What Dr. Daniel Amen Learned from 115,000 Brain Scans That You Should Know

I am so excited to be here because what I get to do is talk about my obsession, which has been the brain. But I want to start with this slide. I saw this recently. If you knew a train was going to hit you, would you get out of the way? So that's going to become very important. It's 1991. I'm a psychiatrist, been a psychiatrist for about 10 years. And I order my first brain spec study. Spect looks at blood flow and activity. It looks at how your brain works. It's different than a CAT scan or an mri. Those are anatomy studies. So we're looking at function. So I'm the director of a dual diagnosis unit, a psychiatric hospital unit that takes care of drug addicts. So this is a healthy brain. This is an addicted brain. And right away, you realize why you shouldn't do drugs. It's because they damage your brain. I got so excited about this technology that I scanned everybody I knew, including myself. And when I scanned myself, this is my first scan. I was horrified. I'm like, why is it so bumpy? A healthy brain is fat and beautiful and smooth and even. And I was horrified because I don't drink. I've never used drugs. But I had meningitis when I was in the army when I was 18. And I had a lot of bad brain habits. And what I'm excited about, what our work is all about, 20 years later, my brain is younger, and it doesn't usually work that way. You literally can change your brain, and when you do, you change your life. Imaging changed everything for my children because, in fact, if you dated one of my daughters for more than four months, you had to come to the clinic and get a scan. It's actually meet the parents. But worse, imaging changed my love life. After being in a long marriage that I wasn't very happy with, I was determined the next woman I would give my heart to, I would first see her brain. And so I got very attached to Tana. And two weeks later, she's in the clinic, she's getting scanned. Her brain is beautiful. Now she gets to stay. Imaging literally changed absolutely everything I do with my own patients. So the current psychiatric model is you tell the doctor your symptoms, he gives you a diagnosis that actually is just a regurgitation of your symptoms, and then he gives you a medicine to attack the symptoms. So if you're depressed, you get a depression diagnosis, and you get an antidepressant. If you're anxious, you'll get an anxiety disorder diagnosis and medicine for that. My favorite to Explain this is if you explode intermittently, if you have temper problems, they'll actually give you a diagnosis called Intermittent Explosive disorder. So think about that ied and then they don't know what to do. And did, you know, outcomes in psychiatry happen to be no better than they were in the 1950s? So it's psychiatry's dirty little secret. So when I started looking at people's brains, I'm like, oh, my goodness. Scans taught me that depression wasn't one thing. In fact, it's a symptom, that there were many different causes. In fact, giving someone the diagnosis of depression was exactly like giving them the diagnosis of chest pain. And doctors don't give people the diagnosis of chest pain because it doesn't tell you what causes it or what to do for it. And so I've written a number of books. One, my latest one, Healing add, where I talk about seven different types of add. Don't put everybody on a stimulant, because you can make some people much better and a whole bunch of other people dramatically worse. Imaging helped me see the underlying biology behind the symptoms. So was your brain overactive? Was it underactive? Was it toxic? Either from substance abuse or alcoholism or an environmental toxin like mold? Or did you have a traumatic brain injury? Traumatic brain injuries are one of the major causes of psychiatric illness. But of course, nobody knows that because nobody's looking at the brains of their patients on a regular basis. Imaging. And this was the beautiful part, this is the heart part of imaging. It decreased stigma.

Hey, I hope you're enjoying this video. And I want to let you know that I have a new book that's come out, and if you'd like to get it absolutely free, there's a link below in the description. Or you can wait till the end of this video, or you can Simply go to joe'sfreebook.com and you can get a copy there.

I love that because. Because people saw their problems as medical and not moral. It decreased shame, decreased guilt. And the other part I truly loved is the families then got on board because it increased forgiveness and compassion. We have nothing else in psychiatry that's that powerful or that immediate Imaging actually completely changes the discussion around mental health. Nobody wants to see a psychiatrist. I mean, how weird is that? I decided I want to be a psychiatrist, and now nobody wants to talk to me. You're not going to shrink me. No one wants to be labeled as abnormal or defective, but all of us want better brains. So what if mental health was really all about brain health? Imaging changed everything. About my health. Oh my goodness. There are 200 studies now that say as your weight goes up, the actual physical size and function of your brain goes down. Oh my God. That should scare the fat off anyone. This is the biggest brain drain in the history of the United States. Two thirds of us are overweight. Can you imagine the neurons and the IQ points we're losing? In fact, a couple of years ago I coined this term called the dinosaur syndrome. Big body, little tiny brain, you're going to become extinct. Now I know that's rude, but it's true. And when I read the first study, I lost 30 pounds because I don't want to be a dinosaur. Imaging can change the Alzheimer's epidemic. Did you know Alzheimer's disease is expected to triple in the next 25 years? There's no cure for it on the horizon. If you're fortunate enough to live until you're 85, you have a 50% risk of being diagnosed with with Alzheimer's disease. And the little scary nugget we've learned in the last 10 years, Alzheimer's disease starts in your brain 30 to 50 years before you have any symptoms. So if you knew a train was going to hit you, would you get out of the way? This 59 year old woman was diagnosed with Alzheimer's disease. It's a scan on the right, you can see the whole back half of her brain is deteriorating. Likely she had brain changes in her 20s. I think all of us should be scanned by 50 because treatment works when early or late?

Early.

And how would you ever know if you were vulnerable unless you looked? Imaging changed everything for the NFL. And my problem with the NFL is if you don't admit you have a problem, you can't do anything to solve it. And imaging really broke the NFL's denial. We did the first and largest study on active and retired and NFL players and it just changed everything. So our first study on 100 players, the Blue equals damage across their whole brain. And you know, I think most 9 year olds would figure out it's a brain damaging sport. That's not hard. What was really exciting about our work with the NFL was we showed that 80% of our players could rehabilitate their brains on a smart program. Now how exciting is that? You're not stuck with the brain you have. You can make it better. Now, I hate this graph because I just turned 60 a couple of weeks ago. But it's really clear based on a study we did with 8,000 people, your brain gets less and less active as you age. So sort of like as your skin falls off your face, as you age, the same process is happening in, in the brain, but it doesn't have to. That's really the exciting. So a typical 82 year old scan on the left, my friend Doris Rapscan on the right. Fat, full, beautiful for 82. You know, if something happens to Tana, I'm asking her out. So the most exciting thing I'm going to tell you is you can literally change your brain and change your life. But how would you know unless you looked? So my favorite story to illustrate this is my oldest daughter, Brianne. Always easy, always sweet. But the sad truth is I never thought she was very smart. Had to get her tutors, had to work hard, had her tested, and in 10th grade she fell apart, she got depressed. She came to me one night in tears and she said, dad, I just don't think I can be as smart as my friends. And, and it broke my heart. Next day, scanned her at the clinic and I'm like, oh my God. I cried when I saw this because what it indicates she had really low energy, low blood flow in her brain. I knew how to fix it. I mean, that's really what made me so sad because I had been fixing people's brains for years. The next day, on just a little tiny bit of targeted medication for her was much better. Three months later. This is a girl who never got one A in her life. The next three months later, straight A's. The next ten years, straight as. So the ultimate question is, which brain do you want? Which brain do you have of these? And how would you ever know unless you looked? I am so grateful to be here because of course, you know, brains run the world. They run the stock market, the local market, huge corporations, mom and pop shops down the street. Brains run governments, although not that well, schools. It's actually our program in the Fraser Academy in Vancouver. We teach thousands of kids every year to care about their brains. Churches. We have a brain health program in churches around the world. Families, it's my family and you. Yet most people rarely think about their brains, which is a huge mistake, because success in anything you do always starts with a healthy brain. After looking at NOW's 115,000 scans and some of the most interesting people in the world, including Joe. And it is very clear to me that when your brain works right, you work right. And when your brain is troubled for whatever reason, a head injury, an infection, mold exposure, you're going to have trouble in your life. With a healthy brain, people are happier physically Healthier because they make better decisions, wealthier because they make better decisions because. And they're more successful in everything they do. When your brain is not healthy, people are sadder, sicker, poorer, less successful.

Hey, I hope you're enjoying this video and I want to let you know that I have a new book that's come out and if you'd like to get it absolutely free, there's a link below in the description. Or you can wait till the end of this video or you can Simply go to joesfreebook.com and you can get a copy there.

So your competitive advantage or your disadvantage is the actual physical functioning of your brain. But let's be clear, you're in a war for the health of your brain. Everywhere you go, someone is trying to shove bad food down your throat that will kill you early. The real weapons of mass destruction.

Or.

