CHAPTER 3

CONTROL YOURSELF

BOOST THE BRAIN’S EXECUTIVE CENTER TO MAKE GREAT DECISIONS AND AVOID ONES THAT RUIN YOUR LIFE

The best car safety device is a rearview mirror with a cop in it.

BRITISH COMEDIAN DUDLEY MOORE

The prefrontal cortex (PFC), the front third of the brain, is the cop in your head that helps you decide between right and wrong and determine whether an action is beneficial. It assists you in directing your behavior toward your goals and braking when it starts to get out of control. The PFC is the leader in you and is arguably the most important part of your brain when it comes to making the decisions that will help you feel better fast and make it last.

Neuroscientists call the PFC the executive part of the brain because it functions as the chief executive officer of your life. When it is healthy, this boss in your head is goal-oriented, focused, organized, thoughtful, and simultaneously present- and future-oriented; exhibits good judgment; learns from mistakes; and is able to control your impulses. When this part of the brain is hurt, for whatever reason, it is as if the leader in your head has gone on vacation (when the cat’s away, the mice will play), and you are more likely to act in impulsive, ineffective, irresponsible, or abusive ways. This not only hurts you but can hurt others as well. Healing the PFC can therefore help you and those around you —colleagues, employees, your kids —feel better fast. In this chapter, we’ll explore how the PFC develops and how to protect and strengthen it.

The PFC is proportionally larger in humans than it is in any other animal by far. It represents 30 percent of a human’s brain, 11 percent of a chimpanzee’s brain, 7 percent of a dog’s brain, 3 percent of a cat’s brain (which is why cats need nine lives), and one percent of a mouse’s brain. The PFC is the part of your brain that makes you human. It is involved in the following executive functions:

THE PREFRONTAL CORTEX

Side view of the brain with an arrow pointing to the lower front region.

Pinocchio’s Jiminy Cricket embodies the role of the PFC. Near the opening of the movie, the Blue Fairy dubs Jiminy “Pinocchio’s conscience, lord high keeper of the knowledge of right and wrong, counselor in moments of high temptation, and guide along the straight and narrow path.” Jiminy’s job is to help Pinocchio work toward his goal of becoming a real boy. When Jiminy is away from Pinocchio, the wooden boy nearly loses his life from a series of bad decisions. Similarly, not having a healthy PFC costs many people their success in life and, in some cases, their very lives. The PFC supervises you. It is the small voice in your head or the angel on your shoulder encouraging you to do the right thing and to reach the goals that are most important to you. When your PFC is hurt or its activity level is low (as it often is in people who have attention deficit hyperactivity disorder, or ADHD), your impulses —the devil on the other shoulder whispering in your ear to do the wrong thing that feels right in the moment —are more likely to win. Before we look at the differences between a healthy and a troubled PFC, here is a quick overview of how this brain region develops.

THE BRAIN’S LATE BLOOMER

Brain development is a fascinating construction tale, where genes and environment work together to make us who we are. At times during pregnancy, the fetus’s brain produces 250,000 new cells per minute. Babies are born with 100 billion neurons; however, only a relatively small number of those neurons are connected. About three-quarters of the brain develops outside the womb, in response to our environment and experience. Nature and nurture always work together. Brain development is especially rapid during the first few years of life. By age three, a toddler’s brain has formed close to 1,000 trillion connections —about twice as many connections as adults have. Between the ages of 3 and 10 is a time of rapid social, intellectual, emotional, and physical development. Brain activity in this age group is more than twice that of adults, and although new synaptic connections continue to be formed throughout life, never again will the brain be as capable of easily mastering new skills or adapting to setbacks.

The abundance of connections helps explain why it is generally easier for children to learn languages and music. Young children are able to learn just about any language and how to play musical instruments more easily than adults, even though adults often have more motivation. With age, the number of connections decreases, which helps to explain why it becomes harder to pick up an instrument, acquire languages, lose native accents, and even roll our r’s!

On the next page is a graph of activity in the prefrontal cortex across the lifespan, based on more than 70,000 scans we’ve done at Amen Clinics. You can see that, on average, a child’s PFC is very active. In this case, that does not mean better function but is more akin to unbridled activity. However, over time the activity begins to settle down and work more efficiently for two main reasons: pruning and myelination.

