The Science & Process of Healing from Grief | Huberman Lab Essentials

Welcome to Huberman Lab Essentials, [music] where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today we are going to discuss how we conceptualize grief both at an emotional and at a logical level. I'm going to teach you about the neuroscience and the psychology of grief and incredible findings that have been made in just a few key laboratories that point to the fact that we essentially map our experience of people in three dimensions. Let me just give you a little hint of what those dimensions are. They relate to space, where people are, time, when people are, I'll explain what that means, and a dimension called closeness. And how those three dimensions of space, time, and closeness are what establish very close bonds with people and are what require remapping, reorganization within our emotional framework and our logical framework when we lose somebody for whatever reason. The important thing to point out is that grief is a process. Like any biological or psychological event, it has a beginning, a middle, and an end. And I do believe that being able to orient in terms of where you are in that process can be immensely beneficial. Not just for predicting how long it's going to last, but in order to conceptualize the person or animal that you lost in a way that allows you to best preserve their memory while maintaining your own functional capacity in life. Along those lines, I want to point out that grief and depression, while they can feel quite similar in certain ways and have overlapping symptomology, loss of appetite, challenges sleeping, crying in the middle of the day for no apparent reason, etc., they are distinctly different processes. As we wade into this important topic, I'd like to emphasize some of the common myths and misunderstandings about grief. Some of the myths and misunderstanding arrive from the beautiful work of Elizabeth Kubler-Ross, a psychologist who wrote the famous book on death and dying. The different stages of grief very quickly are denial, anger, bargaining, depression, and acceptance. But unfortunately, those five stages were sort of taken to be gospel for a long time, and we now know based on neuroimaging, based on more in-depth psychological evaluation, and frankly more researchers and clinicians moving into this area and observing that while much of what Kubler-Ross described does hold true, it's not always the case. How do I know this? Well, I know this because brain imaging studies and involving what's called functional magnetic resonance imaging, fMRI, in which you can evaluate which brain areas are more active than others according to blood flow, which correlates with neural activity, and so forth, teaches us that the brain areas that are associated with motivation and craving and pursuit are some of the primary brain areas and circuits that are activated in states of grief. We understand also on the basis of brain imaging studies that in order to understand grief, we have to understand how attachments are represented in our brain. And it turns out that both attachments and the breaking of attachments in healthy ways are governed by three important what we call dimensions. The three dimensions of relating to someone or an animal or a thing are space, time, and closeness. And in order to illustrate each one and how they work together to support relationships and their involvement in the grieving process, I'm going to tell you about an experiment. The experiment involves putting people into a brain scanner that allows the researcher to evaluate brain activity in different areas. In fact, can look in a very non-biased way, not make any predictions about which brain areas are going to be involved. The experiment is the following. The person we should say the research subject first sees images of things that reside at different distances from one another. So, in one case, it's a beach or a parking lot with bowling balls set at different distances from one another. Their brain is imaged, and as their brain is imaged they see different pictures of different scenes, the beach, the parking lot, etc. Bowling balls spaced in different ways, close together, far apart, regularly spaced, non-regularly spaced. When one does this sort of experiment, you see a lot of brain areas activated. Not surprisingly, the visual cortex, the area of the brain that is responsible for creating visual perceptions. But also a brain area that seems uniquely tuned to the distance between you and the objects. We'll refer to that measure, that dimension as we call it, as proximity. Then, subjects listen to tones. Those tones also are spaced from one another. So, it could be something as simple as my hand uh meeting the table top that I'm happening to be sitting in front of, so it's They image the brain. Of course, areas of the brain that are associated with auditory perception are active, not surprisingly. But as they evaluate different types of sounds and patterns of sounds, for instance they can start to parse brain areas that seem uniquely tuned to the spacing of sounds independent of what sounds are coming in. That is, it becomes active specifically in response to changes in the spacing between sounds, much in the same way as they could identify brain regions that were only activated when there were changes in the distance between objects, such as the bowling balls that I used in the previous example. And then the subjects saw a different set of images. The images that they saw were of people and of faces. And some of the images that they saw were of people's faces