Processed pesticide sprayed highly glycemic, low fiber food like substances. The clown and the king have killed more people than ISIS has ever dreamed. And these food companies use neuroscientists. They use trick to hook your pleasure centers because you know this woman would never look this way if she ate that. Tech companies create addictive gadgets that hook our attention and distract us from our loved ones. New study from Microsoft. The attention span in humans is now 8 seconds. A goldfish is 9. This is evolution going the wrong way. Study from the Harvard Business Review said that only 10% of us are high in both focus and energy, the two things that drive success. 90% of people are without one or the other. Which is why in your bag I put our focus and energy supplement. This is the one I hate now that I'm 61, because it's very clear to me after doing a study with 8,000 people, your brain gets less and less active as you age. Typical 55 year old brain with lots of wrinkles worse at 82. But here's a friend of mine who actually lives In Phoenix at 82, she has a stunningly beautiful brain. Brain aging is much more about your habits than your age. So here's the program. This is the $250,000 idea. And for you in this room, it's way more than that. If you pay attention to me, it's, you're not stuck with the brain you have. You can make it better. I can prove it. Here's the plan we use at Amen clinics. First you gotta look at your brain. So baseline brain health assessments. We do a study called SPECT that looks at blood flow and activity. Here's A healthy scan compared to someone with accelerated aging, someone who has Alzheimer's disease, which we can tell decades before you have any symptoms. Someone with a brain injury, someone whose brain's working too hard, such as people who have obsessive compulsive disorder and people who have underactive brains. This one drank way too much. I think of imaging like a map. You know, a picture's worth a thousand words, but a map is worth a thousand pictures. A map tells you where you are and gives you direction on. On how to get to where you want to go. Without a map, you don't know, and you're lost. And it can cost you your life. The second thing we do is we don't want you to have normal anything. Normal is sick. 51% of the US population at some point in their life will have a mental illness. And if you're fortunate enough to live until you're 85, 50% of you will be diagnosed with Alzheimer's disease. That's normal. And I don't want any part of it. And Genius Network people don't either. So I want to know your important numbers. And you got a copy of my new book, Change youe Brain, Change youe Life. This program is in there, in chapter 19, in detail. The third part is your brain. You know, people go, oh, take my supplement, because it'll give you a great brain and it has one thing in it, and that just doesn't work. Why? Because the brain does not get sick in one way. It gets sick in many different ways, and that's exactly how we get it better. So we take a multiple mechanism approach, from omega 3 fatty acids for inflammation, ginkgo for blood flow, and so on. And the last thing, and I'm really proud of this, in 2005, I wrote a book, and I got all sorts of grief for it. It was called Preventing Alzheimer's. You can't do that. But since then, there have been programs at UCLA and Johns Hopkins called Preventing Alzheimer's. I love that. Here's the short course. You want to prevent Alzheimer's disease in yourself or your family, you have to prevent or treat all of the risk factors that are associated with it. And if you go after obesity, diabetes, heart disease, hormone levels that are not optimized, and all the rest of these, this is how you prevent it. So let me show you how this works. Joe's one of my favorite people. I love Joe having a problem. I called Joe. Having a great day. I'll call Joe. And Joe called me. He's like my Brain's not right. And this was about five years ago, and he got hurt. He had a head injury. Most people don't know that head injuries are a major cause of addictions and psychiatric problems. And nobody knows because psychiatrists are the only medical specialists that never look at the organ they treat. How crazy is that? He came, his brain was troubled, and he just. What I love about Joe is he just did everything I said. Imagine if you just did everything he said, where your business would be. And in seven months, his brain is better. Five years later, it's freaking normal. It's healthier than his age. Some of you who've come to my clinic, I'll tell you, your brain looks older than you are, and his looks younger than he is. I love that for him. We also did the world's largest study on active and retired NFL players at a time when the NFL was lying that they had a problem. And we demonstrated high levels of damage in 96% of the players that we study. It's horrible. And, oh, by the way, if you played football at any level, 80% of you have brain damage. But my job, my love, is never to tell you you have a bad brain, unlike the eternal optimists. Well, can we make bad brains better? And in fact, on this program, 80% of our NFL players showed improvement in memory, attention, mood, and sleep. You are not stuck with the brain you have. You can make it better. Here's one of our players, Freddie Dreier, who said, I replaced a part of my mind that had been lost. My energy and focus are much better. Duval Love played 20 years. He's an offensive guard. His brain just looked awful. Year later, it's much better. Oh, by the way, lost 110 pounds. I was pretty excited for him. Now he has a master's degree. He thinks he's really smart. It's really awesome. And so November 3rd, Change youe Brain, Change youe Life, which is in 26 countries. And I'm so proud of this book, but it's old. And so I had to revise it and I expanded it and I put all of my best work into this book. So I'm very excited. I called Joe up. I said, joe, how do we get this to the world? He said, well, I have a forum, the Genius Crowdsource Blueprint. And I. I'm a good student. I just. I do what he tells me to do. So we have a name. I changed my brain and changed my life to win the prize Best video or Essay on how you used my work. To help your brain and your life. Our goal is a thousand stories, a million more books sold. And the prize is we will pay for you to come to. To Southern California, get a full evaluation that we pay for. I'll actually do it because I don't do many of them anymore. And we'll give you a year's worth of supplements. And the deadline is February 14th. Cause that's love My Brain Day. And the first day, we got 60 entries, so we now have about two. It's been out for, like, four days. So one of them, Steve, writes my rental car confirmation number. And I'm thinking, why do I want to know this? The reason I know is that I'm supernaturally able to remember things that I would never have been able to. And they don't go away. My productivity and creativity is off the charts. I'm able to connect with my wife in ways I've never experienced. And the sexual intimacy is another area of peak performance. I love that. But my favorite one so far is Cheryl. My brain was broken because of your work. I went from being homeless and hopeless without the custody of my three children to being an RN on a busy surgical trauma unit in a stable relationship. But most importantly, I'm able to be a good mother to my children. You are not stuck with the brain you have. You can make it better. I can prove it.

