Transcript Document

GROUP PSYCHOTHERAPY &
INTERPERSONAL NEUROBIOLOGY
AN ATTACHMENT THEORY PERSPECTIVE
PHILIP J FLORES, PhD, ABPP, CGP, FAGPA
6065 LAKE FORREST DRIVE
SUITE 150
ATLANTA, GA 30328
[email protected]
(404)-250-9340
AIM OF THIS MODULE IS TO TRANSLATE
RECENT FINDINGS IN NEUROSCIENCES TO
CLINICAL APPLICATIONS
THE THINGS MOST HELPFUL ARE:
1. IMPLICIT REALM OVER EXPLICIT REALM
2. REJECTION OF MIND-BODY DUALISM
3. AFFECT OVER COGNITION
4. MOST COMPATIBLE WITH A
INTERPERSONAL RELATIONAL APPROACH.
ALL OF THIS IS BECAUSE OF THE RECENT
DISCOVERY OF. . .
NEUROGENESIS &
NEUROPLASTICITY
VCL SAPOLSKY #9C 0;20 - 1:20
• ATTACHMENT CHANGES
THE
• STRUCTURE & BIOLOGY
– (SYNAPTIC STRENGTH, NEURONAL
PATHWAYS, ETC.)
–
(NEUROTRANSMITTERS,
DOPAMINE, CORTISOL,
OXYTOCIN, ETC.)
OF THE BRAIN
EARLY 1990’s DOGMA
“THE BRAIN IS A NONE DIVIDING ORGAN”.
• Last 10 years have over-turned the mistaken view that
the brain does not make new neurons.
• NEUROPLASTICITY: Experience & practice strengthens
pre-existing synapses & alters neural networks.
• NEUROGENESIS: The brain does make new neurons &
synapses.
– Hippocampus & Olfactory Bulb
– Prefrontal, Temporal, & Posterior Parietal Cortex
• ATTUNEMENT, CONGRUENCE & EMPATHY INCREASES
REGULATION OF NEUROTRANSMITTERS & HORMONES.
– Pour more juice into quiet circuits.
– Damp down activity in buzzing ones.
HOW DO NEURO-NETWORKS
GET ORGANIZED?
• “NEURONS THAT FIRE TOGETHER
WIRE TOGETHER.”
(HEBB, 1949)
•
When neurons fire simultaneously, their
synaptic connections become stronger,
raising the likelihood that the firing of one
will trigger the firing of the other.
•
THE GOOD NEWS & THE BAD NEWS
Behavior or thoughts repeated enough become
habitual & automatic.
THE SYNAPTIC SELF:
HOW OUR BRAINS BECOME WHO WE ARE
• We all have the same brain systems.
• The number of neurons in each brain system
is more or less the same for each of us.
• The particular way these neurons are
connected is distinct, and that uniqueness,
in short, is what makes us who we are.
• “My notion of personality is pretty simple:
your “self”-- the essence of who you are-reflects patterns of interconnectivity
between neurons in your brain.” J. LeDOUX (2002)
NEGATIVE PLASTICITY
(N. DIODGE)
• LATER LEARNING IS ENERGETICALLY UNFAVORABLE
WITHIN A NEURAL NETWORK.
• NEW LESSONS MUST FIGHT AN UPHILL BATTLE
AGAINST THE PATTERNS ALREADY INGRAINED.
• EXISTING ESTABLISHED NEURONAL PATTERNS CAN
EASILY OVERWHELM & ABSORB MODERATELY NOVEL
CONFIGURATIONS.
• THE NATURE OF NEUROVIRTUALITY ENSURES THAT IT
TRIMS THE AMBIGUITY FROM REALITY & PORTRAYS
LARGELY WHAT ALREADY HAS BEEN SEEN.
• A CHILD WHO KNEW & LOVED A DECEITFUL, SELFISH,
OR JEALOUS PARENT DOES NOT OFTEN LEARN TO
LOVE DIFFERENTLY AT AGE 20, 40, OR 60.
ADVANCES IN THE NEUROSCIENCES INDICATE
TWO DIFFERENT, ANATOMICALLY LOCATED
SYSTEMS IN THE BRAIN FOR:
• LEARNING, KNOWLEDGE & MEMORY,
• EXPLICIT MEMORY: Anatomically located
specifically in the hippocampus.
•
EFFORT IS REQUIRED: Retrieval is slow & predominantly
under the domain of left hemisphere (left temporal lobe).
• IMPLICIT MEMORY: Anatomically located in
the limbic area (amygdala) & predominantly
under the domain of right hemisphere.
•
NO SENSE OF EFFORT: Retrieval is rapid (60
milliseconds), not easily explained & consciousness or
awareness is not involved.
