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Speaker A: Welcome to the Huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today we are discussing journaling for mental and physical health. I want to emphasize that today's discussion is not a general discussion about the value of journaling. Rather, it is a discussion about a particular form of journaling that the scientific peer reviewed data says is especially powerful for improving our mental and physical health. In fact, what I will describe today is a journaling method that is supported by over 200 peer reviewed studies in quality journals. And I frankly was not aware of this journaling practice prior to researching this episode. But in researching this episode, have come to discover that this practice should easily be placed among some of the other critical, so called foundational pillar practices in terms of its impact on improving mental and physical health, including things like lowering anxiety, improving sleep, improving immunity to things like colds, flus, etcetera, as well as reducing the symptoms of autoimmune disorders such as arthritis, lupus, and also providing some relief for fibromyalgia, which is a condition of excessive pain. The particular journaling method and protocol that I will describe has also been shown to improve various metrics of everyday living, including improved memory, decision making, and on and on and on. So much so that again, I was very surprised that I had not heard of this particular journaling method. One would think that if such a powerful method existed, that everyone would know about it. But it turns out that this particular journaling method has been somewhat cloistered within the fields of psychology and psychiatry. It's not that nobody was aware of it. In fact, I learned about it for the first time from our associate chair of psychiatry at Stanford University School of Medicine, my colleague and collaborator, doctor David Spiegel, who, as some of you may know, has been featured as a guest on this podcast previously, and upon hearing about it, I decided to explore the primary research, that is, the studies that demonstrate the power of this particular journaling method, and was absolutely blown away by the positive impact this particular journaling method can have. What's wonderful about it, you'll soon discover, is that it takes a relatively small amount of time. In fact, it's something that you could do during the course of one week, or even across one month, and then never do again. And the data say that it would still have lasting positive benefits both for body and mind. So while it's rare to feature one particular protocol as an entire Huberman lab podcast. That is indeed what I will do today. It is important that we go into some depth about the specific protocol because there are some important details that everyone should know if they want to apply it and make it as effective as it can be. And in addition to that, we'll talk about some of the underlying science that's been published explaining why and how this protocol is so effective for mental and physical health. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is element. Element is an electrolyte drink with everything you need and nothing you don't. That means plenty of salt, magnesium, and potassium, the so called electrolytes, and no sugar. Now, salt, magnesium, and potassium are critical to the function of all the cells in your body, in particular to the function of your nerve cells, also called neurons. In fact, in order for your neurons to function properly, all three electrolytes need to be present in the proper ratios. And we now know that even slight reductions in electrolyte concentrations or dehydration of the body can lead to deficits in cognitive and physical performance. Element contains a science back to electrolyte ratio of 1000 milligrams. That's 1 gram of sodium, 200 milligrams of potassium, and 60 milligrams of magnesium. I typically drink element first thing in the morning when I wake up in order to hydrate my body and make sure I have enough electrolytes. And while I do any kind of physical training and after physical training as well, especially if I've been sweating a lot, if you'd like to try element, you can go to drink element. That's lmnt.com Huberman to claim a free element sample pack with your purchase. Again, that's drinkelementlmnt.com Huberman Today's episode is also brought to us by waking up. Waking up is a meditation app that includes hundreds of meditation programs, mindfulness trainings, yoga, NIDRa sessions, and NSDR non sleep deep rest protocols. I started using the Waking up app a few years ago because even though I've been doing regular meditations since my teens and I started doing yoga Nidra about a decade ago, my dad mentioned to me that he had found an app. Turned out to be the waking up app, which could teach you meditations of different durations, and that had a lot of different types of meditations to place the brain and body into different states, and that he liked it very much. So I gave the waking up app a try, and I too found it to be extremely useful because sometimes I only have a few minutes to meditate, other times I have longer to meditate. And indeed, I love the fact that I can explore different types of meditation to bring about different levels of understanding about consciousness, but also to place my brain and body into lots of different kinds of states, depending on which meditation I do. I also love that the waking up app has lots of different types of yoga Nidra sessions. For those of you who don't know, yoga Nidra is a process of lying very still but keeping an active mind. It's very different than most meditations, and there's excellent scientific data to show that yoga nidra and something similar to it called non sleep deep rest, or NSDR, can greatly restore levels of cognitive and physical energy, even with just a short ten minute session. If you'd like to try the waking up app, you can go to wakingup.com huberman and access a free 30 day trial. Again, that's wakingup.com huberman to access a free 30 day trial. Okay, let's talk about this particularly transformative form of journaling that initially was researched by doctor James Pennebaker. James Pennebaker was a professor of psychology at Southern Methodist University when he first started researching this form of journaling and its positive impacts on the body and mind. But he has since moved to the University of Texas, Austin, where he still runs a laboratory, and has continued his studies on the role of journaling and other forms of language, both spoken and written, in terms of their impact on one's mental and physical health. So the origins of the research into this particular form of journaling started in the mid eighties, and it was really in 1986 that the first published manuscript about this form of journaling was published. Now, I want to be clear that prior to James Pennebaker studying this form of journaling, clearly others had used the form of journaling that I'm about to describe. However, it was Pennebaker that really started attaching measurements of the specific types of changes that occurred in people when they did this journaling in a particular way, and indeed came up with the precise protocol that we'll talk about today. So Pennebaker and colleagues, and James Pennebaker in particular, really deserves credit for the discovery of this method. As you'll soon learn, Pennebaker was absolutely meticulous in figuring out exactly how long the method should be carried out, what exact forms of change occurred in the body and mind. He was careful to explore the method in the context of students as well as in the general population, in veterans, in elderly, in kids, and on and on. So it's really that incredible attention to detail and that scientific rigor that makes the protocol so incredibly powerful. So that first scientific study of this particular form of journaling, as I mentioned, was published in 1986, and I provided a link to that study in the show note captions but what that study essentially consisted of was inviting undergraduate students into the university laboratory one at a time, and they were to spend 15 to 30 minutes writing about the most difficult, even traumatic, or possibly non traumatic, but still very difficult experience that they can recall from their entire life. The instruction included that they should write for the entire time. That is because they were writing by hand in that particular experiment, that they were to not stop moving their hand for the entire duration of the 15 to 30 minutes. And in addition to that, that no one besides them, the person writing, would see what was written at the beginning, middle, or even after the experiment. In fact, the students were invited to tear up the paper at the end of the writing exercise if they so chose. Okay, so the first key instruction is that they take a moment to think about what is the most difficult, perhaps even traumatic, experience of their entire life. The second instruction was that they were supposed to write for 15 to 30 minutes. And the third instruction was that they were supposed to write for the entire time. That at no point would they take a pause unless somehow, emotionally or physically, they were able to keep moving their hand on the paper. In fact, they were told to not pay attention to accurate grammar, to not pay attention to rereadability. They were told, in fact, that their writing could be replete with spelling errors or grammatical errors. That didn't matter. What was most important is that they tap into a particularly negatively charged memory of their prior life experience. Now, of course, because this was an experiment carried out in a university laboratory, there was a quiet place where the students could write undisturbed. But since we're taking this particular protocol and we're exporting it to the real world through this podcast, so it's important that if you decide to implement this protocol in your own life, that you carry out the writing in a place where you will not be disturbed for that entire 15 to 30 minutes duration. It's also important that you know that even though that 1st 1986 study was done, having students write out these memories by hand with a pen and paper or a pencil and paper. There have been many subsequent studies that have explored whether or not the pen and paper was particularly important. It turns out it's nothing. The exact same magnitude of positive effects are observed regardless of whether or not people write out their passage of words by hand or type it out on a word processor or any other form of writing. Now, just to make sure that everyone gets the exact same protocol that was provided in that first initial study from Pennebaker and colleagues, and that has been used, really, over and over and over again for more than 200 peer reviewed studies that demonstrate the power of this protocol. I'm going to read to you some of the specific instructions from that first study. So the subjects were instructed to write about something that you are thinking about or worrying about way too much. Or if you're not thinking about or worrying about something way too much, perhaps you've deliberately tried to not think about this series of events or event, something that you've been dreaming about at night, perhaps in disturbing dreams, or something that you feel is affecting your life in an unhealthy way, either internally or externally. So it could be in your emotional state, your inability to calm down when you want to be calm. Maybe you're ruminating, maybe even compulsive thought. Maybe it's leading to addictive or compulsive or habitual behaviors. Or perhaps you can identify a specific trauma or set of traumas that you know are really plaguing your body and mind. The specific instructions that were given to the subjects in those experiments are the specific instructions that I'm going to give to you now, should you decide to implement this journaling protocol. And those instructions are as follows. I want you to write down your deepest emotions and thoughts as they relate to the most upsetting experience in your life. Really let go and explore your feelings and thoughts about it as you write. You might tie this experience to your