In our brains, it consists broadly of the prefrontal cortex, which is that large gray matter area right behind our foreheads that's so important for future planning, delayed gratification, and also autobiographical narratives and storytelling. And we have these deep limbic structures or emotion brain areas, the nucleus accumbens and the ventral tegmental area that are rich in dopamine releasing neurons. And when it comes to the problem of compulsive overconsumption or addiction, we have a problem either in the prefrontal cortex, which is kind of like a problem in the brakes on the car, the control centers, or a problem in those limbic structures which are kind of like the accelerator on the car. So another very exciting discovery just in the last 75 years, is the discovery of dopamine as a human brain neurotransmitter. Now, dopamine was known long before then as an animal neurotransmitter. But it was only discovered in the 1950s as a human brain neurotransmitter. And for those of you who may not be exactly familiar with what a neurotransmitter is, neurotransmitters are chemicals that we make in our brain that bridge the gap between neurons. Neurons are these long, spindly cells that conduct the electrical circuits that make up who we are, but they do not touch end to end. There's a gap between them called the synapse. That synapse is bridged by molecules called neurotransmitters. Those neurotransmitters allow for fine tuning of that electrical circuit. Dopamine has been discovered as one of the most important neurotransmitters for the exposure of pleasure, reward, and motivation. Now, it's not the only neurotransmitter involved in that process, but it is the final common pathway for all reinforcing substances and behaviors. This image represents a series of experiments done in rats and mice where a probe was placed in the nucleus accumbens to measure dopamine firing. We're always releasing dopamine at a kind of baseline tonic level in our brain. When we do something that's pleasurable, rewarding, reinforcing, or simply that, our brains tell us that this is important for your survival, so you should pay attention to it. We increase dopamine firing temporarily above baseline, and this shows in rats and mice anyway, how much we increase those dopamine levels. For chocolate, it's 55% above baseline. Sex is 100%, nicotine 150, cocaine 225, and amphetamine 1000. Now, the very high amount of dopamine released by amphetamine is somewhat artifactual in the sense that the mechanism of action of amphetamine is to release dopamine directly into the synapse, Whereas these other kinds of reinforcers have their own unique chemical cascade, and dopamine is their final common pathway. So it's not necessarily that amphetamine is so much more addictive than these other things, Although in rats it may actually be because, in fact, rats will press a lever for cocaine or amphetamine until exhaustion or death. What this also doesn't quite represent is that although we are very similar to rats in terms of this very basic, evolutionarily conserved part of our brain, we're also very different because we have these large gray matter cortices that are overlay these deep limbic structures that we can use to modulate it. And, for example, we're also just different from rats in the sense that it's very hard to get a rat addicted to alcohol. But for human beings, it's very simple to get addicted to alcohol. You can actually make genetic strains of rats that get addicted to alcohol, but it's just hard to do this also doesn't take into account the very important point of inter individual variability. So what releases a lot of dopamine in one person's reward pathway may not release a lot of dopamine in another person's reward pathway and vice versa. And from an evolutionary point of view, that makes sense. If you've got a tribe of people trying to survive in a world of scarcity, you wouldn't want everyone going for the same reward. You would want some people interested in finding mates, other people interested in meat, other people interested in berries. This drug of choice concept becomes particularly important when we think about the ecology and the world that we live in now, where we have so many different types of drugs, including many drugs that didn't exist before. Dopamine is also very important for movement. And it's probably no coincidence that the same neurotransmitter that's essential for pleasure, reward and motivation is also important for movement. And even the most primitive nematode will release dopamine in response to food in its environment. And that dopamine allows it to locomote toward the food. One of the big problems today is that we don't actually have to move our bodies in order to get the things we want. So there's this big disconnect between the function of dopamine as something that has us engage in movement in order to get our reward, and the actual getting of the reward. Which is of course partially what makes things addictive. Right. What is the difference between cocaine and broccoli? It's the amount of dopamine that's released and how fast it's released in the reward pathway. But the other thing that's different about what's addictive and what isn't is the relationship between how hard we had to work to get the dopamine and how much dopamine is released. Because really we are physiologically designed for so called natural rewards, food, clothing, shelter. But really what that means is that we're physiologically designed to go into some kind of physiologic deficit that then drives us to want to do the work to get the reward to survive. Whereas today we don't actually need to do that work to survive. And we have all this amazing, highly potent stuff that's handed directly to us that makes our brain very confused in a way that I'm going to talk about now. So to me, the most exciting finding about processing pleasure and pain in the last 75 years is the finding that pleasure and pain are actually co located in the brain. So the same parts of the brain that process pleasure also process pain. And they work like opposite sides of a balance. So imagine that deep in your nucleus accumbens, you've got this teeter totter, like in a kid's playground, that represents how we process pleasure and pain. It's an obvious oversimplification, but it gets at a very fundamental aspect of what happens in our brain as we become addicted. So when we experience something pleasurable, the balance tips one way. When we experience pain, it tips the other. But there are certain rules governing this balance. And the first and most important rule is, is that the balance wants to remain level, or what neuroscientists call homeostasis, so that with any deviation from neutrality, our brains will work very hard to restore a level balance. How do our brains do that? First, by tilting an equal and opposite amount to whatever the initial stimulus was. And I like to imagine that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again. But the gremlins like it on the balance, so they don't get off as soon as it's level. They stay on until it's tilted and equal and opposite amount to the side of pain. That's the comedown, the hangover, the blue Monday. Or maybe even just that moment of wanting to eat one more piece of chocolate, watch one more TikTok video. It can be even outside of conscious awareness. Now, if we wait long enough, those gremlins get the memo that there's no more dopamine incoming. They get off the balance and homeostasis is restored, and we kind of go on our way. But until that happens, while those gremlins are on the pain side of the balance, we are in a state of physiologic craving and wanting. We want to restore homeostasis. And by the way, the work of restoring homeostasis also triggers our adrenaline or our innate stress response, so that it is strong and it is work inducing in order to bring that balance level again. But what if we don't wait? What if we continue to consume our drug of choice? Over days to weeks, to months, to years, those gremlins start to multiply. And pretty soon we've got enough gremlins to fill this whole room. And now they're camped out on the pain side of the balance, tents and barbecues in tow. And now we're entering addicted brain, right? And essentially this means we are changing our hedonic or joy set point such that we need more of our drug and in more potent forms, not to get high or feel good, but just to level the balance and feel normal. And even more importantly, when we're not using our drug of choice, we're walking around with a balance that's tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and craving. And this is why people with severe addiction will relapse even after they can see that when they're not using, their lives are better. It's because their brains aren't better. They're walking around in this state of physiologic pain. This is also why it's so difficult to stop addictive substances and behaviors when we're chasing dopamine, because we're exposed, experiencing that craving that comes from having that pleasure. Pain balance tilted to the side of pain. Now, with enough neuroplasticity and enough sustained abstinence from our drug of choice, and I'll get into how long that needs to be in just a little bit, those gremlins eventually get the memo. They hop off and homeostasis is restored. Just to represent this graphically, at the simplest level, what we're really talking about is dopamine firing. That initial exposure to anything that's reinforcing or rewarding increases dopamine firing above baseline, followed then by neuroadaptation, which is dopamine freefall, not just to baseline, but below baseline into a dopamine deficit state, where we're in a state of craving, which if we then just wait long enough, we go back to the level balance homeostasis, or a neutral baseline level of dopamine firing. So in other words, initial exposure to reinforcing substances and behaviors brings our dopamine levels up and we feel good. But with repeated exposures over time to the same or similar reinforcing substance and behaviors, and maybe in one person it takes two weeks for this to happen. For another person, it could take 10 years. But eventually our brains will adapt such that that initial upward deflection of dopamine gets weaker and shorter in duration, but that after response, that dopamine deficit state gets stronger and longer, and we eventually settle out at a new set point. And again, now we're in addicted brain. This is a neuroimaging study done by Nora Volkoff and her colleagues. This is now human brains, not rat brains. What you see here is the nucleus accumbens, and which is the area that's sort of lighting up in the middle, and red represents dopamine transmission, healthy, robust dopamine transmission. And what you'll see on the left hand side is that in the nucleus accumbens of these healthy control subjects, there's plenty of red, so plenty of dopamine transmission. On the right hand side, you have images of people who have been using cocaine, methamphetamine, alcohol and heroin in an addictive way for a longish period of time. And you can see that there's very little red in their nucleus accumbens. In other words, they have subthreshold or below normal levels of dopamine transmission. And what I find incredibly