an integrative approach to therapeutic intervention€¦ · an interpersonal neurobiology approach...

An Interpersonal Neurobiology Approach to Trauma and its Treatment

Daniel J. Siegel, M.D. 1


Daniel J. Siegel

Mindsight Institute

Mind Your Brain, Inc., (c) 2017

An Integrative Approach to Therapeutic Intervention

Consilience and IPNB

From Science to Subjectivity

Relationships, Mind, and Brain

The Centrality of Integration


Therapeutic Strategies of Intervention

The psychotherapeutic relationship “SNAGs” the brain toward integration:

S timulates

N euronal

A ctivation &

G rowth




Developmental

Trauma:

Abuse and

NeglectMind Your Brain, Inc., (c)

2017

The Six Interrogatives of the Mind:

WhatWhereWhoWhenHowWhy?


How does attachment shape the development of the mind?




What is Dissociation?


What is an “Integrated Self”?


A Surprising Notion

An often not discussed process is at the heart of both neural function and relationships. What do you think this might be?

In other words, what is the shared element between relationships and the brain?

And what does the “mind” have to do with these?




RELATIONSHIPS

(EMBODIED) BRAIN MIND

WHAT CONNECTS MIND, BRAIN, AND

RELATIONSHIPS?


An Overarching View:Energy and Information Flow is the basic “element” of the system of our lives

When this flow happens “inside of us” we are looking at the embodied brain

When this flow happens “between us” we are looking at our relationships

The Mind may emerge from this flow—and also regulate it!


The Mind—What is it?

1. Information Processing (Feelings, Thoughts, Memories …)

Subjective Experience we feel in Awareness

AND an...

“Embodied and relational, emergent self-organizing process that regulates the flow of energy and information”




Four Facets of MIND:

Subjective Experience

Consciousness

Information Processing

Self-Organization


A Working Definition of a core aspect of the Mind

An Embodied and Relational

Process that

Regulates the

Flow of Energy and Information

(An Emergent Property that arises from the interactions of elements of a system—i.e. from the flow of energy within embodied neural activity and relational communication)


The CLIFF of Energy

Contours

Location

Intensity (Amplitude and Density)

Frequency

Form




Integration: A simple but powerful framework

Integration is:

The

LINKAGEof

D I F F E R E N T I A T E D Parts


The River of Integration


Trauma and Impaired Integration

Trauma induces neural effects on the capacity for integration:� Linking fibers damaged

� Epigenetic changes

� Self-reinforcing interpersonal behaviors

� A “Trapped Mind” caught in a neurally and interpersonally reinforcing loop of potentially maladaptive, destructive, and addictive behaviors.




Major Interpersonal Neurobiology Principles

Mind viewed as a self-organizing emergent property or process that REGULATES energy and information flow

Harmony and Health emerge from integration—the linkage of differentiated elements of a system

Chaos and/or Rigidity result from impaired integration

The mind is both EMBODIED and RELATIONAL

Regulation entails MONITORING and

MODIFYING



Rethinking the DSM: integration as health and disorder as examples of "un-health”

Integration, Presence and Health

1. Studies of Well-Being reveal the interconnected connectome, or the linkage of differentiated regions best predictor;

2. Studies of impaired well-being reveal impaired integration in the brain (trauma and non-trauma related disorders);

3. Neural integration is the mechanism beneath regulation (mood, emotion , thought, attention,

behavior, relationships, morality)

4. Integrated Relationships � Neural Integration � Health





Integrative Prefrontal Functions�Bodily

Regulation

�Attuned

Communication

�Emotional

Balance

�Fear Extinction

�Flexibility

�Insight

�Empathy

�Morality

�Intuition


Trauma and the Brain

Neglect and Abuse impair the development of integrative fibers of the brain.

The timing of traumatic experience shapes which fibers are affected.

Integrative impairment leads to classic PTSD symptoms including dissociative processes.




REGULATION

Monitoring

Modifying



Belonging, Attachment, and Disorganization

Reactivity (NO!) versus Receptivity (Yes…)

Threat state of REACTIVTY: Four F’s

� Fight

� Flight

� Freeze

� Faint




Parent-Child Relationships

How an “attachment figure” interacts with a child is how they share energy and information.

This E and I flow exchange shapes the activity and growth of the brain.

How does this happen, and what do we know from science about how to optimize that neural growth?