childhood, your relationship with your parents or siblings, people you have loved or loved now, or even your career or schooling. How has this experience related to who you have now become, who you have been in the past, and who you would like to become? The instructions then continue to say, many people have not had a truly traumatic experience in their lives, but everyone has had major conflicts or stressors, and you can write about the most dramatic or stressful experience you've ever had. Okay, so those are some of the key instructions that subjects in these experiments were given before they do the exercise. And, of course, they were given a few minutes to think about what they wanted to write. But once they selected what they wanted to write, they started writing. There was a timer going in the background for 15 to 30 minutes. And the reason, by the way, I keep saying 15 to 30 minutes, is that some experiments employed a 30 minutes period. Other experiments employed a 20 minutes period, others employed a 15 minutes period. Turns out there were no major differences between the 15 minutes and the 30 minutes period writing blocks in terms of the positive impact that they had on mental and physical health. But for some people and their particular experience that they're writing about, 15 minutes is simply going to be too brief a time in order to capture the entire experience and as many thoughts and feelings about that experience as one would perhaps put down onto paper or type out if they had a full 30 minutes. So you can allow yourself 15 to 30 minutes and feel welcome to stop before the 30 minutes period is over. Or perhaps you're going to restrict yourself to 15 minutes, and you're going to force yourself to get out as much as possible in that time. It really doesn't matter, or so say, the data. Okay, so before I continue to detail the specifics of this writing protocol, you've probably already noticed that what I'm describing is a very different form of journaling than, say, morning notes, which is a form of journaling that writers often use in order to, quote, unquote, clear out the clutter. This is a process of sitting down and writing down in stream of consciousness, whatever's on your mind for the first five to 15, maybe even 30 minutes every morning, as a way to sort of clear out your mental processes and get ready for the day, perhaps a day of other forms of writing or other activities entirely. What I'm describing is also distinctly different from so called gratitude journaling. In fact, it's quite the opposite. It's not writing about things that you're grateful for, necessarily. It's writing about things that are extremely unfortunate that happen to you, and that you have very charged, negative emotions about. In addition, the form of journaling that we're talking about today is distinctly different from the form of journaling that I and many others have undertaken, perhaps not on a daily basis, but perhaps on a daily basis where you essentially are writing out the contents of your daily life, a so called diary. And I mention that because I think many people do journal, and some do so on a consistent basis. I would put myself into that category. Although the last few years I have not been journaling too much. I have literally stacks and stacks of journals dating back to the early nineties. I brought a few of them along today and no, I'm not going to read them to any of you. In fact, when I was looking at these last night, and by the way, these are from the late. So this is summer of 1997, so I would have been late in my undergraduate career. This is fall of 90 619 92. Always done on the same composition notebook at that time, and always done by hand. I'm surprised that my handwriting was as legible as it was. It's gotten worse over the years. I don't know what neural process that reflects, but in any event, in reading over these journal entries, it was clear to me that just as I had recalled that each and every one of them was essentially an update about what was happening lately, what I was hoping for some challenges, you know, basically a diary of sorts. And these are kept in the second drawer of the second. No, I'm just kidding. The idea for me is also that no one will ever read these besides me. It was quite an interesting exercise to go back and read those. And yeah, there were a few cringe moments, but there were also a few moments where I found myself smiling. Because in certain ways so little has changed between the person I was then and the person I am now. And fortunately, in so many ways certain things have changed between the person I was then and the person I am now now. I mention all of that simply because I think the form of journaling that I've been doing for some years, this sort of autobiographical approach to daily entries or pseudo daily entries, is far and away different than the type of journaling that we're talking about for sake of improving mental and physical health during today's episode. Which is not to say that gratitude journaling or autobiographical daily entries, aka diary type journaling, is not useful. In fact, there are data to support that. Gratitude journaling in particular, can be very beneficial for both body and mind. Everything from improving general states of happiness to reducing anxiety, improving relationships, and on and on. But to get back to the protocol that we're talking about today, you probably noticed that it is not a protocol that's likely to feel very good, at least not at first. And indeed, that's what the research shows. And this is something that you really need to be aware of, that when subjects are given this research assignment, during the assignment, they are often quite distraught. Oftentimes they cry. Oftentimes they find themselves holding their breath in anxiety. Oftentimes they'll finish that 15 to 30 minutes writing block and they'll feel as if they had run a mental marathon, and therefore, the subjects were given a period of five to 15 minutes post writing to settle down and transition back into their day. So I highly recommend that you incorporate that into your protocol as well. So if you're going to allow yourself, say, 20 minutes to write, you want to give yourself probably ten minutes of quiet time to bring your composure back and reset yourself so that you can re enter daily living. Because the writing that you're going to do for this particular protocol is designed to tap into very negative, if not the most negative, experiences of your life. And so that's something to be taken seriously. And it's an entirely unreasonable expectation that you could write about something as difficult as the most difficult experience in your life and then simply pivot and go back into everyday life right away. So you'll want to designate a time of day or night, perhaps, when you can do this writing and still allow yourself some time to, you know, settle down your autonomic system, you know, return your breathing to normal, perhaps, you know, wash your face with some cool water, remind yourself that the rest of the day continues, that you're doing great. In fact, you made it through this first installment of the journaling exercise. So you're probably starting to get the impression that this form of journaling that Pennebaker and colleagues really researched and pioneered the evolution of is quite different than other forms of journaling. And, in fact, it's very different. I've already told you that the idea is to sit down and write for 15 to 30 minutes. Write continuously. Write about something that really, to you, is one of the most, if not the most difficult experiences of your life. In addition to that, for this form of journaling to be most effective, that is to bring about the greatest positive shifts in mental and physical health. You're actually going to write about that exact same thing four times. Now, the way that that was initially researched by Pennebaker and others was to have the same person, of course, write about the same experience four times on four consecutive days for 15 to 30 minutes each. So students or people from the general population or veterans were literally coming into the laboratory and sitting down and writing about the most difficult experience of their life that they could recall for 15 to 30 minutes on one day, and then again on the next day, and then the next day and the next day. So much of the data on this particular journaling method reflects that four consecutive days of 15 to 30 minutes, writing bouts of the most difficult experience that you can recall. However, there have been variations on this protocol, such that people selected one day per week, and it doesn't even have to be the same day like every Monday. It could be Monday of one week and then Wednesday of the next week and so on, such that you write only one day per week about the most difficult experience you can recall, and then you write about that same difficult experience one week later, and then again one week later, and then again one week later across the course of a month, or any four week period for that matter. Now, I don't know about you, but when I hear that, that I'm going to need to write about the most difficult experience of my entire life that I can recall for even 15 minutes, let alone 30 minutes, let alone two times. And here we're talking about four times, perhaps even on four consecutive days. That actually speaks to some intensity, some demand. In fact, I find myself kind of leaning away from that experience a little bit. But as we'll talk about later, that's exactly the point of this type of exercise, which is that we are harboring these stories, these experiences, and in some cases, partial recollections. In another case, detailed recollections of the difficult thing that happened to us, perhaps even the most difficult thing that happened to us. And those narratives exist in our nervous system. These are not necessarily traumas as we talked about before, although they can be traumas now. We hear a lot about trauma, and these days, people will call all sorts of things trauma and traumatizing and say that they've been traumatized by this or traumatized by that. There's actually a specific definition of trauma that was provided by Doctor Paul Conti, who, as some of you know, is a medical doctor and psychiatrist. He's been a guest on this podcast. First, to talk about trauma, he wrote an excellent book about trauma. I provide a link to that book in the show, note captions, by the way. And he and I did four episodes of the Huberman lab podcast, a so called guest series specifically aimed at mental health, what it is, how to build mental health, specific protocols. And Doctor Paul Conti is really, truly a world expert in trauma. And he defines trauma as any experience or experiences, plural, that modify our brain and neural circuitry. So it could be brain or body or both, such that we do not function as well emotionally, behaviorally, or cognitively going forward from that experience. Okay, so not everything constitutes a trauma, but many things do. So, applying that definition, I think it's fair to say that many, if not most people have some form of trauma stored in their nervous system. And other people perhaps don't have such traumas, but everyone has had stressors. In fact, I think it's fair to say that everyone has had major stressors in their life, provided that they've lived it all. That's just part of life, unfortunately. Or maybe fortunately, maybe it makes us who we are in positive ways. If we are able to transmute those negative experiences and stressors or traumas into particular forms of learning that allow us to do better. And indeed, that's possible. And that was discussed with Paul Conte in that four episode series on mental health. But the particular form of journaling that we're talking about today. Was really designed to have people focus on those difficult experiences. And then for four episodes. Total. Yes, total. There's no ongoing every week. Or, you know, it's not like having to seek out sunlight every morning and getting sunlight in your eyes. Or trying to get the best possible night sleep at night, like I'm always encouraging people to do. This is really a short term protocol, but it's one that is indeed very intense. Okay, so along those lines that