powerful about this is that on the right hand side, the images of those individuals who were using these addictive substances were taken two weeks after they stopped using. What that tells us is this dopamine deficit state. Those gremlins don't hop off the balance right away. It takes. Takes a while for them to get the memo and hop off. And it is also possible that in some individuals, perhaps they've lost the plasticity to ever reset their reward pathway and that they're in a chronic dopamine deficit state for life. And that's why, for example, for some patients with severe opioid addiction, we will actually use opioids to treat their opioid addiction. Things like methadone maintenance or buprenorphine, not to, not to help them get high, but just to level the balance, restore homeostasis, and give them a fighting chance of engaging in recovery. The second rule of the balance is that the balance remembers. So once those gremlins are created, even if they hop off the pain side of the balance, they never entirely go away. They're hiding in the wings, eager to hop on again. Which is why we can see people relapse even after a single exposure to their drug of choice, even after decades of absence of. Perhaps you've all seen that in someone that you know. We certainly see it in clinical care all the time. So since those gremlins are already created and waiting in the wings, what we know from that is that we have a kind of permanent or latent echo, a permanent change to the brain, even once people get into recovery. One of my favorite rat experiments is where they took rats. They gave them an injection of cocaine daily for seven days. And what they found was that with each successive injection of cocaine, the same amount on every day, the rats went from hiding out in the shadows of the cage to being in a running frenzy all around the middle of the cage on day seven. Then they stopped giving those rats injections and they waited a year, and a year is about a rat lifetime. And then they re injected those rats with cocaine, and they were immediately in a running frenzy, exactly as they had been on day six. Which tells us that even after a sustained period of not being exposed to our drug of choice, there's a kind of latent echo. Now, this should not be a cause for feeling hopeless or despairing, because we see people get into recovery all the time. And my colleague Edie Sullivan at Stanford has shown that what happens in the brain of someone who's getting into recovery is probably not so much that they repair those damaged neural networks, but that they form new neural networks that go around those damaged areas. All right, so let's focus on this graphic here. This is from a series of experiments looking at dopamine levels in the brains of rats and mice when you give them an injection of cocaine that they have to work for, so they have to press a lever for it. But these are rats and mice who have basically been taught or trained to know that they'll only get cocaine if they first see a light and then press the lever. If they go up and just press the lever on any old occasion, they're not going to get cocaine. So in other words, this is what we call a cue induced learning. This is classic Pavlovian learning. They know when they see the light, they can go get cocaine if they press the lever. But look at what happens to dopamine levels during this process. Now, if you go all the way to the right side of this graphic, you'll see that when the rat receives cocaine, dopamine levels go up. That's what's happened, at least within those initial bouts of exposure. But look at what happens when the rat sees the light. Just seeing the light and knowing that cocaine is on its way increases dopamine firing a little bit above baseline. So we get a little bit high, just anticipating our drug of choice. But look what happens right after that upward deflection. Dopamine levels don't go just back down to baseline. They go a little bit below baseline. So there's a mini dopamine deficit state, which sets up the craving that makes us then want to do the work to go get our drug of choice. Because, remember, we want to restore homeostasis. And this is why it's so important when people are trying to change a habit of compulsive overconsumption, or people are trying to get into recovery from severe addiction, that they insulate themselves not just from their drug of choice, but also from the triggers or reminders that will set them up for this craving cycle, that will make them want to go get that drug of choice. So what happens when we have learned to anticipate a certain reward and we don't get that reward? Right? So here you see the graphic. The rat has been trained to think that when it sees a light, it presses the lever, it gets cocaine, it sees the light, it presses the lever. No. Cocaine dopamine levels go way below baseline. This, to me, is really, really interesting because there are a lot of inferences you can make from this. First of all, what it says is that as people get into their addiction, their drug of choice essentially stops working and can even turn on them and do the opposite of what they hope for. We see this all the time. For example, with cannabis, right? I use cannabis to help my pain. I use cannabis to go to sleep. I use cannabis to go relax. Now my cannabis makes me anxious, makes me paranoid. Drug turns on them through the process of neuroadaptation. If we are addicted to a our drug of choice, we do not learn from that experience. Instead, what we do is we try harder to get more, to bring those dopamine levels back up to baseline or even get them above baseline. I also think more broadly speaking, you know, in the process of learning, right, generally what we're doing is we're kind of making mental maps of the world, and then we're testing them on the world. And when those mental maps work out and we, we've got it right, we get a little hit of dopamine. And when those mental maps don't work out, meaning we got it wrong, we probably go into a dopamine deficit state. And then we can either fight that awareness or we can change our mental maps. This is just to speak broadly about the importance of childhood and adolescence as a very influential time in terms of the development of the brain. What you see here is a series of brains from about age 4 to about age 20. And Red here represents the number of neurons that we have in our brain as well as the number of neuronal synapses. So synapses, again, are where those neurons connect. And when we are five years old, we have 50% more neurons and neuronal synapses than we will have for the rest of our lives. We are totipotent cells. We're sponges, right? We can learn anything between about age 5 and age 25, we cut back on or prune, as neuroscientists call it. Other neurons we're not using and we myelinate and make more efficient with blue here, the neurons that we use most often. So you can see in this graphic, we have a lot of red for neurons at age 5 and a lot of blue for myelin at age 20. And essentially at age 20 or 25, we have the neuronal scaffolding that we'll be left with for the rest of our lives. So a very important time to make sure that we are creating really good and healthy coping strategies for ourselves, for our kids, et cetera. All right, I want to widen the lens now and sort of extrapolate from the neuroscience, really exciting advances in neuroscience of pleasure and pain and addiction to talk about what I call the plenty paradox. And the plenty paradox is essentially the mismatch between our primitive wiring for processing pleasure and pain and the world that we find ourselves in today. So you might reasonably ask, why on earth would Mother Nature create a pleasure pain processing system consisting of this balance? It seems especially cruel because it means anything that we find pleasurable will eventually become less pleasurable over time and might even be a source of pain for us. Why do that? Well, in a world of scarcity and ever present danger, this is actually a great mechanism because it means we are the ultimate seekers, never satisfied with what we have, always looking for more. It's exactly what's going to keep us alive. But in today's world, a world in which most of our basic survival needs are met, a world of overwhelming overabundance, this actually becomes a liability. And I would go even so far as to say that almost every aspect of our lives has become drugified in some way, made more potent and reinforcing, that is to say, releases more dopamine very quickly in the reward pathway. Been made more accessible. Our phones are basically 24. 7 hypodermic syringes delivering digital dopamine made more novel. Novelty is one way to overcome addiction, right? Overcome tolerance. We combine two drugs together to make a third new drug, and we overcome tolerance. And then just sheer quantity. Quantity matters when it comes to highly reinforcing substances and behaviors. The more we use and the more often we use, the more we change our brain. TikTok never runs out. This is an example of the types of things that people can get addicted to. I'll just let you sort of. Oh, can you see it there? Oh, here it is. The print is a little small. I'll read kind of the general categories. So we have our traditional drugs, alcohol, nicotine, cannabis, et cetera. We have medications. These are the things that doctors prescribe to us mostly with good intentions. We've got media, Internet, technology. I'm personally very vulnerable there. We can get addicted to other people, right? We can get addicted to our own bodies. One of the most common types of addictions we're seeing now is addiction to sex, pornography, compulsive masturbation, love, sex and pornography. This is certainly my own category of vulnerability as well, which I talk about in my book. In my early 40s, I got addicted to romance novels, which I actually think is socially sanctioned pornography for women, which is all good in moderation. But what happened to me as I went from reading the Twilight Saga, which, for those of you who don't know, is teenage vampire romance novels, to reading about butt plugs at three o' clock in the morning while reading about 50 Shades of Gray? Reading all the time, got a Kindle. People didn't know what I was reading. I could read anonymously on the bus at work, spending less time with my kids, with my husband, even taking romance novels to work and reading in the 10 minutes between patients. But probably the biggest and most impactful part of it that I really didn't see till later was that I got progressively more depressed and unhappy with my circumstance, even though I had a lot to be grateful for. And I had this kind of narrowing of focus where the only thing that I really wanted to be doing was reading romance novels or to be in this escape world. And the ways in which continued engagement in our highly reinforcing substances and behaviors ends up with those gremlins on the pain side of the balance means that we can no longer take pleasure in modest rewards or things that used to give us pleasure. Because we've narrowed our focus on this one thing and it's the only thing that has salience for us. I would also just emphasize that our food supply in general has become highly drugified, as was mentioned