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Neuroscience and Ethics of Trauma-Informed Practice

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Mental Health – What is it?

Mindsight • the ability for one person to perceive the mental state of another.

Mental Health – How do we get there?

“Mindsight depends on linking together wide arrays of neural input – from throughout the entire body, from multiple regions of the brain, and even from the signals we receive from other people.”

Dan Siegel

Brain Anatomy – The Hand Model

http://www.youtube.com/watch?v=DD-lfP1FBFk

Review 5 - steps

Brain Anatomy – Vertical Integration

Brain Stem (“reptilian brain”)• Controls body’s energy levels (i.e., regulating

heart rate and respiration)• Moves information from the body proper to the

brain (i.e., nauseas, hair on the back of your neck, nervous feeling, rapid heart beat)

• Influences response to flee, fight, or freeze in the face of overwhelming situation

Brain Anatomy – Vertical Integration

Brain Stem (i.e., “reptilian brain”)• “Giving” and “receiving” love are the

same• Working together, the brain stem and

limbic areas– oPush toward deep drives (i.e., food, shelter,

reproduction, safety)o Influences states (i.e., drive toward vs.

satiated) of arousal (i.e., sexual and appetite)

Limbic Area (“old mammalian brain”)

• Emotional center of the brain• Attributes meaning to feelings (i.e.,

feelings have meaning)• Motivates us to act in response to

meaning we assign (i.e., emotions evoke motion)

• Mammalian lineage – our drive to connect with others

Limbic RegionHypothalamus, Amygdala, and Hippocampus

Hypothalamus • Secretes hormones (i.e., cortisol) to help

regulate the body (i.e., sexual organs, thyroid)

• Small amounts of cortisol enhance functions such as memory

• Overwhelming situations with which we can’t cope lead to chronically elevated cortisol.

Limbic Region Cont’dHypothalamus, Amygdala, and Hippocampus

Hypothalamus – High Cortisol Over Time

• Sensitizes limbic reactivity so that minor adversities spike cortisol.

• Interferes with brain growth and damages neural tissues

• Self-soothing activities (i.e., meditation, walks in nature) that draw on higher areas of the brain are critical to create a “cortical override”

Amygdala• Fear response• Emotional states can be created without

conscious awareness • Remembers any and all dangers and

generalizes (i.e., attacker, man who looks like attacker, to man, etc)

Hippocampus • Organizes explicit memory• Compares different memories and make

inferences• Late maturation

Cortex (“new brain”)

Cortex• Abstract and symbolic thought• Understand concepts such as self, time,

others• Executive planning, social functions• Consciousness, perception, attention

Middle Prefrontal Cortex• Integrates cortex, limbic and brain stem

Left, Right Hemispheres

Brain Anatomy – Horizontal Integration

Left-right integration enables us to:

• Put feelings into words

• Think about feelings

At birth – • Hippocampus (memory and learning) not

well developed• Implicit memory (memories without a

“sense” of recollection)• Implicit memory enables development of

mental models i.e., transferring felt experience of

pacifier with nubs to visually recognizing it

Memory

Implicit memory • begins in the womb • predominates through early life • enables creation of mental models of the

way the world works – no effort on our part

• can continue to shape who we are without our awareness

Memory Cont’d

• Hardwired from birth to detect sequences, make maps of other’s intentions

• A neuron that mirrors the behavior of others, as though the observer were doing the behavior.

• Fires when observing intentional behavior• Same neuron fires when conducting the

behavior• Cross-modal (i.e., vision, touch, smell, etc.)

Mirror Neurons

• A neural network called insula (i.e., information superhighway) runs from mirror neurons to limbic area which sends messages to the brainstem and body, then back to middle prefrontal cortex.

• This process informs the cortex of our state of mind (i.e., energy and information flow).

Resonance Circuit

• This enables us to resonate physiologically with others; our respiration, blood pressure, heart rate changes with other’s internal state.

• When we sense our own state, it is easier to resonate with others.

Resonance Circuit Cont’d

• We come to know our own mind (i.e., energy and information flow) through interaction with others.

• It is the awareness of our own body signals that help us understand the difference between me and you.

• It is important to track distinction between me and you, lest we become flooded with others’ feelings, leading to quick burn out.

Resonance Circuit Cont’d

• Brain structure and processes affected by microexpressions in infant-caregiver dyads

• Synapses are programmed to receive certain microexpressions

• If the expected experiences are not experienced, neurons die

• Death of neurons leads to a smaller volume amygdala and hippocampus (Glaser)

Infant Care-Giver Dyads – Prelude to Attachment

Neurobiology for Clinical Social Work, Applegate and ShapiroNeuroscience of Psychotherapy, Cozolino

• Microexpressions occur via verbal and nonverbal responsive communication such as:

o Voice pitch, tone, rhythmo Pupil dilationo Movement of eyebrowso Degree of eye opennesso Fullness or terseness of lips o Level of muscle tension in the faceo Other verbal and nonverbal communication

Infant Care-Giver Dyads – Prelude to Attachment Cont’d

• Prolonged mutual gazing increases infant’s metabolic activity and neural growth

• Reflexive smiling evokes positive feelings which stimulates brain development

• Infant and caregiver adjust to each others’ gestures, behaviors, and sounds in a song and dance fashion

Infant Care-Giver Dyads – Prelude to Attachment Cont’d

• A responsive song and dance (i.e., exchange of microexpressions) sets children up to experience secure attachments. (Cozolino)

• Good-enough parenting

Infant Care-Giver Dyads – Prelude to Attachment Cont’d

• Secure attachment sets the stage for integrated neural networks.