PREFRONTAL CORTEX ACTIVITY OVER THE LIFE SPAN

Graph showing a sharp rise in activity from birth to age 6 and then a gradual decrease till it flattens around age 40 at a little over half the original height of the line. Then there are some short spikes in the 70s and a small arc through the 80s and 90s.
Pruning shears.

In the first years of life, the brain has an abundance of cells, connections, and possibilities. As we age, our brains begin the pruning process, eliminating connections that are unnecessary, incorrect, or not being stimulated, in order to strengthen and enhance the connections that are being used. Pruning helps the brain become more efficient, similar to the effect of pruning on plants, but it’s crucial that the right things get pruned. As you can see in the graph (“Prefrontal Cortex Activity over the Life Span” above), at around age seven, PFC activity begins to decrease at a rapid rate. That’s because the brain has begun to prune extraneous connections. The brain is one of the best examples of the “use it or lose it” principle. Connections that are used repeatedly in the early years become permanent, while those that are not used are pruned. This is why it’s important for children to be raised in an enriched environment. It allows them to keep more of the tracks in their brains since the brain strengthens what is used and eliminates the unstimulated connections. Experience, opportunity, and stress all influence how much pruning takes place.

At the same time pruning is occurring, brain cells are being wrapped with a white fatty substance called myelin that works like insulation on copper wires. Myelination helps nerve cells work 10 to 100 times faster. A myelinated cell is much more efficient, which is another reason why the PFC becomes less active from about the age of 7 to 25 (seen on the graph) as myelination progresses.

Diagram of an unmyelinated neuron and a myelinated one. The myelin appears as a string of nodules covering the long, thin part of the neuron.

Myelination starts in the back of the brain and over time works its way to the front. In infants, the cerebellum (coordination center) and occipital lobes (vision) develop first, which support balance, coordination, speech, vision, and motor movements. During this time, young ones are learning how to crawl, walk, and talk. The parietal lobes, at the top back part of the brain, develop more in the elementary school years. They’re involved with throwing and catching balls and the ability to read and solve math problems. During the teenage years, the limbic or emotional brain becomes much more active. The limbic system is involved with feelings, bonding, and friendships. The PFC is the last part of the brain to develop, and it continues during late adolescence and into the mid- to late twenties. Healthy myelination of the PFC is also associated with intelligence, attention, processing speed, reaction time, musical ability, and working memory.

Anything that disrupts myelin formation can delay or damage brain development. Here are the main culprits:

Even though we think of 18-year-olds as adults, their brain development is far from finished. Myelin continues to be deposited in the PFC until age 25 or 26, making the executive part of the brain work at a higher, more efficient level. Were you more mature at 25 than at 18? I sure was. It is ironic that the car insurance industry knew about maturity and brain development long before society did. When do car insurance rates change? At age 25. Why? Because that is when people display better driving judgment and are statistically less likely to get into accidents, which means they cost insurance companies less money.

MYELINATION STARTS FROM THE BACK AND GOES FORWARD

Diagram of the brain with an arrow sweeping from the lower rear over the top toward the front.

It is critical for more people to be aware that brain development continues into early adulthood. In addiction medicine, it is common for therapists to say a teen’s development becomes arrested at the age he or she started to use drugs. If a teen starts abusing alcohol, drugs, or both at age 15 and doesn’t stop until he is 30, emotionally, as a 30-year-old, he will seem about the same as a 15-year-old. Teenage and early adult smoking and drug or alcohol abuse, as well as brain injuries from contact sports, all have the potential to disrupt brain development —in some cases permanently.

One of neurologist Sigmund Freud’s concepts that has proved useful is that human personality is made up of the id, the ego, and the superego. The id is our child mind that wants what it wants when it wants it; the ego is our healthy adult mind; and the superego is the parent inside our heads telling us what we should and should not do. Effective CEOs have healthy egos. If their superegos are too strong, they are likely to be punitive micromanagers who hold on to hurts. If their ids are in control (which means their PFCs are less active), they may be chasing the secretary around the office. They’re not working effectively but are letting the child within run things.

To keep the PFC healthy, you have to stop poisoning the brain. Frequent happy hours will not help to build a healthy ego or PFC. I have never understood why business events are typically filled with alcohol. After all, the business of life is about brain function. If you’re constantly diminishing brain function, over time your life is less likely to be what you want it to be.

