Transcript Holding your clients frontal lobe in the palm of your hand

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Heidi V Carlson, MS, LMFT; PsyD., LP
Wendi Kaisershot, RN, C
Jim Campbell, LSW
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We Were Made to Be Awesome!!
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 We
are MEANT to ATTACH
 Attachment
 Our
Brain is MEANT to CHANGE
 Brain
 Our
Basics
Brain is mostly NONVERBAL
 Sensory
Information
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How do you impact Treatment?
Your explanation guides your intervention
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Attachment and The Brain
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What we need to know
Often
patients within treatment
facilities are developmentally much
younger than their age.
Their
Their
brain is structured differently.
brain changed to survive an
adverse environment yet, this comes
at a high price.
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Brain is a Biosocial Organ
 The
(Gibbson, 1996)
brain is a “social brain” (Solomon & Siegel, 2003)
 It
is the central player of emotions in social
communication (Adolphs, 2000)
 It
is misleading to focus on the individual’s
behavior in the absence of information about the
interaction and social circumstances in which the
biology (brain) developed.
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Central components of
Mental Health
Way
one adapts to their
environment
The
way one copes
These
behaviors develop from
attachment experiences and the
way their brain is constructed.
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A closer look at:
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Brain
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Attachment (setting the foundation)
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Sensory input
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Treatment
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Brain is an “organ of adaptation”

Adapts to the physical and social worlds; it is stimulated
to grow and learn through positive and negative
interactions
70%
of our genetic
structure is added after
birth (Schore, 1994)
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Brain Development

We know that during the first 3 years of life brain is very
active.

The teenage years & young adult years are the next major
period of growth.

Brain is NOT fully developed until
Brain
25.
develops through a “use it or
lose it”process.
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Good and Bad News

Brain is slow to develop
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The brain incorporates
environmental factors
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This increases its
chances to survive
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Brain is built to
survive in a particular
environment (culture,
language, climate,
nutrition, and each
caregivers gives
unique shape to the
brain)
The bad news- lack of
the essential
ingredients then
becomes YOUR job to
attempt to restructure
neural architecture
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Attachment is:
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A special enduring form of emotional relationship with a specific
person.

Involves soothing, pleasure and comfort.

The loss or threat of loss evokes distress.

The child finds
security and safety
in the context of
this relationship.
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Attachment Theory
 Bowlby
(1969)- interaction occurs within a
context of:
 facial expression, posture, tone of voice,
physiological changes, tempo of
movement, and incipient action.
 Attachment
is vital to the survival of the
species (which is really one’s capacity to
cope with stress)
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Attachment
 Early
attachment experiences organize lasting
schemas which, in turn shape our experience of
those around us throughout life
 The
amount of integration between emotional and
verbal networks will determine whether or not we
become aware of our emotions or can put them
into words.
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Implicit Memory & Explicit Memory

What memories we encode
which become second nature
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Frist 18 months of our lives we
encode ONLY implicitly

These are often sensory –
perceptions, emotions, bodily
sensations and as older
learning to crawl, walk, ride a
bike, drive a car (encoded
with smells, tastes, sounds,
sensations, touch)
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What we use to form
expectations about the way
the world works, based on
previous experiences (Siegel &
Bryson, 2011)
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Implicit memory creates
something called priming, in
which the brain readies itself
to respond in a certain way
Trauma- expand definition
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 Has
a major impact on brain
development.
 Persistent
stressors in the first 2 years prune
neural connections in the prefrontal cortex and
inhibit effective regulation of arousal (Schore,
2003).
 Basis
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of attachment is “attunement” to others
They are attuned to self because of early childhood
experiences.
A Key Concept:
Regulation
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
Regulation of affect is a
central organizing
principle of human
development and
motivation (Schore,
2001a).
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Ability to regulate
emotions are essential to
adaptive function of the
brain (Damasio, 1994).
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Right Brain
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Process social-emotional
information

Facilitating attachment
functions

Regulates bodily and
affective states (Schore,
1994, 2001a)
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Dominant in the first 3
years of life
Maturation is dependent
on experience- which is
embedded in the
attachment relationship
(Schore, 1994)
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Left Brain
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Develops later on

Linear processing uses information from right side of brain to
gather the subjective emotional self-experience and then tell
a logical story.
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Corpus Callosum
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Corpus Callosum