earlier, with the addition of salt, fat and sugar. Sugar is incredibly addictive. We have lots of good data that it lights up the nucleus accumbens. It's very hard to stop. If you've ever tried to give up sugar, it's very, very difficult. And then, of course, for this audience, work, achievement, money. I thought Tommy said it really well. Go get money, but just don't love money. Again, how do we define addiction? Very broadly, it's the continued compulsive use of a substance or behavior despite harm to self and or others. This is not to trivialize addiction, severe addiction, or even to say that anything can be addictive. But really it's when A passion or a hobby crosses over into being harmful to self or harmful to others, and recognizing that, we may be the last person to recognize it. So this is really important. When we're chasing dopamine, we often lose a sense of causality. Mark did a really nice job this morning talking about the importance of because statements. Why are because statements so powerful? Because we all want to understand causality, right? We're trying to figure out what leads to what. But just be aware that when we're in our addiction cycle, we don't see causality necessarily. And so we might have to either take some action or go on blind faith when someone else is telling us that this substance or behavior is causing harm to our lives or to the people who love us. So one of the hypotheses that I would just like to put out there is that our mental health crisis has many different causes, of course. But I would hypothesize that one of the causes may in fact be that we are both at an individual and a sort of national collective level, in a dopamine deficit state, which may be contributing to the rising rates of depression and anxiety. And this is really important because if that's true, then that means the intervention is quite different from the typical things that you will find recommended or prescribed from a psychologist or a psychiatrist or mental health care provider. One of the interesting paradoxes is that, in general, if you look at happiness surveys and wealth, the wealthier people become, the happier they become. And if you look at this from an epidemiologic perspective, as nations get wealthier, especially as they're moving out of poverty, when you do happiness surveys nationally, those populations will endorse getting happier. Something changed about 20 years ago, and the wealthiest nations in the world started reporting that they were less happy than they had been before. Not only that, the richest nations are now showing the highest rates of reported depression, anxiety, and also suicide. And I'll get to that in a second. You could say, well, maybe the culture's changing. It stimulated reporting. Now everybody talks about their disorder. I would absolutely agree with you that that's part of the phenomenon. But I don't think that's the whole phenomenon. I actually think people are less happy. And I think the reason that they're less happy is because overabundance itself is a physiological and psychological stressor. We were wired to strive. In the absence of anything to strive for, we are not thriving. And if you had to question on any space around stimulated reporting, I think suicides will tell you that that's no longer just a reporting phenomenon, people are ending their lives more often in the wealthiest nations of the world. You can see here that second bar graph is both men, women, and both. And you'll see that people in high income countries now kill themselves at rates far higher than in the lowest income countries. And this is unprecedented, at least in the time that we've been documenting these data. Finally, in terms of the epidemiology, it is probably the poorest people living in the richest countries who are the most unhappy and vulnerable to the problems of addiction and other forms of mental health. Why? Because they are surrounded by all of these cheap pleasures, have easy access to them, without the same kind of access to the kinds of healthy and rewarding sources of dopamine that we really need to thrive. Deaths of despair, you may have heard of it before. How many folks have heard of the term deaths of despair? Okay, so not very many. This is the work of Anne Case and Angus Deaton. These are two Princeton economists that have shown that for the first time in many generations, people, white Americans who are not graduating from high school are dying younger than their parents and grandparents. Okay, so for 200, 300 years, we've all had increased longevity. Right? The average person in 1800, 17, 50 used to live to about age 30. Now, on average, especially in wealthy nations, we're living older and older, more centenarians than ever before. But in this generation, for the first time, we saw people who were dying younger. Top three causes of death in this cohort were alcohol related liver disease, drug overdose, and suicide. And they've called these deaths of despair. And all of this is probably on some level tied to the Internet. In 2021, adults in the US spent on average 8 hours and 5 minutes with digital media each day. This is not digital media for work, okay? This is digital media for entertainment. I don't think in the early 2000s, when the smartphone first came out, anybody would have predicted that we would be spending this much time on digital media. Digital media, digital devices, they're a powerful tool and they're also a very potent drug. They light up the same nucleus accumbens, the same reward pathway. We're seeing more and more people getting addicted to social media, video games, YouTube, and just sort of indiscriminate Internet addictions. All right, and sort of ending this brief talk today, I want to tell you what are some of the somewhat novel, but really quite simple things that we're doing about this in our clinical work, which are just a lot different than what we were doing 20 years ago. So 20 years ago, if a patient came in to see me with anxiety, depression, inattention, insomnia, the first, the first thing I would have done was prescribe an antidepressant and, or recommend them for some form of psychotherapy. Today, the first thing that I do is actually screen them for their consumption of highly reinforcing drugs and behaviors. And if I'm finding a pattern of repeated use of caffeine, alcohol, cannabis, pornography, video games, social media, shopping, romance novels, one of the first things that I might do is to recommend a dopamine fat. And the reason I do that is because when patients are willing and able to engage in a dopamine fast, which is essentially giving up their drug of choice for four weeks. And I'll tell you a little bit more about the four weeks. What we find is that they will often return feeling less depressed, less anxious, better able to sleep without our having to do any other intervention. And even if they don't feel better, we still have a lot of information from that. Because if they don't feel better even after they've given up their drug of choice, then we know that there's something else going on. So what we tell patients is we'd like you to abstain from your drug of choice long enough for those neuroadaptation gremlins to hop off the pain side of the balance so that homeostasis can be restored, so that you can have a supple pleasure pain balance that can respond to cues in your environment of both pleasure, pleasure and pain. And you can restore your joy in everyday rewards like things as simple as a sunset. We asked for four weeks because we know from Nora Volkoff's work and from clinical practice that two weeks is not enough. Remember that image of the brain? We're still in a dopamine deficit state at two weeks. That tracks exactly to what we see in clinical care. Those first 10 to 14 days are hell, no matter what your drug of choice choice is. Now, it's true that some drugs of choice, that withdrawal period can be life threatening. Those would be opioids, benzos and alcohol. In which case, if you are physically dependent and at risk of a life threatening withdrawal, you need to go into the hospital for medically monitored detox. But the vast majority of people addicted to those drugs and other drugs can actually stop cold turkey if they are able to. Not everybody is able to. That's why we have rehabs. I'm very grateful for rehabs. They get a bad rapid. I'm really glad they exist. Some People need to go into a rehab in order to be at enough distance from their drug of choice to be successful. But essentially what we find is that those first 10 to 14 days are really, really bad. Your gremlins are not off the pain side of the balance. And we warn people that that will be the case. And this is the most important thing that we say to people because if we don't say it, people feel like the pain that they experience in early withdrawal and is the pain that they're going to be left with the rest of their lives. And since that is so intolerable, they go back to using their drug of choice. People with a severe addiction, when they come in, they see only two possibilities. I use drugs and I'm miserable. I don't use drugs and I'm miserable. What we have to teach them is there is a third way in which you don't use drugs or you use an extreme moderation and you're not miserable. The way to get there is, is to abstain for long enough to reset reward pathways, return to homeostasis, and then decide what your next steps are. So we recommend four weeks and we warn people they're going to feel worse before they feel better. We recommend self binding strategies. So what is self binding strategies? That's an acknowledgement that willpower is a limited resource and that if we're relying alone on willpower, we will not be successful. Therefore, we have to create literal and metacognitive barriers, but between ourselves and our drug of choice so that we can leverage our willpower and meet our goal of abstention for four weeks. General categories. These are just some general categories. You can make up any categories, but space is a category. So this is both literal barriers between ourselves and our drug of choice. Get the sugar out of the house, get the alcohol out of the house, throw your bong away, run water over your cigarettes and put them in a garbage can far away so you can't go fishing them out again. Delete the app. Unsubscribe yourself from that sports betting website. These are the literal kinds of. You just create that little pause, right? That little pause that allows us to kind of take a breath and say, okay, I don't want to do this. And if there's a little bit of a break, maybe I'll be more successful. Time is a really interesting kind of self binding strategy. So the dopamine and fast itself is really a form of using time as a self binding strategy. But also later, after the dopamine fast, we talk about, well, what do you want to do now? Do you want to continue to abstain or do you want to go back to using in moderation? The vast majority of our patients want to go back to using in moderation. Even if I think they're not a good candidate for that, they often have to learn that for themselves. This is like a PhD, their own little PhD in neuroscience. So what we say is, okay, that's your goal. What is moderation going to look like? And here we really drill