Transcript Behavioral Health Training and Enterprises, P.C.

The Brain:
Trauma and Addiction on a Cellular
Level
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All behaviors and emotional processes (both
healthy and maladaptive) are a result of neural
pathways that have developed within the
brain. A neural pathway is a network of
neurons within the brain (that controls the
body), and are responsible for the automation
of emotions and behaviors within the
individual.
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CNRT assumes that addictions are a result of
the brain having been altered as a result of
some traumatic process (however slight it may
appear).
The brain develops in a use dependent fashion.
Maladaptive coping mechanisms resulting
from trauma, develop maladaptive neural
pathways. These often lead to addictions.
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Healing is a process of changing the brain at
the cellular level, and hence, developing
healthier neural pathways. Thus, it is not just
enough to “know the steps of getting well.”
Healing must take place on many levels within
the brain.
As healthy pathways are used more frequently,
they become more primary in the decision
making processes of life.
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As unhealthy pathways are used less
frequently, they atrophy or become less
important in the decision making process.
If the person returns to the addiction after a
period of abstinence (regardless of how long
that has been), the maladaptive pathway
becomes reactivated, leading the person back
into the addiction (in almost an automatic or
trancelike state).
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The maladaptive neural pathways that have
been developed as a result of trauma, and as
part of the addiction, will continue to exist in
the brain (pruning stops). Treatment consists of
helping the client develop more adaptive
neural pathways around the old pathways, and
helping them choose those newer pathways,
rather than the addiction based pathways.
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People engaged in an addictive or any other
unhealthy process can change!
Healing requires a great deal of work and
effort on the part of the patient.
If the individual can get to the core issue of
what he/she is avoiding, without acting out,
healing will begin to take place.
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Effective treatment increases an individual’s
ability to choose more healthy options.
Treatment is about increasing their options.
CNRT assumes that the issue of what brings
the client into therapy is not necessarily the
issue that needs to be treated. “The issue is not
necessarily the issue.”
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The Diagnostic and Statistical Manual of the
American Psychiatric Association (DSM-IV)
does not recognize sexual addiction as a
diagnostic category. However, all of the
criteria for substance dependence can be
applied to sexual addiction and compulsivity.
The criteria are as follows:
Tolerance as defined by:
I.
I.
II.
II.
A need for markedly increased amounts of the
behavior.
A markedly diminished effect with the continued
use of the same amount of the behavior.
Unsuccessful attempts to cut down or control
the behavior.
Withdrawal as manifested by either of the
following:
III.
I.
The characteristic withdrawal syndrome for the
behavior:
I.
II.
III.
IV.
V.
II.
Sleepless nights
Intrusive dreams
High level of waking anxiety
Irritability
Emotional lability
The same behavior is engaged in to avoid
withdrawal symptoms.
IV.
V.
VI.
Engaging in a behavior in greater amounts
and for longer periods of time than was
intended.
Large amounts of time dedicated to planning
for, or engaging in the behavior.
Important social, occupational or recreational
activities are given up or reduced because of
the behavior.
VII.
The behavior is continued despite knowledge
of it having a persistent physical or
psychological problem that is likely to have
been caused or exacerbated by the behavior.
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Sexual addiction is often known or referred to
as sexual compulsivity.
Types of sexual compulsivity
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Chronic pornography use
Voyeurism
Exhibitionism
Making obscene phone calls
 (Song by Ray Stevens)
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1-900 Sexual Lines
Cybersex
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Types of sexual compulsivity (Cont.)
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Sexual chat rooms
Multiple affairs
Prostitution/escorts/strip-club use
 Song by Kenny Rogers
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Compulsive masturbation
Frottage
Transvestic fetishism or cross-dressing
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Cerebral Cortex
The smart part of the brain
 Future oriented
 Can process consequences
 This part knows what to do to avoid the addiction
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Limbic System
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The emotional brain and consists of the following
main parts:
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Amygdala
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Influences behavior and activities to meet body’s
internal needs
 Feeding, Sexual interests and emotions like anger
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Can assume executive control of body in dangerous
situations (fight or flight).
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Hippocampus
Involved in learning and memory and recognition of
novelty.
 Helps in identifying spatial differences.
 Helps to sort out relevant aspects of situations that
will be stored in long term memory.
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The Thalamus
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The relay station of the brain.
Sorts, interprets, and directs sensory signals received
from the spinal cord and the midbrain to the cerebral
cortex.
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The Nucleus Accumbens
This is the “pleasure center” of the brain.
 This part of the brain rewards us for doing things
that are life sustaining and perpetuating.
 The primary neurotransmitter in this part of the
brain is the chemical Dopamine.
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The Hijacked Brain
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Dr. Patrick Carnes refers to the neuro-chemical
process of sexual addiction as the “hijacked brain.”
(Carnes, 2004).
The emotional part of the addicted brain can receive
information from a trigger before the cortex can
interpret what the trigger is (Gibson, 2000).
This process helps to maintain the addiction.
This is why relapse is so common.
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If treatment is to be effective, the clinician must
help the client to strengthen the
communication between the Limbic system
and the Cortex.
CNRT is a model to facilitate this process.
The process of neural change within the brain
is known as neural plasticity.
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Discussions of Neural plasticity began as early
as 1783 between Charles Bonnet (Prominent
Naturalist) and Michele Vincenzo Malacarne
(Anatomist).
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Published in 1793 in Journal de Physique.
Indicated that trained animals showed more folds in
the Cerebellum than the untrained.
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The hypothesis that exercise and training can
enlarge a particular part of the brain was
promoted in the nineteenth century (Well,
1847, Acherknecht & Vallois, 1956).