THE ROLE OF THE PFC

A helpful analogy for understanding the PFC is to imagine yourself at the top of a mountain road in the Colorado Rockies. It’s winter, and you’re in a high-performance sports car, such as a Lamborghini, Porsche, or Ferrari. Your goal is to get to the bottom of the mountain safely, while enjoying the ride along the way. To navigate the miles of steep, winding roads and hairpin turns, effective brakes are a must. When the brakes are worn or damaged, you are much more likely to get into a serious accident. Brakes help the car and driver adjust to whatever situation presents itself —wind, rain, snow, ice, and other drivers who may be sleep-deprived or may have had too much to drink. A healthy PFC serves the same function as the car’s brakes, allowing you to safely navigate life, adjusting to whatever situations arise. This brain region is especially critical during the stressful or scary turns in life. When the PFC is hurt or too low in activity, the brakes are weak, and all sorts of problems arise. For one, you are more likely to figuratively skid off the road you intended to be on. And when the PFC works too hard, as it often does in obsessive-compulsive disorder (OCD), the brakes are always on, stopping any progress down the mountain or in your life.

Photo of a curving mountain road in winter.

You need brakes when driving on a dangerous Colorado mountain road.

Problems with the PFC

When the PFC is hurt or damaged for whatever reason, people often struggle with

With these issues, there is also a higher incidence of

As you can see, protecting your PFC means protecting your ability to feel good now and later.

The brain is a sneaky organ. We all have weird, crazy, stupid, sexual, violent thoughts that no one should ever hear. The PFC protects us from allowing those senseless thoughts to escape our mouths or stops our fingers from pressing the send button on an inappropriate or unhelpful e-mail, text, or tweet.

Several years ago, while attending a medical conference, I was sitting in the back of the room with a friend I’ll call Joelle. As I mentioned in Memory Rescue, Joelle had been in a car accident a few years earlier. She had been stopped at a traffic light when a pickup truck going 70 miles per hour plowed into the back of her BMW. The driver’s-side airbag deployed, but the violent impact of the rear-end collision and the airbag crashing against Joelle’s head slammed her soft, gelatin-like brain against the front part of her skull, ripping blood vessels and bruising and damaging her PFC. From the time of the accident, Joelle’s reactions were unfiltered, and she was much more likely to say anything that came into her mind. Often it was funny, but sometimes it could be very hurtful. Before the medical conference session started, two obese women sitting in front of us were discussing their weight. One woman said to the other, “I don’t know why I’m overweight; I just eat like a bird.”

Joelle looked at me and said, loud enough for everyone around us to hear, “Yeah, like a condor.” My face immediately turned red, and I looked at Joelle in complete embarrassment. Horrified, she put her hand to her mouth and said, “Oh no, did that get out?”

“Yes.” I nodded.

“I’m so sorry,” she said as the women moved away from us.

While I was writing this chapter, one of my friends got an inappropriate text from a consultant employed by her investment firm. They had worked together for more than a year without incident. But one evening when the consultant had too much to drink, he texted her, “Please send sexy pics.” Shocked, my friend ended the consultancy. The man lost a high-paying job because his PFC went on temporary leave. When the cat’s away . . .

I once had lunch with a close friend who was having marital problems. I knew Chuck had ADHD, which is associated with low PFC function, and was struggling at home in his relationships with his wife and children. As usual, Chuck was telling me about the turmoil in his life. All of a sudden his affect changed, his eyes brightened, his tone became more excited, and in a hushed voice he told me about a woman he had recently met on an airplane. She was pretty, smart, and interesting, and she seemed to like him a lot. She had even come to his office for a visit. As he started to go on, I interrupted him.

“Chuck, do you like attorneys?”

“What do you mean?” he said, looking surprised.

“Play it out,” I said. “You’re having marital problems, you meet this attractive woman who seems interested in you, and she’s been to your office. The next step, if it hasn’t happened already, is you are going to have an affair. Your wife will likely find out, and she will never forgive you. She’ll file for divorce. You’ll spend a lot of money on attorneys and hate yourself for putting your family through your betrayal. Then, a year from now, you will have lost half your net worth and be visiting your children on the weekends. Plus, they will be upset that you betrayed them, too.”