right up close. And other images were of people at a distance where you could see the whole body of the person. Now, they also varied the emotional relationship to those people. That is, they were able to get photographs from these research subjects' lives so they could show them pictures of, for instance, their sister or some random person off the street. They could show them pictures of a parent or of a neighbor or of a celebrity that's well-known or of somebody that they didn't know at all. So, they were able to vary both the position of the person, close or far, and they were able to vary the emotional distance to the person, which is this dimension that I'm referring to as closeness, which is not physical closeness, but how attached or how well you know somebody. Now, this is maybe sounding like a somewhat complicated experiment, but the takeaway from this experiment is exquisitely simple and exquisitely important. The result was that in all three conditions, changes in the physical spacing of these objects, changes in the temporal, that is, the time spacing of these sounds, and changes in the emotional distance between the subject and different people, the same brain area was uniquely activated. And that brain area, it turns out, is a brain area called the inferior parietal lobule, the inferior parietal lobule. Now, you don't need to know where the inferior parietal lobule is. In fact, you don't even need to know the name of this brain area. What you do need to know, however, if you want to understand grief and how to move through grief, is that your map of people is not a map of emotional closeness per se. It is a map of emotional closeness what we call attachment that is interwoven, that is braided in in a very intimate way with your map of where they are in physical space and where they are in time. When you saw them last, when you're likely to see them again, and if you were to want to see them, how much time it would take to reach them or for them to reach you. Now, earlier I said that one of the key functions of our nervous system is to be able to make predictions. And so it's somewhat obvious, but nonetheless important to state and restate that one of the most powerful aspects of our attachments to people animals and things is our ability to predict what it would take to see them again and when we are going to see them again. Now, if all of this sounds like a bunch of neuro psycho babble parsing of the obvious I'd encourage you to suspend that belief for the moment because if you understand that all relationships are mapped in the brain and body through these three dimensions, space, time, and closeness or proximity of space, proximity in time, and proximity of attachment, how close or rich or bonded you are to someone well, if you can understand that then it almost becomes obvious or at least it becomes intuitive as to why after the loss of somebody in particular a death or the loss of an animal this map has to be reordered. Why? Because if we are attached to someone or an animal at a deep level it is almost always on the basis of a lot of what we call episodic experience, a lot of episodic memories, memories of things that happened. Episodic memories are literally the conscious recollection of your experience of somebody or an animal or a thing. And within that memory you have an understanding of what has happened with them in association to you, what's going on with them, where it happened, when it happened. When somebody is taken away from us for whatever reason, episodic memories persist for some period of time and they are still linked to our feelings of attachment. Grief is the process of uncoupling, unbraiding, and untangling that relationship between where people are in space, in time, and our attachment to them. This is very, very hard to do and for some people it's almost impossible to do at least at the outset of grief. When we have a rich catalog of experiences with somebody or of them, that memory bank is not just flushed out the moment that we learn that they're no longer with us. What happens is the brain continues to make these predictions that they will be in a certain place or a certain time, right? That they'll be in a certain time zone or they'll walk in the door any moment. All of those predictions still hold. The neural activity continues. We call this reverberatory activity. That explains the yearning for and the desire to interact and yet it's just beyond our reach because once they're gone, our brain still functions in a way, these neural circuits still function in a way that put us into an action state of seeking them, looking for them in the same location, expecting them to contact us at whatever frequency that we were used to hearing from them or that we could reach out to them and reliably get a response. It is immensely disorienting, in other words, to maintain a close attachment and at the same time to not be able to make predictions about where that person, animal, or thing is in space and time. So, with this current understanding in mind, a few things start to become obvious and entirely normal to us in the best and most healthy sense of the word normal. For instance, if you've lost somebody, or an animal, or even a thing that was vitally important to you, it should make perfect sense to you as to why you keep looking for that person. Those expectations, those predictions that the brain is making are entirely normal because they are based on that deep catalog of episodic memory that you maintain about that person. Again, it's simply an activation of this map that involves closeness, space, and