Alexander Bain (1872), a philosopher,
suggested that memory formation involves
growth of what we now call synaptic junctions.
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“The theory of free arborization of cellular branches capable
of growing seems not only to be very probable but also most
encouraging. A continuous pre-established network - a sort
of system of telegraphic wires with not possibility for new
stations or new lines – is something rigid and unmodifiable
that clashes with our impression that the organ of thought
is, within certain limits, malleable and perfectible by welldirected mental exercise, especially during the
developmental period. If we are not worried about putting
forth analogies, we could say that the cerebral cortex is like a
garden planted with innumerable trees – the pyramidal cells
– which, thanks to intelligent cultivation, can multiply their
branches and sink their roots deeper, producing fruits and
flowers of ever greater variety and quality” (Cajal, 1894).
“We can now identify a large range of neural
changes associated with experience. These
include increases in brain size, cortical
thickness, neuron size, neuron size, dendritic
branching, spine density, synapses per neuron,
and glial numbers. The magnitude of these
changes should not be underestimated...we
consistently see changes in young animals in
overall brain weight on the order of 7-10% after
60 days...It would be difficult to estimate the
total number of increased synapses, but it is
probably on the order of 20% in the cortex,
which is an extraordinary change! (continued)
“Typical experiments showed that the dendritic
fields of these neurons increased by about 20%
relative to cage-reared animals (Kolb&
Whishaw, )
 The above experiments were done on animals
with visually and motorically enriched
environments, versus just being in a cage with
normal cage stimulation.
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We also know that early learning and
development effect dendritic development.
The following pictures show synaptic density
at ages 5 days, 6 years and adult. They also
show metabolism of sugar at the same ages
(brain activity).
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5 days
6 years
Adult
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Most dense synapses are at about age 6-9 years
old.
By age 19-24 years old, the brain loses the
ability to prune unused synapses and the brain
can only form new synapses and neural
pathways beyond this point.
With this knowledge, we can understand that
early trauma and exposure to intense situations
can alter the “sexual template” and future
development of the brain.
Damage occurs to the hippocampus with
trauma victims causing a significant decrease
in volume and a change in perception.
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Ron Gibson describes this process in terms of
High and Low roads.
Our senses are hard wired to the thalamus.
The same sensory messages are sent to the
cortex and the amygdala, but due to this hard
wiring, the message gets to the amygdala about
20 milliseconds earlier than the cortex.
This time lag allows the amygdala to take
control or executive function over our behavior
and utilize most or sometimes all of our
cognitive resources to respond to the perceived
threat (fight or flight response).
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Under these conditions, memories become
lodged in the implicit system and are not
stored in the explicit memory of the frontal
cortex.
These implicit memories will be “pre-verbal” in
nature, and may be recalled only as emotional
responses which can be irrational or
inappropriate to the current situation (Gibson,
2000).
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When these pre-verbal emotional states are
activated by triggers, environmental states or
high emotional states, high arousal conditions
are instituted in our mind and body. Since
there is no logical or apparent danger, we begin
to seek ways to reduce this aroused state. The
activation of the pleasure center of the brain
(the Nucleus Accumbens), gives us the desired
effect
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The most important priority in our body next
to survival itself, is that of Homeostasis.
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Homeostasis is the body’s priority to maintain the
“status quo” or to keep everything the same.
This is such an important priority that when
any change occurs, the body immediately
begins to work on countering that change.
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For example, if we put a stimulant into our
body, it will immediately begin producing a
depressant drug to counter the arousal
produced from the stimulant.
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The problem is that this race to produce
equilibrium also causes a lot of fluxuation and
so the body begins to learn.
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The body (in an effort to minimize the
impact of the drug to the body’s
equilibrium), begins to recognize the
surroundings, people and situations that
drugs are used in, and then begins to
introduce the “anti-drug” before we actually
introduce the drug to get high. This insures
that the drug does not get us as “high” and
produces “tolerance.”
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With this we see that the body actually begins to drive
the cravings and addictive process.
The same process goes for what is called “process
addictions.”
Process addictions are those compulsive behaviors that
are not dealing with externally introduced drugs or
alcohol, they are internal chemicals that are triggered
by certain behaviors (sex, gambling, food, cutting,
relationships, exercise, etc.).
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The process for these “process addictions” are basically
the same as drug use, except it is that we are becoming
addicted to our body’s own “drugs.”
Every substance that allows us to get “high” has a
counterpart that our body produces naturally. These
chemicals either directly connect to neuron receptor
sights, or cause the body to release neural chemicals
that produce the “high” or euphoric feelings.
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These are the same chemicals that are overproduced in the body by either substance use
or compulsive behaviors.
The body gets used to having intense amounts
of these chemicals and resets the body’s
equilibrium.
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Addiction , or compulsive behavior comes in
two forms: Substance and Process addictions.
Substance addictions use chemicals that act
directly on the dopamine receptors in the
pleasure center of the brain
Process addictions deal with a learning process
that allows the brain to learn from the
environment and produce dopamine on
demand.
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Trauma and maladaptive coping skills can predispose a person to a particular form of
addiction or compulsive behavior.
Homeostasis is the #2 priority in the body and
contributes to a person staying in an addictive
pattern once he/she is there.
Healing from addiction is about change on the
cellular level and changing the brain’s neuralpathways to enhance new patterns of behavior.
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These are some of the techniques that CNRT
brings to brain change.
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Scripting
 Duration, Frequency, Consistency
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Treatment Pillars
Biofeedback/Neurofeedback
Mind Mapping
 Assessment Phase
 Changing Associations
 Visual Reinforcement-learning
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Music
 Intensity
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Remapping/Inner Child Work