Temperament and Attachment

Temperament

An inborn feature of the child (not only genetic)

Inborn predisposition of the nervous system

May have lifelong impact that is influenced by experience – especially with caregivers

Attachment

The relationship of the child to the caregiver over time

Research has shown attachment shapes the developing mind

Attachment impacts self-regulatory circuits


Chess and Thomas’ Nine Aspects of Parental Report of Temperament: Matching

Activity Level (the motor activity)Rhythmicity (regularity of functions)Approach (positive response to new stimuli vs. withdrawal)Adaptability (ease with which responses are modified)Threshold of Responsiveness(sensitivity level)

Intensity of Reaction (the general energy level of a response)Quality of Mood (the intensity and nature of emotional responsiveness)Distractablity(responsiveness to extraneous stimuli altering ongoing behavior)Attention span/persistence(vigilance in attending to task)




The Brain is a Social Organ

The function of the brain is to engage with other people, other brains, in the shaping of its development over time and in shaping its activity in the present

Humans can have more than one attachment figure=“Alloparenting”

We “see” each others’ minds with reflective function, mentalization, “mindsight” and theory of mind


A simple but profound pattern

Integration (the LINKAGE of DIFFERENTIATED PARTS) may be the heart of well-being

Integration in Relationships is the basis for SECURE ATTACHMENT…and leads to:

Integration in the Brain, the basis for optimal SELF-REGULATION


Integration and Neuroplasticity

Integration creates Harmony

Impairments to Integration lead to Chaos and/or Rigidity

The Nine Domains of Integration

Strategies for Enhancing Neuroplasticity




The Mindful Therapist

What PART do we play as therapists?

John Norcross’ findings: The Presence, Empathy, and Openness to Feedback of the Therapist are crucial elements in therapeutic outcome in meta-analyses of psychotherapy research.

What is the Neurobiology of Presence?


Using the power of awareness and attention to catalyze neural integration


How do clinicians approach assessment using mindsight and integration?




The Part we play as therapists:

Presence

Attunement

Resonance

Trust

Truth

Tripod

Triception

Tracking

Traits

Trauma

Transition

Training

Transformation

Tranquility

Transpiration


Mindfulness, Mindsight, & Integration

“Mindfulness”

Self-Compassion: Mindfulness, Self-Kindness, and our Interconnected Humanity (K. Neff)

Mindsight: Perceiving energy and information flow within and between people and moving that flow toward integration � Insight

� Empathy

� Integration. Mind Your Brain, Inc., (c) 2017

Principles of Neuroplasticity

1. Relationships

2. Sleep

3. Nutrition

4. Aerobic Exercise

5. Humor

6. Novelty

7. Close Paying of Attention




Ways to Change a Brain

Mechanisms of Change:� Synaptogenesis

� Neurogenesis

� Myelinogenesis

� Epigenesis

Strategies of Change:� The Focus of Attention

activates specific circuits

� A Sense of Trust enhances receptive learning

� Memory Retrieval as a Memory Modifier

� Unlearning and Learning

� Deep Practice and Skill TrainingMind Your Brain, Inc., (c) 2017

The Brain in the Palm of Your Hand


The Brain: A Systems View of Brain Anatomy, Function, and

The Mind





An Example: The Low Road

Temporarily Disengaging the Middle Aspect of the Prefrontal Cortex dissolves the nine functions of the middle PFC including Body Regulation, Attunement, Emotional Balance, Response Flexibility, Fear Modulation, Insight, Empathy, Morality, and Intuition





The “Four S’s” of Attachment: Children Need to be:

Seen

Safe

Soothed

In order to develop “Secure Attachment”

Remembering REPAIR is essential, as ruptures may be common!


Impaired Attachment: Developmental Trauma

Impaired growth of:

Corpus Callosum

Hippocampus

Prefrontal Cortex

The interconnections of the Connectome


THERE IS

NO SUCH THING

AS

PERFECT PARENTING!!!




The Importance of REPAIR

No such thing as a perfect parent

Secure attachment is based on showing up for a child, being present, and taking PART: Presence, Attunement, Resonance and Trust in the Parent-Child connection

REPAIR following ruptures is a crucial component of secure attachment


The PART we play as parents

Presence & Protection

Attention & Attunement

Resonance & Recognition

Time & Trust


The Basics of Attachment I

“Sensitive Caregiving” is the basis of secure attachment. This means parents tune in to the signals sent by a child and make sense of what the child is feeling and needing.

A signal for a baby is often a non-verbal cue such as crying, facial expressions, gestures, and states of alertness or sleepiness.




The Basics of Attachment II:

When a child has a consistent experience of being seen, of “feeling felt” by the caregiver, the child develops well in their emotions, thinking, and relationships.

Research suggests that these attuned, sensitive communications shape the healthy development of the brain in ways that support future functioning: Early Relationships Matter!


Making Sense: The Central Importance of Coherent Narratives“Earned Autonomous” State of Mind

How one has come to make sense of life experiences determines “adult state of mind with respect to attachment.”

“Coherent Self-Knowledge” involves an integration of past-present-future.

Coherent Autonoetic State vs. “Cohesive Narratives.”


What is a robust predictor of a child’s security of attachment?

How a parent has MADE SENSE of his or her life…

In other words, it’s not what has happened to a parent, but how that parent has taken the time to make sense of how the past has influenced his or her devleopment.




Relationships in Research Studies�Relationship Type

B - Secure ................

A - Avoidant..............

C - Ambivalent ..........

D - Disorganized.........

�Parenting Behavior

Responsive, Consistent

Rejecting, Distant

Inconsistent, Intrusive

Frightening, Confusing, Fearful


Adults Making Sense of Their Lives: What Science Reveals (Adult Attachment Interview)

Adult StoryFree/Secure-----------

Dismissing-------------

Preoccupied------------

Unresolved------------Trauma or Grief

�Child Attachment

---------------Secure

--------------Avoidant

-------------Ambivalent

---------Disorganized


How does Frightening Parental Behavior (Fr) and Unresolved Trauma or Loss (U) impact Disorganization (D) from the point of view of mind?




