Brain Rules

I've been sent a review copy of "Brain Rules" by John Medina. The book, which includes a DVD, is an exuberant and entertaining hodgepodge of material thrown together out of which the author extracts "12 Principles for Surviving and Thriving at Work, Home, and School." The DVD has a perky in your face Dr. Medina leading you through the storyline. It is an enjoyable self help book, I think aimed at hooking readers less sophisticated than most of you who read this blog. A companion website offers supplemental material and references supporting each brain rule. (I find the references idiosyncratic and a bit dated). Here are the author's bottom line rules:

EXERCISE | Rule #1: Exercise boosts brain power.
SURVIVAL | Rule #2: The human brain evolved, too.
WIRING | Rule #3: Every brain is wired differently.
ATTENTION | Rule #4: We don't pay attention to boring things.
SHORT-TERM MEMORY | Rule #5: Repeat to remember.
LONG-TERM MEMORY | Rule #6: Remember to repeat.
SLEEP | Rule #7: Sleep well, think well.
STRESS | Rule #8: Stressed brains don't learn the same way.
SENSORY INTEGRATION | Rule #9: Stimulate more of the senses.
VISION | Rule #10: Vision trumps all other senses.
GENDER | Rule #11: Male and female brains are different.
EXPLORATION | Rule #12: We are powerful and natural explorers.

Lotus therapy

Yet another article on benefits of mindfulness meditation in this morning's NYTimes science section.

Blogging as self-medication

Maybe I've found one of the reasons I do this blog (other than to keep me off the streets): An article by Jessica Wapner in the June issue of Scientific American discusses studies on the therapeutic value of blogging. Blogging is claimed to provide physiological benefits similar to those that have been shown for expressive writing (serving as a stress-coping mechanism, improving memory and sleep, and boosting immune cell activity.) Blogging may act as a "placebo for getting satisfied." The blogosphere offers an antidote to social isolation. (Checking out my 'mdbownds' YouTube video postings reveals that the Debussy Reverie video has been viewed 98,739 times and 157 comments made; this mindblog gets 500-600 visitors each day. While this is social connection, I totally don't know any of you people, except for a handful of friends.) I find fleeting virtual world contacts a pallid substitute for real life huggable friends, and sometimes fret that my time spent hunkering over a keyboard provides too convenient an excuse for the harder work of being a robust member of real (versus virtual) social groups.

Tranquility...

A MindBlog reader suggests that I pass along this link on "50+ Simple 30-Second Ways to Bring Tranquility To Your Life"... Hmmmm, good luck.

MindBlog becomes a drop-out student at a brain enhancement site

When the folks at happy-neuron.com offered me a free log in to check out their brain enhancement/preservation exercises I said "Sure, I'll try it out and do a review." The site offers a brief discussion of the science of brain fitness is offered, and the scientific contributors have reasonable credentials. Several have associations with gerontology and aging programs, as is the case with other brain enhancements sites. The single study I was pointed to testing the effects of the happy-neuron exercises was a pilot effort carried out by Robert Bender, a geriatrics and family practice physician in Des Moines, Iowa. He did not respond to my email requesting information on the study.

Well.... to do a proper review one really has to get into it, and I tried, but simply was unable to do this. One could just pick directly from ~ 35 classic style tests (of memory, attention, language, executive function, and visual spatial skills) with a thin video game veneer, or let a "coach" present you with 20 minutes worth of exercises. I chose the "coach" option which chooses exercises for you, monitors your progress, strengths and weaknesses, etc. (It didn't tell me what my strengths and weaknesses were, but perhaps I didn't stick with it long enough for it to get back to me...) The exercises were mildly engaging and indeed left me feeling 'brain tired' after 20 minutes. I did get a bit tired of variations on the towers of Hanoi game (classic form, then basket balls in hoops, then bells in cathedral towers, etc.) I found the 'exit' or 'next' buttons sometimes blanked out or froze the browser window.

I found it difficult to get hooked on the system in a daily basis (I came along before the video game revolution on which my kids were raised). The exercises soon took on an "eat your spinach" aspect. I suspect my motivation might have been greater to pursue them if had been accumulating more striking evidence of my own impending cognitive decline.