deliberately journaling about a particularly distressing experience or set of experiences. Is likely to bring some degree of sadness, anxiety, frustration, anger, perhaps other emotions as well. It's important that you know some of the data that have been collected about this journaling protocol. One of the more important features of this protocol is that when people do it, they tend to bin out into two different groups. And these two groups have been described as low expressors and high expressors. Now, low expressors and high expressors have nothing to do with introversion and extroversion. That's actually been looked at, and they have no relationship. Okay, so some people who are very talkative and very extroverted, they could be a low expressor. Somebody who's very introverted, tends to only share when they really have something to say. And maybe doesn't have a lot of interest in social interactions. Or as some of you who heard the episode on relationships know, an actual introvert is somebody who really enjoys social interactions. But they are very sated, they are very satisfied by less social interaction than our extroverts. If you want to learn more about that, check out the episode I did on relationships. But in any event, when people sit down to do this exercise and when they consent to having their writing analyzed and when they undergo a number of other different tests, it turns out there are two different groups that segment out. The first are these low expressors. The low expressors tend to use less descriptive language in their writing. They tend to get less emotional during the first bout of writing, that first day of 15 to 30 minutes writing. Whereas the high expressers tend to be people that use a lot of negative language to describe their negative emotions about the negative experience. So that means more negative descriptor words were used at higher frequency. These people, when they have their physiology measured, also tend to have higher amounts of distress and upset in the first bout of writing, that 1st 15 to 30 minutes episodes. So we've got two different groups, the low expressors and the high expressers. The low expressors on day one are sharing a bit less. They're expressing less, on paper, of their particular emotions that they can recall from that traumatic or very distressing event. And overall, based on physiological measures as well. So, cortisol increases as well as skin conductance, changes in heart rate and blood pressure. The lower expressors are effectively relatively more calm, less distressed, as they write about this very stressful event in their lives, relative to the high expressors who have higher blood pressure, higher heart rate. They tend to be the ones that cry more or hold their breath more or sob more, have higher levels of cortisol during that first round of writing. Now, for the protocol to be effective, it doesn't matter if you're in the low expressor or high expressor group. Here's what's interesting. I just mentioned that on day one, the low expressors are less distressed physiologically and psychologically, as they write about this, for them, very distressful event, whereas the high expressors are much more distressed, significantly more so, in fact, when these are measured in laboratory studies on both mental and physical dimensions of stress. Now, that's on day one. But then what's observed is an opposite pattern of progression, such that the low expressors become more and more distressed as the writing exercise continues from day two, three and four. Whereas the high expressers, these people that use a lot of language to communicate their distress and are experiencing a lot of physiological and emotional distress as they're writing on day one, their amount of distress from day one to two to three to four actually goes down more dramatically. So you can expect that you fall into one or the other group. This was truly a binary distribution where people binned out into one or the other based on a number of different measurements. But here's the good news. Turns out it doesn't matter whether or not you're a low expressor or a high expresser. You want to use the form of writing that's most natural for you, and that for you, communicates what that negative experience was like. And how it has affected you and perhaps how it's affected others as well. The important thing to know is that both groups, both the low expressors and the high expressors, benefit from this journaling protocol, such that three weeks later and even three months later, and even years later, both groups are experiencing far less distress and baseline levels of stress than they did prior to embarking on the journaling protocol at the very beginning. Now, the reason I mention these two groups, the low expressors and the high expressers, is that it's a non trivial detail of this writing protocol, because some people are very familiar with communicating their emotions both in writing and perhaps in speech as well. And this actually has been looked at. There's a wonderful study also by Pennebaker and colleagues. And I should mention that even though he studied these journaling protocol for a good number of years, his laboratory has evolved now to studying all sorts of things related to how the particular language usage patterns that people use in everyday speech as well as in their writing, how that reflects their underlying psychological tone and emotions. But also, and I find this so interesting, how the particular words that we use in writing and speech actually shape in a causal way our emotional state. So I'll talk a little bit about that later. But the important thing to focus on now is the results of this study entitled Natural emotion vocabularies as windows on distress and well being. And this again is a study that was done by Pennebaker and colleagues. I've linked to it in the show note captions, and it essentially examines people's natural language usage patterns. Now, what do I mean by natural and why is that important? Well, there have been many, many studies of people's vocabulary and assessing whether or not people have more knowledge of negative words to describe negative emotions or positive emotions. These studies are varying in their form, but generally consist of having people circle words they recognize or maybe writing out the definitions to. And it turns out that people that have more extensive knowledge of words that describe negative emotions themselves tend to have a lower affect or negative emotional state as compared to people who have more extensive knowledge of vocabulary words that pertain to positive emotions. So, a crude example of what I just described is somebody that has fairly limited knowledge of words that describe positive emotional states. So perhaps they recognize the word happy, they recognize the word ecstatic, they recognize the word joyful, but they have a fairly limited word set that pertains to positive emotions. Whereas by comparison, this is always relative within the same person. Right. By comparison, the person knows four times more words that pertain to a negative emotional state. Okay. In general, those people tend to be more depressive, tend to have higher levels of anxiety and so forth, as compared to somebody where the reverse pattern is true, where they have knowledge of far more words that pertain to positive emotional states as compared to negative emotional states. Now, on the face of it, that result probably seems straightforward, right? People that have a lot of words to describe happiness are more happy. People that have a lot of words to describe sadness and negative emotions are more sad. But it didn't necessarily have to be that way. And it turns out that it's not always that way. What do I mean by that? Well, the particular study that I've been describing here, this natural emotion vocabularies as windows on distress and well being, is an important paper because it explored not the words that people have knowledge of, but the word patterns that people tend to use in their natural speech, either spoken or written. And what Pennebaker and others showed is that people that tend to use a lot of negative words tend to have more negative emotional states, whereas people that naturally tend to use words that describe positive emotional states have more positive emotions. And this related to both mental and physical metrics of negative emotions and positive emotions. So, this is a significant result, because what it says is that our knowledge of vocabulary words is, while interesting and perhaps important for other things, is not nearly as important as which particular words we use on a frequent basis. And so, whereas before I said, okay, if you're going to embark on this protocol of four writing sessions, 15 to 30 minutes each, that you should not monitor your writing, that you want to sit down, start writing, and just don't stop. You don't want to pay attention to grammar or spelling or anything else. And then after the fourth writing session, you don't look at what you've written for at least a week, but then a week or more later, you go back and you read what you've written, paying careful attention to the number of words that you use that reflect a negative emotional or affect, as it's sometimes called, state in the first versus the second versus the third versus the fourth. Journal entry. Now, this might seem a little bit detailed and reductionist for protocol that we would discuss on this podcast here. We're really talking about you doing your own data analysis of self. But if you think about it, a practice like this, both can be very quick and highly informative. So, for instance, you can go back and simply circle all the words that, at first blush to you, appear to reflect a negative state and put a square around all the words that just by your read, seem to reflect a positive state, and then compare them across those four journal entries. And of course, you can opt to not do any of this. But what people find, that is what was discovered in the research literature, is that on average, the patterns of language use from the first to the fourth entry shift dramatically, such that by the fourth entry, people, even though they're still writing about the same negative experience, are writing about that experience in a very different way. Not only are they naturally using fewer negative words to describe their recollection and experience of that negative event, but the number of positive words is also increasing. Now, this is important because when Pennebaker and colleagues gave the instruction to people to do this protocol, they encourage them to think about three things before they ever start writing. The first is, of course, to write about facts about that difficult experience. I think that's sort of obvious, that when people are going to recall a difficult experience, they're likely to write down facts about that experience. The second thing that they want to remind them to include were emotions that they felt at the time of the experience, as well as emotions that they happen to feel now about that experience. And third, that people include writing about any and all links that come to mind about the negative experience and things that may be happening today or plans for the future. People from the past, present, or future. Really any link, no matter how distant it might seem or how random it might seem, to include that in the writing. Okay, so just to repeat the three things that they were instructed to include before they ever set their pens to paper or started typing out their negative experience. First, facts about the hard experience. So whatever they can recall that happened in that hard experience, or perhaps it was something that didn't happen and that was why it was a hard experience, but facts related to that hard experience. Facts of the hard experience. Second, that they include writing about emotions felt at the time of the experience, well as emotions felt now while writing about that prior experience. And third, to include any writing about any links that spring to mind about the negative experience and anything that's happening now or perhaps happened in the past or things that you have planned for the future now. That third category of links between the experience and other