(impaired growth)
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Pre-frontal Cortex
Last part of brain to develop
 Development
of the pre-frontal cortex depends
upon relationship based experiences
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Executive functioning
 Emotion regulation (ability to manage mood)
 Logical thinking
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Problem solving
Planning ahead
Memory
Impulse control
Arousal states and sleep
Stress control
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Back to the
Limbic System
 Includes
the Hippocampus and Amygdala
 Each consist of two lobes, one on each side of
the brain
 Both aid in transmitting information from the
body on the way to cerebral cortex
 Important in understanding trauma
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Amygdala
Hippocampus
Mature at birth
Matures between 2nd and 3rd
year of life
Infantile memories are
Hippocampus not yet available
processed through the amygdala
Facilitates storage of the
emotional and sensory content
of these experiences
Thus the memory is experienced
as emotions and physical
sensations without context
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Hypothalamus: controls
appetite, hormones, and
sexual behavior
Neocortex: Site of higher
cognitive functions and
sensory integration
Hippocampus:
crucial to memory and
learning facts
Amygdala:
responsible for anxiety,
fear and emotions
Cerebellum: seat of
motor control and
coordination
Brain stem: responsible
for sensory input and
physiological responses
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Function
Impairment
Amygdala
fear conditioning; aggressive
behavior; triggers fight/flight
Increased arousal,
impaired fear conditioning
Hippocampus
Retrieval of verbal and
emotional memory
Memory impairment,
especially verbal memory
Left hemisphere
Regulate analytical responses;
mediate emotional responses;
language processing
Difficulties in accurate,
effective reading of
situation; language
processing
Corpus Callosum
Communication and integration Poor integration and
between hemispheres
modulation of responses
to daily interactions
Prefrontal cortex
Center for executive functions
Poor organization, rigid
problem solving;
increased impulsivity
(Creeden, 2007)
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During Stress/Trauma
Amygdala
Hippocampus
This is working
throughout
stress/trauma
Stress level increases- the
hormones released may
suppress the
hippocampus
(Rothschild, 2000)
This may distort memory
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Amygdala
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Well developed at birth

Involved with emotional learning
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Central neural hub of emotional experience
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Functions as an appraisal for danger, safety, and familiarity in
approach-avoidance situations
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Amygdala continued
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Feelings of anxiety, déjà vu, and memory-like hallucinations
have been reported with stimulation of the amygdala
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Individuals under stress may be particularly vulnerable to
the intrusion of powerful memories from early childhood
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Memory