CHARACTERISTICS OF MEMORY
I.
IMPLICIT PROCESSING SYSTEMS (EARLY
MEMORY): PRESENT AT BIRTH.
PATTERNS & “RULES” OF RELATIONSHIPS :
(“IF I DO THIS, THAN THIS WILL HAPPEN.”)
II. EXPLICIT PROCESSING SYSTEMS (LATER
MEMORY- COMES ON LINE AFTER AGE OF TWO):
A. SEMANTIC, NARRATIVE: INITIALLY DEVELOPS
AFTERT TWO YEARS OF AGE.
B. AUTOBIOGRAPHICAL: PROGRESSIVE
DEVELOPMENT WITH ONSET AFTER SECOND
YEAR OF LIFE.
Siegel (2002)
EXPLICIT MEMORY & HIPPOCAMPUS
• HIPPOCAMPUS MORE INVOLVED IN RETRIEVAL
OF MEMORY. (H.M. Removal of hippocampus)
• MAYBE STORAGE???
• MEMORIES ARE “NOMADIC”, TRAVEL OR ARE
STORED THROUGHOUT THE BRAIN.
• AFTER “ABOUT 10 YEARS”, MEMORIES NO
LONGER REQUIRE THE HIPPOCAMPUS FOR
RETRIEVAL. (10 YEARS or 10 THOUSAND HOURS)
• THEY BECOME PART OF THE NEURAL SYSTEM (
INTUITIVE, IMPLICIT, CHARACTERLOGICAL, AUTOMATIC, HABIT)
–
BRAIN RULES (2008) JOHN MEDINA, MD,
MEMORY DOES NOT IMPLY
CONSCIOUSNESS
• IMPLICIT MEMORY USE TO BE THOUGHT OF AS JUST
MOTOR OR MUSCLE MEMORY.
• AND AS “OVER LEARNED BEHAVIOR THAT WAS
ENCODED DIFFERENTLY IN A PERSON’S MIND.”
• IMPLICIT MEMORY IS MUCH MORE & IS RELATED TO
ALL “HOW TO” MEMORY & KNOWLEDGE.
– (DIFFICULT TO EXPLAIN, BUT EASY TO DEMONSTRATE).
• NON-CONSCIOUS vs UNCONSCIOUS
•
1. UNCONSCIOUS OFTEN IMPLIES REPRESSION.
•
2. IMPLICIT IS INFORMATION THAT HAS BEEN
ENCODED & PROCESSED SO RAPIDLY THAT IT
HASN’T HAD TIME TO EVEN REACH
CONSCIOUSNESS TO BE REPRESSED.
IMPLICIT PROCESSES
KNOWLEDGE WITHOUT AWARENESS
•
•
•
•
IMPLICIT NOT JUST MEMORY
IMPLICIT KNOWLEDGE
IMPLICIT COMMUNICATION
IMPLICIT RECEPTION & PROCESSING OF
INFORMATION.
– (60 MILLISECONDS vs 250 MILLISECONDS)
• IMPLICIT AFFECT REGULATION
• IMPLICIT RULES OF RELATIONSHIPS
TESTING FOR KNOWLEDGE
“I KNOW WHY” vs “I KNOW HOW”
• I KNOW WHY - HIPPOCAMPUS:
EXPLICIT MEMORY & KNOWLEDGE.
– SELF REPORT: COGNITIVE, NARRATIVE
• I KNOW HOW - AMYGDALA:
IMPLICIT MEMORY & KNOWLEDGE.
• DEMONSTRATED THROUGH INTUITION, BEHAVIOR,
ACTION & EMOTIONS. (REFLECTED IN THE BODY)
– VISIBLY REFLECTED IN GESTURES, POSTURE, PROSODY,
FACIAL EXPRESSIONS (i.e. SMIRK, FLUSHING), EYE GAZE, &
MOVEMENT HABITS.
THINKING FAST & SLOW
DANIEL KAHNEMAN (2011)
NOBEL PRIZE RECIPIENT
• SYSTEM 1: IS FAST, INTUITIVE, EMOTIONAL
& NON-CONSCIOUS. BOTTOM UP MODEL (IMPLICIT)
• SYSTEM 2: IS SLOWER, DELIBERATE &
LOGICAL. TOP DOWN MODEL (EXPLICIT)
• DUAL PROCESS THEORY: Each system influences
the other with mixed results.
• System 1 dominates & effort is required before system 2
can exert any influence on system 1. (“You have to think”.)
• However, System 2 sometimes interferes with System 1,
resulting in reduced efficiency.
BLINK –THE POWER OF THINKING
WITHOUT THINKING M. GLADWELL
• The primary message of the book by Malcolm Gladwell,
addresses why many of us know in a few seconds who
can be trusted, when something or someone is fake, etc.