down on details. When are you going to use how, how much, how often? Who are you going to use with? What are going to be your red flags for when you're using more than you said you were going to use or in a way you didn't want to. So part of that could be scheduling specific times for scrolling meaning. So this is really, I think very helpful looking at sort of what's the larger meaning behind my wanting to abstain. When people report feeling better, which most of them do after the dopamine fast, we have them do a pros and cons list. What was better about not using and what was bad about not using. When people talk about what was better, they'll talk about things like, I was more present in my life, less anxious, less depressed, better able to sleep, able to pay attention. The top of the list of what was bad about not using. Couldn't hang out with my friends because all my friends use whatever that drug may be, right? Number two was bored. Really bored, had a whole bunch of time that I didn't know what to do with. Boredom is a really powerful and scary emotion and we really in the modern world don't have to deal with it very much and we don't really know what to do with it because boredom brings up all kinds of existential issues like wow, if I don't know what I'm doing with myself right now, what am I supposed to be doing? I'm betting that many people in this room don't deal with a lot of boredom because you guys are way too busy. But I bet also that boredom would be pretty scary to deal with. And people is a great way to engage in self binding. So you know, having doing the dopamine fast with somebody else, doing it together as a family, engaging in a 12 step community or other mutual help community. When we co regulate our behaviors with other people, we are much more likely to be successful. Whereas if we live alone and we have to manage these consumptive behaviors alone super hard, and then finally there are a lot of interesting medications Not a lot. But I would say there are more coming down the pike. So, for example, we have a medication called naltrexone, which is an opioid receptor blocker that we use to help people quit using opioids. The mechanism there is obvious. If you're blocking the opioid receptor, the opioid that you're ingesting cannot bind and stimulate that receptor. But we also use naltrexone to treat alcohol use disorder, and not just for people who want to stop drinking, also for people who want to reduce their use, because it turns out that the chemical cascade for alcohol, it works on the gaba, or inhibitory neurotransmitter system, but it also works on our endogenous opioid system. So when we're blocking the opioid receptor with naltrexone, basically what my patients tell me is when I'm on naltrexone and I drink a beer, I really don't want another one. I'm kind of good with one, whereas normally I would want to drink the whole six pack. Also, interestingly, remember that reminder mechanism, how when we're reminded of our drug of choice, we get a little boost in dopamine. Naltrexone actually helps decrease craving because probably when people are reminded or triggered, they don't get that same dopamine boost because the chemical cascade is blocked by the naltrexone. So they don't get triggered in the same way, too. We have other medicines, Wegovy or Ozempic is being used now to treat binge eating and obesity. And we're also finding that it's helpful for alcohol use disorder. Alcohol, because it's caloric, works on the same appetitive mechanisms as food. This is a really old but very powerful study. This was a cohort of adult males who, who met criteria for major depressive episode and also alcohol use disorder or alcohol addiction. They were put into a psych unit where they received no treatment for their depression, but they also did not have any access to alcohol for four weeks. At the end of those four weeks, 80% of those individuals no longer met criteria for major depression. So what's very powerful there is, again, just by intervening around the consumptive addictive behaviors, symptoms of depression and anxiety get better. Finally, this pleasure pain balance works both ways. Those gremlins are agnostic to whatever the initial stimulus is. If we press on the pleasure side of the balance, they hop on the pain side of the balance. If we press on the pain side of the balance, they will actually hop over onto the pleasure side of the balance and we will get dopamine indirectly by paying for it up front. The classic and evidence based examples of this are exercise, ice cold water baths, fasting, meditation, and prayer. I put on here. You wouldn't necessarily think of meditation and prayer as doing what's painful, but for most people it's effortful. And anything that requires a kind of sustained and effortful engagement tends to be difficult. And when we do that, and we know that all of these things increase dopamine, but the way that they do it is different from the way that intoxicants do it. Remember intoxicants, you get that burst of dopamine followed by dopamine free fall. Here you get something very different. You get the initiation of the activity with a slow increase in dopamine over the latter half of that activity. Then that dotted line represents when the activity stops. You see here, dopamine levels remain elevated for hours afterwards before going back down to the baseline position. You never go into that dopamine deficit state that drives the craving. So this is a wonderful way to get your dopamine. However, it's not without its own pitfall. So anything that gives us dopamine has the potential to be addictive. Most personality types will not be drawn to the kinds of addiction to pain. But I'm guessing that a disproportionate number of people in this room probably have the personality type that could get addicted to pain. And you see that, you know, with workaholism or exercise addiction and the intervention really is the same, where we ask for people to take a break from that activity or the exercise or whatever it might be for a period of time to reset reward pathways and then a plan for re engagement. I also forgot to say that when we, we think about addictions that it's not possible to completely eliminate, like a food addiction, you can't just stop eating for four weeks, or a workaholism addiction, you know, you can't just stop running your business for four weeks. What we ask people to do is think of a bullseye and to really drill down what is the specific activity that's problematic, what is the specific food that's problematic and put that in the center of their bull's eye and have that represent their drug of choice, the thing that they're going to abstain from. So for work, it might be a certain way of engaging with digital media after hours or I don't know, you guys could probably tell me better. For food, it's something like sugar, right? Giving up sugar. Then that second ring of the bullseye represents the trigger behaviors. So these are things that are not the drug itself, but the thing that trigger us to use our drugs. So it might be something like going by a bakery where there's a lot of smoking. And then that outer circle is the things that are healthy sources of dopamine, Things we want to do more of, kind of approach behaviors. These are exam. Sorry. Hormesis is a branch of science that is interested in looking at the ways that exposing ourselves to mild to moderate doses of toxic stimuli actually makes us more resilient. Hormesis is Greek for to set in motion. And basically what's happening is when we expose our bodies to mild to moderate doses of noxious stimuli, our body senses injury and then essentially upregulates feel good neurotransmitters like serotonin, norepinephrine. These are examples of activities that my patients have told me are hermetic for them. You'll see many of them are quite ordinary activities, but they're doing them unplugged. We are living in a time when we're constantly stimulated. Simply sitting quietly and not being stimulated for a period of time gives our brains time to rest and recover. I've talked a little bit about dealing with boredom and other painful emotions and also slightly mentioned getting addicted to pain. Believe it or not, we used to think that rats on a running wheel just simply measured locomotion or physical activity. But then it became apparent that certain strains of rats actually get addicted to running wheels. And they will run on ever smaller running wheels until their little rats or their little tails are curved up in the shape of a running wheel. Some of those rats will in fact run to death. And then I love this experiment that was done in the Netherlands. They took running wheels and they put them in nature and they said, surely in, you know, God's great wonderful nature, nothing's going to go into a running wheel. Not true. Rats, slugs, squirrels, all kinds of animals were intrigued by moving through three dimensional space against gravity in a novel way which maybe explains roller coasters and Ferris wheels and things like that. Finally, this is my last slide. I've really emphasized sort of what we can do at an individual level to cope with our drugified addictogenic ecosystem. But it's obviously not just an individual problem. This is also a problem that needs to be solved at both, both the community level, the level of governance. This is a meme somebody sent me. Are you 18? Because otherwise you can't go into this porn site and as you can see, it's pretty easy to access. And we're now seeing legislation that's happening in certain states that makes it, for example, harder for people under the age of 21 or under the age of 18 to access certain states sites. I think this is really important. We need to have these guard rails. When I think about community, I really think about schools. You know, we were really led to believe that one child, one laptop would solve all of our education problems. Now what we have is one child, one inattentive child who's not learning. So I think that smartphones should essentially be banned from the top down during school hours. There are schools that are doing this now, and there are different ways to accomplish it. For example, there are these pouches that you kids put their phone in the pouch, they lock the pouch, it can't transmit or receive, and then they unlock it at the end of the day. That way the school doesn't have to deal with holding onto the phones. Whatever it takes. Let's get the smartphones out of the schools so teachers can teach and kids can learn. Yeah, especially like K through 12. I mean, it's just so obvious that we need to do that. And then in terms of governance, I mean, so we're seeing, you know, the Facebook meta lawsuit. We'll see if that goes anywhere. There's legislation all over the country. In China, the government actually said that kids can't play video games except for two days a week, two hours a day, and that the corporations that make the video games are responsible for creating the facial recognition software to police it. And I know that that could never happen in the United States, but boy, parents in China were jumping for joy when they came up with that. And I really do think that we need some kind of government legislation and guardrails to protect our kids.

