Transcript Social Work Practice in the Time of Neuroscience

Social Work Practice in the Time of Neuroscience
PROFESSOR EMERITUS
DR. ROB MACFADDEN,FACTOR
INWENTASH FACULTY OF
SOCIAL WORK, UNIVERSITY OF
TORONTO
Social Work Practice in the Time
of Neuroscience: Integrating the
Brain into Practice
Women’s College Hospital
Social Work
May 13, 2015
www.robertmacfadden.com
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Social Work Practice in the Time of Neuroscience
Questions for Reflective Exercise
1. From the presentation, what take away or AHA moment speaks to you as a Social
Worker?
2. How did the learning support or substantiate your role as a Social Worker within
your program?
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Social Work Practice in the Time of Neuroscience
BIO-PSYCHO-SOCIAL
“The Missing Link”
For decades social work has committed itself to a biopsychosocial
perspective with little evidence of the profession embracing the biological
side.
With the new knowledge emerging from neuroscience, social work is at a
crossroad in adoption of this new paradigm. Advances in imaging and
other technologies have opened a vista into the brain to reveal the
fundamental components and processes that underlie our thinking, feeling
and action.
Rosemary Farmer (2009), a social worker, has identified this focus on the
brain as the “missing link” for our profession.
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Social Work Practice in the Time of Neuroscience
New Paradigm: Neuroscience
shared with a range of professions
provides a common perspective and language
breaks down “silos”
fundamental focus: brain is central to understanding feelings,
behaviours, beliefs
central to understanding health and well-being
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Social Work Practice in the Time of Neuroscience
BRAIN FACTS
The brain is the most advanced and complex organ in our known universe.
1. The human brain has about 100,000,000,000 or 100 billion neurons.
From the age of 35 years about 7000 neurons are lost daily.
2. During early pregnancy the neurons in the fetus can multiply at a rate
250,000 neurons/minute.
3. Brain is composed of 75 to 80% water. Dehydration can affect proper
functioning of brain.
4. All the thinking in the brain is about electricity and chemicals. The brain
is more active at night than during the day.
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Social Work Practice in the Time of Neuroscience
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Social Work Practice in the Time of Neuroscience
NEURONS & SYNAPSE
Neurons that fire together, wire together (Hebb’s Law)
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Social Work Practice in the Time of Neuroscience
Pre-frontal Cortex
Anterior Cingulate
Cortex
Insula
Thalamus
Brain Stem
Sets goals, makes
plans, directs
action, shapes
emotions, partly by
guiding and
inhibiting the
limbic system
ACC
Steadies attention
and monitors plans,
integrates feelings
and thoughts
Senses the internal
state of your body,
including gut
feelings, helps you
be empathic
The major relay
station for incoming
sensory information
Sends neuromodulators
such as serotonin and
dopamine to the rest of
the brain. Regulates
heart rate, breathing
HippoCampus
Amygdala
Forms new
memories
Alarm bell that
responds to
emotionally
charged or negative
stimuli
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Social Work Practice in the Time of Neuroscience
http://www.youtube.com/watch?v=DDlfP1FBFk
“FLIPPING YOUR LID”
Dan Siegel’s Brain Hand Puppet from Siegel & Hartzell (2003),
Parenting from the inside out. P.173
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Social Work Practice in the Time of Neuroscience
TRIUNE BRAIN
The brain has developed over millennia and this history influences who we are
today. The brain is an archeological record. (Triune Brain by Paul MacLean)
In general terms, the brain can be seen in terms of three evolutionary
components:
The reptilian brain was the first core to develop and is basic life sustaining,
controlling key functions such as respiration, circulation, the endocrine system,
reproduction, arousal & homeostasis. Much is reflexive and drive based- fear,
rage, eating, and mating which still retains a degree of control over our actions.