I did find it very interesting to pursue the exercises to the point of brain fatigue, which my brain was clearly saying "enough of this, dammit, I'm tired." However, I have not found exercise to the point of fatigue useful or relevant in the daily gym routine to which I am addicted (varying combinations of running, swimming, weights at the Univ. of Wisconsin gym). I feel it would take a similar sort of addiction process to bind me to the routine performance of games like these, and I did not get reinforcement from the "coach" that might have nudged me in that direction ("Hey, you're doing great on executive function and rotating visual images, but your short term memory sucks...")

I may continue to putter with this as well as other brain exercise sites, and if lightning strikes and I get enthusiastic, I'll report back to you.

Want to chill out? Exaggerate you abilities.

An interesting article by Gramzow et al. in the Feburary issue of Emotion finds that exaggeration (such as students inflating their grade-point average) doesn't induce the anxiety that usually goes with lying or keeping secrets. Some clips from Benedict Carey's discussion of the article:

...embroiderers often work to live up to the enhanced self-images they project. The findings imply that some kinds of deception are aimed more at the deceiver than at the audience, and they may help in distinguishing braggarts and posers from those who are expressing personal aspirations, however clumsily...The researchers pulled the students’ records, with permission, and found that almost half had exaggerated their average by as much as six-tenths of a point. Yet the electrode readings showed that oddly enough, the exaggerators became significantly more relaxed while discussing their grades...It was a robust effect, the sort of readings you see when people are engaged in a positive social encounter, or when they’re meditating...The ones who exaggerated the most appeared the most calm and confident.

Here is the Gramzow et al. abstract:

Students who exaggerate their current grade point averages (GPAs) report positive emotional and motivational orientations toward academics. It is conceivable, however, that these self-reports mask underlying anxieties. The current study examined cardiovascular reactivity during an academic interview in order to determine whether exaggerators respond with a pattern suggestive of anxiety or, alternatively, equanimity. Sixty-two undergraduates were interviewed about their academic performance. Participants evidenced increased sympathetic activation (indexed with preejection period) during the interview, suggesting active task engagement. Academic exaggeration predicted parasympathetic coactivation (increased respiratory sinus arrhythmia). Observer ratings indicated that academic exaggeration was coordinated with a composed demeanor during the interview. Together, these patterns suggest that academic exaggeration is associated with emotional equanimity, rather than anxiety. The capacity for adaptive emotion regulation--to keep a cool head when focusing on academic performance--offers one explanation for why exaggerators also tend to improve academically. These findings have implications for the broader literature on self-evaluation, emotion, and cardiovascular reactivity.

Brain exercises

A few moments with google, using search items like "brain exercises" will immediately bring you to a large number of web sites that offer to improve your mental function, combat the decay of mental performance with aging, etc. Some of these have appeared since my previous posting which listed several. A recent NYTimes article (from which the graphic on the left is taken) points to a number of these sites and offers an interesting discussion.

I have held back from taking the plunge into brain exercises, partly because I'm afraid of what I might find find out about how far gone I already am, and partly because some which appear to be most thoroughly researched and academically respectable want your money. But, now happy-neuron.com has offered me a free login to try out their regime, and so I have taken the bait. I will be offering my opinion of this site after immersing in their 20 min exercise sessions for a few weeks, and if I have the stamina or remaining self-esteem (and get offered a free login), will review some of the other sites in subsequent posts.

An integrated view of our subjective energies.

I recently attended the Wisconsin Symposium on Emotion (Now in its 14th year). Its topic was "Emotion, Consciousness and Psychopathology." I want to mention the talk given by A.D.(Bud) Craig, which was a real tour de force, the kind of science I feel I can integrate with my own personal experience. Its title was "How do you feel? The neurobiological basis for human awareness of feelings from the body." I have referenced Craig's work in previous posts, also check here. Here are PDFs of his two recent review articles in Trends in Cognitive Science (2005) and Nature Reviews Neuroscience (2002) which I recommend.

His view is that in our nervous systems, there is a fundamental bilateral partitioning or separation, from basic spinal cord and brain stem homeostatic systems to our highest prefrontal lobe functions, in which the right side spends energy and the left side brings it in. This reflects the relative activities of the sympathetic versus parasympathetic nervous systems. (enter 'parasympathetic' in the google search box in the left column to see some previous mindblog posts on autonomic regulation of chilling out versus getting excited).