“Wow,” Chuck said, looking deflated. “I never thought about it like that.”

“That is what your prefrontal cortex does for you,” I said. “It plays things out.”

Chuck later told me that he never called the woman back. The cat was back.

Thoughtfulness, Consideration, and Love

A fascinating lesson from our brain imaging work is that when I help my patients’ brains function better, especially the PFC, they are significantly more thoughtful, considerate, and loving.

Bryan called himself “the anger broker of the San Fernando Valley.” He came to see me after he got out of the hospital following a serious suicide attempt. Two weeks earlier his wife had served him with divorce papers; that night he locked himself in a closed garage with his car running. When the paramedics broke in to rescue him, he screamed obscenities at them. And when I first met Bryan, he was condescending and hostile to my office staff and then to me. I listened patiently for the first hour, then told him that if he wanted me to help him, he had to get scanned. I was not going to put up with his abuse for long and had no intention of allowing him to abuse our staff, so we had to get him the best help quickly. While Bryan was being scanned, he even complained about Mike, our amazing scan technologist, which was a first.

Bryan’s PFC was clearly damaged, including on the left side, which tends to be the happier side of the brain. Damage to the left PFC is often associated with depression, irritability, and aggression. We put him on our BRIGHT MINDS brain rehabilitation program (see chapter 2, pages 39–44), which included supplements, HBOT (hyperbaric oxygen therapy), and dietary changes, and after three months the differences in both his behavior and his scan were stunning. He literally became one of the nicest people I’ve known. He still brings our staff gifts and talks to them with gratitude and love. When your brain works right —especially the PFC —you work right.

BRYAN’S INITIAL SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Low PFC activity

AFTER TREATMENT SPECT SCAN

Surface SPECT scan showing uniform blood flow.

Overall improvement

Conscientiousness and Longevity

One of the executive functions of a healthy PFC is conscientiousness, and its payoff can be a longer life. We know this thanks to the remarkable work of Dr. Lewis Terman, a Stanford University psychologist who studied 1,548 bright children who were roughly 10 years old in 1921 when Terman’s research began. Now, more than 90 years later, the long-term study has produced a treasure trove of insights linking healthy brain function to longevity.[90]

On the positive side, thoughtful planning, hard work, perseverance, and accomplishing goals were all associated with longevity in the study. Prudent, persistent achievers who had stable families and social support (all signs of a healthy brain) also lived longer. And those who did the best on long-life measures had habits, routines, and social networks that encouraged exercise. Clearly, your social relationships have an impact on your health, and associating with others who are healthy is one way to improve your own well-being.

On the negative side, participants who were most disappointed with their achievements died the youngest. In fact, a lack of success and dependability in one’s career (a common sign of a low-functioning PFC) was linked with a huge increase in mortality. How one reacted to a loss also affected longevity: If the loss led to drinking, depression, anxiety, or catastrophizing (exacerbating poor brain function), an early death was often the result; but if instead the loss led to renewed zest for life after a period of grief (thanks to employing brain-healthy recovery skills), the result was a five-year longevity boost beyond the average.

In one of the more intriguing findings, the study showed that people with a carefree outlook underestimated risks and tended to die early from accidents and preventable illnesses. While this finding has often been taken to mean that pessimists outlive optimists, the truth is that optimists who work hard and are more careful tend to live longer than average. It’s only the optimists who don’t worry, plan, or think about the consequences of their actions who wind up dying sooner. Worry, as it turns out, is a necessary function for staying healthy if it means that you care and think about the future. My clinical experience backs up this observation. A moderate level of anxiety is a good thing. Of course, too much anxiety is not good, but not having enough is connected with taking unreasonable risks that can harm health and safety.

Leadership

The brain is involved in everything we do, including how we think, feel, act, and get along with others. Leadership is all about people —managing and guiding their brains, minds, thoughts, actions, and behavior. Yet in graduate schools of business, where people train to be leaders, there is very little formal education about the brain.

