A Science-Supported Journaling Protocol to Improve Mental & Physical Health

27:05whereas the high expressors, 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 bend out into one or the other based on a number of different measurements. But here's the good news. It turns out it doesn't matter whether or not you're a low expressor or a high expressor. 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.

27:55The 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 mentioned these two groups, the low expressors and the high expressors, 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.

28:33And this actually has been looked at. There's a wonderful study also by Pentebaker 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.

29:08So 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 Vocabulary as Windows on Distress and Wellbeing. 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.

29:42These 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.

30:27Whereas 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 if you'll have a lot of words to describe sadness and negative emotions are more sad, but it didn't necessarily have to be that way.

31:05And 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 Pentebaker 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.

31:45And 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, 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.

32:22And 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.

33:03So 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.

33:42Not 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 Pentebaker 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.

34:15The 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.

34:56First, 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 as 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.

35:34Now that third category of links between the experience and other things, maybe direct and obvious, maybe these are real aha moments where you go, oh my goodness, I 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.

36:11Again, 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. Actually, I 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.

36:46So 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.

37:21You'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 And perhaps more importantly, we're going to talk about the incredibly positive benefits both at the level of neural changes, so called neural plasticity, 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 minute writing protocol.

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39:36Okay, 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.

40:29However, 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. They're 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 experience 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.

41:04In addition, and earlier I mentioned this, I realized, well, I'm mentioning 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 for about 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.

41:42In addition, people suffering from IBS 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. Penabaker 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.

42:25in 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, our 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 we're writing about something quite different than the people that we're in the so -called experimental group.

43:09So it's important to keep in mind that we're not simply talking about phenomenology here. We're 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, it would be very hard to do in a study, say, of physical exercise, where you have people, perhaps, you know, run on a treadmill, getting their heart rate up to 85 % of their maximum heart rate for 30 minutes, five days a week.

43:58You would expect that that group, compared to a group that did nothing, would experience significantly greater shifts in positive health metrics like lower blood pressure, certainly not during the exercise, about during the exercise, about 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 equivalents of time spent and effort spent.

44:29But 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.

45:07And 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 are 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.

45:43It'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 Penet Baker, 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.

46:14But this particular study I'm about to describe explored how the disclosure of traumas or the writing out of very stressful experiences impact immune function and 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 Hibramin Lab podcast about immune function in the brain some years ago, and you can find that by going to HibraminLab .com, just put immune system into the search function.

46:49It will take you to that episode and to any timestamps of other episodes where I touch on the 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 at 15 weeks prior to the study, and again, And then six weeks into the study.

47:23Okay, 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 assessed 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.

48:03They 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.

48:38They are able to isolate from the blood something called telymphocytes. Telymphocytes 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. We think of bone as just these hard components of our body and our skeleton that allow us to be upright and to be rigid and to move about and not be jelly -like. But indeed, in the center of the bone is marrow. And the marrow itself is performing an important physiological role. many roles in fact one of which is to create these T lymphocytes or white blood cells.

49:15They 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.

49:52If 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 and infection. And they did that with something called concanavalan A. Concanavalan A is what's considered a mitogen. It's something that activates telemphasites and it activates what are called natural killer cells. Now, that's a lot of detail for sake of this episode. Basically what the concanavalan A is doing is it's mimicking an infection, but in this particular study, this is all being done on telemphasites that have been collected.

50:35They're put into a dish and then they're exposed to different concentrations going from low to medium to high of that concanavillon 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 of telemphasite activation from the concanavalan mitogen challenge, which mimics infection, then 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.

51:27And 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 disclosures, that is people that really poured themselves into this writing protocol, experienced a greater degree of immune activation, that is a fighting off response to this mitogen, concanavolin A, vended people that were low disclosures. 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.

52:15Now the field of so -called psychonuroeumunology 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 10 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.

52:51Now, 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 mentioned this because if you look into the history of why James Pentebaker and colleagues started exploring this particular pattern of journaling, it actually relates to his own personal experience.

53:19And I don't want to spend too much time on this, but it's worth mentioning that Pena Baker is 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.

54:06Now 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 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 about one of those examples. And in that way, he's truly a pioneer in thinking about quote unquote psychonuro immunology, 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, and people that are chronically stressed, which includes, of course, psychological stress.

54:47What are the effects on the nervous system, the immune system, etc? And as you could imagine, in general, people who were more stressed over 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's a little counterintuitive. What Pena Baker 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.

55:19So 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 gonna 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 Lynch -Pin 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.

56:10Now 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 short lists 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.

56:49In 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.

57:26and 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 allows 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.

58:12So 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 sometimes called, or your internal representation, both conscious and unconscious of what happened during that stressful or traumatic event.

58:57Now, 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.

59:47I really want to emphasize that 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?

1:00:23So 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 sub -cortical structures.

1:00:57They 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 sub -cortical. Now those sub -cortical 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.

1:01:33If I do A, what will happen? If I do B, what will happen? The 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 sub -cortical 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.

1:02:18Okay? So that's a very brief top level contour lesson in prefrontal cortical function and comparing it a bit to some sub cortical 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 in 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 sub -cortical structures ramp up their activity when people recall traumatic events, at least at first.

1:02:59Okay, 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 about, people not only shift the sort of language that they use to describe their feelings and 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.

1:03:39And 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 about.

1:04:17But 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 didn't happen perhaps is relevant too, but what happened?

1:04:57Second, how did it make you feel? That's 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.

1:05:33So 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.

1:06:12There'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 about, 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.

1:06:54And here we're saying recalling that trauma in 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.

1:07:34We 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 catacoleumines, dopamine, epinephrine, endoreponephrine 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.

1:08:13Hey, 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 anytime we're in a deep relaxation state some of you have heard me talk about Neural Plasticity before but the key elements to remember for today's discussion is that But 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 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.