The right and left insula appear to be central in processing feelings, all the way from basic (interoceptive) body sensing (posterior insula) up through subjective feelings, disgust, trust, anger, social hurt, empathic happiness, lust, pain, etc. All of these are homeostatic emotional currency that help regular body balance all the way from from blood pressure, glucose, heart rate, salt regulation, up through social self image. Here is a graphic from his 2005 article that shows the central role of the left and right anterior insula (which act as the sensory cortex of limbic system) in receiving information about body state and feeling from sympathetic and parasympathetic input and then interacting with anterior cingulate (the motor cortex of the limbic system) and frontal cortex. (click to enlarge):


Positive emotions (pleasant music, maternal emotions) correlate with enhanced left parasympathic, left anterior insula, left anterior cingulate and left frontal activation, while negative emotions (anger, fear, etc.) enhance activation of the corresponding structures on the right side.

Some very simple manipulations can stroke the relative activation of these two systems. Slowing one's breathing, as usually happens during meditation dials up the left anterior insula system, while breathing more rapidly increases anxiety and right anterior insula activity. In fact, giving instruction to a subject to breathe more slowly or more rapidly can change their emotional reaction to stimuli. In one experiment mentioned by Craig, a picture of a baby seal elicited warm nuturing emotions when breathing was slowed, but when breathing was increased, subjects were more likely to suspect the seal might attack or bite them! Experiments are now being attempted to measure whether oxytocin (the affiliative, trusting hormone) correlate with left insular activation while right insula activation correlates with cortisone (the stress hormone) release.

This sort of global description fascinates me, because it instructs us in how integrated a package we are, and how attention to some of the basement details of our daily life (such as breathing) can fundamentally alter our mood and temperament.

Enhance your working intelligence with simple exercises...

Bakalar points to an interesting study by Jaeggi et al. showing that fluid intelligence (the kind of mental ability that allows us to solve new problems without having any relevant previous experience) can be enhanced by simple working memory training. It turns out that carefully structured training of the kind of memory that allows memorization of a telephone number just long enough to dial it enhances performance on standard tests of fluid intelligence. This suggests that fluid intelligence and working memory depend on the same brain circuitry.

Middle Age Misery

Blanceflower and Oswald have done a fascinating study (PDF here) showing that across cultures, from Azerbaijan to Zimbabwe, we are happiest towards the beginning and end of our lives, leaving us most miserable in middle years between 40 and 50. For both men and women in the UK, the probability of depression peaked at around the age of 44. In the US, men were most likely to be unhappiest at 50, while for women the age was 40. The cause of the apparent U-shaped curve is not known. Quoting Oswald (the graphic is from his website):

...one possibility is that individuals learn to adapt to their strengths and weaknesses, and in mid-life quell their infeasible aspirations. Another possibility is that cheerful people live systematically longer...A third possibility is that older people might compare their lives with their peers'. Seeing their friends die could mean people value their remaining years more highly...It looks from the data like something happens deep inside humans. For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year...Only in their 50s do most people emerge from the low period. But encouragingly, by the time you are 70, if you are still physically fit then on average you are as happy and mentally healthy as a 20-year-old. Perhaps realising that such feelings are completely normal in mid-life might even help individuals survive this phase better.

Faith and Healing

Jerome Groopman reviews Anne Harrington's new book "The Cure Within - A History of Mind-Body Medicine" in the NY Times Book review of Jan. 27. Harrington is professor and chair of the History of Science department at Harvard. Here is the final section of that review:

Harrington offers close observations of the interactions between the Harvard cardiologist Herbert Benson (and later the neuroscientist Richard Davidson of the University of Wisconsin) and the Dalai Lama and his Tibetan monks. She admits longing for scientific support for what is, in essence, an “Orientalist” conception, that the “Other” holds wisdom and therapeutic treasures beyond those imaginable to us in the West. Some of Harrington’s wish is fulfilled in the biology of the placebo response. Recent studies show that belief, even in inert treatments, can have profound benefits in relieving pain, likely via release of endorphins and other mediators in the brain. But despite several decades of concerted research in the field of psychoneuroimmunology, to my scrutiny no robust effects of meditation or other relaxation techniques that could combat illnesses like cancer or AIDS have been identified.

