don’t think it relates to anxiety per se, but it is very interesting when that, oh, here it is in relationship to anxiety, I think it can cause anxiety. If you can’t tell the difference, if you’re somebody who’s in a state of, like, as I said, we’re all kind of hallucinating all the time, and a controlled hallucination. When we agree upon it, we call it reality.

But it’s like when we disagree, if a person is hallucinating, it says, I see a person standing there, but five other people in the room don’t see that person standing there. There’s no agreement between us. Then you have to assume that that’s a hallucination, that there is no person there. So some of it is subjective. Do you see patients or strictly research? Both actually. So I am both a cognitive neuroscientist and the clinical psychologist. I see patients for treatment as well as do clinical research. And what I really love to do is integrate the two. So I think the research informs the clinical practice and vice versa. And also I think understanding how the brain works and the neuroscience can help with therapy, with psychotherapy, because they’re all interrelated and these artificial boundaries between disciplines, like there’s psychology and then there’s neuroscience, and then there’s neurology.

I mean, there’s a lot of overlap between the two, and I think it’s really important to have a dialogue between those. Can we use our brain to create good habits? Yes. So learning is basically actually physical changes in the brain. So there’s something called long-term potentiation, which is basically when you learn something. So you have, let’s say two neurons that are interacting. And when one fires, the next one fires. And if you practice over time, it becomes easier. That tract of information becomes easier because your brain actually will change, it’ll grow more receptors on the receiving neurons, so it’ll more easily fire when it gets stimulated. That’s what learning is. And so good habits is that if you do something over and over again, your brain grows new connections, it makes that process, that behavior easier to engage in. And that’s what learning is. So practice actually the brain.

And so if it’s anything, I mean, I take a kid who is learning to brush their teeth, and you do it day after day after day, and then at some point it becomes automatic. And when it does, then you have these subcortical areas that sort of take over. It becomes implicit or unconscious. You just wake up, you brush your teeth, you don’t even think about it. But when you see a child learning it, they really have to consciously think about it. It’s like anything habits first, they are conscious. You practice them until they become implicit, unconscious, and then become much easier.

How is your research helpful to families who care? Oh, we did that one. Let me ask one here. Can a chemical balance in the brain be reversed? I wouldn’t say reversed, but I would say it can be modulated in the sense that that’s basically what psychopharmacology is. It’s if you have a neurochemical imbalance, let’s say you have decreased serotonin, you can help what an SSRI is, it’s called the selective serotonin reuptake inhibitor. It basically stops the neurons from after the serotonin’s been released, it has to clean it out of the synapse, so it doesn’t keep stimulating it. But what it does is that this drug makes it stay in the synapse longer. So it keeps activating the neurons. And over time, our brains can modify themselves in terms of synaptic plasticity to help with that process. But I don’t know if it would be reversing, can we make ourselves happier is another question.

And I think, yes, we all have the power within us, but I’d like to say that, and I say this to patients as well, that the goal isn’t necessarily happiness. These are these high moments that we all can have glimpses of, but I don’t know anybody who’s just walking around totally happy all the time. And there’s this misperception, why aren’t I happy all the time? Everyone else is happy. That’s not true. And then you’re giving yourself such a standard to try to reach that. It’s impossible. But what I think is the best is if we can reach sort of equanimity, is just feeling like at peace, feeling okay. And then you get these moments of happiness or joy that come. But when you go back to baseline, what you want is your baseline to be peaceful. That should be the goal. You don’t want to have, some people have a happiness and then they have a low, and then they stay at the low, and then they’re searching for the happiness peaks.

But you want stability, and I think that’s the goal. And our brain and our bodies, they want homeostasis. It wants to get to that state. And so sometimes people need a little help, whether it’s a neurochemical boost or psychotherapy, but that’s where what is going on in a person’s brain when they’re addicted to a substance. This is from Anne Marie, when they’re addicted to a substance and what can they do to alter the behavior. So addiction is very complicated, and it’s not only addiction to a substance. People can have behavioral addictions as well. The same neurocircuitry in the brain, for example, that’s involved with pathological gambling is also involved with drugs of addiction. And so what’s happening is that first you make poor decisions, and ultimately then the drug itself takes over. And then as I said, how the brain adapts. If you’re giving, let’s say a brain cocaine, you’re overstimulating and it gets that signal, oh, I’m being overstimulated, so I need to down regulate.
It’ll close down some of its receptors. Basically it sends a message to the DNA and it tells the proteins what to do, and it says down regulate, we’re getting too much stimulation. And so then what happens is that, so they want to reach homeostasis, but then it needs the cocaine to get just to a normal level, right? Because it’s now when you take the cocaine away because it’s self-regulated, to adjust to this new environment where it was always being stimulated. But that’s what withdrawal is. It has to take time now to build back up again, right? Once the stimulant is taken away. So what we do have control over in some sense is the decisions we make if we decide, okay, I want to not use this drug anymore. It might mean having to go to rehab to get through a very uncomfortable period when the brain needs to reestablish a new homeostasis without the drug. And that can be a very difficult process, but making the decision to go through it to get to the other end, usually the brain can reestablish a new kind of balance over time.

How long does it take to break a habit? There are various things that are written about this. I think that there’s no steadfast answers, there’s no clear answer to that, but I would say as long as till you as an individual get to the point where it comes naturally in some ways to you. So if you have, I don’t know, a habit of biting your nails, let’s say, you might have to put, sometimes you put this chemical on it, so every time you taste it, it tastes gross and you get this aversive response. And so you start to learn over time to not do it. And then when the habit is truly broken, it’s that when you don’t even have the urge to say, put your fingers in your mouth anymore, right? When that becomes natural. So I just don’t know. I think it varies for different people.

Okay. Here’s one from ADHD to addiction. Are as genetically related as hair color and perhaps math scores. What tools are currently available to enable parents to break the chain that binds their children from similar faiths? So I think this is a kind of nature nurture question about how much is it nature, how much does it nurture? And the answer is, it’s a bit of both. Yes, we are born with certain genetic predispositions to perhaps even get certain psychiatric illnesses, but usually it’s sparked by a stressor. So we call it a stress ESIS model. So you have a diasis, which is a vulnerability, let’s say, to get depression, but you might never develop it unless you have a significant stressor that then targets your vulnerability. Then wherever your weaknesses will come out. But so let’s say you have your prone to anxiety. You might never be the most relaxed person in the room, it’s just not in your DNA, but you can certainly, I think your genetics give you the boundaries with which you can be within, right?

So you might somebody who’s relaxed, their boundaries are over here. You are over here. But with therapy and with practice, you can either be at the higher end or the lower end within your particular genetically predetermined boundaries. So relative to yourself, you can become more relaxed. You can also know what your predilections are, if it’s alcoholism runs in your family, and you can restructure your environment so that don’t keep alcohol in the house. If obesity runs in your family, maybe there’s a genetic predisposition. Don’t keep unhealthy foods in the house. So you have to learn what your predilections are, restructure your environment to help you behave in the ways that you want to in terms of achieving your long-term goals.