(Brainstem)
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Social Work Practice in the Time of Neuroscience
TRIUNE BRAIN
The paleomammalian brain was added on and brought with it learning,
memory and emotion. (Limbic system)
The neomammalian brain was a third addition and brought enhanced
cognition, enhanced social connection and sense of self and selfawareness. Problem-solving was enhanced and an increased emphasis
on social connection enabled us to organize into larger communities, to
increasingly plan ahead and to learn more from experience. (Neocortex)
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Social Work Practice in the Time of Neuroscience
TRIUNE BRAIN
Louis Cozolino describes psychotherapy in “It’s a Jungle in There”
(Psychotherapy Networker 2008 September/October) is like working with
an anachronistic menagerie- a human, a horse and a crocodile within the
same body.
Our skull shares its space with ancient brain equipment and our
functioning requires integrating and coordinating these highly specialized
and complex systems. These areas of our brain can vie for dominance
and experience conflict with each other without us being conscious of
this.
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Social Work Practice in the Time of Neuroscience
Cozolino & Santos (2014, p.157) remark that,
Due to their very complexity, our brains are
extremely vulnerable to dysregulation,
dissociation and emotional distress.
Cozolino notes that the inherent weaknesses of our brain
provides helpers (like social workers) with a form of job
security.
The authors also note that
…adding a neuroscientific perspective to our
clinical thinking allows us to talk with clients
about the shortcomings of our brains instead of a
problem with theirs (p. 175).
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Social Work Practice in the Time of Neuroscience
Velcro for Negatives: Tilted towards Anxiety and Fear
Evolution favours an anxious gene (Aaron Beck).
We can be anxious/fearful about anything (e.g., our furniture).
Human condition is tilted towards anxiety or fear.
If ten positive things and two negative things happen to us in a
day, we will spend most of our time focused on the two negative things.
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Social Work Practice in the Time of Neuroscience
Teflon for Positives
The brain does not focus on positives and we have to work hard
sometimes to become aware of positive experience them. An entire
field of Positive Psychology has emerged that highlights how important
positive experiences and emotions are to our health and well-being.
Martin Seligman is a pioneer in this area (his recent book is titled,
“Flourish”) and Rick Hanson has done considerable work in helping us
to learn how to maximize the benefits of positive emotion. His recent
book is entitled, “Hardwiring Happiness”.
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Social Work Practice in the Time of Neuroscience
THE POWER OF INTENTIONAL ATTENTION
Attention resembles a spotlight, illuminating what it rests upon (Hanson)
Consciousness may play a direct role in harnessing neural plasticity by altering
previously automatic modes of neural firing and enabling new patterns of
neural activation to occur. Attention directs change.
The basic steps linking consciousness with neural plasticity are as follows:
Where attention goes, neural firing occurs. And where neurons fire, new
connections can be made. Directing attention purposefully shapes the brain
and impacts one’s life.
Most neuroplasticity is incremental, not dramatic
Neuroplasticity is double-edged- can work for or against you.
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Social Work Practice in the Time of Neuroscience
Critical Discovery in Neuroscience?
Neuroplasticity and Neurogenesis
Neuroplasticity is the brain’s ability to reorganize by creating new neural
connections over the lifespan.
Neurogenesis is the process by which new neurons are generated.
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Social Work Practice in the Time of Neuroscience
Neural Circuitry: We’re all electricians.
Circuits are being formed, weakened, strengthened, and purged. Experience
is like a scalpel. Much happening unconsciously and may be consciously
driven.
Meditation is an act of circuit building- if you have an awareness of this, then
it’s a conscious act of circuit building.The ability to control and to direct your
attention is essential to well-being. It is the core of emotional regulation.
Secret to deliberate circuit building: paying attention. Intentional attention.
The ability to connect with, attune to, and help build new neural connections at
the heart of psychotherapy. We are all gardeners, helping each other manage
and grow our gardens.