So what I want to do is just share with you just eight tips, maybe principles, if you will just really remind you of what you're doing when you do it well. So I want just everyone, just quick acronym. Just be faster. All right, so be faster. And these will be the Just really quick. How many is that? Eight. Eight quick tips. And then we'll do a, sit down. So the b. To learn how many of you came here today, like to upgrade your mind. How many of you came here today, like to have a better memory. How many. How many of you forgot why you came here today? Have you ever done. Have you ever done that? Walk into a room of your own home and just forgot why you're there. Feel absent minded. Senior moments come a little bit early. So the B here stands for believe. If you believe, you can believe, you can. Either way what? You're right. Who said that? Henry Ford said that. I believe all behavior is belief driven. You could learn a technique for how to remember names and maybe we could talk about that in the conversation today. But if you believe, people come to me all the time. They're like today, just right before he started said Jim, I'm just getting too old, you know, I'm not smart enough. I have a horrible memory and I always say stop. If you fight for your limitations, you get to keep them. Right? Your brain is this incredible supercomputer and your self talk is the program it will run. So if you tell yourself I'm not good at remembering names, you are not likely to remember the name and the next person you meet because you program your supercomputer not to. Does that make sense? Right. And again, you know this. And so this is just a reinforcement. Let me show you what a belief is real quick. Stand up and just make some distance between the person next to you. So if you went like this, you could kind of not, you know, take touch anybody. Some of you done this exercise before, Shake out your body. All right, notice where your feet are and keep them stationary. I want you to just point forward with your right hand. You're other right hand, sir. All right hand. And what I want you to do without moving your feet, turn to your right, clockwise as far as you could go. And notice the exact point you're pointing at. Okay, Come back center. Put your arms by your side. Empty your hands not in your pocket and take a deep breath. Exhale and just breathe normally. Breathe normally. And if you're comfortable, close your eyes. It'll help you to focus. And I want you, I'm going to take you through a quick 30 second visualization exercise in your mind's eye. I want you to imagine with your arms by your side, see and feel yourself pointing forward again. But this time imagine you're going twice as far as you did the first time. See and feel. Imagine you're going further. If you can't imagine it, imagine you can imagine it. And then with your eyes closed, see and feel yourself going three times around like you're Gumby. You're getting a great stretch. This is a pleasurable thing. You're made out of rubber. See and feel yourself going three times around. What does that feel like? And then one more time with a smile on your face, thinking what does this have to do with reading faster? See and feel yourself going four times around. 1, 2, 3, 4. All right, open your eyes. Watch this. Open your eyes. Point forward with your right hand. Turn to your right as far as you can. Now go. All right, Clap if you went further a second time. Have a seat. Have a seat. Now raise your hand just so we see this. How many people went further a second time? Raise your hand. My quick question for you is were you physically capable of turning that far the first time? Yes or no? Yeah. Nobody took a yoga class and my eyes were closed. Right, but you're physically capable. Where is the limitation if we're talking about becoming limitless? Where was the limitation if there was one in your mind? And some people say I didn't have a belief on how far I could turn. But how many ideas of certainty do we have in our mind? And so we're going to talk a little bit about mindset and growth mindset. Be able to change limiting beliefs. And I know there are people in this room that are experts at this. But we start with the belief your mind is always eavesdropping on your self talk. The E very quickly is exercise. Exercise and execute. There is a lie. I talk about seven lies to learning and limitless. And a lie for me is a limited stands for everything's an acronym for me. It's a limited idea. Entertained. It's not true that you're too old. It's not true that you're not smart enough. It's not true you have a horrible memory. One of the lies I talk about is that knowledge is when we hear a lot. Knowledge is what is power and is that true knowledge alone. So it has a potential to be power. It becomes power when we what? When we apply it, when we implement it, when we execute, when we exercise. So the bad news, it takes a little. It takes effort to learn how to remember names. But the truth is the good news, it doesn't take as much as you think. But you have to take knowledge turn into power. I asked myself three questions to do this. Throughout the weekend, I'll be thinking about this. How can I use this? I'm obsessed with this question. I must ask this question 100 times a day. How can I use this? Second question? Why must I use this? Because a lot of information stays in your head. But if you're not acting with your hands, you have to check in with the second H, which is your heart, the purpose. Because reasons reap results. If you can't come up with a reason to remember someone's name, you're not going to remember that person's name. It goes from your head to your heart to your hands and ask yourself, why? How can I use this? Why must I use this? Third question, when will I use this? I think one of the most powerful productivity performance tools we have is in our phones, our calendars, but a lot of times we'll schedule investor meetings, doctor appointments, PTA meetings, but not our own execution. I think for every hour you spend learning something, you're on clubhouse. You have to spend an equal hour implementing. Is that fair? The f. And we'll go through these fast. Forget. As Joe mentioned, there's a lot of power in unlearning things and a lot of us get stuck. Right. It's the curse of expertise, they call it. The curse of expertise is somebody who's become an expert. They become more closed minded because they feel like they know all of this. Right. And your mind is like a parachute. It only works when it's what? When it, when it's open. And so I would temporarily forget what you know about a subject so you could learn something new, so you could be able to adapt so you're not tied to the old ways. A lot of people, you hear this all the time, right. It's in our industry also as well where people say they have 30 years of experience, you know, in direct response. But sometimes when you go discover they have one year experience that they've repeated that many times also. Right. And so first learn something new. Forget about what you know because the half life information gets shorter and shorter and shorter. Right. And so have that open mind. The other thing I would say, forget. Forget about distractions. And that's easy to say, but you know, how many of you multitask a lot? You've seen the research suggesting that most people can't multitask. Do two cognitive activities at once. The task switching, which wastes a lot of time, could take 5, 10 minutes to regain your focus on an activity. So when you're here, be here. It could also make more errors when we're trying to multitask. And the third thing, it uses up a lot of energy. Anyone suffer from brain fog or mental fatigue? Going switching. There's a cost. Energetically you use more brain glucose from going task to task and you're context switching. So you're lighting a certain pattern of your nervous systems lit up and then you're going from this and then coming back. So stick on that. Forget about what you know, forget about multitasking and not so forget the A really quick. The A stands for active. I always think that learning, like life, is not a spectator sport, right? The old 20th century model for education was sit there, be quiet, be lectured to. And the human brain does not learn through consumption as well as it does through creation. Future belongs to the creators, right? And that's what's truly limitless. There's no limit to your creativity or imagination or ability to solve problems. But it requires us to be active in our learning. How can you be more active in your learning? This is very meta right now. How can you be more active in your learning? You could ask questions, you could be taking notes. We did an episode on different ways you could take notes also as well in our podcast. The S stands for state. I want to remind you the next few days that all learning is state dependent. And I'm defining state functionally as a snapshot of your mood, of the mood of your mind and your body. How do you feel? Because the key to a long term memory is information by itself. Do this information, say this information. Put your hands out. Information combined with emotions become long term memories. And you know this. How many of you have a song that you could listen to and it could just take you back to when you're a teenager. How many of you, it's a food or a fragrance, could take you back to when you're a child? The challenge is how do we up the emotion? Is that part of your middle brain when you're talking about emotion? And your amygdala also, it's connected to your hippocampus, right? Your memory. So when you could tie emotions, the state you learn something in is a state that you're going to be able to encode it. So your memory has three parts. You encode information, you store it and then you retrieve it. Right? But if you can encode it with, with, with. With emotions. Because we are not logical. People don't buy logically. They buy what? Yeah, they buy emotionally and they justify logically because we're not logical, we are biological. You think about dopamine, oxytocin, serotonin, endorphins, and so control your state. Like right now, who controls how you feel? You do, Right? Like sit the way you'd be sitting. If you're really paying interested in what I was saying and really paying attention. Sit the way you be sitting right now. Why do you even have to move? But you know that your physiology is going to affect your psychology, right? Okay. So that's your state and you control that. And Then finally, the last few letters, T stands for teach. Your intention matters. If you want to learn the information better over the next two and a half days at a meta level, I'd be thinking, how do I teach this to somebody else? How do I teach this to my team? If I have to give a TEDx talk or a 10 minute talk on Monday to my team, how would I go about learning this? They call it the explanation effect. The explanation effect. If you have to explain it to somebody else, you're going to learn it better, you're going to focus better, you're going to ask questions, you're going to integrate it. Then finally the E and the R. The E, I'm going to call it entry. Entry is really just to and enter it into your schedule like we talked about. Because I feel like if you don't put it into your schedule, it doesn't get done. Same as with your workouts, your ice baths, your meditation, you know the day could escape you and then you don't get to it, you're floating. And so make sure you enter it your studies. And finally the R. This is the retrieval, all right, this is retrieval, review. So I'll put two things, the way to learn anything faster. Remember I said learning is not a spectator sport. You don't consume information, you don't push information inside the human brain. You learn it better by pulling it out. Review is spaced repetition interval training. When you separate, you take data and you study it and you review it over a period of time spaced like an hour later, a day later, a week later. Then you consolidate short to long term memory. So it's wonderful to take lots of notes. How many of you gone to an event? You take lots of notes and then you never see that, you never review those notes again, right? So you could enter going back to the E, your review. The other great way besides the review for R is retrieval, active retrieval. And this is a technique where you are quizzing yourself. It's shown in studies to be so much more powerful than reading something twice. You could read something and then quiz yourself. It takes a lot less time than reading something twice because usually when you're reading something twice, you're not really learning it. More people are recognizing it and there's a difference because that doesn't mean it's here you're recognizing. I've seen this before. But until you quiz yourself, after you take notes, you go through it and then you test yourself, then you're going to get a lot more out of it. I'm going to end with this. And then we're going to have a chat, I think, right? Everyone stand up. You're like, oh, you're one of those guys. But learning really is, you know, I haven't shared. This is just something that I came to realization recently. I couldn't. I had a brain injury, as you heard, when I was. When I was a child. And it took me three years longer to learn how to read. And you know, it's a big challenge for me as part of my self identity. I felt like I wasn't enough. I felt like I was broken. I never had the answer in school. So when they passed around that book, you remember when they passed around that book in circles and you had to read out loud? I would dread that even thinking about it. I have to work with Dr. Don in this room because I get this stress and anxiety because I couldn't. The words didn't mean anything to me. My parents met for the PTA in elementary school, in public school, and they assigned me reading tutor. Right. And that, that helped me. And I'll talk a little bit about the, the origin of how I got started and learned how to read because it's kind of very serendipitous. But what I want to do here is I realized that reading. There's an audio, visual and motor skill component to reading and actually learned that from. From Doe's mom. She. She wrote this. I'm going to show this. It's not scripted. I wrote, this is a workbook from 1972 and I use this. I didn't realize this, but 30 years ago when I started my teaching, fundamentally I was a reading teacher and my passion was helping kids because I couldn't read. And on a recent Zoom preparing for this because I was organizing my library and I saw that this reading lesson plan was by Virginia Polish and it's in 1972. And I get goosebumps thinking about this because I was like. I asked Joe on Zoom, is there any relation? And he said, yeah, that's my mom. And so much so that 30 years ago, when I started my practice, I used all these books as my tools to begin my career. And so when we're talking about connections and capabilities and caring, you know, this is just, yeah, I want to thank your mom because that made the biggest difference for me. Love to take that work and do something on scale. So what I want to do real, real quick is I want to. I want to end with this and then have this conversation. Visual, auditory, kinesthetic. I asked Joe, you know, what would make, you know, why. Why do this event you're returning? You know, what. What's the experience that you want to create? He's like, jim, this is what I've always. Besides capabilities. It's. It's, you know, it's his mission. He. He wants. He wants people to connect with each other, care for each other, you know, and contribute to each other, you know, and that will make a better world. And so I'm going to do a quick exercise that could really exemplify that. I want you to find a partner again that you do not yet know and introd. Go, go, go. Find someone you do not yet know. Quick, quick, quick, quick. You need a partner. You need a partner. Go, go, go. Repeat after me. Sh, sh. You can keep my mic on repeat after me. All right, so what we're going to do is we're going to do something where we can connect with each other. We could care for each other and contribute and cheer each other on. I believe that the world, now more than ever, all of us need somebody to encourage us. We need a person to encourage us, to cheerlead for us, to. To challenge us, to be kind to us, right? If you haven't found that person yet, you know, my recommendation is to be that person, right? You be that person for somebody else, especially be that person for who? You know, for yourself, right? And so quick exercise to really. To just get the room, the energy up to the next level. We're going to play a game that you all played before. It's called rock, paper, scissors. Does everybody remember how to do this? But we're gonna do it a little bit different. So let's do it. Rock, paper, scissors. Do this with me. You put one hand out a flat, and then you go what? You make a fist and you go, rock, paper, scissors, shoot. Does everyone remember this? Do it again. Rock, paper, scissors, shoot. And then you're gonna do rock, paper, scissors. So rock, right? What beats rock, paper, paper? Right? What beats paper, scissors? And what beats scissors? Rock. All right, so what we're going to do is maybe one of the largest rock, paper, scissors games ever. But here's where we're going to get the supporting each other. You're going to do it once. Whoever wins is going to raise their hand. They're going to search for somebody who also is raising their hand, and they're going to battle that person. The person who loses, the person who loses their job then is all of a sudden they become part of the winning team. So everyone's gonna win here Right. And they are gonna cheer that person on that they just lost to. To the highest level. Okay. It's like the super bowl you won. So what's the sound you make? What's the sound you make when you're cheering or celebrating? What's the sound you make when you lose? No, that was a lot more organic. All right, so you're gonna go rock, paper, scissors. Whoever wins raise their hand. That person follows that person around and cheers for them. At the end, we'll have two people left, right? Half of the room's gonna be cheering for one. Half the room, hopefully, is gonna be cheering for the others. And we'll bring them on stage and then we'll go. Are you sure? You ready? Find somebody else. Find somebody else that's raising their hands. Go, go, go. Can we just make sure we get this? 30 minutes. That's okay. I'm gonna end it now. But can you give us, like, 30 minutes on the clock, or is that okay? We might. We might just go. Okay, you keep it. But, yeah, it just goes when we. Okay, I'll keep it. You want to. You want to bring the chairs out now? You're going to get great B roll. You're going to get great B roll. Go, go, go, go. Cheer.