Harrington concludes with the questions that her students at Harvard regularly ask: Which mind-body narratives are “true”? Are all the stories we tell ourselves about illness equally valuable? Harrington has already answered these queries in part in the voice of the woman with breast cancer in the Stanford study. Yet, she has still been “haunted” over the years by unusual events, like the case of a man whose tumors seemed to melt “like snowballs on a hot stove” in response to a “worthlesss” cancer treatment that he nonetheless believed in. The physicist Freeman Dyson once noted that, to a scientist, an event like the spontaneous remission of a tumor is viewed as occurring at the asymptote of probability, one in several million, but through the eyes of a believer it becomes not mathematics but a miracle. Harrington shows us that, whatever science reveals about the cause and course of disease, we will continue to tell ourselves stories, and try to use our own metaphors to find meaning in randomness.

Are you holding your breath?

I notice - if I am maintaining awareness of my breathing - that the breathing frequently stops as I begin a skilled activity such as piano or computer keyboarding. At the same time I can begin to sense an array of unnecessary (and debilitating) pre-tensions in the muscle involved. If I just keep breathing and noticing those tensions, they begin to release. (Continuing to let awareness return to breathing when it drifts is a core technique of mindfulness meditation). Several sources note that attending to breathing can raise one's general level of restfulness relative to excitation, enhancing parasympathetic (restorative) over sympathetic (arousing) nervous system activities. These personal points make me feel like passing on some excerpts from a recent essay which basically agrees with these points: "Breathtaking New Technologies," by Linda Stone, a former Microsoft VP and Co-Founder and Director of Microsoft's Virtual Worlds Group/Social Computing Group. It is a bit simplistic, but does point in a useful direction.

I believe that attention is the most powerful tool of the human spirit and that we can enhance or augment our attention with practices like meditation and exercise, diffuse it with technologies like email and Blackberries, or alter it with pharmaceuticals...but... the way in which many of us interact with our personal technologies makes it impossible to use this extraordinary tool of attention to our advantage...the vast majority of people hold their breath especially when they first begin responding to email. On cell phones, especially when talking and walking, people tend to hyper-ventilate or over-breathe. Either of these breathing patterns disturbs oxygen and carbon dioxide balance...breath holding can contribute significantly to stress-related diseases. The body becomes acidic, the kidneys begin to re-absorb sodium, and as the oxygen and CO2 balance is undermined, our biochemistry is thrown off.

The parasympathetic nervous system governs our sense of hunger and satiety, flow of saliva and digestive enzymes, the relaxation response, and many aspects of healthy organ function. Focusing on diaphragmatic breathing enables us to down regulate the sympathetic nervous system, which then causes the parasympathetic nervous system to become dominant. Shallow breathing, breath holding and hyper-ventilating triggers the sympathetic nervous system, in a "fight or flight" response...Some breathing patterns favor our body's move toward parasympathetic functions and other breathing patterns favor a sympathetic nervous system response. Buteyko (breathing techniques developed by a Russian M.D.), Andy Weil's breathing exercises, diaphragmatic breathing, certain yoga breathing techniques, all have the potential to soothe us, and to help our bodies differentiate when fight or flight is really necessary and when we can rest and digest.

I've changed my mind about how much attention to pay to my breathing patterns and how important it is to remember to breathe when I'm using a computer, PDA or cell phone...I've discovered that the more consistently I tune in to healthy breathing patterns, the clearer it is to me when I'm hungry or not, the more easily I fall asleep and rest peacefully at night, and the more my outlook is consistently positive...I've come to believe that, within the next 5-7 years, breathing exercises will be a significant part of any fitness regime.

Exercise effects on brain and cognition

Hillman et al., provide an interesting review article (PDF here) that examines the positive effects of aerobic physical activity on cognition and brain function, at the molecular, cellular, systems and behavioral levels.

The results of a meta-analysis of the effects of fitness training on cognition showed that the benefits of fitness training on four different cognitive tasks were significant. As illustrated in the figure, fitness training has both broad and specific effects. The effects are broad in the sense that individuals in aerobic fitness training groups (represented by the red bars) showed larger fitness training effects across the different categories of cognitive processes illustrated on the x-axis. They are specific in the sense that fitness training effects were larger for some cognitive processes, in particular executive control processes, than for other cognitive processes.