time. Not surprisingly then, the reordering of that map that's required in order to move through the grieving process is going to involve some remapping. Psychologists and neuroscientists generally agree that the best way to approach moving through grief is actually to remap these dimensions while maintaining the close sense of attachment to the person. By not in any way trying to undermine the intensity of the attachment or how important it was to you. So, we'll now talk about how that process works and the different entry points, as they're called, to engaging in that process. These are tools gleaned from the research psychology, the clinical psychology, and the neuroscience literature. The first one involves the acknowledgement and really the understanding that you don't want to disengage or dismantle your real attachment to someone, an animal, or a thing. That's a real thing and there is actually no adaptive reason to try and persuade yourself or numb yourself or somehow avoid the thinking of just how much they meant to you. What is important, however, is that you make some effort to shift your mindset and your understanding of that person in a way that holds in mind that yes, indeed, the attachment is very real and in some cases is very, very intense, but is now going to be uncoupled from the other two dimensions of the map, namely space and time. So, it's a complicated process, you can imagine, but you really want to hold and register two things at once. One way to do this is to set aside a dedicated period of time of maybe 5 or 10, maybe even as much as 30 minutes, in which you are going to feel deeply into your closeness and your attachment to that person, animal, or thing. But, you are consciously going to try and prevent yourself from thinking about a couple of categories of things. First of all, you want to actively try and disengage from any attempt to engage in what's called counterfactual thinking. The what ifs. What if I called them a day earlier? What if they had taken a different route home? What if I had taken a different route home? These counterfactual modes of thinking are an infinite landscape of possibility, and they are very closely tied to guilt. So, as an infinite space, it's a very precarious one, and it will not allow you to uncouple that intense emotional attachment that I'm telling you is actually vital to hold on to from that catalog of episodic memory that you've established. In fact, it's going to strengthen those bonds. So, in this dedicated 5 or 10 or 30, whatever period of time you can tolerate and maintain focus, the idea is to think about your attachment in a rich way, and to perhaps even experience that in your brain and body. This tool, if you will, of dedicated blocks of time for really spending some effort, and it is indeed effort to access the emotional connection while starting to uncouple the other nodes of the map, as it were, is something that is hard, but in terms of the options one has in order to deal with grief, it is indeed the most adaptive way to go about it. Now, I'd like to consider why two people, both who are intensely attached to a person that is no longer there, can experience the grief of the loss of that person in such different ways. We don't really know how other people feel. There's no clear way of knowing that the expression someone else has, or whether or not they're crying or not, or their body language, really represents how they feel inside. So, that is important to keep in mind. Nonetheless, there does seem to be a sort of a split among people, and indeed among animals as well, even within a species, in terms of how intensely they feel the yearning aspect of grief. And it appears, based on a number of different lines of evidence, that that relates to this molecule that some of you have probably heard of, which is oxytocin. Oxytocin is a hormone {slash} peptide. A peptide just means a protein, generally a small protein. And a hormone is generally something that functions at numerous locations in the body to impact numerous organs and areas of the brain. Oxytocin has a variety of roles in the brain and body. It's involved in milk let-down during lactation. It's involved in pair bonding both in males and females. It's involved in bonding of parent to child, and indeed between romantic partners, et cetera, et cetera. Let's talk about some of the animal models that inform us about the potential roles of oxytocin in the grieving process. There's a species of animal called the prairie vole, and believe it or not, the prairie vole has been studied fairly extensively by neuroscience and psychology researchers. Prairie voles are one species of animal, but depending on where they live, you find that some prairie voles are monogamous, that is, they mate with the same prairie vole for life. They raise litters of little prairie voles, and other prairie voles, generally that live in different locations in the wild, are non-monogamous, sometimes called polygamous. The neurochemical and circuit basis for this monogamy versus non-monogamy quite interesting. However, in the context of grief and attachment, the prairie voles have taught us a lot. And they've taught us a lot through the following experiment. Take two prairie voles that are coupled up, so these would be monogamous prairie voles that have established a couple I guess you would call that a prairie voledom, anyway. Put them in a cage together, they mate together, they raise young together, and then you separate them. You literally put a physical barrier between the two of them, and you can evaluate how strongly one prairie vole will