1:08:53And 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.

1:09:32There have been two separate collections of work in the psychology and neuroscience literature in the last 10 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.

1:10:12There 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.

1:11:07We'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 away and not think about it because it is confusing.

1:11:51It 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.

1:12:27And this is super important that are also involved in regulating the activity of those sub -cortical 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 Prostings of the National Academy of Sciences, entitled Increasing Honesty in Humans with Non -invasive Brain Stimulation.

1:13:13Now, 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 diorl 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 nine dollars.

1:14:00And today corresponds to roughly ten dollars. 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.

1:14:40And what one finds in this study and other studies that have been unsubssequent 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 and one given profession or another, pick your favorite profession if you were to assume anyone 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.

1:15:19Now, neuroimaging studies show that when people lie, certain areas of the frontal cortex increase in their activity, although the The major effect, when one looks nearly, is a reduction in the prefrontal cortex, and in particular subcompartment 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 non -invasive 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.

1:15:51You can simply put this tool. It's a little coil. You put it over a particular part of the brain bone, the outside of the skull indeed on the outside of the hair and you can either inhibit or stimulate particular brain areas using this trans cranial 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.

1:16:25It 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.

1:17:04Okay, so they went from reporting that they had matched the number on the screen and therefore or one 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, should we say mildly dishonest, or dishonest only in certain conditions. There we were getting into judgment calls and I don't wanna 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 Dorsal Lateral Prefrontal Cortex was activated.

1:17:43They 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 the given experience of theirs. Activing 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 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?

1:18:58So all that discombobulation and that lack of coherent story that then leads to lack of coherence in terms of one's autonomic function. So 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 Dorsal lateral 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 our experiencing presently is good for us both in the short term and the long term.

1:19:43And this I believe and other researchers, both neuroscientists and psychologists and psychiatrists that I've talked to about this result are an 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.

1:20:13And 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 in 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.

1:20:57This 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 no 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're talking about today could positively impact things like fibromyalgia symptoms.

1:21:37Well, it makes perfect sense, really. When we start to think about the prefrontal cortex as this highly flexible seed of our cognition about our self -reversitation, our ideas about who we are and about when certain elements within our brain embody 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, right, getting woken up in the middle of the night and not being able to go back to sleep or elevated heart rate panic attacks anxiety and on and on.

1:22:13I talked about some of this in the Hubert & Lab podcast episode that I did about stress and how to master stress with particular protocols. It also came up in the discussion with Dr. Paul Conti in the episode about trauma and the series on mental health. So what we're We're pulling together here as 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.

1:22:56I 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.

1:23:34I 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, etc. 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, etc., 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.

1:24:07And yet, the journaling protocol that Pennabaker 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. It's intense, right? 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.

1:24:41And last but certainly not least, it's been shown over and over again. I mean more than 200 peer reviewed studies, not just from Pena Baker 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 a 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.

1:25:25Like how come I haven't heard about this? And I don't really have an answer for that although I will say that Pena Baker and others I think we're very early in their merging of mind and body states although So 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.

1:25:58And frankly, whatever the reason, I'm just grateful to my colleague, Dr. David Spiegel, who again is our associate chair of psychiatry at Stanford. He's a medical doctor of 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 really challenging, stressful, maybe even traumatic memories day after day after day for four days.

1:26:44Personally, I don't want to do that. Other people might opt to do that in, you know, 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, it 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.

1:27:20Unless 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.

1:27:51and 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 coherence about the topic or the event that you wrote about. Keep in mind that for each of the four bouts 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.

1:28:29The 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 healthcare professional. Because there are data that suggest 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.

1:29:06Now 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, which is challenges sleeping, distress, etc. by hearing about very stressful events that have occurred to others. Okay, this is third -hand trauma or observational trauma, sometimes called. So if we were to adhere to the protocol as it was used in the various studies that formed the basis for what we're talking about today, we would say that you are writing about something that is for your eyes only.

1:29:48In 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 expressor category.

1:30:28So 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 physical, that you simply don't want to do it or that it's impeding other areas of life, by all means, just stop.

1:31:09Okay? 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.

1:32:08In 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 AK traumatic event as a way to first wait 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.

1:32:44So 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 Pena Baker and Colleys as just a protocol. I look at it as an entire body of literature that includes a center of massive data that But 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.

1:33:35And 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 Endor and join 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. And on both Spotify and Apple, you can leave us up to a five star review. Please check out the sponsors mentioned at the beginning of today's episode. That's the best way to support this podcast. If you have questions for me or comments about the podcast, where topics or guests that you'd like me to consider for the Hubertman Lab podcast, please put those in the comments section on YouTube.

1:34:10I do read all the comments. Not on today's episode, but on many previous episodes of the Hubertman Lab podcast, we discussed supplements. While supplements aren't necessary for everybody, many people derived hermentus benefit from them for things like improving sleep, for hormone support, and for improving focus. To learn more about the supplements discussed on the Hubertman Lab podcast, you can go to LiveMomentus, spelled O -U -S, so it's livemomentus .com slash Hubertman. If you're not already following me on social media, I am Hubertman Lab on all social media platforms. So that's Instagram, Twitter, now called X, LinkedIn, Facebook, and Threads.

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1:35:13Again, all completely zero cost to sign up for the neural network newsletter. You simply go to HubermanLab .com, go to the menu tabs, scroll down to newsletter, and put your email there, you'll receive an email, and if you approve, you'll start receiving the monthly newsletter. Again, it's completely zero cost, and I want to point out that we do not share your email with anybody. Thank you for joining for today's episode where we discussed a journaling protocol that has been demonstrated in the scientific literature to significantly improve mental and physical health. And last but But certainly not least, thank you for your interest in science.