things may be direct and obvious. Maybe these are real aha. Moments where you go, oh, my goodness, realize now that what's been happening for the last six months is a direct mirror of what happened in that earlier traumatic or very stressful episode. Or perhaps the links are more opaque. Maybe the link is, I don't know why, but I keep thinking about this one experience that I had, and I keep thinking about this one person, and I don't know how they're linked. That's fine. Put those down on paper. You could even draw a diagram. But I should mention, it is important that you try to the best of your ability to write things out in complete sentences again, they don't have to be perfect grammar or even pseudo perfect grammar. The spelling can be off. Your handwriting can be a mess. Although if your handwriting is truly a mess, it might be hard to read later. By the way, folks, my older sister always teases me that my handwriting is frozen in the third grade. I actually would like to show her my journal entries. My handwriting was actually quite a bit better than it is now, which basically speaks to some degree of cognitive decline for me. But in any case, the point is that this third category of establishing links between the prior negative experience and whatever else is an important component of the writing protocol. So whatever it takes to include those links, they are worth including. Now, I want to reemphasize that even though I pointed to the positive health benefits of using more positive words in one's writing or speech, as opposed to negative words, which tend to be associated with worse health outcomes, both in terms of physical and mental health, it is important, and it's central to this writing protocol if you're going to get the positive consequences of it, that you're not monitoring the words that you're using too closely, you're not trying to write this so someone else can see it, you're not trying to write the great american novel. You're not writing your eulogy, you're not writing your autobiography. You're really writing this for you. I can't emphasize that enough. You're doing this writing protocol so that you can work through something that is stressful or traumatic, that resides in your nervous system and that is not serving you well. Indeed. Next we're going to talk about what happens when these narratives of our prior negative experiences are not worked through, that they have not been put either to speech or to pen, to paper or typed out. And perhaps more importantly, we're going to talk about the incredibly positive benefits, both at the level of neural changes, so called neuroplasticity, which is the literal rewiring of neural connections, as well as psychological benefits, reduced anxiety, improved mood, improved sleep, and improved immune function, that are the consequence of doing this. Four bouts of 15 to 30 minutes writing protocol. I'd like to take a quick break and acknowledge one of our sponsors athletic greens athletic greens, now called ag one, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking athletic greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking athletic greens, and the reason I still take athletic greens once or usually twice a day is that it gets me the probiotics that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long term health. And those probiotics and athletic greens are optimal and vital for microbiotic health. In addition, athletic greens contains a number of adaptogens, vitamins and minerals that make sure that all of my foundational nutritional needs are met and it tastes great. If you'd like to try athletic greens, you can go to athleticgreens.com huberman and they'll give you five free travel packs that make it really easy to mix up athletic greens while you're on the road, in the car, on the plane, etcetera. And they'll give you a year's supply of vitamin D, three, k, two. Again, that's athleticgreens.com Huberman to get the five free travel packs and the year's supply of vitamin D. Three, k, two okay, so let's talk a little bit about the positive mental and in particular physical changes that occur in people that do this writing exercise. I should mention that most of the studies, and again, more than 200 quality peer reviewed studies of this protocol have been carried out and are still ongoing, not just in Pennebaker laboratory, but in many, many other laboratories as well, reveal that the positive physical shifts that occur in people that complete this four bouts of writing in the way I described is both significant and long lasting. Now, of course, it is not the case that these four episodes of writing can completely cure major forms of depression or post traumatic stress disorder, although they have been shown to benefit, that is, to reduce depressive symptoms and to reduce the symptoms of post traumatic stress disorder considerably. But they shouldn't be considered complete therapeutics for those conditions. However, they have been shown to significantly improve many other health metrics, and I alluded to some of these at the beginning of today's episode. There have, for instance, been studies of this type of journaling protocol for people that have been suffering from chronic anxiety and insomnia, and indeed, they experienced significant relief as well. People who have suffered from arthritis, people who are going through cancer treatment. People who have lupus, which is an autoimmune disorder, report significantly improved symptoms, not necessarily cured from those conditions, but significantly improved symptoms as a consequence of doing this writing protocol. In addition, and earlier I mentioned this, I realized, but I'll mention again, people suffering from fibromyalgia, which is a chronic pain condition that is or can be very debilitating, has shown significant improvement in symptomology, that is, reduced chronic pain after they do this, four bouts of writing in the way that I described. And again, the relief from pain seems to be ongoing, again, not a total cure of their symptoms. I don't want to provide false hope here or over blow the positive impact of this particular writing protocol, but nonetheless statistically significant shifts that were pervasive over time. In addition, people suffering from IB's or irritable bowel syndrome have achieved some significant degree of relief of their symptoms relative to people who also have irritable bowel syndrome, but who do not do the exact same protocol that we're talking about today. Now, of course, in all of these studies, we're not talking about people that simply do this writing protocol as compared to people that don't do the writing protocol. Pennebaker and others, of course, are excellent scientists, and so they provide adequate control conditions. The control conditions in most cases were to have people also do 15 to 30 minutes of writing, but to do journaling in the more conventional manner of autobiographical report, of what they've been up to lately, or what they plan to do, in fact, very much like my journal entries from college and in the year subsequent to that. So it's important to understand that what we're talking about today is a journaling protocol, which seems somewhat conventional, but the exact protocol is highly unusual, as we've been talking about throughout today's episode. And in addition, all of the data that we're discussing in terms of positive mental and physical effects are data that were established relative, that is, are statistically significant as compared to a control group that also wrote for an equivalent amount of time, tended to write out an equivalent number of words on average, and yet were writing about something quite different than the people that were in the so called experimental group. So its important to keep in mind that were not simply talking about phenomenology here, were talking about scientific studies where very specific measurements of the experimental group, that is, the group that did this particular form of writing about something very distressing or even traumatic, four times, 15 to 30 minutes per time, relative to a control group that did nearly the equivalent form of mechanical processes of writing, but that the specific emotional content related to that writing was the major variable that differed. In fact, that is one particular strength of the protocol we're describing today, that, if you think about it, would be very hard to do. In a study, say, of physical exercise, where you have people perhaps run on a treadmill, getting their heart rate up to 85% of their maximum heart rate for 30 minutes, five days a week, you would expect that that group, compared to a group that did nothing, would experience significantly greater shifts in positive health metrics like lowered blood pressure. Certainly not during the exercise bout. During the exercise bout, you can bet that their blood pressure and heart rate went way, way up, but that, of course, afterwards, they would adapt to that exercise by having a resting heart rate that was lower than any group that did nothing or that walked on a treadmill. But it's actually very hard to think about a control group that would provide real equivalence of time spent and effort spent, but that would differ only on one variable, which would be heart rate. You could probably come up with something, but it'd be very difficult to do. Whereas in the studies that we're talking about during today's episode, essentially everything was the same, right? People are still writing, they're still sitting, they're still doing it for the same amount of time. It's simply that the content of the writing is different at the level of the emotional tone of the subject that they're writing about, which I find both exciting and personally quite motivating to do the sort of protocol that I've described today, because it leads to such dramatic shifts in health across a huge range of dimensions, both in people suffering from certain conditions and people who are not suffering from certain conditions. And then the question becomes, why? What is actually happening at a physiological level that can explain all of these incredible psychological and physical positive shifts that occur? Okay, so, as with any protocol that's shown in many, many studies, again, here, more than 200 peer reviewed studies to have positive effects on mental health or physical health. You can imagine that there's going to be a constellation of positive effects that occur that can explain, say, the improvement in autoimmune conditions or the improvement in anxiety, that is, a reduction in anxiety or the improvement in sleep patterns. It's not going to be just one thing. However, there are some general categories of physiological changes that have been observed in people that do the particular protocol we're talking about today that I think can explain a great number of the mental and physical shifts that occur. Now, one of the more important studies in this area that's been published. And here again, this is a paper by James Pennebaker. But I don't want to give the impression that he's the only person or the only laboratory that's looked at this particular writing protocol. Many others have as well, and I'll provide links to some of those in the show. Note captions, but this particular study I'm about to describe explored how the disclosure of traumas or the writing out of very stressful experiences can impact immune function at the level of specific cell types of our immune system that are challenged in a way that mimics the sort of challenge we would experience if we were to be exposed to a bacteria or virus. Now, without getting into a detailed lecture about immunology, and by the way, I did an entire episode of the Huberman lab podcast about immune function in the brain some years ago, and you can find that by going to hubermanlab.com, comma, just put immune system into the search function. It will take you to that episode and to any timestamps of other episodes where I touch on immune system or protocols related to immune brain function. In the meantime, this particular study is very interesting and worth highlighting, because what they did was to essentially have people do the exact same protocol that we've been describing throughout today's episode. But they also included blood draws from