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Social Work Practice in the Time of Neuroscience
Reacting to Challenges: the Autonomic Nervous System:
Stephen Porges & the Polyvagal Theory
Excerpted from stephenporges.com
Neuroception describes how neural circuits distinguish whether
situations
Porges
believes our
nervous
system is in a
constant quest
for safety.
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MINDFULNESS MEDITATION & NEUROSCIENCE
http://www.youtube.com/watc
h?v=8tz146HQotY
https://www.youtube.com/watch?v=MK
kDAOW2yd4
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Social Work Practice in the Time of Neuroscience
SEEKING SAFETY
This new vagal circuit also inhibits heart rate and arousal. It shares a
pathway that co-ordinates the nerves controlling the muscles in the face and
head. So people are literally showing their heart on their face. This circuit
impacts our voice and middle ear muscles.
To calm a person you need to smile and talk to them in a soothing (i.e.,
prosodic) way.
Clinicians need to appreciate the importance of creating safety in our work.
Avoid low frequency sounds (predators) such as ventilation systems and
traffic sounds. Explore what kind of seating feels safe or comfortable.
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Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
There are no “single” brains.
Humans are social to the core; the mind is both embodied and relational.
Human development and maturation is the longest of all the mammals;
infant and parent are an inseparable dyad.
We need considerable “home assembly”. Brain maturation occurs into the
twenties. Brain development occurs throughout a lifetime.
Social relatedness is structured by neural networks of bonding and
attachment, play, predicting other’s behaviours and feeling the feelings of
others. At birth, baby set up to encourage social connections through
reflexes such as grasping, eye contact and following. It makes them cuddly
and attractive to kick start bonding and attachment.
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Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
Attachment = Survival
Abandonment = Death
Infant and children use their parents’ prefrontal lobes as an external prosthetic
to help them regulate their emotions (Cozolino, 2006)
Attachment involves the creation of feelings and perceptions connected with
self and other and includes evaluation of the worth of self and other and
whether other people are predictable, safe and encouraging or unpredictable
and dangerous.
Baby is now being seen as an important agent (not just passive) in the
attachment resonance. Neurochemical cascade between parents and baby
including endorphins, dopamine which rise and fall with touch and separation.
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Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
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Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
Mirror Neuron System
Knowing you, knowing me, knowing you.
Considered the root of empathy. Allows us to map the mind of others. Mirror
neurons respond to acts with intention or purpose. Includes any act in others you
can predict (unconsciously) from experience.
Automatic. Hardwired to detect sequences and make maps in our brains of the
internal states of other people. Cross modal: operates on all sensory levels. A
sound, touch or smell can cue us to the internal state of another. Through
embedding the mind of another in our firing patterns, this forms the basis of our
mindsight maps.
Not only behavioural intentions of others but emotional states of others. We
come to resonate with the emotional states of others.
Mirror neurons are neural components designed to pay attention to the behaviours,
feelings, intentions of others and to provide this information to our brains. This is a
type of social Wi-Fi.
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Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
Mirror Neuron System
Knowing you, knowing me, knowing you.
Mirror neurons are neural components designed to pay attention to the
behaviours, feelings, intentions of others and to provide this information to
our brains. This is a type of social Wi-Fi.
When we watch others, the mirror neurons pick up these cues and through
the collaboration of other brain components such as the insula, this
information flows throughout our body and brain. Aspects of our body
resonate with this information and change parts of our own physiology.
These changes are sent up the insula and into our prefrontal cortex which
perceives these changes as a “feeling”.
Thus, in watching others, we resonate and our bodies change to attune and
to reflect these states in others. We are able to feel empathy for the other.
The mirror neuron system in others sense the change in our bodily states
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and resonates with these changes and the other “feels felt” by us.
Social Work Practice in the Time of Neuroscience
SOCIAL BRAIN
Cozolino points out that psychotherapy works because:
the brain is a social organ of adaptation shaped to connect with
and change in response to others;
this change occurs through neuroplastic processes;
therapists and patients co-create narratives that support neural
integration.