– OTHERS ARE HORRIBLE AT THIS.
• WHY OUR BEST DECISIONS ARE OFTEN THOSE THAT
ARE IMPOSSIBLE TO EXPLAIN TO OTHERS.
• ex: Doctors diagnosing cardiac emergencies in the ER
decreased in accuracy when given too much information
– (Instilled a heart attack decision tree in the er)
INTUITION & SYSTEM 1
• Intuition is simply rapid (hundreds of
milliseconds) cognition with the required
knowledge partially swept under the carpet,
all courtesy of emotion and much past
practice (10,000 hours or ten years).
• The quality of one’s intuition depends on
skill & how well we have reasoned in the
past.
RECRUIT SYSTEM 2 TO HELP MAKE
SYSTEM 1 WORK MORE EFFECTIVELY
• HELP PEOPLE LEARN WHEN TO:
– 1. TRUST THEIR IMPLICIT
KNOWLEDGE
»
OR
• 2. IF THEIR IMPLICIT RULES ARE
ABERRANT, HELP THEM QUESTION
THEIR ASSUMPTIONS & PERCEPTIONS.
THE NEUROSCIENCES ARE TEACHING US THAT
THE MOST EFFICIENT WAY TO CHANGE A
PERSON’S BRAIN IS NOT TO GIVE THE PERSON
DRUGS THAT MIMIC, BLOCK, OR SUBSTITUTE
FOR ENDOGENOUS NEUROTRANSMITTERS,
• But rather provide the person with an ongoing
opportunity for novel experiences & optimal emotional
arousal within the context of a strong, supportive
interpersonal relationship & affective bond.
• In short, if you want to change a person’s mind, be
emotionally attuned to him/her & talk with him in a
meaningful, caring manner.
• State of the art neuro-imaging techniques have
confirmed this to be so. Dan Siegel, MD, 2007
FUNDAMENTAL TASK OF
IMPLICIT TREATMENT
• HOW TO WORK WITH WHAT IS BEING
COMMUNICATED BUT NOT SYMBOLIZED
WITH WORDS.
• HOW DO WE RECOGNIZE MOMENTS OF BOTH
SUBTLE & HEIGHTENED EMOTIONAL,
BODILY BASED, IMPLICIT COMMUNICATION?
• ATTACHMENT THEORY DESCRIBES HOW
IMPLICIT SYSTEMS OF THE THERAPIST
INTERACT WITH IMPLICIT SYSTEMS OF THE
PATIENT.
• PSYCHOTHERAPY IS NOT THE “TALKING”
CURE, BUT THE “COMMUNICATING” CURE.
THE PROCESS OF CHANGE STUDY
GROUP IN BOSTON (DAN STERN)
• Is exploring the “something more” other than
interpretation that is required for successful
treatment.
• The relational procedural domain is distinct from
the symbolic domain.
• Change occurs through the relationship &
intersubjective moments (moments of meeting)
between the interactants that create new
organizations and alters implicit knowledge—the
patient’s way of being with others.
“MOMENTS OF MEETING” CANNOT BE
PLANNED, THEY HAPPEN.
• JUST AS INTERPRETATION IS THE
THERAPEUTIC EVENT THAT
REARRANGES THE PATIENT’S
CONSCIOUS EXPLICIT KNOWLEDGE,
• THE “MOMENT OF MEETING” IS THE
EVENT THAT REARRANGES IMPLICIT
RELATIONAL KNOWING FOR BOTH THE
PATIENT & THERAPIST. (D. STERN)
– BUBER EX.
EXIT INTERVIEW RESEARCH
• “It wasn’t anything that the therapist
said to me that stands out as much as it
was the look on his face when i told him
how i had been treated by my father
and the tone of his voice when he
responded to me.”
• I only remember being caught in the
moment, feeling this kindness like i
never known before.“
– CINDY M.
KOHUT, SELFPSYCHOLOGY &
IMPLICIT COMMUNICATION
• “Therapeutic change and growth takes
place in an atmosphere evoked by the
therapist’s sustained empathic efforts.”
• Patients will recognize their therapist’s
consistent efforts to understand & this is
often more important than what the
therapist says. (Rutan & Stone, 2013)
EVOLUTION PROVIDED US WITH TWO
PRIMARY TYPES OF AFFECT REGULATION
• INTERACTIVE REGULATION (A. SHORE)
•
vs
SELF REGULATION (D. SIEGEL)
•
–
MINDFULNESS TRAINING
• AVOIDANT/DISMISSIVE: A bias towards excessively reliance
on auto-regulation techniques. (“Help ain’t coming”.)