Who's.

Okay, wait one here. You still in? Are you still in, John? All right, let's bring. Let's. I lost control of the room. All right, who's left? Who's left? All right, here we go. The championship right here. Ready? Go. There we go. Last one.

This is the last right.

Everybody else is out. Do we have a winner? All right, all right. We can say. Yeah, Women are maybe. All right. Every.

Do we.

Who's the winner? Ready? Raise your hand. All right, let's give her a hand. Real hand. All right, have a seat. Have a seat, everybody. Congratulations to. Let's give another round of applause. Applause to everybody. Creating an environment, especially now. There's a quote in Limitless. There's a quote in Limitless from a French philosopher, and he says, life is the C between B and D. Life is C between B and D. B stands for birth. D stands for death. Life, C. Choice, right? And every day we're making choices on who we're going to be that day. You know, you heard this quote that everything that you do, every decision you make, is a vote for who you want to be. Right? And we're making these choices consistently. And we always have the ability in adversity or competition. Also, we have a choice on our mindset. So thank you, everybody. All right.

Well, there's a variety of things that I could talk to you about, but what I think first is just because if I get into learning and stuff, in terms of the time, I'm afraid we won't cover it. So you have done an incredible job of not only documenting, writing a great book, read the whole thing. And we've known each other for quite a while.

Yeah, 15 years.

15 years. Yeah. And basically you learn marketing and you learn how to. Writing a great book is one thing. Being able to distribute the information, get it out to the world. You've sold millions of dollars worth of stuff and I don't know, can you publicly talk about how many books you've sold?

I don't know, actually. That's a great question. We donated. We donated.

Is your memory bad?

No, I just don't. I forgot that would be bad. I actually don't. I don't remember the last time I forgot something actually, but I never knew, so I can't forget. Yeah, I had some great mentors, many in this room. Brian Michael Fishman and I and Ryan, we used to have this like bagel club, you know, when we're all living in Connecticut and we would meet every month and, you know, brainstorm and share marketing.

Well, let me ask you about that though. So with Mr. Consumer Health Summit and all this, did they eat bagels or was it more like a gluten free.

That's what I'm talking about.

That's when the group broke up.

Yeah, gluten free.

Gluten free. There was a big scandal around that.

Well, no, so, so here's the thing. Like, so you are on the COVID of Entrepreneur magazine. This is from last year, right?

So.

And you've got, I mean, you, you work with a lot of, a lot of very well known people, teaching them a lot of actors and actresses and teaching the movie scripts and stuff like that. So how do you best people that are already high performing, very prolific, intelligent executors. What are the things that they usually come to you for help with? What are the biggest problems that they have other than just basic stuff that all humans have, you know, memory and focus and.

Yeah, so I would say people are one extreme, right? They come just like they come to you because they're in deep levels of pain, you know, they're distracted, they're overloaded, they just cannot keep up. And they need capabilities to be able to catch up, keep up and get ahead or else they're extremely successful. Like everybody in this room, you have to be to be here and they want that edge and they know that they have to be able to. Your ability to learn and translate that learning into action rapidly I think is our competitive advantage. Including unlearning also is well because sometimes we don't grow and we don't innovate because we feel we get very comfortable. And you know, what's that quote? The same level of thinking that's created the problem won't solve the problem. And so getting those distinctions to upgrade.

So this phone, any phone, how, how much has this impacted stress overwhelm? I mean there's, we are, we are just. So there's, there's a, in the, in the spa here, at this hotel, there's a deluge. Is that how it goes?

I did that. You know where you did that. That was painful.

You should try it. If you've never. It's, it's, it's shocking. So you, you basically pull the chain down and it just hammers you with freezing cold water. It's a deluge. So it's almost like being a deluge of non stop constant communication. What are some recommendations you have for dealing with the overwhelm? Because I think we get really wired. When I say we, of course I'm speaking from my own life experience. You know, it's very. This thing is constantly tempting everyone. There are apps and they have attention. Engineers whose entire jobs are designed to make technology and apps and everything addictive. So what are some recommendations you have for focusing in a world that has many things that can throw you off?

We talked about in the book I called Digital Deluge. How many of you feel like there's too much information, too little time? Raise your hand as entrepreneurs like taking a sip of water out of fire hose. Just like that deluge. It's just very painful and you're drowning information. But you're starving for the essentials, the wisdom. And how do you filter it all through and how do you prioritize? I would say the most important thing is to keep the most important thing, the most important thing. And this device while. And I'm not anti technology, nor am I. Fire is great. It could cook your food or fire could be burn down your home also as well. It's just how it's utilized. But I don't think anyone would argue that the, that people have more stress, more distraction and a lot of it is amplified by technology. So the devices I talk about in the book, it talks digital daily. Too much information, too little time. That's why we talk about speed reading, accelerated Learning digital distraction. How many of you feel like it's really difficult to hold your concentration in a world full of rings and pings and dings, app notifications, social media alerts? And it's been my experience that focus is more like a muscle. And a lot of us are flexing our distraction muscles when we're engaging with our phone without conscious thought. Right. Mindlessly. And then there's these two other ones. Digital dementia. Somehow, many of you heard this term digital dementia in healthcare. It's where we're outsourcing our memories to our smart devices. And because of it, our brains aren't getting the requisite exercise all the time, and we become more forgetful because we're so dependent and reliant on it. And that's a challenge to us also as well. So your memory, there's no such thing as a good or bad memory. I would reframe it. There's a trained memory and an untrained memory, but it simply just is not taught. Just like you take the elevator, you could do that every single day, or you could use the stairs. There's a consequence in terms of if we're using it, use it or lose it is your brain. And then finally, I just made up this word, digital deduction. I read this study where children this generation, they don't have the same analytical ability, rational ability to be able as previous generations. And part of it, they were saying that because of technology, because these devices are doing the thinking for us also as well, because they have algorithms. And the school teaches you a lot what to learn and what to think, but not necessarily how to learn and how to think. So this whole area of meta learning, I'm very passionate about meta learning. We heard meta a lot. Learning how to learn, metacognition is thinking about your own thinking. Yeah.

You know, it's interesting to think about what technology can facilitate, good or bad. What have you found since you've written the book, since you've been doing all this? If you had to look at the most valuable tools, technologies, hacks, however you'd want to describe it, that have been the most useful for you?

Yeah, so I'm not super tech. I'm so analog, to be honest. I wrote this book in my journal mostly. How many of you, when you're taking notes, even prefer handwriting notes to digital? That's always been mine, actually. When people are tested, they do better. When students are tested for comprehension and retention, which is what matters, they found that people who actually handwritten notes had had better comprehension and retention. So I'm very, I don't use a whole lot of apps outside of, you know, our, our database, our, our slack and things like that. But I think the apps are amazing. How do you scale things? You do it through technology, through people, through systems, right through money. But money, usually capital, you know, funds those first, first three things. But I'm all for technology again, but we upgrade our phones. How many of you have the latest, latest phone or like last couple? We upgrade our phones, our apps, our computers. But you know, I don't think we take a lot of time upgrading, upgrading our minds as you are doing right now. You know, obviously.

What are you currently working on? And how would someone define integrative medicine? Because when you hear that, it's like, what does that actually mean?

Well, I think that, you know, this is a new system which I think is clearly the way of the future that places great emphasis on the human organism's potential for healing. So that I think most people have very little confidence in their body's ability to heal. So that's the first thing, a strong emphasis on healing. It also looks at patients as more than physical bodies. It's whole person medicine that looks at the mental, emotional aspects, spiritual aspects of being. It places great emphasis on lifestyle. So when you sit with an integrated physician, they will ask you about diet, sleep, what you do for fun, you know, all that stuff. Then we make use of all available therapies, wherever they come from, as long as they're not going to hurt people and show reasonable evidence of efficacy. And we don't reject conventional medicine and we don't accept alternative treatment uncritically. I am absolutely certain this is the way of the future because the great promise of integrative medicine is that it can lower health care costs by bringing in treatments that are not dependent on expensive technology, including pharmaceuticals, and as well as through its attention to lifestyle, really practice real prevention. And I'm also confident that one day we'll be able to drop the work integrative. It'll just be good medicine.

Good medicine. You know, okay, let's kind of talk just that term, good medicine. So there's a lot of doctors, medical and there's a lot of, you know, there's functional medicine, doctors, there's all kinds of different doctors. And there are, I think like when any industry, there's some amazing ones and there's ones that just aren't a lot of it. Is this a pill for an ill? You know, it's either medicine or some sort of supplement. And to what degree do because we live in a culture where they want a magic pill.

Right.

And a lot of people are trained that way. And you see so much advertising that way. And of course, your emphasis on food, and I believe food is medicine. So how do you think about supplementation and exercise and eating as it all works together? I mean, what are your thoughts on supplement?

Well, you know, I think the big components of health, lifestyle, certainly diet. And there's a lot of information that we have about what is a good diet. I see an awful lot of people today who follow extreme eating patterns that I think are unwise in the long term. I think physical activity is critical to good health. I think it's also important to change the nature of physical activity as you age. In my 20s, I ran and then I got signals from, from my knees that they didn't like that anymore. And I changed to cycling. I did that for a long time. Now I'm a swimmer and that's my main activity. I also have two big dogs that walk me every day. But I love swimming. But I think it's important to be physically active. I think that managing stress is key, and there's lots of ways of doing. You can't live without stress, but you can practice methods that neutralize itself harmful effects on your mind and body. My favorite are simple breathing techniques because they're so time and cost efficient.

Okay.

I hope you found that video awesome and useful. So if you want to get a free copy of my book, I want you to click here. And if you want to watch some more videos that will be useful and awesome, click here.

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