He adds that psychotherapy works because it uses the ability of brains to
connect, attune, join together and trigger neuroplasticity in the service of
positive change
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The face and voice are significant channels through which safety is
communicated to another. Face is the area particularly where presence is
communicated to the client (Geller and Greenberg). Faces are information
centres along with voice.
Over time, the therapist’s warm facial connection, receptive posture, open
heart and listening presence promotes safety and neural regulation of the
client’s physiology, strengthening emotional regulation.
Therapist’s preparation involves cultivating personal presence prior to
meeting. This is internal attunement which generates calm and safety within
the therapist. Therapeutic presence involves attuning to oneself and one’s
felt sense of the client. Feeling felt impacts the client’s physiology though
calming feelings of safety.
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MINDFULNESS MEDITATION
In mindfulness, Dr. Dan Siegel believes the process of following your
breath in a certain way and with certain mental filters, leads to the
meditator developing a positive, supportive relationship with oneself.
This is similar to us being a secure parent to ourselves. We are
responsive, accessible and attuned to our behaviour, feelings and
perceptions.
Therapists talk about creating a supportive, holding environment with
clients. Mindfulness is a form of a supportive, holding relationship with
ourselves.
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Social Work Practice in the Time of Neuroscience
Therapeutic relationships are viewed as forms of attachment
relationships which create the conditions for optimal change.
Interpersonal relationships involve biochemical changes which
result in many things including new neural connections and
learning.
This new perspective views social workers as physical
change agents involved in stimulating new neural
connections.
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EMOTIONS
In neuroscience, emotion and feelings are related but different. Antonio
Damasio, a distinguished neuroscientist views emotions as playing out in
the theatre of the body. Emotions are bodily responses that evolved to
ensure our survival and they are at the core of who we are and that they
reflect prepackaged decisions of great complexity (LeDoux, 1996).
Damasio views feelings as occurring in the theatre of the mind, after
emotional arousal begins. He believes that emotion, feeling and biological
regulation are all in the “loop” of high reason. Damasio (2003, p. 86)
describes a feeling as “…the perception of a certain state of the body
along with the perception of a certain mode of thinking and of thoughts with
certain themes.”
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Positive Emotions: Hanson and Happiness.
Have to activate inner states first, then install them. Fostering states until
they become traits is the secret.
Negative states can quickly become negative neural traits.
Most positive states are wasted because they are too short-term. Need
to transfer short term states from short-term memory buffers to long term
storage or no lasting value.
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H-E-A-L PROCESS
Have- you have the positive experience – notice one or create one
Enrich. Increase duration, intensity, multimodality (bring into body,
sit up proudly), Novelty heightens learning and increase personal
relevance.
Absorb. Visualize it sinking in, sense it, build it.
Link. (optional). Hold positive feelings or thoughts or memories in
awareness and introduce some painful thoughts, feelings, etc. (natural
antidote).
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The positive material will gradually associate with the negative
material, soothing, easing and eventually replacing it.
Have more episodes over the day, even 30 seconds at a time, half
dozen times a day. Dozen or so seconds each time. Will turn
activated states into traits eventually.
It is startling to realize how unwilling the mind is to give the
gift to oneself of a positive experience (Hanson).
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Social Work Practice in the Time of Neuroscience
Let us be grateful to people who make us
happy. They are the charming gardeners
who make our souls blossom.
Marcel Proust
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Social Work Practice in the Time of Neuroscience
Siegel defines the mind as an embodied and relational process that
regulates the flow of energy and information. Regulation is central to
mental life, and helping others with this regulatory balance is fundamental
to understanding how the mind can change.
Goal is to promote mental health and well-being. Key is promoting flow (versus
chaos and rigidity) and integration (i.e., everything working together individually,
and in harmony). Triangle of well-being: Empathic relationships, healthy mind and
integrated brain.