work to get access to the other prairie vole. And what you observe is that the monogamous prairie voles will work very hard to get back to their mate, but the non-monogamous prairie voles will not work as hard to access a prairie vole partner. This turns out to be interesting when you start to explore the patterns of so-called oxytocin receptors in the brain. To make a long story short, and to also bridge to the human literature, it turns out that the monogamous prairie voles have far more oxytocin receptors in this brain area that I mentioned earlier, the nucleus accumbens. And again, to remind you, the nucleus accumbens is a brain area associated with motivation, craving, and pursuit. So, it's as if the monogamous prairie voles have a capacity to link the attachment circuitry and the molecules of attachment, in this case oxytocin, to reward pathways and to motivational pathways. So, in other words, non-monogamous prairie voles seem to have less yearning for attachment overall, at least to a single individual prairie vole. And when we look at the human literature in terms of oxytocin receptor expression and brain imaging experiments and so on, what you find is the same. The people that experience intense grief and a deep yearning and a motivation to reconnect with the person, animal, or thing that is lost, in many cases, have heightened levels of oxytocin specifically, or I should say oxytocin receptors, to be exact, specifically within the brain regions associated with craving and pursuit. So, for those of you that find yourself in this kind of stuck mode, this persistence of trying to reach into the past or wishful thinking, this um counterfactual thinking, the yearning, the desire, and the impulsivity, the kind of leaning in and at a almost reflexive way to try and access that person again, to text them, to want to hear from them, could, and I have to highlight could, reflect the fact that you just so happen to have more oxytocin receptors or maybe more oxytocin overall in this brain area that's associated with motivation and pursuit. It does not necessarily mean that you are more capable of attachment than people who move through grief more quickly. And I should say that people move through grief at different rates, even if two people lost the same person or same animal, people move through this at different rates, and some of that is, no doubt, psychological, but some of it, no doubt, is also neurochemical and biological. I'd like to take a moment and explore this idea that allowing ourselves to really feel the attachment to somebody can accelerate or at least support adaptive transitioning through grief. There's a really wonderful study that on the face of it appears to be a what we call a negative result. A negative result is when a hypothesis is posed and then turns out the hypothesis is not true. But as is the case with so many interesting scientific findings, often when there's a negative result, there's a more interesting result nested in that negative outcome. And this is the case in a particular paper I'll share with you now. This is a paper published in the journal Biological Psychology and again the title is posed as a question, which is emotional disclosure for whom? A study of vagal tone in bereavement. What this study explored was whether or not written disclosure of the emotional connection to somebody that was lost would be effective as a way for people to move through the grieving process. The study also explored the so-called vagus nerve. The vagus nerve is an extensive nerve pathway that is bidirectional between brain and body. So brain to body and body to brain. The way to think about it in terms of what we're going to talk about now is heart rate and heart rate variability. The vagus nerve is generally associated with parasympathetic functions and has the capacity to slow down our heart rate, in particular by exhales and just simply because of the movement of the diaphragm and its relationship to the heart and the thoracic cavity, exhales result in slowing down of the heart rate. This is what we call an increased vagal tone. Now, in this study what they did is they had people and I should say it was 35 participants go through a writing exercise for a period of weeks. And there were two different groups. One group was in the so-called written disclosure group. What they did is they on day one, they would write about what happened when a loved one died. And indeed they used people who had experienced real loss. And so they were asked to talk about and write about their deepest emotions and thoughts about it, memories of their loved one, very intense stuff if you think about it, if they're in the immediate period of having lost someone. Then they actually were asked to write a letter to the person that they lost. The other group was a so-called control group where they were simply told to write about how they use their time. So an emotionally kind of empty writing exercise, if you will. They described what they would do today after they woke up, etc. No no heavy emotional content and so on. What I didn't tell you thus far is why they had them do this exercise at all. They had them do this exercise because many of the effective practices for moving through grief involve, as I mentioned earlier, getting close to and actually deliberately experiencing the attachment that one has to that person that was lost, not distracting oneself, not getting into this counterfactual thinking, the what if what if what if, but rather thinking about or in this case writing about the real attachment. And so that the initial idea was if people