• ANXIOUS/PREOCCUPIED: A tendency to under auto-regulate
& rely excessively on interpersonal regulation. (Fear of
abandonment & constant relational difficulties)
• DISORGANIZED : Big problems arise when a person cannot do
either or relies excessively on one strategy at the expense of the
other. (Trauma)
“MEDICATION CAN HAVE A
DEVASTATING EFFECT OF
KEEPING PEOPLE SHUT OFF
FROM OTHERS.”
(Bessel van der Kolb, MD, 2007)
• Also prevents the person from
developing more effective self-regulating
or interactive regulation skills.
• Do anti-depressants impair our ability to love?
THE BRAIN: AFTER TWENTY YEARS OF
ACCUMULATED RESEARCH EVIDENCE
T. INSEL (2011) DIRECTOR OF NIMH
• “IT IS CLEAR THAT WHAT CAN BE
ACCOMPLISHED BY PHARMACEUTICAL
INTERVENTIONS HAS BEEN CLEARLY
OVERSOLD.”
• “IT IS ALSO CLEAR THAT WHAT CAN BE
ACCOMPLISHED BY PSYCHO-SOCIAL
INTERVENTIONS HAS BEEN CLEARLY
UNDERSOLD.”
EMOTIONAL PAIN ASSOCIATED WITH REJECTION
EVOLVED AS A SURVIVAL MECHANISM TO KEEP
US ATTACHED TO THE LARGER GROUP
“COGNITION IS MORE THAN KNOWING THE
EXTERNAL WORLD. IT IS ALSO KNOWING
THE INTERNAL WORLD OF ONE’S BODY”.
ALAN SCHORE (2007)
• IT IS CRUCIAL THAT A PERSON BE ABLE TO
RECEIVE & UNDERSTAND INFORMATION FROM
HIS/HER OWN BODY.
• THE ABILITY TO EXPERIENCE & READ
INTEROCEPTIVE CUES FROM THE BODY AS
WELL AS EXTROCEPTIVE CUES FROM THE
ENVIRONMENT IS CRUCIAL.
• “CHILDREN, WHO HAVE BEEN TAUGHT BY
EXPERIENCE, TO NOT TRUST THEIR INTERNAL
EMOTIONAL SIGNALS, WILL BE AT A
DISADVANTAGE AS AN ADULT.” (LEWIS, AMINI & LANNON, 2000)
.
THE POLYVAGAL THEORY &
THE SOCIAL ATTACHMENT SYSTEM
S. W. PORGES
• The degree to which we experience attachment as
uncomfortable or threatening, rather than
rewarding and pleasurable, is determined primarily
by the neurobiological adaptations our CNS makes
as a result of our earliest attachment experiences.
• Why do some people lack responsiveness to
soothing voices & smiling faces of people who care
for them, input that helps most people calm down?
NEUROCEPTION: THE BRAIN IS ALWAYS RECEIVING
INFORMATION FROM THE BODY, COURTESY OF THE VAGUS NERVE
THE BRAIN IS A LIKE A CEO THAT DOESN’T LIKE TO MICROMANAGE
“HE GIVES ME THE CREEPS”.
• A GOOD EXAMPLE OF INTROCEPTIVE
COMMUNICATION & GOOD VAGAL TONE.
• PRIMITIVE INTERNAL COMMUNICATION THAT
ENHANCES SURVIVAL FOR ALL SOCIAL MAMMALS.
• PROSODY: LOW GROWL, HIGH PITCHED SHRIEK. MUSIC TO SET
THE TONE IN A SCARY MOVIE.
• SMELL: A SINGLE SYNAPTIC LINK FROM AMYGDALA
• FACIAL MUSCLES: FROWN, SMIRK, SMILE, COLD BLANK EYES,
GAZE AVERSION, FLAT FACIAL AFFECT.
• GESTURES: HEAD MOVEMENT, BODY POSTURE
• INCONGRUENCE & EXPECTATION: SURPRISES & INCONSISTENCIES
EVOLUTION, VAGAL TONE & THE
PHYSIOLOGICAL REGULATION OF EMOTION
• While all mammals with vertebrates have vagus nerves,
only social mammals have a myelinated vagus nerve.
– Evolution & reptiles
• Without conscious awareness it detects safety & acts as a
“vagal brake”, promoting the down regulation of the
sympathetic nervous system & activation of the
parasympathetic nervous system.
– fight, flight & freeze response are moderated, thus reducing
metabolic demands & strain on the body & brain.
• This vagal brake is wired to muscles of the face & head,
allowing social mammals to detect safety & be comforted
by smiles, eye contact, prosody & gestures of the face.
IMMOBILIZATION WITHOUT FEAR
• NEUROCEPTION & GOOD VAGAL TONE REFLECTS THE
CAPACITY -- WITHOUT CONSCIOUS AWARENESS -- TO
ASSESS SAFETY.