An Integrated brain, coherent mind, empathic relationships
Daniel J. Siegel
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SOME PRACTICE TAKEAWAYS
Need to understand how to explain the workings of the brain to clients and to appreciate
the importance of the normalizing effect that this knowledge can have for many clients. The
“handy” brain puppet is a useful tool for this purpose.
Need to become experts in understanding and impacting the stress response. This
involves understanding both the “brakes” (i.e., things that activate the parasympathetic
system such as breathing, self-hypnosis, mindfulness) and the “accelerators” (e.g.,
sometimes a certain level of arousal is required).
Clinicians need to be become “amygdala whisperers” and learn how to soothe the
client’s fear and anxiety. Helping clients to learn how to self-soothe and helping
partners and families to soothe each other is essential. Emotional regulation and coregulation.
Positivity and positive emotions, the foundation of Positive Psychology, are extremely
important. We need to help clients find positives in their lives and learn how to
recognize them, savour them, and marinate in them. Also related to Strengths-based
work. Building social support networks is another example of using positives.
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SOME PRACTICE TAKEAWAYS
We need to be sensitive to what we are communicating to client unconsciously (e.g.,
through non-verbal communication) and what implicit messages that agencies give off
(e.g., messy and drab waiting room suggesting client low worth).
Powerful right brain to right brain communication is occurring implicitly and is seen as
the most important form of communication in terms of impacting the client.
Use the mirror neuron system to “sense” the experience of the client but always check to
see if your perceptions are accurate. (Tuning Fork)
Work to improve vertical integration (cortex with the brain stem and internal organs and
visceral system) by promoting body work so that the client is able to be aware of internal
sensations and improve the vertical low essential in integration and mental health.
Work to improve horizontal integration (right brain to left brain communication) by
exploring feelings, autobiographical self, experiences and how these connect with the left
brain understanding through, for instance, the development of self-narratives. This
enhances integration and mental health.
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SOME PRACTICE TAKEAWAYS
Understanding that evoking certain experiences, including intentional attention,
activates neuroplasticity which helps to build new neural connections (i.e.,
learning) and the speed of the connections. Aerobic exercise, mindfulness
practice, nutrition, therapeutic relationships can all promote neuroplasticity.
Conditions that promote therapeutic change:
positive therapeutic alliance with resonance, attunement, accurate empathy
naming feelings and integrating into self-narrative
feeling safe and feeling felt
working on highly relevant goals with tasks that make sense
incorporating self-soothing and co-soothing
repairing relationship ruptures
deliberately facilitating positives and positive emotions
monitoring the therapeutic relationship and outcomes
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Bibliography
Cozolino, Louis (2010). The neuroscience of psychotherapy: Healing the
social brain. Second Edition. NY: W.W. Norton & Company.
Cozolino, L., Santos, E. (2014). Why we need therapy- And why it works.
Smith College Studies in Social Work, 84:157-177.
Damasio, A. (2001). Interviewed in the video, produced by David Grubin,
Secret Life of the Brain. NY: Public Broadcasting System.
Hanson, R., Mendius, R. (2009). Buddha’s brain. Oakland, CA: New
Harbinger Publications.
Hanson, R. (2013). Hardwiring Happiness. NY: Harmony Books.
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Schore, Allan (2012). The Science of the Art of Psychotherapy. NY: W.
W. Norton & Company.
Seligman, Martin (2011). Flourish. NY: The Free Press.
Siegel, Daniel J. (2013). The developing mind: How relationships
and the brain interact to shape who we are. Second Edition. NY:
Guilford Press.
Siegel, Daniel J. (2010). The mindful therapist: A clinician’s guide to
mindsight and neural integration. NY: W. W. Norton & Company.
Van der Kolk, B. (2014). The body keeps the score: Brain, mind
and body in the healing of trauma. NY: Viking.
See also robertmacfadden.com for a range of related resources from
documents to webinars.
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