the subjects in those experiments, and they collected that blood from subjects both before and after the writing episodes. In fact, they took the blood 15 weeks prior to the study and again six weeks into the study. Okay, now, keep in mind that people were completing the writing exercise over the course of, at a maximum, four weeks, but they were still monitoring these subjects in terms of their psychological and physical health after the final writing exercise. That was a key component of essentially all of the studies of this particular protocol. They'd assess people before they did the writing assignment. They assessed people during the writing assignment, and they assessed people often long after the writing assignment was completed, even years after the writing assignment was completed. So in this particular experiment, they're drawing blood 15 weeks before and six weeks into the study. Six weeks into the study is after all of the writing. That is, the four bouts of writing have been completed. They also divided subjects in this study into people that were so called high disclosers. So these are people that revealed a lot about their particular traumatic or stressful episode in their writing and people that were low disclosers. They also included a control group, and the control group was essentially as I described before, it consisted of people that also were doing journaling for the equivalent amount of time as people that were in the experimental group, but that were not writing about a traumatic or stressful experience. Now, the basic takeaway of this study is as follows. They take the blood. They are able to isolate from the blood something called t lymphocytes. T lymphocytes are an essential component of your immune system. These are cells that many people describe as white blood cells. They are manufactured in the bone marrow, which I still find amazing. Right? We think of bone as just these, like, you know, hard components of our body and our skeleton that allow us to be upright and to be rigid and to move about and, you know, not be, you know, jelly like. But indeed, in the center of the bone is marrow. And the marrow itself is performing important physiological role, many roles, in fact, one of which is to create these t lymphocytes, or white blood cells. They actually are born of the bone marrow, but then they mature in a structure called the thymus. The thymus is an organ that sits essentially behind your sternum. And it's there that the cells that originate from the bone marrow are matured into what are effectively white blood cells, which are essentially cells that go out and combat infections, bacterial infections, viral infections, even fungal infections. Now, they combat infection not alone, but in collaboration with other immune cell types that you can learn about. Again, in that episode that I did about the immune system and the nervous system, if you choose to go listen to it. And even if you don't, here's what you need to know about this study. In this study, what they found is that when they took the blood from these subjects, isolated those t lymphocytes, and then challenged those t lymphocytes with something that mimics an infection. And they did that with something called concanavalin a. Concanavalin A is what's considered a mitogen. It's something that activates t lymphocytes and it activates what are called natural killer cells. Now, that's a lot of detail for sake of this episode. Basically what the concnavalin A is doing is it's mimicking an infection. But in this particular study, this is all being done on t lymphocytes that have been collected. They're put into a dish, and then they're exposed to different concentrations, going from low to medium to high of that concnavalin A, mimicking a low grade, moderate or severe infection. And what they observed in this study is remarkable. I mean, to me, this just still blows my mind, people that did this for bouts of writing protocol experienced greater degree of t lymphocyte activation from the concanavalin mitogen challenge, which mimics infection, than did people who wrote about something that wasn't stressful or traumatic. Now, that itself is pretty striking if you think about it. I mean, we're talking about a writing exercise that generates an emotional state versus a writing exercise that does not produce as negative or intense an emotional state. And we're talking about a significant effect on the immune system or the mobilization of immune cells in response to an immune challenge. In addition to that, however, they observed that high disclosers, that is, people that really poured themselves into this writing protocol, experience a greater degree of immune activation, that is, fighting off response to this mitogen concanavalin A, than did people that were low disclosers. So this really speaks to the fact that the intensity of the emotional state during the writing exercise is having a significant impact on the immune system at the level of something as basic and yet as powerful as how much deployment of immune response there is to an infection. Now, the field of so called psychoneuroimmunology has been around for more than 30 years. In fact, if you don't apply standard definitions to that field, it's been around for thousands of years. But really, it's only in the last ten years or so that scientists and physicians, at least standard scientists and physicians, have started to really adopt the understanding and really apply to their studies and their clinical practice. This firm idea that the body and mind are linked in this way, that emotions can really shape our physical responses and that physical responses also can shape, of course, our mental responses. Now, I'm not trying to be disparaging at all of traditional science or medicine. It's just that until recently, these fields have existed more or less as silos. People that studied bodily organs versus people that studied the brain, people that studied emotions and psychology versus people that studied the immune system. And there's been some crossover, but by and large, it's been very siloed. Now, I mention this because if you look into the history of why James Pennebaker and colleagues started exploring this particular pattern of journaling, it actually relates to his own personal experience. And I don't want to spend too much time on this, but it's worth mentioning that Pennebaker has actually spoken about and written about in, by the way, an excellent book that I've linked to in the show note captions where he talks about his experience in suffering pretty severely from asthma as a child, and that that asthma was seasonal. And yet at some point later in his life because he had certain relatives visiting him in his new home location, that his asthma would come and go as a consequence of interacting with certain members of his family independent of season. And basically what he deduced from his own personal experience is that there must be some link between our emotions, either negative or positive, and our immune system or other physical ailments or thriving in the physical sense. Now, he certainly wasn't the first one to come up with that hypothesis, but indeed, he was one of the first to really start exploring a protocol within the laboratory, an experimental protocol that could really tap into high degrees of emotionality, in this case, negative emotions. And the consequence of that on physical health outcomes. And this study that I mentioned is but one of those examples. And in that way, he's truly a pioneer in thinking about, quote unquote psychoneuroimmunology, but couching it not in the direction that most people do, which is, for instance, there have been lots of studies where people have said, okay, in people that are chronically stressed, which includes, of course, psychological stress, what are the effects on the nervous system, the immune system, etcetera. And as you could imagine, in general, people who were more stressed over long, long periods of time had worse physical outcomes, and people who were less stressed had better physical outcomes. But the protocol that we're talking about today is quite a bit different. So if you step back and think about it, it's a little counterintuitive. What Penebaker essentially did was to have people deliberately induce a negative experience, and yet they're seeing positive physical health outcomes, or in this case, positive effects on immune system function. So that leads to the question of what's really happening during and after these four episodes of writing. And that's where things get especially interesting as it relates to the nervous system and to neuroplasticity, or the nervous system's ability to rewire itself in response to experience. So that's what we're going to talk about next. Okay, so what's happening at a mechanistic level that allows people who do these four bouts of writing about something traumatic or stressful to achieve these long lasting positive shifts in mental and physical health? Now, there could be any number of different changes occurring at the level of the mind or body, but what we're talking about here is trying to find the pivotal one, or sometimes referred to as the linchpin mechanism, that when one taps into that mechanism, it wicks out into all these different systems of the brain and body and provides all of these different positive benefits. Now, in researching this episode, I thought long and hard about this and came up with a short list of ideas. And as is always the case, people have worked in this area on this particular protocol, and protocol similar to it in the field of psychology and neuroscience, have also generated their own short list. And those shortlists converge at the level of one particular mechanism that is worth describing. And that one particular mechanism is anchored around the concept of neuroplasticity, that is, our nervous system's ability to change in response to experience. And if you've heard me talk about neuroplasticity before, neuroplasticity in childhood occurs through rather passive experience of any sorts of events. In fact, one of the hallmarks of childhood is that just the mere exposure to an experience reshapes the brain, not necessarily permanently, but often in a way that is very long lasting. Now, that's a feature of childhood, because if you think about what the nervous system is really designed to do for us, it's, of course, what allows us to move our limbs. It's what allows us to have a heart rate that goes in the background without us having to think about it. So called autonomic functions. It's what keeps us breathing without us having to think about it, and on and on. But one of the main functions of the nervous system is to be a predictive machine to make good guesses about what's to come next. And one of the ways to make really good guesses about what's to come next is to take a certain period of life that we call childhood, superimpose on that period of life, that childhood, what we call a critical period or sensitive period, during which our experiences create a sort of map within us that allow us to predict, okay, well, if this person's in the room later, well, then that's likely to happen. Or if those people are in the room, any number of different things could happen, but of one particular category of experience as opposed to another. That's really what your nervous system does. It becomes a prediction machine, and it becomes a prediction machine by drawing strong correlations between emotional states, your physical surroundings, your perception of who's there, what's there, what happened just prior to something, and how it made you feel later. So when we talk about recounting a stressful or traumatic event, if you recall, there were three components to it. It involved facts about that experience. So, literally, who was there, what happened. As to the best of our recollection, if you recall the second thing, it's also about recounting how that experience made you feel at the time and how it makes you feel now and then. If you recall, the third thing that's critical to include, it's about any links or associations between what happened and really anything at all. So if you think about it, all three of those things in that list are really about tapping into your neural map or your schema, as