Holding your clients frontal lobe in the palm of your hand

1. Holding your clients frontal lobe in the palm of your hand Heidi V Carlson, MS, LMFT; PsyD., LP Wendi Kaisershot, RN, C Jim Campbell, LSW

2. We Were Made to Be Awesome!!

3. We are MEANT to ATTACH • Attachment • Our Brain is MEANT to CHANGE • Brain Basics • Our Brain is mostly NONVERBAL • Sensory Information

4. How do you impact Treatment? • Your explanation guides your intervention

5. Attachment and The Brain

6. What we need to know • Often patients within treatment facilities are developmentally much younger than their age. • Their brain is structured differently. • Their brain changed to survive an adverse environment yet, this comes at a high price.

7. Brain is a Biosocial Organ (Gibbson, 1996) • The 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.

8. 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.

9. A closer look at: • Brain • Attachment (setting the foundation) • Sensory input • Treatment

10. 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)

11. 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 25. • Brain develops through a “use it or lose it”process.

12. Good and Bad News • 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 • Brain is slow to develop • The brain incorporates environmental factors • This increases its chances to survive

13. Attachment is: • 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.

14. 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)

15. 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.

16. Implicit Memory & Explicit Memory • What memories we encode which become second nature • 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) • What we use to form expectations about the way the world works, based on previous experiences (Siegel & Bryson, 2011) • Implicit memory creates something called priming, in which the brain readies itself to respond in a certain way

17. Trauma- expand definition • 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 of attachment is “attunement” to others • They are attuned to self because of early childhood experiences.

18. Regulation of affect is a central organizing principle of human development and motivation (Schore, 2001a). Ability to regulate emotions are essential to adaptive function of the brain (Damasio, 1994). A Key Concept:Regulation

20. Right Brain • Dominant in the first 3 years of life • Maturation is dependent on experience- which is embedded in the attachment relationship (Schore, 1994) • Process social-emotional information • Facilitating attachment functions • Regulates bodily and affective states (Schore, 1994, 2001a)

21. Left Brain • 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.

22. Corpus Callosum • Corpus Callosum • (impaired growth)

23. Pre-frontal Cortex Last part of brain to develop • Development of the pre-frontal cortex depends upon relationship based experiences • Executive functioning • Emotion regulation (ability to manage mood) • Logical thinking • Problem solving • Planning ahead • Memory • Impulse control • Arousal states and sleep • Stress control

24. 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

26. 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

28. During Stress/Trauma

29. Amygdala • Well developed at birth • Involved with emotional learning • Central neural hub of emotional experience • Functions as an appraisal for danger, safety, and familiarity in approach-avoidance situations

30. Amygdala continued • Feelings of anxiety, déjà vu, and memory-like hallucinations have been reported with stimulation of the amygdala • Individuals under stress may be particularly vulnerable to the intrusion of powerful memories from early childhood

31. 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)? • 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-

32. Hippocampal Memory Networks • Is the structure for storing and encoding conscious information and learning • Matures later • 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 • Chronic stress associated with difficulty transferring short-term into long-term memory • 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

33. AMYGDALOID-HIPPOCAMPAL INTERACTION • 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; • Amygdala heightens awareness of specified aspects of the environment • Hippocampus inhibits responses, attention, and stimulus input. • Amygdala involved with generalization • Hippocampus with discrimination • (ex. Spider) (Cozolino, 2002)

34. Stress • Mild levels of stress- is involved in the growth and connectivity of neurons and neural circuits • Moderate stress triggers release of neurohormones that enhance cortical reorganization (Siegel, 1999) • Too much stress-damaging

35. 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

37. Neurogenesis • New neurons seem to be generated in different areas of the brain • Especially in regions involved with learning • i.e. hippocampus, the amygdala, and the frontal and temporal lobes

40. Overall Have:Limbic irritability • Increased activity in amygdala; • High degree of activation of amygdala can generate emotional responses to fragmented perceptual information (Creeden, 2007); • High levels of amygdala stimulation may have an inverted impact on hippocampal organization.

41. 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.

42. What do we do now?Create Neural Connections • Increasing Affect Tolerance and Regulation • Development of Integrative Narrative

43. 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 • Known as Plasticity

44. 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.

45. What this means for treatment: • We need to lower the amygdala first and foremost in treatment; • Primary focus on safety and stabilization; • Active and persistent teaching of self-regulation; • Want to focus on effectively reading and responding to both internal and environmental cues.

46. Autonomic Nervous System • 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)

47. Balance –Buddha’s Brain – good book!(Hanson & Medius, 2009 SNS PNS • Fire • ) • Fire Department

48. Use all your tools:Changing the Brain • Understanding of the brain concept • Teach your clients and staff about the brain basics: • Brain coloring book- 3D brain app-simple brain sheets • This empower your clients • Increase the PNS • Use of multiple relaxation strategies • Attunement and Attachment • Narratives – • re-author their story • Use Visual Aids • Signs/charts/sayings/I am poster (both staff and clients)

49. Must Create Environments which support the following: Clients Need: • Structure • Consistency • Flexibility • Compassion

50. Often Logic Will NOT work!! • To help someone calm and problem solve you must FIRSTrespond to the right brain’s emotional needs. • Acknowledge the emotion- use your NONVERBAlS- physical touch, empathetic facial expressions, a nurturing tone of voice, nonjudgmental listening