Physical activity has been found to enhance cognition, with a selectively larger effect on executive control functions compared with other cognitive processes. Accordingly, brain structures that mediate executive functions would be expected to show disproportionate changes as a result of participation in physical activity. One such structure is the anterior cingulate cortex (ACC), which is part of the brain's limbic system and has connections with multiple brain structures that process sensory, motor, emotional and cognitive information. Two convergent lines of research indicate that physical activity exerts a substantial influence on the ACC and the concomitant executive processes that it mediates.

Regret

How do we feel about alternative versions of ourselves - lost possible selves, or the person we might have been? Benedict Carey writes a nice piece on this question. A few clips:

...Over the past decade and a half, psychologists have studied how regrets — large and small, recent and distant — affect people’s mental well-being. They have shown, convincingly though not surprisingly, that ruminating on paths not taken is an emotionally corrosive exercise. The common wisdom about regret — that what hurts the most is not what you did but what you didn’t do — also appears to be true, at least in the long run.

...young adults who scored high on measures of psychological well-being tended to think of regretted decisions as all their own — perhaps because they still had time to change course. By contrast, older people who scored highly tended to share blame for their regretted decisions. “I tried to reach out to him, but the effort wasn’t returned.”

...those who are able to talk or write about this lost future without sinking into despair or losing hope tend to have developed another quality, called complexity...an ability to incorporate various points of view into a recollection, to vividly describe the circumstances, context and other dimensions...that this knack for self-evaluation develops over time; it is a learned ability.

...therapists have long known the value of seeing regretted choices in the context of what has been gained as well as lost.

...the perspective from which people remember slights or mistakes can affect the memories’ emotional impact... reimagining painful scenes from a third-person point of view, as if seeing oneself in a movie, blunts their emotional sting and facilitates ... clearheaded self-perception.

Less SAD with more sun and serotonin

Welberg offers a summary and review of work by Willeit et al. on the role of serotonin, and a serotonin transporter, in seasonal affective disorder. Here is an portion of the review:

Short, dark winter days put most of us in a gloomy mood, but in people with seasonal affective disorder (SAD), they can cause severe clinical depression. Fortunately, this depression can be treated with bright-light therapy (BLT), and it disappears altogether in summer. Willeit et al. now show that these changes in mood are associated with alterations in the efficiency of the serotonin (5-hydroxytryptamine) transporter (5-HTT) in the patients' blood platelets.

One theory of depression posits that impaired functioning of monoamine neurotransmitters, such as serotonin, causes the disorder, but it is unknown how this impairment might arise. Serotonin levels in the synapse are controlled by the 5-HTT, and Willeit and colleagues therefore investigated whether alterations in 5-HTT functioning might underlie depression in SAD.

The authors compared people with SAD with healthy volunteers, and assessed 5-HTT functioning in winter, after 4 weeks of BLT and in summer. They did this by measuring 5-HTT-mediated inward and outward transport in blood platelets (which are easily obtainable). In winter, both inward transport rate and outward transport were enhanced in the platelets of SAD patients compared with healthy controls. Importantly, these differences in platelet 5-HTT functioning disappeared after 4 weeks of BLT and were absent in summer. The number of 5-HTTs and their affinity for serotonin did not change with BLT or with the seasons, indicating that the increased 5-HTT inward transport that was found in SAD patients was due to increased efficiency of the transporter.

The authors also assessed the patients' depression levels at the three time points, using a structured interview. They found that post-treatment, both inward transport rate and outward transport correlated with depression scores in SAD patients. Moreover, patients whose depression did not decrease after treatment did not show a change in 5-HTT-mediated outward transport after treatment.

Are we having fun?

This is an engaging bit of fluff, be happy! (if the Strauss waltz repeated in a loop doesn't drive you crazy.)

Naturopathy wins over physical therapy advice?

Chronic lower back pain is perhaps the most commonly reported workplace disability. Szczurko et al. conducted a randomized clinical trial of 75 postal service employees experiencing more than six weeks of chronic back pain, dividing them to receive Naturopathic care (n = 39) or standardized physiotherapy (n = 36) over a period of 12 weeks. The study was conducted in clinics on-site in postal outlets. Participants in the Naturopathic care group received dietary counseling, deep breathing relaxation techniques and acupuncture. The control intervention received education and instruction on physiotherapy exercises using an approved education booklet. The authors suggest that naturopathic care provided statistically significant greater improvement than physiotherapy advice.