it's sometimes called, or your internal representation, both conscious and unconscious, of what happened during that stressful or traumatic event. Now, a hallmark feature of traumas, as well as a hallmark feature of addictions, as well as a hallmark feature of compulsive behaviors or negative habitual behaviors and negative habitual states like chronic stress, anxiety, the sorts of things that trigger insomnia, the sorts of states of body that trigger immune compromise and give us autoimmune or other types of immune system. Challenges are that a certain component of our nervous system, and our brain in particular, are less engaged than they normally would be in the healthy condition. Now, I want to be clear that in any one of these conditions, whether or not it's irritable bowel syndrome or it's fibromyalgia, or it's chronic anxiety or depression, there are many, many different brain centers and networks, that is, stations within the nervous system of the brain and body that are involved. I really want to emphasize this. There's no one location in the brain, for instance, for fear or anxiety. It's always a network phenomenon, the relative activation of different brain centers at different times and so on. But with respect to thinking about traumas and stressful experiences, we have to ask ourselves, what is it about the emotional states and all the mapping, the representation around those emotional experiences that would somehow impact our immune system, like our thymus, of all things, or our bone marrow? Or conversely, what would it be about a stressful experience that would impact our heart rate, that would somehow then also change our brain? So the mechanism that seems to be a sort of smoking gun of sorts, that is, the mechanism that really does seem to be at least one of those linchpin mechanisms, is that when we experience very stressful or traumatic experiences, our prefrontal cortex, the neural real estate that's just behind our forehead, which has several different subdivisions, in fact, is reduced in its overall levels of activity and other areas of the brain that sometimes are referred to as the limbic areas of the brain. Although if we were to be more accurate than that, the modern neuroscience really refers to these as subcortical structures. They aren't necessarily limbic structures per se, although they can include components of the limbic system, so they can include things like the hypothalamus. So this dense collection of neurons that resides over the roof of your mouth, that's involved in things like aggression or temperature regulation, sleep wake cycles, and so on, as well as structures that perhaps you've heard more about, such as the amygdala, which is involved in threat detection, but other structures as well, all of which are subcortical. Now, those subcortical structures can be compared in a fairly general but still accurate way to the prefrontal cortex, which is involved in contextual planning, involved in assessing outcomes. If I do a, what will happen, if I do b, what will happen? The prefrontal cortex is also associated with our self concept of our identity, who we are, what we are about, what we value, what motivates our decisions to do or to not do things. So I don't want to create any false impressions that the prefrontal cortex is somehow a more evolved structure than the subcortical and limbic structures, but in some sense, it is. It's involved in more quote unquote, sophisticated functions, or at least functions that involve us really thinking and being able to place a coherent narrative of what happened in the past, what's happening now, and what's likely to happen in the future if conditions a, b, or c happen to arise. Okay, so that's a very brief, top level contour lesson in prefrontal cortical function and comparing it a bit to some subcortical and limbic structure functions. Now, there have been neuroimaging studies, in particular studies by the Lieberman laboratory at University of California, Los Angeles. But neuroimaging studies and other laboratories as well, that have established that when people recount very stressful or traumatic events, the prefrontal cortex level of activity is reduced as compared to when people recall less stressful or less traumatic events. In addition to that, those subcortical structures ramp up their activity when people recall traumatic events, at least at first. Okay, this is very important. What I'm about to tell you is that the repeated visiting of stressful and traumatic events in a structured way, or even in a pseudo structured way, as is the case when people first start journaling about that stressful or traumatic event on day one, when it tends to be a pretty unstructured narrative that's actually been shown in the literature. And then over the course of that second and third and fourth writing bout, people not only shift the sort of language that they use to describe their feelings in that event, as we talked about earlier, but the degree to which there's a more coherent narrative placed on the structure of that writing. Increases with each subsequent bout of writing. And this is very important, because what we're really talking about here is people going deeper into their recollection of the experience, not remaining at such a superficial level. And two things are happening. Even though they're going deeper into this very distressing event. They're perhaps even experiencing heightened levels of distress. Right. If you recall back to earlier in the episode, when I talked about people who tend to be on the low disclosure end of things, they're not very verbose. They don't tend to use a lot of emotional words. And early on, they're not sharing too much about this experience. And over time, it increases, whereas the other group decreased the level of emotionality with each subsequent writing bout. But in each case, the coherence of the narrative, that is, the degree to which the narrative takes on a story like structure, increases from the first to the fourth writing bout. And this is very important, because what we're really talking about here is increasing the amount of truth telling, the honesty around the experience. And when we say honesty, I'm not talking about any prior debate or ongoing debate about what happened during those experiences. Remember, when people do this protocol, you're recalling what happened. What were the facts in your mind? What were the facts? What happened. What didnt happen, perhaps is relevant too. But what happened second, how did it make you feel? Thats something that you are uniquely qualified to answer factually. Because only you can really know how you feel. Sometimes it takes some effort to think into how you feel. To really get a clear sense of how you felt and how you feel. But only you can report that factually. No one can dispute that those are your feelings, and that's part of what you're writing about. And then, of course, there's the third component of what are the connections between different experiences that are coming to mind. And there again, that is your unique factual report of what's going on inside your head around that event. Okay, so what we're talking about here is an exercise in writing that, yes, is distressing. But that we know, based on neuroimaging data over time, is increasing the baseline levels of activity in certain key areas of the prefrontal cortex. And that we know is associated with improvements in the symptomology around trauma and other stressful events. Now, it's extremely important to highlight this truth telling component. And the fact that your truth about these experiences is indeed your truth. And it's such a key component of the writing exercise. So what we're looking at here is a situation where the event or events that happened actually happened. There's no changing that. But your narrative about those events is vitally important in terms of how you experience either ongoing distress from or relief from those events, and in sort of a counterintuitive way, reporting those events in a way that initially is very stressful or that can be stressful in any number of those different for writing bouts over time provides relief from that stress. So why do I say counterintuitive? Well, you could say, okay, well, then, does distress itself cause changes in the prefrontal cortex that are positive? No. In fact, the opposite is true. We know that being under conditions of duress or stress or trauma reduces activity in the prefrontal cortex. And here we're saying, recalling that trauma and stress in ways that are highly emotional and negative is actually increasing ongoing activity in the prefrontal cortex. And indeed, yes, that is the case. So how could that be during development? Neuroplasticity is a passive process. Whatever we are exposed to changes our brain in a way that allows us to more reliably predict the future. Right? That's one of the key functions of the brain. But as an adult, meaning from age 25 onward, and really, that's not a strict cutoff, could be late teens, maybe 19, all the way up to, say, age 120, which we think is perhaps the maximum lifespan that humans could possibly reach. We don't know. Most people don't reach 120, but let's say from 19 all the way up to 120. We know that neuroplasticity is created when the nervous system goes into states that are atypical as compared to our normal waking states. And one of the key triggers for neuroplasticity is when we have high levels of the so called catecholamines, dopamine, epinephrine, and or norepinephrine in our brain and body. That creates a state change that we call autonomic nervous system shift, where we have elevated heart rate, more distress, high degrees of emotionality. It is highly uncomfortable often, and yet that signals to the neural tissue, hey, something's happening here, and we need to rewire. We need to change. And the actual rewiring occurs during deep sleep, and states such as non sleep, deep rest, or any time we're in a deep relaxation state. Some of you have heard me talk about neuroplasticity before, but the key elements to remember for today's discussion is that these states of heightened levels of emotionality are the trigger for neuroplasticity, and that the actual rewiring of neural connections happens in sleep and states such as non sleep depressed. So, if we were to be completely logical, we would sit back at this point and say, okay, here's a protocol in which we deliberately make ourselves stressed out again about a very stressful or traumatic event. And yet, even though that stressful or traumatic event at first created problems for our mental and physical health by revisiting it and triggering that stressful experience again four times in a lot of detail, somehow it's giving me relief from that experience. It's creating positive mental and physical shifts. I mean, how could that be? How could it be that the negative experience, on the one hand, creates problems, and then, on the other hand, recreating that negative experience relieves those very same problems? There's something completely illogical about that framework. Right. Well, here's where things get really interesting. There have been two separate collections of work in the psychology and neuroscience literature in the last ten years which have focused mainly on two concepts. The first concept is that extremely stressful and traumatic experiences, because they induce a relative reduction in the activity in the prefrontal cortex, divorce our mind from creating a coherent, structural narrative about what happened during those particular episodes, and in doing so, create a sort of confusion about responsibility. Now, there's a whole discussion to be had about this, and we will have that discussion in a future episode of the podcast about how trauma is actually mapped within the brain and body. There are a lot of theories about this, right? Sometimes we hear that it's all mapped within the body. Sometimes we hear it's all mapped within the brain. Turns out, as is almost always the case, it's both. But there does seem to be both neuroscience based and psychology, both clinical and research, psychology based evidence for the idea that when people experience very stressful and traumatic events, that the representation of those events is somewhat fractured in the sense that