• WHEN SAFETY IS DETECTED, VAGUS SYSTEM INHIBITS
THE SNS, WHICH ALLOWS SOCIAL ENGAGEMENT &
“IMMOBILIZATION WITHOUT FEAR.”
– Attachment, bonding, sex, spooning with your partner, etc.
• IF RISK IS DETECTED, THE INHIBITION FOR
FLIGHT/FIGHT/FREEZE IS REMOVED.
•
When confronting danger, the first part of the nervous system will try to
•
negotiate by using face, vocalizations & language.
If this fails, fight or flight mobilization kicks in. If fight or flight is
impossible, the freeze response gets activated (dissociation, fainting).
• TRAUMA & INSECURE ATTACHMENT RESULTS IN POOR
VAGAL TONE & & THE SYSTEM MALFUNCTIONING.
SCOTT, L. & KITCHENS
GOOD VAGAL TONE HELPS
DETECT FRIEND FROM FOE
• WHEN VAGAL SYSTEM IS WORKING CORRECTLY, IT
DETECTS IF THE ENVIRONMENT IS SAFE OR
DANGEROUS.
• DETECTING RISK WHEN THERE IS NONE KEEPS THE
HPA SYSTEM OVER ACTIVE.
• PEOPLE WITH IMPAIRED SOCIAL ENGAGEMENT
SYSTEMS ARE PRONE TO MISINTERPRET SAFETY AS
THREAT & OBJECTIVE DANGER AS SAFETY.
• GOOD VAGAL TONE IS LIKE GOOD MUSCLE TONE, IT
REQUIRES A SECURE BASE IN WHICH TO EXERCISE
& PRACTICE RECIPROCAL INTERACTION.
AMYGDALA = FEAR:
EARLY WARNING SYSTEM OF THE BRAIN.
RUN FIRST, EVALUATE SECOND.
• SIGHTS, SOUNDS & SMELLS HAVE DIRECT IMMEDIATE
ACCESS TO THE AMYGDALA.
– OFTEN JUST A SINGLE SYNAPSE AWAY
• TRIGGERS A BODY WIDE REACTION IN MILLISECONDS,
IGNITING THE HYPOTHALAMUS WHICH PUMPS OUT A
CASCADE OF HORMONES THAT –
– RAISES HEART RATE, PUMPS BLOOD TO MUSCLES, SHUTS DOWN
NON-EMERGENCY FUNCTIONS LIKE IMMUNITY & DIGESTION.
• ALL THIS OCCURS W/O PASSING THROUGH THE NEOCORTEX & REQUIRING RATIONAL THOUGHT OR
“MAKING” A DECISION.
WHAT INFLUENCES THE
AMYGDALA’S FAST TRACK?
• THREAT
• THE STARTLE RESPONSE IS THE FASTEST
REFLEX WE HAVE IN THE BODY
(5 MILLISECONDS)
• EAR HAS THE LARGEST DIRECT NEURON
TO THE LIMBIC SYSTEM & MOTOR STRIP.
– (3 MICRONS)
• STRESS (WHY ARE YOU SO JUMPY?)
• PAIN (THE DENTIST BARELY TOUCHES THE DRILL TO YOUR TOOTH)
PRE-FRONTAL CORTEX IS PART
OF THE LIMBIC SYSTEM
• CONFIRMS WHY THOUGHTS CAN EFFECT FEELINGS
(CBT THERAPY, INTERPRETATION @ PSYCHODYNAMIC).
• HOWEVER, EVIDENCE ALSO EXISTS THAT FEELINGS
STIMULATE & TRIGGER THOUGHTS.
– “Cognitive science may be turned on it’s head once
academicians realize how profoundly human thoughts are
influenced by affective feelings.”
THE ARCHAEOLOGY OF MIND. (PANKSEPP, 2012, P.5)
• “AN EMOTION CAN ONLY BE MEDIATED BY ANOTHER
CONTRARY OR STRONGER EMOTION.” SPINOZA (1630)
• THE BEST WAYS TO INFLUENCE FEELINGS IS WITH
STRONGER, MORE POWERFUL EMOTIONS.
– Ex: MAN & DOG
WHEN EMOTION & REASON COLLIDE,
EMOTION INVARIABLY WINS
“PASSION ALWAYS WINS OVER REASON.”
SPINOZA (1630)
“It is understandable that many wish to
envision our affective lives as being
completely intertwined with our cognitive
abilities, but from a neuro-evolutionary
perspective, this is not correct.”
PANKSEPP, THE ARCHAEOLOGY OF MIND. (2012, P.5)
WHAT HAPPENS TO THE BRAIN
WHEN AN EVENT IS TOO
TRAUMATIC?