What do the different types of adult stories sound like?

Free - flexible, coherent, self-reflective, balanced perspective

Dismissing - incoherent, inflexible, minimize emotional significance, insist on lack of recall

Preoccupied- preoccupation with past intrudes on present, intense idealization

Unresolved - disorganization, disorientation around issues of grief or trauma


Brain Development: Inspire to Rewire

Repeated Activation Creates, Strengthens and Maintains Connections:

� “Neurons which FIRE together WIRE together”

� Where Attention Goes, Neural Firing Flows and Neural Connection Grows

Development across the lifespan: plasticity AND self-organization:

A simple idea: “Human connections shape neural connections”


Secure Attachment Promotes:

Flexible self-regulation

Prosocial behavior

Empathy

Positive sense of emotional well-being and self-esteem

Coherent life-story




The Central Role of the Integrating Prefrontal Cortex:

� Bodily Regulation

� Attuned Communication

� Emotion Regulation

� Response Flexibility

� Fear Modulation

� Insight

� Empathy

� Morality

� IntuitionMind Your Brain, Inc., (c) 2017

STRENGTHENING THE MIND:

Enhancing Regulation:

Monitoring

Modulating


Presence and “Mindful Awareness”

� “A form of awareness that comes from paying attention, on purpose, non-judgmentally to the present moment” (Kabat-Zinn)

� Mindful Practice involves:

� A Loving Awareness and a Kind Attention (Goodman-Kornfield/Kornfield; Shapiro)

� Focusing Attention on Intention

� Awareness of Awareness itself

� “Training the Mind” to focus on inner experience

� Fundamentally Integrative: Differentiating Sensory Awareness from Observing/Narrating Awareness and Linking with Attentional Practice




Mindfulness: Using awareness & the

focus of attention to transform:

The Brain (Davidson et al) (Holzel, et al)

The Immune System (Davidson et al)

Sense of Well-Being (Kabat-Zinn et al)

Physician Burn-Out (Reduction: Epstein, et al)

Attention (Jha, et al)

Relational Function (Shapiro, et al)

Epigenetic Regulation (Fredrickson, et al)

Telomerase Levels (Epel, et al)


Domains of Integration

Consciousness

Bilateral

Vertical

Memory

Narrative

State

Interpersonal

Temporal

Identity (Transpirational)


Time and the Brain

Integration as Embracing of Opposites

�Certainty versus Uncertainty

�Permanence versus Transience

�Immortality versus Mortality




The Wheel of Awareness


The Plane of Possibility


Implications and Applications of the Wheel of Awareness

10,000 person study: Universal findings across wide range of backgrounds;

Shift in relationships with others and self;

Reduction in Chaos and Rigidity;

Illumination of Nature of Awareness itself:

� Quotes: “Clarity, Joy, Expansiveness, the infinite, eternity, God, Love, Peace, Sense of being a fundamental part of the whole, connected to others, the world, the universe




Identity, In-Group/Out-Group

Evolution of In-Group versus Out-Group distinctions

Reactivity (NO!) versus Receptivity (Yes…)

Threat state of REACTIVTY: Four F’s

� Fight

� Flight

� Freeze

� Faint Mind Your Brain, Inc., (c) 2017

Integration, Presence and Health

1. Studies of Well-Being reveal the interconnected connectome, or the linkage of differentiated regions best predictor;

2. Studies of impaired well-being reveal impaired integration in the brain;

3. Neural integration is the mechanism beneath regulation (mood, emotion , thought, attention, behavior, relationships, morality)

4. Integrated Relationships � Neural Integration � Health


Ruptures in Our Parenting and Flipping Our Lid: The Low Road and the Vital Importance of Repair

Temporarily Disengaging the Aspect of the Prefrontal Cortex……..

dissolves one or more of the nine integrative

functions of the PFC including:

Body Regulation, Attunement, Emotional Balance, Response Flexibility, Fear Modulation, Insight, Empathy, Morality, and Intuition




Secure Attachment and Compassionate Connections

Integration and Self-awareness allow us to meet life’s challenges with more resilience flexibility, and joy in our internal and interpersonal worlds…

And a bonus realization:

We are ultimately connected to each other as part of a larger whole


“SELF”:

Singular Noun

or

Plural Verb?Mind Your Brain, Inc., (c)

2017

The Optical Delusion of Isolation

Albert Einstein had a sense of the importance of this issue when he stated: “A human being is a part of the whole, called by us ‘Universe,’ a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest, a kind of optical delusion of his consciousness.




This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. Nobody is able to achieve this completely, but the striving for such achievement is in itself a part of the liberation and a foundation for inner security."


“MWe”

Mind Your Brain, Inc., (c)

2017

Integration

Made Visible

Is

Kindness and Compassion


an integrative approach to therapeutic intervention€¦ · an interpersonal neurobiology approach...

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