people, by not talking about them, by not creating a coherent narrative around them, start to form false correlations between the kind of stress that they create in our body and mind when we think about them and a confusion about what happened, a confusion about why we feel terrible when maybe we weren't the perpetrator or create a sort of lack of coherence between our bodily state and what we're thinking. Especially because we're not the perpetrator, right here, we're talking about traumas and stressful things that happened to us. Maybe we were participants in that by virtue of our circumstances. But when we talk about traumas. What we're really talking about are things that we would have never elected to do otherwise. Okay, so I don't want to be too abstract about this, but again, within the neuroscience and psychology understanding of trauma and stress, it seems that there's a lack of coherence about the narrative. There's also a mismatch between the bodily state and thoughts about that experience. And there seems to be a confusion about who or what was responsible for inducing that negative state in a way that, in some sense, causes people to set aside that narrative and try and push it away and not think about it, because it is confusing. It can often even be discombobulating for those that have suffered from very stressful events and trauma. I think some of this will resonate with you. Now. A separate literature that's largely nested just within the neuroscience community, although it's starting to wick out into the psychology community as well, is the idea that when people tell the truth, and in particular when people tell the truth with a very coherent, structured narrative, the levels of activity in the prefrontal cortex increase, but not just temporarily. That is that there's neuroplasticity of these prefrontal cortical structures, which are both involved in generating coherent narratives but are also involved, and this is super important, that are also involved in regulating the activity of those subcortical structures, like the hypothalamus and limbic structures. In other words, that when we can increase our understanding of an event, when we can understand why certain emotions arose, what our role in it really was, what others roles in that particular event were, well, then, by increasing the activity of the prefrontal cortex, it's better, both in that moment and going forward, to regulate the activity of these other subcortical structures. And I think one of the more impressive experiments within that whole field of linking prefrontal activity to truth telling is an experiment that was published a few years ago in the proceedings of the National Academy of Sciences entitled increasing honesty in humans with noninvasive brain stimulation. Now, this is a very artificial scenario where people come into the laboratory, and they have people do what is essentially a die rolling game. They roll dice. Okay, so they're rolling dice, and then after they roll the dice, only they can see the score that they get with those dice. And then a number is presented on a screen, and they have to report whether or not the die roll that they did matches or does not match the number that's presented on the screen. And if it does match, then they get a monetary award. And the monetary award is not huge, but it's not insignificant either. For each die roll, where they match the number that's presented on the screen, they get the equivalent of. And because this experiment was done in Switzerland, nine swiss francs, which at the time of the study corresponded roughly to $9. And today corresponds to roughly $10. So they do this repeatedly. And so, in some sense, the subjects in these experiments are in a place to make not an enormous amount of money, but again, not an insignificant amount either. Now, here's the key component of the study. The statistics of the dice that they roll and the statistics of die rolling and the numbers that they are presented make sure that there can only be a correct match, on average, 50% of the time. Okay? And in this experiment, the subjects are asked to report entirely on the honor system, what they got when they rolled the dice. And what one finds in this study and other studies that have been done subsequent to it, is that when you take everyday people, so you take men and women, you take a broad age range, you're not selecting for sociopaths. You're not selecting for people in one given profession or another. Pick your favorite profession. If you were to assume any one given profession has less honest people than others, they collect people from all sorts of walks of life, and people report getting the same number that is presented to them, that is a match about 68% of the time, which means they are not faithfully reporting what happened. Now, neuroimaging studies show that when people lie, certain areas of the frontal cortex increase in their activity. Although the major effect when one looks neurally is a reduction in the prefrontal cortex and in particular, subcompartments of the prefrontal cortex that we'll talk about in a moment. And this particular study, entitled increasing honesty in humans with non invasive brain stimulation, as the name suggests, used noninvasive brain stimulation. So this is transcranial magnetic stimulation, which is a really nice and convenient tool because you don't have to drill down through the skull. You can simply put this tool. It's a little coil. You put it over a particular part of the brain on the outside of the skull, indeed, on the outside of the hair. And you can either inhibit or stimulate particular brain areas using this transcranial stimulation. I've actually had this done not in this particular experiment, but I had it done when I was a graduate student some years ago, and it was placed over my motor cortex, and I was instructed to tap my fingers in a particular sequence, and then they inhibit neural activity. In a particular brain area, and I was unable to tap in that same sequence, and they could even shut down my ability to tap. It was terrifying, frankly. Although I don't want to discourage anyone from participating in any of these experiments, should you choose. And, yes, of course, your motor abilities come back immediately afterwards. That's why they can run these experiments. Now, in this experiment, what they did is they stimulated or inhibited neural activity in particular areas of the prefrontal cortex. And what they discovered was, I think, and many others, by the way, also agree, a remarkable result, which is that when they stimulated over a particular region of the prefrontal cortex, people's honest report of what happened when they rolled the die relative to the number they were presented increased. Okay? So they went from reporting that they had matched the number on the screen and therefore won money 68% of the time. That number was reduced down to what? Down to 50% of the time. In other words, this stimulation of the prefrontal cortex took dishonest people, even though they were, shall we say, mildly dishonest or dishonest only in certain conditions, they were getting into judgment calls, and I don't want to do that. And made them truly honest. They faithfully represented reality. When a particular area of the prefrontal cortex, and that area, by the way, is the dorsolateral prefrontal cortex, was activated, they became truly honest. They faithfully represented what happened in the die rolling game. Now, the conditions in this experiment are far and away different from the journaling protocol that we've talked about up until now. However, there have been subsequent studies that have shown that, indeed, when people tell the truth to the best of their abilities, they are absolutely trying to faithfully report what happened in a given experience of theirs. Activating the prefrontal cortex goes up and it persists afterwards. There is, indeed, neuroplasticity of the prefrontal cortex. So the hypothesis that seems to be the most likely and indeed has the greatest weight of evidence for it, is that when people accurately and truthfully report an experience, even if that experience is a stressful and traumatic one, the repeated activation of the prefrontal cortex that occurs during that truth telling, even though the truth telling is about a highly negative experience, has the net effect over time of leading to more activity in the prefrontal cortex. And that has a sort of runaway positive effect in the sense that it creates a more coherent framework and understanding of the stressful thing that happened. Right. So all that discombobulation and that lack of coherent story that then leads to lack of coherence in terms of one's autonomic function underlying stress and confusion about who's responsible, that does seem to be resolved, or at least partially resolved. And the prefrontal cortex, of course, doesn't harbor one area just for faithful, accurate reporting of traumas and stressful events. That very same area, that dorsolateral prefrontal cortex, is responsible for faithful reporting of all sorts of other things. And there are now more and more studies showing that truth telling, faithful, accurate representation of what we at least experienced in our past and are experiencing presently is good for us, both in the short term and the long term. And this, I believe, and other researchers, both neuroscientists and psychologists and psychiatrists that I've talked to about this result, are in agreement that when one sees all these positive shifts in, say, immune system function, like, how could it be that these cells produced by the bone marrow and the thymus are somehow better able to deal with an infection when one has recounted a traumatic or stressful event? Right. First of all, it's counterintuitive. Second of all, why would that be? I mean, how are the body and brain linked in that way? Well, they're linked through this thing that we call the nervous system. And the key component of the nervous system in this context is that when the prefrontal cortex can organize its understanding of why our autonomic nervous system was so active, well, then the autonomic nervous system, it seems, becomes less likely to be active when it's not supposed to. Okay. That could at least partially explain the reductions in anxiety, the improvements in sleep, the reductions in insomnia. And because the nervous system and the immune system are in direct communication, this often isn't discussed. But not only does the immune system impact the brain, but the brain has networks, literally neural circuits that innervate structures like the spleen, like the thalamus, that can communicate with the bone marrow. Right. This isn't science fiction. This is really the case. In fact, there was an article that just came out in the journal Nature this month, and I'll provide a link to it in the show. Note captions which is finally starting to acknowledge that, yes, while these fields of immunology and brain science and psychology have existed as disparate silos up until now, it's oh so clear that the nervous system is the connection between all these different components of brain and body. And so while it might seem counterintuitive that a writing protocol of the sort that we've been talking about today could positively impact the immune system or that a writing protocol of the sort that we are talking about today could positively impact things like fibromyalgia symptoms. Well, it makes perfect sense, really, when we start to think about the prefrontal cortex as this highly flexible seat of our cognition, about our self representation, our ideas about who we are, and about when certain elements within our brain and body ought to be activated and when they ought not to be activated. Because so much of the negative symptomology of stressful events and traumas is about the kind of disarray and discombobulated activation of wakefulness in the middle of sleep, getting woken up in the middle of the night and not being able to go back to sleep or elevated heart rate, panic, panic attacks, anxiety, and on and on. I talked about some of this in the Huberman Lab podcast episode that I did about stress and how to master stress with particular protocols. It also came up in the discussion with Doctor Paul Conte in the episode about trauma