The naturopathic route involved hands-on intervention (acupuncture), and there is this curious point suggesting some rather significant motivational differences:

Data was available on 100% (39) of the naturopathic care group at week 8 and 75% (27) of the control group at week 8. Complete data on participants at week 12 was available on 92% and 63% respectfully.

Happiness Tips

I enjoyed watching an interview of Tal Ben-Shahar on the John Stewart Daily News shows several days ago, discussing his new book "Happier." He has integrated threads of the positive psychology movement initiated largely by Martin Seligman (see my post on Seligman) to offer the most popular undergraduate course at Harvard. Although I usually have a gag reaction at most of the self-help stuff I see, I thought I would pass on some of the sane happiness tips from his website. And, a quick search at YouTube gets you his promotional video, also shown below.

* 1. Give yourself permission to be human. When we accept emotions — such as fear, sadness, or anxiety — as natural, we are more likely to overcome them. Rejecting our emotions, positive or negative, leads to frustration and unhappiness.

* 2. Happiness lies at the intersection between pleasure and meaning. Whether at work or at home, the goal is to engage in activities that are both personally significant and enjoyable. When this is not feasible, make sure you have happiness boosters, moments throughout the week that provide you with both pleasure and meaning.

* 3. Keep in mind that happiness is mostly dependent on our state of mind, not on our status or the state of our bank account. Barring extreme circumstances, our level of well being is determined by what we choose to focus on (the full or the empty part of the glass) and by our interpretation of external events. For example, do we view failure as catastrophic, or do we see it as a learning opportunity?

* 4. Simplify! We are, generally, too busy, trying to squeeze in more and more activities into less and less time. Quantity influences quality, and we compromise on our happiness by trying to do too much.

* 5. Remember the mind-body connection. What we do — or don't do — with our bodies influences our mind. Regular exercise, adequate sleep, and healthy eating habits lead to both physical and mental health.

* 6. Express gratitude, whenever possible. We too often take our lives for granted. Learn to appreciate and savor the wonderful things in life, from people to food, from nature to a smile.

Why don’t we do what we know works better?

I mull frequently about an issue that I’m sure readers of this blog are familiar with. Having assembled a fairly extensive toolkit of techniques to maintain personal poise, sanity, vitality, etc. (tools of the sort mentioned in the essay on my website titled “Mindstuff: a guide for the curious user.”), how is it that I don’t use them more religiously to maintain those desired qualities? Well…. there are some limits intrinsic to the fact that they are constructions of my adult mind, mainly over the past 15—20 years. They require attention and energy for their maintenance, unlike the pandora’s box of less useful older habits and ways-to-be-in-the-world that formed in my youth, and are more hard wired into place. During periods of inattention or low energy, I don’t notice the these older autopilots and temperaments slipping back into place to resume their residency. This, I suppose, is why practitioners of various healthy mind regimes (schools of meditation, cognitive therapies, or whatever) keep saying: “How do you get to Carneige Hall? Practice, practice, practice!”

Joseph LeDoux perhaps puts it better in some recent comments:

One of the things I've learned about the brain is that anxiety and stress breed anxiety and stress. So, it makes sense that we should do things to reduce anxiety and stress in our daily lives, like the sorts of breathing exercises that are used in meditation. These are effective in part because they push the autonomic nervous system toward its parasympathetic side, slowing the driving force of the sympathetic system and reducing the arousal level of the body and the brain. Do I do these exercises? Not as often or as effectively as I probably should. But cardiologists probably don't always eat the right things or exercise as much as they should, either. It's one thing to know what to do, and another to do it. (If we could figure out that discordance, we'd really know something.)

3rd and 1st person narrative in personality change

Benedict Carey writes a piece in the Tuesday NY Times science section (PDF here) reviewing work done by a number of researchers on on how the stories people tell themselves (and others) about themselves do or don't help with making adaptive behavior changes. Third person narratives, in which subjects view themselves from a distance - as actors in their own narrative play - correlate with a higher sense of personal power and ability to make personality changes. First person narratives - in which the subject describes the experience of being immersed in their personal plays - are more likely than third person narratives to correlate with passivity and feeling powerless to effect change. This reminds me of Marc Hauser's distinction of being a moral agent or a moral patient. The third person can be a more metacognitive stance, thinking about oneself in a narrative script while the first person can be a less reflective acting out of the script.