DISORGANIZED ATTACHMENT:
STRESS, CORTISOL & THE
DIFFERENTIAL IMPACT ON
HIPPOCAMPUS
ATROPHY
vs
AMYGDALA
INCREASE IN VOLUME
FEAR & LONG TERM POTENTIATION
AMYGDALA NEURONS UNDERGO SPECIFIC
CHEMICAL & STRUCTURAL CHANGES THAT
FORM AN IMPRINT, OR MEMORY, OF THE
SENSORY IMAGE THAT ACCOMPANIES A
PARTICULAR THREAT.
IN NEUROSCIENCE LINGO, THE SENSORY INPUT
IS “POTENTIATED.”
IN PLAIN LANGUAGE: THE PREVIOUSLY
UNREMARKABLE STIMULUS (i.e.. MUGGER’S FACE,
CAR BACKFIRE, HELICOPTER) NOW EVOKES
TERROR STATES. (CHRISTINE & DARK BEDROOM)
TRAUMA & BRAIN ADAPTATIONS:
• “RESEARCH HAS DEMONSTRATED
THAT AFTER 24 HOURS, MEMORY OF
THE FEAR RESPONSE HAS
CONSOLIDATED & CANNOT* BE
ERASED.” (MICHAEL DAVIS, MD, 2009)
WHY OUR ISSUES REMAIN
OUR ISSUES
• HOW MANY TIMES HAVE WE HEARD OUR
PATIENTS LAMENT, “WHAT IS WRONG
WITH ME? WHY AM I STILL STRUGGLING
WITH THESE FEELINGS AFTER ALL
THESE YEARS OF THERAPY.”
LIMBIC IMPRINTING &
INTROJECTION OF BAD OBJECT
• AMBIVALENT/DISORGANIZED
ATTACHMENT & INTROJECTION
•
THE HAUNTING PRESENCE OF THE
INTERNALIZED ATTACHMENT TO THE
SELF/OBJECT REPRESENTATION.
AMYGDALA & IMPLICIT PROCESS
• ACTIVATED DURING THE ENCODING OF
UNPLEASANT OR AROUSING EMOTIONAL
SENSORY MATERIAL.
• ALSO RESPONSIBLE FOR THE INDIVIDUAL’S
ABILITY TO PROCESS PROSODY (THE
EMOTIONAL INTONATION IN VOICES).
– PROSODY CONVEYS DIFFERENT SHADES OF
MEANING.
• ACTIVATED DURING PERCEPTION OF EMOTION,
NOVEL STIMULI, FEAR, ANXIETY, EMPATHY,
AND MOTOR INITIATION.
– JULIE M. EX
• GREATER ACTIVATION DURING FEARFUL OR
ANGRY FACES AS OPPOSED TO HAPPY FACES.
WHY FAKING EMPATHY DOESN‘T
WORK.
•
“EMOTIONS COME FROM PHYLOGENIC,
ANCIENT TIMES & THE ABILITY TO READ &
DISPLAY THEM IS AN INBORN GIVEN, THAT IS
HONED BY MILLIONS OF YEARS OF
EVOLUTION.
•
CONTRIVED FEELINGS, MIMICKING
EMOTIONAL STATES, AND IN-AUTHENTICITY
ON THE THERAPIST’S PART, NO MATTER HOW
WELL INTENDED, ARE WORST THAN USELESS.
•
THE PATIENT’S INBORN ABILITY TO READ
EMOTIONS CORRECTLY FAR EXCEEDS THE
THERAPIST’S ABILITY TO DECEIVE.”
(Lewis, Amini & Lannon, 2000)
PAUL EKMAN & FACIAL EXPRESSIONS
• YOU CANNOT HAVE AN EMOTION
WITHOUT A COROLLARY EXPRESSION
IN THE BODY.
• EMOTIONS ARE HARDWIRED,
INSTINCTUAL, NOT LEARNED (i.e. BLIND
BABIES)
• FACIAL EXPRESSIONS ARE IDENTICAL
ALL OVER THE GLOBE IN EVERY
CULTURE.
TOMPKINS’S 9 PRIMARY AFFECTS
1. SHAME, 2 ANGER, 3. FEAR, 4. DISGUST, 5. SURPRISE,
6. EXCITEMENT, 7. CONTEMPT, 8. JOY & 9. DISTRESS
•
•
EMOTIONS ARE HARD WIRED, HIGHLY PATTERNED CIRCULATORY &
MUSCULAR ACTIONS (i.e. STARTLE RESPONSE), OF WHICH ONE FREQUENT
DISPLAY IS A “FACIAL EXPRESSION” (i.e. BLUSHING, FROWN).
