social work practice in the time of neuroscience: integrating the brain into practice 1 social work...

Social Work Practice in the Time of Neuroscience: Integrating the

Brain into Practice

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Social Work Practice in the Time of NeurosciencePROFESSOR EMERITUSDR. ROB MACFADDEN,FACTOR INWENTASH FACULTY OF SOCIAL WORK, UNIVERSITY OF TORONTO

Social Work Professional Development Day Sunnybrook Health Sciences

October 15th, 2014Bayview Campus, Room EG21 Harrison Hall

www.robertmacfadden.com

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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?

Social Work Practice in the Time of Neuroscience

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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.

BIO-PSYCHO-SOCIAL


“The Missing Link”

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shared with a range of professionsprovides a common perspective and languagebreaks down “silos”fundamental focus: brain is central to understanding feelings, behaviours, beliefscentral to understanding health and well-being


New Paradigm: Neuroscience

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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.


BRAIN FACTS

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NEURONS & SYNAPSE

Neurons that fire together, wire together (Hebb’s Law)

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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 Hippo-Campus Forms new memories

ACCSteadies attention and monitors plans, integrates feelings and thoughts Amygdala Alarm bell that responds to emotionally charged or negative stimuli

Senses the internal state of your body, including gut feelings, helps you be empathic

The major relay station for incoming sensory information

Sends neuro-modulators such as serotonin and dopamine to the rest of the brain. Regulates heart rate, breathing

Dan Siegel’s Brain Hand Puppet from Siegel & Hartzell (2003), Parenting from the inside out. P.173

“FLIPPING YOUR LID”

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



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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)


TRIUNE BRAIN

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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 self-awareness. 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)


TRIUNE BRAIN

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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.


TRIUNE BRAIN

https://www.psychotherapynetworker.org/magazine/recentissues/2008-septoct

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Cozolino & Santos (2014, p.157) remark that,

Due to their very complexity, our brains areextremely vulnerable to dysregulation,dissociation and emotional distress.

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).

Cozolino notes that the inherent weaknesses of our brain provides helpers (like social workers) with a form of job security.

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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 aday, we will spend most of our time focused on the two negative things.


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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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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.

THE POWER OF INTENTIONAL ATTENTION

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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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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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Excerpted from stephenporges.com

Neuroception describes how neural circuits distinguishwhether situations or people are safe, dangerous,or life threatening.• Neuroception explains why a baby coos at a caregiverbut cries at a stranger, or why a toddler enjoysa parent’s embrace but views a hug from a strangeras an assault.• The Polyvagal Theory describes three developmentalstages of a mammal’s autonomic nervous system:Immobilization, mobilization, and social communicationor social engagement.• Faulty neuroception might lie at the root of severalpsychiatric disorders, including autism & schizophrenia.

Reacting to Challenges: the Autonomic Nervous System: Stephen Porges & the Polyvagal Theory

Porges believes our nervous system is in a constant quest for safety.

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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.

SEEKING SAFETY

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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 BRAIN

Attachment = SurvivalAbandonment = 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 BRAIN

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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 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 and resonates with these changes and the other “feels felt” by us.

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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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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.


MINDFULNESS MEDITATION

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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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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.”

EMOTIONS

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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 oneEnrich. 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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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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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 relationshipsDaniel J. Siegel

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.


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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 co-regulation.

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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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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Conditions that promote therapeutic change:

positive therapeutic alliance with resonance, attunement, accurate empathynaming feelings and integrating into self-narrativefeeling safe and feeling feltworking on highly relevant goals with tasks that make senseincorporating self-soothing and co-soothingrepairing relationship rupturesdeliberately facilitating positives and positive emotionsmonitoring the therapeutic relationship and outcomes

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.

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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.

social work practice in the time of neuroscience: integrating the brain into practice 1 social work...

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