and the series on mental health. So what we're pulling together here is a mechanistic understanding of why something like writing for 15 to 30 minutes about a stressful or traumatic episode would or even could induce all these positive shifts in mental and physical health. And while we don't have a complete understanding about the underlying mechanisms, the activation and the neuroplasticity of the prefrontal cortex seems to be one of the most logical and the most likely that sits at the center of at least the top list of the most important mechanisms. I want to be clear that, yes, indeed, I'm saying that when you write about your truth, about the facts, the events of an experience, and your emotions as they relate to that experience and the connections that you draw between any number of different things around that experience, that the truth telling is the stimulus, and that the emotion that accompanies that truth telling is what allows for neuroplasticity to occur, and that indeed, truth telling and heightened levels of emotion, even if they're negative emotions, really do seem to have a positive rehabilitative effect. They're not necessarily going to cure every ailment. I certainly don't want to give that impression. Nor am I saying that people can't still benefit from therapy, talk therapy, or other forms of therapy, like prescription drug therapy, et cetera. Those certainly have their place. You should talk to an expert psychiatrist, psychologist, medical doctor, of course. And in fact, the data on the sort of journaling that we talked about today indicate that people's progression through talk therapy, drug therapies, et cetera, for depression and ptsd is accelerated and significantly so when they do this type of journaling. So the sort of journaling we're talking about today and other therapies are not mutually exclusive. And yet the journaling protocol that Pennebaker and colleagues came up with, I think is spectacular because it has a number of important features, and some of those are perhaps obvious to you already. First of all, it's completely zero cost. I mean, it costs a bit of time, but not even that much time. It has an emotional cost. We should acknowledge that. And the more intense it seems, the more effective. And third, it's something that really can be done either in the course of four days or across an entire month. So it has some degree of flexibility to it, I would even say a great degree of flexibility to it. And last, but certainly not least, it's been shown over and over again. I mean, more than 200 peer reviewed studies, not just from Pennebaker, but from others as well, to have myriad positive effects on the body and the mind in ways that are not just short term, but that are pervasive, not just over months, but indeed over years. So I don't know about you, but when I first learned about this literature, I was, well, initially a little bit skeptical, because that's just my nature. I'm like, wait, how could journaling have such a huge impact? I mean, I've been journaling for years. I know other people that journal on a regular basis, and I've never heard of this particular impact, and I certainly haven't heard or seen the data. But when I started looking at the data, I thought, oh, my goodness, like, how come I haven't heard about this? And I don't really have an answer for that. Although I will say that Pennebaker and others, I think, were very early in their merging of mind and body states, although the initial studies weren't really focused on mind and body, all the emphasis on immune system and brain and neuroscience, that actually came later. So I think one of the reasons we haven't heard about this particular form of journaling is that, frankly, it's nested within the academic literature. I haven't heard much about it being incorporated into clinical practices, although I am sure it is incorporated into clinical practices. And frankly, whatever the reason, I'm just grateful to my colleague, Doctor David Spiegel, who, again, is our associate chair of psychiatry at Stanford. He's a medical doctor, incredibly highly esteemed worldwide for his work on neuroplasticity and helping people with stress and anxiety and all sorts of other challenges for informing me about it. So much so that I decide that next month I'm going to do one bout of writing for each week. Within that month, I've opted to not do the four consecutive days of writing. To me, just personally, that seems a bit too intense. It's not the time commitment, it's the emotional commitment of placing myself into close proximity of some really challenging, stressful, maybe even traumatic Memories day after day after day for four days. Personally, I don't want to do that. Other people might opt to do that in tighter succession and do the four days in a row. What the literature tells us again, is that it doesn't really matter as long as you do the four bouts of writing sometime within a month period. Doesn't matter if they all are back to back days or you spread them out by a week or so. Just to recap the other components of the protocol, you're going to write about the same event for all four writing episodes. Those writing episodes can be anywhere from 15 to 30 minutes, but not less. Throughout each writing episode, you're going to continuously write. Unless you need to stop to catch your breath or wipe your eyes dry of tears, you're going to keep writing. It is not necessary to pay attention to grammar or spelling, but some degree of coherence. Maybe not perfect, complete sentences, but some degree of coherence is probably useful, especially if you decide to go back and analyze what you wrote later, which again is an option. You don't have to do that, but if you do want to do that, you're going to go back and circle the negative words. That is, the words that you perceive to be negative, and you're going to square the words that are positive. And if you like, you can also reread them and see whether or not, as was observed in the studies that we described, there was an increase in the amount of cohesion adherence about the topic or the event that you wrote about. Keep in mind that for each of the four ballots of writing, you want to include both facts about the events, facts about how you felt and or feel about those events now and third, any associations whatsoever that happen to come to mind about those events, emotional states, people in your life, anything past, present or future. That third category of things to include is really open to you for anything you want to include. The only requirement for it to be included is that it's true for you. Keep in mind also that this writing protocol is for you. It is not necessarily to be shared. Now, there isn't a rule that says that you cannot share it with anybody. Although I do want to introduce the important caveat that if you are going to share it with someone, that person should be a dedicated healthcare, ideally mental health care professional. Because there are data that suggests that when we write about traumatic and stressful events, while it can be very beneficial for us, it can actually be traumatic or challenging for people that we read it to. Now, there's huge variation around that statement. Certainly many of you probably know friends or family members or other trusted ones that you can talk to that would be able to hear about your stressful or traumatic experience and not be traumatized by it. However, it does seem that the listener can experience trauma and negative symptoms such as challenges, sleeping distress, etcetera, by hearing about very stressful events that have occurred to others. Okay, this is thirdhand trauma or observational trauma, it's sometimes called. So if we were to adhere to the protocol as it was used in the various studies that form the basis for what we're talking about today, we would say that you are writing about something that is for your eyes only. In fact, you are welcome to tear up or delete the document afterwards. And certainly you would want to store it in a safe place so that it's not going to fall into hands of somebody that you wouldn't want seeing the contents of that writing. The other thing to keep in mind is that while it's been demonstrated over and over again that over time, these bouts of writing lead to improvements in mental and physical health. As we talked about earlier, it is very normal and in fact, quite likely that one will feel pretty activated in the negative sense, that one will feel somewhat low, depressed, angry, sad immediately after finishing one of these bouts of writing, especially if you fall into the high expresser category. So it's important that, as we mentioned earlier, that you have a buffer of time after which you complete the writing before moving into your other day's events. I also just personally wouldn't recommend that you do this writing exercise just prior to trying to go to sleep at night if the experience is especially stressful or traumatic. And by definition, the writing exercise focuses on stressful and traumatic events. So keep that in mind as well. And then, as a final point, but certainly a significant one, is to keep in mind that if this writing protocol is creating in you significant enough amounts of stress, either psychological or physical, that you simply don't want to do it, or that it's impeding other areas of life, by all means, just stop. Okay? There was very little, if any, data within the papers that I read that indicated that people had to be removed from the study for this reason. But keep in mind that we're talking about purposefully delving into stressful or traumatic experiences and writing about them in some detail. So it stands to reason that some people might not be able to tolerate that. And I want to strongly request that before anyone embark on this writing protocol that you ask yourself whether or not you are indeed prepared to deal with the emotional state that might accompany faithful, accurate recollection of what happened, what you felt, and any links or experiences a full four times across the protocol. I also see no reason why you couldn't do this protocol for something that wasn't the most stressful or traumatic event in your life, but rather take your first pass at this protocol with something that was very stressful, maybe even traumatic, but perhaps not the most traumatic event as a way of sampling whether or not it's for you. In fact, I plan to do that. In reviewing the literature and preparing for today's episode, I wrote down two things, possibly three, that I would want to write about, and then I rated them one through three, one being the most stressful, perhaps even traumatic, the other being less stressful, and the third, the least stressful of the three, and decided to go with writing about the second in that list. That is the moderately stressful, aka traumatic event as a way to first wade into this protocol. But I will adhere to the protocol. I'm going to write about that same thing four times, as opposed to switching from one event to the next midway through the protocol. So I am going to adhere to the protocol. I'll certainly be happy to get back to you and let you know how it goes. I invite you, if you like, to embrace this protocol, to try it. We've provided links to the literature that supports this protocol. Again, it's very rare, perhaps the first time, that I've ever done an entire podcast episode about a single protocol, or to formulate an entire podcast around a protocol. But frankly, I don't look at this protocol from Pennebaker and colleagues as just a protocol. I look at it as an entire body of literature that includes a center of massive data that all seem to point in the same direction, which is that writing about something very stressful or traumatic for 15 to 30 minutes, four times, either on consecutive days or separated out by a week, between each of those four writing sessions, can produce long lasting positive effects on mental and physical health. And to me, that's a protocol that is simply too valuable to overlook and simply too valuable to not share with you. If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific, zero cost way to support us. In addition, please subscribe to the podcast on both Spotify and Apple. 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