write about this attachment that they're going to experience this attachment and that will serve them in some or many ways in terms of moving through grief. And that wasn't what they found. They found no difference between the two groups until they explored who had higher vagal tone. Who had a greater degree of so-called respiratory sinus arrhythmia. In other words, who was able to modulate their state using their breathing and their body. And what they discovered was that a subset of individuals who had a high degree of vagal tone seem to get more benefit from this writing type exercise. Now this is one study and I would consider it fairly preliminary with 35 subjects, although you know, it's a study unto itself and I think a quite nice one. And it really set the stage for a number of other studies that followed from this group and other groups that really point to the fact that yes, indeed, accessing these states of emotionality by writing or thinking about somebody is quite powerful in terms of engaging the bodily states and the mind states associated with the attachment, and that is very beneficial for moving through grief. That is very beneficial for sensing the attachment. And now it makes perfect sense as to why some people would benefit from that sort of practice more than others, because some people are able to access more real somatic feelings of attachment by writing about the attachment or by thinking about it than others. Because again, what this paper really points to and set off a number of other investigations related to is that for those that can really feel the relationship between breathing, heart rate, what we call vagal tone, well, those people are going to be in a better position to move through grief, not because they are disengaging from the feelings of attachment, but because they are better able to access those feelings of attachment. So, what this relates to, of course, is that tripartite map, that three-part map that we talked about earlier. That representation of space, where things are, where the person is, where their belongings are, where their car is, where their bicycle is. Time, when you were expecting to see them on a regular basis, when they would call, when they would come home from work, et cetera. And that third node or that third dimension of attachment, which is literally attachment and closeness. Now, I'd like to take a moment and consider some of the tools that you can access that support healthy transitioning through grief. And these are tools distinct from that neural map, that space-time-closeness-attachment map that we're talking about before. Rather, it's important to remind ourselves that everything exists in a context of our baseline physiology. And I'm certainly not going to be the first or the last to tell you that everything in life, learning, relationships with people that are still around, our health in every way, immune system, etc., function far better when we're sleeping really well and when we are generally awake during the daytime and asleep at night. There's a particular feature to our diurnal, and diurnal meaning the opposite of nocturnal, our diurnal pattern of the release of a hormone called cortisol. It's linked to our increase in temperature rhythms and can further increase our temperature, which leads to waking and so on. The typical pattern of cortisol in a healthy individual, and we really can say physically and emotionally healthy individual, is that cortisol is going to be somewhat high right around waking and then is going to be highest as it ever will be in the 24-hour period about 45 minutes post waking. Not exactly 45 minutes, but about 45 minutes. And then it will drop gradually such that by about 4:00 p.m. in the afternoon, which is actually when body temperature tends to start to drop as well, cortisol tends to be very low and then remains low in a healthy individual such that at 9:00 p.m. it's very low and throughout the night as we sleep it's very low. There's a very interesting paper exploring the relationship between cortisol rhythms and grieving, in particular complicated versus non-complicated grieving. Again, complicated grieving being the form of grieving that reflects a immense challenge of people moving through the grieving process such that it really needs to be dealt with, right? Again, grieving is healthy, but complicated grieving is a prolonged grieving and has other dimensions as well, hence the name complicated. The title of this paper is diurnal cortisol in complicated and non-complicated grief, slope differences across the day. And the figure to orient to in this paper, if you do decide to check it out, is figure one, which beautifully shows, or I should say very clearly shows that when you compare the cortisol levels between people experiencing complicated grieving versus non-complicated grieving, what you find is the 4:00 p.m. and 9:00 p.m. cortisol levels are significantly higher than they are in the non-complicated grieving group. This raises a very interesting idea. We arrive at a scenario where it makes very good sense to think about modulating, that is controlling the foundation of your life in a way that establishes cortisol rhythms and sleep patterns and patterns of autonomic arousal and catecholamine release that position you to navigate the grief process in the best possible way. If you are somebody who is heading into grief or is challenged with grief, getting adequate sleep at night and establishing as normal a pattern of cortisol as possible is going to be very important. And there's a very simple, straightforward way to do this, and