In his groundbreaking book Emotional Intelligence, Daniel Goleman listed five traits leaders should have; all five involve your PFC. First is self-awareness. Unless you, as a leader, understand yourself, it will be hard for you to understand others. Next is self-regulation, which is knowing how to manage your own internal state, your impulses, and your resources. Third is motivation, which involves handling and controlling your emotional tendencies and which, in turn, guides and facilitates interactions with people (a combination of your emotional brain and PFC). Then there is empathy, which is the awareness of other people’s needs and concerns. Finally comes social skills, which help leaders adapt to the various environments they find themselves in. Other leaders have discussed perseverance; integrity (listening to the angel on your shoulder); and cautious, thoughtful risk-taking —all characteristic of a healthy PFC —as traits that have helped them succeed.

Self-regulation —being able to manage your impulses —is critical to leading others and yourself. Leaders who lack good impulse control may get hit with a sexual harassment suit or make decisions that put their businesses at risk. The PFC also learns from mistakes —which is a key leadership trait since leaders make a lot of mistakes. Many of the world’s best leaders are proud of their mistakes because they learned critical lessons from them. If you make a mistake and you learn from it, you will be a better leader. If you make a mistake but deny it, and instead of looking at it you just put it in a corner somewhere in your mind, odds are you’re going to repeat it.

PROTECT YOUR PFC

Understanding and optimizing PFC development is critical to raising healthy humans, which is why protecting it needs to be one of society’s main priorities. In particular, the PFC needs to be protected from head trauma, toxins (such as alcohol and marijuana), gadget addiction, lack of sleep, low-quality diets, and chronic stress. (For more risk factors to avoid, see chapter 2, pages 33–37.)

Stop the Insanity of Children Hitting Their Heads against Helmets and Soccer Balls

The US Soccer Federation recently banned children under the age of 11 from hitting soccer balls with their heads (it’s actually called “heading”). This is clear progress, as the PFC sits right behind the forehead and is easily damaged by repetitive blows to the head. However, when I heard about the ban, I wondered, Don’t they like kids who are 11 to 25? Why 11, when we know the PFC is not finished developing until 25 in females, and a bit later in males? Society changes slowly, often to its detriment.

Flying soccer balls are a real menace. It is estimated that a ball that’s been kicked hard can impact a player’s head with a force of 175 pounds! Children or teens meet that missile with their skulls, slamming their PFCs against the sharp, bony ridges of the skull’s frontal bones. Does that sound like a good idea when we all need our PFCs for the rest of our lives so that we can be good workers, parents, and grandparents? Here’s the story of one young man who made a smarter choice.

WILL: TOO MANY HEAD WHACKS

Will, age 16, played soccer at an advanced level. He was so good, he even played in Europe for a year. But after he sustained his fourth concussion from being kicked in the head, he had to take off a whole year from school. He was irritable, moody, and easily distracted, and he started making poor decisions. His parents were very concerned when they brought him to the clinic. His SPECT scan showed significant damage to his PFC, in the front of his brain, and damage to his occipital lobes in the back. The brain is housed in a closed space. If it gets hit on one side, it slams against the other side, causing what is called a coup-contrecoup injury (see illustration on page 60).

Even though Will desperately wanted to continue playing the game he loved, he decided to stop. He told me, “I love soccer, but I know I’ll love my future wife and children more. I have to do a better job of protecting my brain.” Using the rehabilitation protocol we developed at Amen Clinics, Will did much better over time and returned to school. His mood, irritability, and decision-making dramatically improved.

WILL’S SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

The holes indicate damage to the front and back of his brain.

Diagram showing the process of brain injury during a head collision. The coup injury happens as the brain moves forward to hit the front of the skull. The contrecoup injury happens as the brain rebounds and hits the back of the skull.

Other common PFC-damaging activities include football, cheerleading, hockey, horseback riding, and trail biking, among others. According to a new study on more than 13,000 teens, 20 percent reported a concussion at some point in their lives.[91] One of the most important lessons I’ve learned from looking at nearly 150,000 scans is that mild traumatic brain injury can ruin people’s lives. Concussions that affect the PFC can permanently decrease a person’s executive function unless it is fully rehabilitated. It is vitally important to make protecting our children’s and young adults’ PFCs a priority.