WHEN WE ACCEPT OR RECOGNIZE AN EMOTION THAT HAS BEEN
TRIGGERED BY A STIMULUS, IT IS USUALLY ASSOCIATED WITH WHAT WE
CONVENTIONALLY CALL A “FEELING”.
AFFECT, EMOTION, & FEELING
CLARIFICATION IN TERMINOLOGY
A. DAMASIO (1999) THE FEELING OF WHAT HAPPENS
• ALTHOUGH FEELINGS, EMOTIONS & AFFECT
ARE ROUTINELY USED INTERCHANGEABLY, IT
IS IMPORTANT TO NOT CONFUSE AFFECT OR
EMOTIONS WITH FEELINGS.
• AFFECT AS A DRIVE.
– TOMPKIN’S NINE PRIMARY AFFECTS.
• EMOTIONS AS BODILY PROCESSES. (Damasio)
• FEELING AS A SECONDARY REACTION TO A
PRIMARY EMOTION/AFFECT
– SOCIAL COMPONENT RELATED TO JUDGMENTS
ABOUT THE PHYSICAL DEMONSTRATION OF AFFECT.
EACH OF US HAS THE SAME NINE
AFFECTS, BUT OUR LIFE EXPERIENCE
MAKES OUR INTERPRETATION OF
FEELINGS QUITE DIFFERENT.
• AFFECT OR EMOTION IS
ALWAYS BIOLOGY.
• FEELINGS ALWAYS
REPRESENTS BIOGRAPHY.
THE ROLE OF EMOTION & AFFECT
REGULATION IN PSYCHOTHERAPY
RESULTS FROM A FOUR YEAR NIMH STUDY (2009) D. H. BARLOW, PhD
• INITIAL EMOTIONS ARE USUALLY NOT THE PROBLEM;
IT’S THE SECONDARY JUDGMENTS ABOUT THE
FEELINGS THAT BECOMES THE PROBLEM
– (THE WAY A PERSON FEELS ABOUT EMOTIONS).
• MOST PEOPLE WITH ANXIETY OR DEPRESSION
RESPOND TO THEIR EMOTIONS IN A SIMILAR WAY:
•
1. CANNOT ACCEPT “NEGATIVE” EMOTIONS LIKE
ANGER, SADNESS, ANXIETY & SHAME.
•
2. THEY TRY TO SUPPRESS OR GET RID OF EMOTIONS.
•
3. THEY HAVE TROUBLE REGULATING THEIR AFFECT
OR LETTING GO.
•
4. BY CONTRAST: HEALTHY CONTROL SUBJECTS ARE
BETTER ABLE TO ACCEPT, LET GO, OR MOVE ON
FROM THEIR NEGATIVE EMOTIONS.
Effects of Reappraisal Goals
Ochsner, Ray, Robertson, Cooper, Gabrieli & Gross (2004)
up-regulate/increase negative emotion
• worry, anxiety, rumination, judgment
Aversive
Emotion
Re-appraise
The feeling or
judgment we have
about the emotion
Altered
Response
• down-regulate/decrease negative emotion
• acceptance without panic or judgment
FEELINGS vs EMOTIONS
(MIND)
vs
(BODY)
• IN MOST CASES, EMOTIONS
THEMSELVES ARE USUALLY NOT THE
PROBLEM.
• IT IS THE PERSON’S FEELINGS ABOUT
THEIR EMOTIONS & THEIR JUDGMENTS
ABOUT THEIR EMOTIONS THAT END UP
CAUSING A BIGGER PROBLEM.
NEW IMPLICIT INHIBITORY LEARNING
• BECAUSE MANY BRAIN ADAPTATIONS ARE DIFFICULT,
IF NOT IMPOSSIBLE TO ERASE, MOST CHANGES
RESULTING FROM PSYCHOTHERAPY ARE BECAUSE OF
“NEW IMPLICIT INHIBITORY LEARNING.”
• “NEW IMPLICIT INHIBITORY LEARNING” IS:
• 1. NEUROPLASTICITY INDUCED BY NEW REPETITIVE
EXPERIENCES & ACTIONS THAT STRENGTHEN &
REARRANGE EXISTING NEURAL PATHWAYS
• 2. NEUROGENESIS IS THE BIRTH & REWIRING OF NEW
PATHWAYS WHICH RESULTS IN MORE EFFECTIVE
RESPONSES TO OLD PSYCHO-SOCIAL STRESSORS.