I apologize to the listeners of this podcast in advance if I sound like a repeating record, but the most powerful way to do this is to view sunlight very close to waking. It does not have to be right at sunrise, but when you get up in the morning, if the sun isn't out, please turn on as many bright lights as possible in your environment. Why do I say this thing about sunlight over and over and over again? Well, having an early day cortisol peak and a very low cortisol level late in the day, 4:00 p.m. and 9:00 p.m., is immensely beneficial. It's reflects a properly regulated autonomic nervous system. It means being alert during the day and your ability to sleep at night is quite tightly correlated to this viewing of sunlight in the morning. If you're have additional questions about this or these protocols, please see our mastering sleep episode also at hubermanlab.com. So, what are the tools that we can think about using in terms of healthy adaptive moving through grief, trying to avoid complicated grief and prolonged grief disorders. Clearly, it's a value to dedicate some period of time, perhaps every day, perhaps every other day, depending on your capacity and schedule. These could be periods of time ranging anywhere from 5 to 45 minutes, maybe longer. These blocks of time would be appropriately described as rational grieving. Rational grieving is a clear acceptance of the new reality that the person, animal, or thing no longer exists in the same space-time dimensionality that we knew them before, and yet holding on to an anchoring to the attachment that we had. This is really anchoring to the depth and the intensity of the attachment that existed as a way to for lack of a better way to put it, push off from those episodic memories, to distance ourselves from them because those episodic memories are the ones that lead us to look for the person in our current reality. And assuming this is a real and complete loss, those sorts of expectations are maladaptive, and they do not serve us well. The second aspect of this is to understand that the node of the map, the component of the neural map that you're anchoring to, is a very real component of you. These are literally cells that represent the depth of attachment. We talked a moment ago about the importance of accessing quality sleep on a regular basis. There again, a rich array of tools to do that in the mastering sleep episode. And again, highlighting the importance of sleep for not just emotion regulation and autonomic control, which is so vital, but also for making sure that neuroplasticity takes place because again, neuroplasticity is a two-part process. There's the triggering of the plasticity, which in the case of the things we're talking about today, will be naturally activated by the practice of a dedicated focusing on the attachment, feeling the attachment to the person, maybe even writing about the attachment to the person as was described in that previous study. But also, just the plasticity is triggered by the mere loss of that person, the intensity of that experience, but neuroplasticity, the literal rewiring of connections, occurs during deep sleep and in what I call non-sleep deep rest or NSDR. And you can find NSDR scripts, these are short behavioral protocols that you do for 10 to 30 minutes at some point throughout the day, maybe even multiple times through day, that have been shown to accelerate neuroplasticity. So, having a such a practice can be very useful. And understand that it involves some cognitive work. We have to hold on to the attachment and imagine and feel as much as we can the attachment while also being extremely rationally grounded and trying to not try to hold on to the past. Trying to not anticipate the person walking in the room. This is very hard because when we think about the attachment, the attachment tends to drag with it those episodic memories, that rich catalog of experiences. And we talked about preparing ourselves for grief. We can prepare ourselves to grieve more adaptively by regulating the level of catecholamines, in particular epinephrine. And tools such as the one found in our mastering stress episode and tools of the sort that we talked about today, increasing that vagal tone by actively building up the relationship between exhales and slowing down of the heart rate, so-called respiratory sinus arrhythmia. Those things can be very useful tools. And of course, I want to restate again, it is often important to access a trained professional psychologist or psychiatrist or both or bereavement group or all of the above in order to get the proper support for grieving. I like to think that the tools that we've talked about today would be not only compatible but would be complementary to the sorts of approaches that they take. And I would encourage you to not lean away from but rather to lean into the building of those episodic memories, to build up a richer and richer set of experiences and emotional attachments because while the process of grieving is in direct relation to how close we are attached to people, there are ways to move through it. And of course, it is the depth of our attachments and the number and the depth of meaning of experiences that we share with others and with animals that makes life so rich and worth living. So, I just want to take a moment and say thank you for being willing to explore this rather complicated and sometimes extremely challenging thing that we call grief from the perspective or through the lens of neuroscience and psychology. And last but certainly not least, thank you for your interest in science. >> [music]