SIX STRATEGIES TO STRENGTHEN YOUR INTERNAL CEO

Consider the metaphor of the elephant and the rider. The PFC is the rider —the thoughtful part of your brain that attempts to direct your life. The limbic system, where your pleasure centers are housed, is the elephant —the powerful, emotional part of you that drives your impulses and desires. As long as the elephant wants to go where the rider directs him, things work fine. But when the elephant wants to go in a different direction, who is going to win that tug-of-war? Most bets are on the elephant. Cravings (elephant) are often controlled by the PFC (rider) when things are going well, but if the elephant is spooked or becomes nervous or afraid, it can take control. (Think of a food binge.) Keeping the rider healthy, strong, and strategic is critical to staying in control of your life.

How do we integrate the rider and the elephant so that our PFCs and limbic brains, our goals and desires, and our thoughts and behaviors are more in sync? We do it by being purposeful with our goals and strengthening our PFCs through continual training. Here are six strategies to strengthen your executive function, which is instrumental in helping you make good decisions, overcome anxiety, negativity, anger, and stress —and feel better fast.

Strategy #1: Learn to say no to yourself.

Experiments starting in the 1960s reveal how critical a healthy PFC is, even at an early age. These studies have focused on the concept of delayed gratification —being able to wait for a reward. One trial that psychologist Walter Mischel used involved preschoolers and marshmallows. The children were told that they could either eat the marshmallow in front of them immediately or wait for a few minutes and get two. Some kids were unable to wait and ate the marshmallow straight off, while others used tactics like clapping their hands or turning their backs on the one marshmallow to resist. After following the children for 14 years, Mischel found that those who had waited —delaying gratification —had higher self-esteem, better coping skills for stress and frustration, higher academic performance (with SAT scores that were significantly higher, on average), and greater social skills than the children who had been unable to wait.[92] (There are reenactments of this landmark work on YouTube; search for “marshmallow test.”)

Similarly, a more recent test with raisins predicted how 20-month-old toddlers —some of whom had been born prematurely, making them more likely to have PFC issues —would perform at the age of eight.[93] The toddlers were tested on how long they could wait before picking up raisins that had been placed under an opaque plastic cup. They were given several training sessions and then asked to wait until they were told that 60 seconds had passed before they retrieved the raisins. Kids who had been born prematurely were more likely to eat the raisins before the full minute elapsed, and those who couldn’t control their behavior were likelier to struggle in school seven years later. Unless they learn how to delay gratification or someone helps them rehab their brains, it’s also likely that those kids will continue to struggle for the rest of their lives.

The PFC is like a muscle: You have to use it so you don’t lose its power to help you exercise patience and make good decisions. Fortunately, you can learn how —there’s even proof in Mischel’s follow-up studies. He asked adults to demonstrate delayed gratification to the preschoolers, using several tactics to keep themselves from eating the lone marshmallow. When the kids were put to the test again and had to resist their impulses, those who had previously grabbed the single marshmallow used the strategies they had just seen the adults practice, successfully “earning” two marshmallows through their patience. Later, the same kids performed similarly to the ones who had a natural ability to delay gratification.[94]

Kids can learn to develop their PFCs —and you can too. In fact, it’s during childhood that the majority of us learn how to exercise our PFCs. We ask our parents if we can do things that aren’t good for us, such as riding a bike without a helmet or eating a lot of sweets, and when their answer is no, we learn how to say no to ourselves. But if you grew up with absent parents, you might not have learned the self-control to say no. Or if one or both of your parents struggled with drugs or alcohol, you might have learned instead to give in to your impulses. You might even have lost your ability to say no because of your own addiction.

Saying no to yourself is like being a loving parent —to yourself. Giving in to your bad behavior, whether it’s eating too much junk food or channel surfing instead of exercising, can ruin your health and lead to premature death. But if you practice saying no, effectively strengthening your willpower and your PFC, you will find it easier to continue to do so over time. By exercising your PFC, you are making and strengthening nerve cell connections in a process known as long-term potentiation (LTP). Your brain makes new connections when you learn something new. Initially the connections are weak, but with practice —saying no to marijuana, candy, alcohol, lashing out at others, gambling, or using your smartphone incessantly —the PFC circuits in your brain are strengthened, or potentiated. When that happens, behaviors become almost automatic —your brain makes it easier to continue doing the right thing! Conversely, if you are ruled by your impulses, your willpower weakens, which makes it more likely that you will continue to be impulsive.