Ever wonder why a patient/client struggles remembering
names, dates, what they did the day before, but seem to have
a superior memory when it comes to emotions (particularly
those that are negative)?
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Brain is geared towards negative emotions – it is what we
needed to in order to survive.
 Important
in understanding trauma
 When amygdala is over sensitized while the
hippocampus is compromised; painful
experiences recorded in implicit memory-
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Hippocampal Memory Networks
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Is the structure for storing and encoding conscious
information and learning
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Matures later
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Under extreme levels of stress (e.g. PTSD secondary to
childhood trauma, combat exposure, prolonged depression,
temporal lobe epilepsy and schizophrenia) have also been
shown to have hippocampal cell loss
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Chronic stress associated with difficulty transferring shortterm into long-term memory
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Given many clients you work with have experienced chronic
stress, it is logical to assume that they will have difficulty in
functions associated with the hippocampus
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AMYGDALOID-HIPPOCAMPAL
INTERACTION
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Amygdala has a central role in the emotional and somatic
organization of experience, whereas the hippocampus is vital for
conscious, logical, and cooperative social functioning;
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Amygdala heightens awareness of specified aspects of the
environment
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Hippocampus inhibits responses, attention, and stimulus input.
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Amygdala involved with generalization
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Hippocampus with discrimination
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(ex. Spider) (Cozolino, 2002)
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Stress
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Mild levels of stress- is involved in the growth and
connectivity of neurons and neural circuits
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Moderate stress triggers release of neurohormones that
enhance cortical reorganization (Siegel, 1999)
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Too much stress-damaging
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Building and rebuilding the brain
 Neurons
are our basic building blocks and
neural networks are the structures that we sculpt
and resculpt
 We
are unable to engage in random actions
because our behaviors are guided by patterns
established through previous learning to which
we automatically return
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Neurogenesis
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New neurons seem to be generated in different areas of the
brain
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Especially in regions involved with learning
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i.e. hippocampus, the amygdala, and the frontal and temporal
lobes
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Overall Have:
Limbic irritability
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Increased activity in amygdala;
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High degree of activation of amygdala can generate
emotional responses to fragmented perceptual information
(Creeden, 2007);
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High levels of amygdala stimulation may have an inverted
impact on hippocampal organization.
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 We
have little or no conscious access to the
information or the logic on which most of
our decisions are based (Lewicki, Hill, & Czyzaewska, 1992; cited
Cozolino, p 158).
 This
nonconscious decision-making shapes
the construction of the self.
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What do we do now?
Create Neural Connections
Increasing
Affect Tolerance and
Regulation
Development
Narrative
of Integrative
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How we learn and adapt
 Based
on the growth and connectivity of
neurons
 Seen in growth of new neurons,
 Expansion of existing neurons
 Changes in connectivity between
existing neurons
o Known as Plasticity
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Environment makes a difference
& Challenges are good
 Enriched
environments demonstrate more neurons
and neural connections
 Includes challenging education & experiential
opportunities
 Areas of the brain dedicated to certain skills
can actually adopt cells in adjacent neural
areas to serve their expanded needs
 Psychotherapy is an enriched environment that
promotes the development of cognitive,
emotional, and behavioral abilities.
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What this means for treatment:
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We need to lower the amygdala first and foremost in
treatment;
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Primary focus on safety and stabilization;
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Active and persistent teaching of self-regulation;
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Want to focus on effectively reading and responding to both
internal and environmental cues.
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Three Components:
 Sympathetic Nervous System (SNS)
 Operates mostly at the level of consciousness to
regulate body systems
 AKA “Fight or Flight Response”
 Parasympathetic Nervous System (PNS)
 Conserves energy in your body- produces
relaxation state, sense of contentment
 AKA “Rest & Digest System”
 Enteric Nervous System Regulates gastrointestinal system
 (Hansen & Menduis, 2009)
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Balance –
Buddha’s Brain – good book!
(Hanson & Medius, 2009
SNS
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Fire
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PNS
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Fire Department
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Use all your tools:
Changing the Brain
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Understanding of the brain concept
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Teach your clients and staff about the brain basics:
 Brain coloring book- 3D brain app-simple brain sheets
 This empower your clients
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Increase the PNS
 Use of multiple relaxation strategies
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Attunement and Attachment
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Narratives –
 re-author their story
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Use Visual Aids
 Signs/charts/sayings/I am poster (both staff and clients)
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Must Create Environments which
support the following:
Clients Need:
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Structure
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Consistency
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Flexibility
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Compassion
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Often Logic Will NOT work!!
To
help someone calm and problem
solve you must FIRST respond to the
right brain’s emotional needs.
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Acknowledge the emotion- use your
NONVERBAlS- physical touch,
empathetic facial expressions, a
nurturing tone of voice,
nonjudgmental listening
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Changing the Brain AKA:
Cooling the Fires
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Must work on changing how their brains are wired
 This is done through:
 Movement structured rhythmic movement (walking/yoga)
 Music/dance/pacing
 Stretches
 Eye contact!!!!
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Cooling the Fires
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Relaxation
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Feeling Safer
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Diaphragm Breathing
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Connect with People who
Support You
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Progressive Relaxation
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Bring Mindfulness to Fear
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Touching the Lips
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Evoke Inner Protectors
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Mindfulness of the Body
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Be Realistic
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Imagery
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Nurture Secure Attachment
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Balance your Heartbeat
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Find Refuge
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Meditation
(Hansen & Mendius, 2009)
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Narrative SelfNurturing your Attachment
 The
self is primarily a matrix of conscious
and unconscious memories organized into
episodes, stories, or narratives
 Shared with others, held internally, or
seen in our public and private identity
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“History
is not destiny----if you’ve
come to make sense of your life. It
isn’t what happened to you that
determines your future-its how you’ve
come to make sense of your life that
matters most”
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(Solomon & Siegel, 2003, p. 16).
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Attachment
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Most important property of humankind
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Emotional Glue
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Necessary to learn to:
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Survive
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Learn
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Work
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Love
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Emotional Nutrition
is the Ingredients for:
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Empathy
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Caring
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Sharing
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Inhibition of
Aggression
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Remorse
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Emotional Nutrition is Mostly
Nonverbal
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Eye contact
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Smell
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Tactile
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Sounds
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Taste
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Attunement Strategies
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Become an observer: focus on non-verbal;
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Be sensitive to ever-changing rhythms and remain flexible to
change;
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Consistently provide a caring, supportive response to cues;
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Remember that persons are unique and so are their needs.
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Bonding Factors
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Quantity does matter
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Attunement
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Reading and responding to cues
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Synchronous and interactive
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Balance need and
provision
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Can be taught
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Getting your Clients to Relax so they
can learn
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Teaching meditation
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Focus
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Mindfulness
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Yoga
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Visual Aids
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A key when to intervene
Errors
in judgment fall into consistent
patterns which suggests that they
reflect stable neural organization.
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All therapeutic orientation will be
successful
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As long as they are able to
foster neural growth and
integration. Enhanced by:
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Safe and trusting
relationships
Gaining new information
and experiences across
the domains of cognition,
emotion, sensation, and
behavior
The simultaneous or
alternating activation of
neural networks that are
inadequately integrated
or dissociated
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Moderate levels of stress
or emotional arousal
alternating with periods
of calm and safety.
The integration of
conceptual knowledge
with emotional and
bodily experience
through narratives that
are co-constructed with
the therapist
Developing a method of
processing and
organizing new
experiences so as to
continue ongoing growth
and integration outside
of therapy (p. 27)
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Neuroscience & Psychotherapy
side by side
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Optimal development:
integration in a context of
a balance of nurturance
and optimal stress
Empathic attunementmay create a biochemical
environment for
enhancing neural
plasticity
Affect and cognition
needed for integration of
dissociated neural
circuits
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Repetitionsimultaneous
activation of networks
(working through)
Ability to tolerate and
regulate affect allows
brain to keep growing
Co-construction of
narratives-supports the
integration of multiple
neural networks
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Any Questions?