MIND FLIGHT: THE PHOBIA OF
INNER EXPERIENCE
• AVOIDANCE OR ESCAPE FROM ONE’S OWN INNER
EXPERIENCES (Steele, 2009)
• REFERRED TO AS “PHOBIA OF INNER EXPERIENCE” OR
“PHOBIA OF MENTAL ACTIONS” (Steele, 2009; Steele et al., 2005;
Van der Hart et al., 2006)
• SOMETIMES REFERRED TO AS “EXPERIENTIAL
AVOIDANCE:” THE RELUCTANCE TO REMAIN IN
CONTACT WITH PAINFUL PRIVATE EXPERIENCES (Hayes,
Strosahl, & Wilson, 2003)
• GENERALLY BASED ON FEAR OR SHAME, AND/OR BEING
OVERWHELMED BY THE EXPERIENCE. (ex: Sally S. &
MaW)
• “KEY TO AROUSAL
MODULATION IS
‘BEFRIENDING’ INTERNAL
SENSATIONS, AND GAINING
AWARENESS OF THE
TRANSITORY NATURE OF ALL
SENSORY EXPERIENCE.”
•
B. van der KOLB (2001)
WE CAN’T CONTROL OUR
EMOTIONS, BUT WE CAN
LEARN TO CONTROL OUR
FEELINGS ABOUT OUR
EMOTIONS
• IF WE ARE SAD, WE CAN’T WILL
OURSELVES TO BE HAPPY.
• BUT WE CAN MAKE AN EFFORT TO NOT
PANIC OR BERATE OURSELVES FOR
BEING SAD.
PROMOTING SELF REGULATION.
ASSESS BOTH WHAT AN EMOTION IS &
WHAT AN EMOTION DOES
• ASSESS THE RELATIONSHIP THE PERSON HAS TO
HIS OR HER INTERNAL EXPERIENCE.
– INCREASE THEIR AWARENESS OF THEIR BODILY BASED
EMOTIONS.
• DOES THE PERSON VIEW EMOTIONS AS GOOD, SAFE,
HELPFUL OR AS BAD, THREATENING &
INTERFERING.
• HOW DO THEY FEEL ABOUT THEIR EMOTIONS?
– ASSESS HOW THEY RESPOND TO OTHER’S EMOTIONS.
• DO THEY EMPLOY ADAPTIVE OR MALADAPTIVE
STRATEGIES FOR AFFECT REGULATION?
MINDFULNESS: Model for breaking the
vicious cycle of the exacerbation of emotions
Emotion
perceived as
intolerable/
unacceptable
Efforts to
suppress
Emotion
perceived as
tolerable/
acceptable
No suppression
Suppression
Fails, Leading to
Panic,
Somatization or
Obsessive
Rumination
Stimulus
Triggers a
Negative
Affect
From: Campell-Sills, L., & Barlow, D.H., (2007).
Mood recovers
naturally
LEARNED SAFETY
(KANDEL & POLLAK, 2008)
• TRAINING MICE TO TAKE ADVANTAGE
OF SOURCES OF SAFETY & SECURITY IN
THEIR ENVIRONMENTS RESULTED IN:
• REDUCED STRESS RESPONSE
• INFLUENCED THE DEVELOPMENT OF NEWBORN
CELLS IN THE HIPPOCAMPUS. (NEUROGENESIS).
• INCREASED BDNF IN HIPPOCAMPUS &
INCREASED DOPAMINE LEVELS.
THE REPARATIVE EXPERIENCE &
LEARNING HOW NOT TO BE AFRAID
• M. MAIN IDENTIFIED A SUBGROUP OF
SECURE PATIENTS WHO DESCRIBED
PROBLEMATIC & PAINFUL CHILDHOOD
HISTORIES ORDINARILY ASSOCIATED WITH
INSECURE ATTACHMENT.
• THESE ADULTS OFTEN HAD EMOTIONALLY
SIGNIFICANT REPARATIVE RELATIONSHIPS
WITH CLOSE FRIENDS, ROMANTIC
PARTNERS AND/OR THERAPISTS.
“LEARNED SAFETY IS A LITTLE
BIT LIKE PSYCHOTHERAPY.”
ERIC KANDEL (2008) NOBLE PRIZE NEUROSCIENTIST, NOT A THERAPIST.
• RE-CONDITIONING YOUR BRAIN: THE “INHIBITION OF
THE FEAR RESPONSE” REQUIRES AN ABILITY TO
IDENTIFY, DEVELOP & EXPLOIT CONDITIONS OF
SAFETY & SECURITY IN ONE’S ENVIRONMENT.
– STAY CLOSE TO PEOPLE THAT HELP YOU FEEL SAFE.
• EARNED SECURITY DAMPENS THE STRESS RESPONSE.
•
REDUCES CORTISOL
•
INCREASES NEUROGENESIS IN HIPPOCAMPUS
– WHICH PROMOTES NEW LEARNING & MEMORY &
•
INCREASES BDNF, DOPAMINE & OXYTOCIN LEVELS