3 to 5 minutes.

One strategy that can help you say no is to use distraction whenever you feel tempted to do something that’s outside your goals. Create a list of activities that will distract you from giving in to the craving or behavior —things as simple as taking 10 deep breaths, humming to yourself, going for a brief walk, closing your eyes and focusing on your goals, or even playing the game Tetris on your smartphone. Research has shown that just three minutes of Tetris decreased cravings for food, drugs, cigarettes, alcohol, and coffee, as well as gaming and engaging in sex,[95] and the benefits lasted for the seven days of the study.

Strategy #2: Practice saying no to others.

Tony Blair, the former prime minister of Great Britain, said, “The art of leadership is saying no, not saying yes. It is very easy to say yes.” Warren Buffett once said, “The difference between successful people and really successful people is that really successful people say no to almost everything.”[96] My father, who was chairman of the board of a $4 billion grocery business, always used to say no. I found it irritating when I was a child, but later I realized the wisdom of it. Saying no is like having effective brakes. In our fast-paced, distraction-filled society, our brakes are becoming weaker and weaker, and we say yes at a dizzying pace to the texts, tweets, posts, and e-mails that distract us from our purpose. Learning to say no to the mundane is essential to being able to accomplish greatness in your life. If you want high-performance results, you must be careful to spend your time wisely and only pursue the most meaningful activities, no matter what others want you to do. Steve Jobs said, “People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are.”[97]

1 to 30 minutes.

Many of my patients with ADHD, who have low PFC activity, don’t think before they act and often overcommit themselves by saying yes to too many things. I have them practice saying these words in front of the mirror: “I have to think about it.” Whenever a friend or someone at church asks you to do something, say, “I have to think about it,” then go home and ask yourself if the request fits in with the goals you have for your life. Odds are, the trouble that has occurred in your life is not from saying no, but from saying yes to things that were not fully thought through.

Time is such a precious commodity today, with the constant bombardment of distractions. Learning to say no can help save your brain and your life. If the answer to a request to spend your time is not an enthusiastic yes, the answer should probably be no.

Strategy #3: Strengthen your decision-making skills.

The best way to reduce stress in your life is to stop screwing up.

ROY BAUMEISTER, PHD

Making good decisions over and over for a lifetime often adds up to good health and success. And when you have made lots and lots of bad decisions, the end result can be struggles with your health and with success in life. You don’t have to be perfect and get every decision right, but the more healthy decisions you make, the better you are likely to look, feel, and act. A bonus is that improving self-control in one area of your life means improving it in other areas. If you start walking every day, for example, you are also likely to start eating better.

Use the following strategies to improve the functioning of your PFC, which in turn will boost the quality of your decisions:

3 to 5 minutes.

Strategy #4: Protect myelination and stop letting children hit things with their heads.

There are many healthy, enjoyable sports that will not compromise your child’s brain health and future. Tennis, table tennis (my personal favorite), all forms of swimming, running, golf, and dance are wonderful ways to exercise a growing body. Encourage your children to protect their PFCs and their future.

Strategy #5: To feel better fast, you have to go slow.

Slow down, you move too fast.

SIMON AND GARFUNKEL, “THE 59TH STREET BRIDGE SONG (FEELIN’ GROOVY)”

In our fast-paced society, it is often the person who can slow down, think about his or her goals, and act accordingly who ends up feeling better fast now and later. Whenever you feel out of sorts, take 10 slow, deep belly breaths, identify your goal in your current situation, and choose the best option for now and later. This simple, thoughtful strategy activates your PFC to calm your emotional brain. It helps you make better decisions and can even alleviate anxiety.[99]

Behaviors you want to change must be practiced slowly, deliberately, and repeatedly so that when you need them, you can implement them immediately. As with learning any new skill, it takes time for the brain to develop new circuits. Be slow and patient when learning anything new.

Strategy #6: Take supplements to sharpen your focus and PFC.

Supplements can help to support focus and executive function. These include rhodiola, green tea extract, L-theanine, ashwagandha, panax ginseng, ginkgo biloba, and phosphatidylserine. See chapter 10 for more information on each, including dosage considerations.