• Insecure attachments sets the state for unintegrated neural networks.

Attachment Patterns & Emotional Regulation

Attachment patterns arise as a result of infant caregiver interactions and establish neural networks:

Behavioral Videos (7:15)•Secure•Insecure/AvoidantAmbivalenthttp://www.youtube.com/watch?v=PnFKaaOSPmk

Neurobiology VideosAvoidant (2:04) http://www.youtube.com/watch?v=qgYJ82kQIyg&feature=results_video&playnext=1&list=PL1A32ED7EF5F192F2Ambivalent (1:56)http://www.youtube.com/watch?v=nGhZtUrpCuc&feature=relatedDisorganized (4:48)http://www.youtube.com/watch?v=zovtRq4e2E8&feature=related

Secure – • Uses caregiver as a secure base for exploring.

Insecure – • Unable to use caregiver as a secure base (true

for ambivalent and disorganized)• Little distress on departure, little response to

return• Little effort to main contact. Low attachment

equals low affect, low self-esteem.• Parent has little response to distressed child.

Attachment Patterns Summary

Ambivalent – • Seek contact upon return but reluctant, or

angrily resistant when contact is achieved. • Children are more anxious. Parent is

inconsistent with dismissive and attentive responses.

Disorganized – • Freezing or rocking. Contradictory, disoriented

behaviors such as approaching but with the back turned.

• Parent likely violent, intrusive, role confusion, negativity, contradictory affective communication.

Attachment Patterns Summary

• Early deprivation or chronic stress increases the chances of damage to the brain, deficits in memory, and prolonged use of primitive defenses.

• Through the connect-disconnect-reconnect pattern, our experience with a “good-enough” parent establishes the neural networks for healthy affect regulation (i.e., being able to tolerate negative affect).

How Trauma Affects Emotions

Two primary implicit/explicit response patterns

1. Recall what happened and separate physical, emotional sensations

• Describe traumatic event in matter-of-fact w/o making implicit body memories explicit

2. Inability to recall what happened (i.e., explicit memory) yet retain physical, emotional senses)

• i.e., abusive childhood isn’t a problem, yet person is profoundly negative, critical, etc./acting out their implicit memories

How Trauma Affects Memory

• Inability to recall traumas that occurred in infancy, may lead children to internalize the somatization of their implicit memories and conclude they are bad.

• Ambiguous stimuli (i.e., silence) activates implicit memory

• Smaller hippocampus (i.e. responsible for memory and learning) due to chronically high cortisol levels, toxicity and cell death

How Trauma Affects Memory Cont’d

Lack of vertical neural integration• Affect dysregulation i.e., inability of the cortex

to process, inhibit and organize information from brainstem and limbic system such as reflexes, impulses, and emotions.

• Trauma or living in an “emotional desert” leads to being cut off from bodily sensations, leading to poor judgment, lack of wisdom.

Responses to Trauma

Lack of horizontal neural integration (i.e., one side dominating) leads to:• Inability to put feelings into words• Somatization (i.e., manifestation of emotional

conflicts into bodily illnesses)• Loss of creativity, richness, and complexity

that results from integration• Inability to understand the nonverbal world

of self and others

Responses to Trauma Cont’d

Interpersonal Neurobiology Series (Cozolino, Siegel)

Restoring neural integration requires simultaneous reregulation of networks on vertical and horizontal planes. This may occur through:

• Strength of the therapeutic alliance• Moderate levels of stress• Narrative which involves emotion and cognition• Mindsight (i.e., ability to perceive the mental state of

another person)

These same factors are at work across psychodynamic, systems, and cognitive approaches to treatment.

Healing Trauma: Strengthening Neural Integration

Narratives are powerful tools for high-level neural integration because they contain:

• Linear storyline and visual imagery, woven with• Verbal and nonverbal expressions of emotion

Healing Trauma: Narratives and Neural Integration

Narratives facilitate neural integration by using circuitry from:

• Left and right hemispheres• Cortical and subcortical networks• Amygdala and hippocampus

Healing Trauma: Narratives and Neural Integration Cont’d

Narratives facilitate • Integration of neural networks • Combining sensations, feelings and

behaviors with conscious awareness• Individuals placing themselves in

alternate points of view

Healing Trauma: Narratives and Neural Integration Cont’d

• Based in neuroplasticity research, Dr. Siegel explains in this video explains how “making sense of what happened to us as a child” is more important than actually what happened.• “Become a Better Parent”

http://www.youtube.com/watch?v=JNNT7loaQAo&feature=bf_prev&list=PL1A32ED7EF5F192F2&lf=results_video

Hope is Present!