NICK: A PFC PICK-ME-UP FOR A MIXED MARTIAL ARTIST

Nick, 25, was an MMA fighter who was brought to the clinic by his mother because he had been arrested after a drunken bar fight and now had started to express suicidal thoughts. I met him when I gave a lecture at the clinic. During the question-and-answer period, he told me I wouldn’t like his profession as an MMA fighter. I smiled and said I liked him but wished he wouldn’t put his brain at risk of damage. Later that evening I reviewed Nick’s scan with him. It showed low PFC and temporal lobe activity. I asked him if he wanted to do an experiment the next day.

I had just finished one of our studies on professional football players. Amen Clinics did the first and largest brain imaging and rehabilitation study on active and former NFL players. We saw high levels of damage on SPECT scans, especially to the PFC, temporal lobes, and cerebellum (which controls motor and thought coordination). This was not a surprise, as anyone who made it to the NFL in all likelihood had already played football for anywhere from 8 to 12 years and had been hit in the head thousands of times during games and practices. The exciting news from our study was that when we worked to rehabilitate their brains through diet, exercise, and the principles in this book, 80 percent of our players showed improvement, especially in blood flow to the PFC, temporal lobes, and cerebellum, and in memory, mood, motivation, and sleep. Our rehabilitation program also included a sophisticated combination of nutritional supplements (a high-level multivitamin, high-dose omega-3 fatty acids, and nutrients that supported brain function through a number of different mechanisms, including ginkgo, rhodiola, ashwagandha, ginseng, and phosphatidylserine).

I told Nick I knew the supplements worked, but I didn’t know how quickly. I said, “How about you come at 8 a.m. tomorrow, I will give them to you, and then we will scan you two and a half hours later at 10:30 a.m.” Nick was excited to see if the supplements could help, and they did (see the before and after scans opposite). The second scan revealed a marked increase of blood flow to his whole brain, especially the PFC and temporal lobes. This did not mean he was cured after one dose of supplements; it meant that his brain had the potential to respond if he consistently put it in a healing environment and gave it the nutritional support it needed.

Nick’s story is encouraging. If an MMA fighter with a history of brain trauma could see rapid improvement in PFC activity, you can see change too. Strengthen your PFC and you’ll make better decisions and feel better fast.

NICK’S BEFORE AND AFTER SPECT SCANS (TWO AND A HALF HOURS AFTER TAKING SUPPLEMENTS)

Surface SPECT scan showing areas of very low blood flow.

Low PFC and temporal lobe activity

Surface SPECT scan showing uniform blood flow.

Improved PFC and temporal lobe activity

SIX KEY STRATEGIES TO STRENGTHEN YOUR INTERNAL CEO

  1. Learn to say no to yourself.
  2. Practice saying no to others.
  3. Strengthen your decision-making skills:
    • Be clear about your goals.
    • Decide on a few simple brain health rules ahead of time.
    • HALT poor judgment —don’t allow yourself to get too hungry, angry, lonely, or tired.
    • Cut out sugar and artificial sweeteners.
    • Start a journal.
  4. Protect myelination and stop letting children hit things with their heads.
  5. To feel better fast, you have to go slow.
  6. Take supplements to sharpen your focus and PFC.

TINY HABITS THAT CAN HELP YOU FEEL BETTER FAST—AND LEAD TO BIG CHANGES

2 to 20 minutes.

Each of these habits takes just a few minutes. They are anchored to something you do (or think or feel) so that they are more likely to become automatic. Once you do the behaviors you want, find a way to make yourself feel good about them—draw a happy face, pump your fist, or do whatever feels natural. Emotion helps the brain to remember.

  1. When I am tempted by something that is bad for my brain (like candy or cigarettes), I will hum to myself for a few minutes until the temptation passes.
  2. After I open my refrigerator, I will throw out one food that is bad for my brain.
  3. When a friend or someone at church asks me to take on a new task, I will say, “I have to think about it.”
  4. When I go to a party, I will ask for a wine spritzer and top it up with club soda so I’m sure I don’t drink too much.
  5. When I slip up on my goals, I will note it down in my journal.
  6. When my child asks if he or she can play a contact sport like football or soccer, I will say, “No, I want to protect your brain from harm.”
  7. When I feel out of sorts, I will take 10 deep breaths and focus on my goals.
  8. When I eat breakfast, I will take a supplement to improve my brain.