neuroscience & intervention 1 neuroscience and social work practice professor rob macfadden,...

Neuroscience & Intervention

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NEUROSCIENCE AND SOCIAL WORK PRACTICE PROFESSOR ROB MACFADDEN, UNIVERSITY OF [email protected]@utoronto.ca

Factor-Inwentash Faculty of Social WorkContinuing EducationUniversity of Toronto

October 30th 2013Module 3 Webinar

mailto:[email protected]

Interpersonal Neurobiology: A Brain-Based Approach

The term “Interpersonal Neurobiology” coined by Daniel J. Siegel (1999) in his book, The developing mind: How relationship and the brain interact to shape who we are. NY: Guilford Press.

Scientific grounded paradigm of Neural Integration. Health and well-being defined as neural integration. Individual well-being and supportive relationships come from brains that are more integrated. An integrated mind reflects FACES: Flexible, Adaptable, Coherent, Energized and Stable.

Triangle of Well-Being

Relationships (how we share energy & information)

Mind Brain(regulates flow of energy & information) (mechanisms by which energy & flow is regulated)

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NEUROSCIENCE AND SOCIAL WORK PRACTICE

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.

About one third of our genome directly shapes the connections within our brains. While genes are fundamental in development, experience shapes our neural connections as well. When neurons activate they have the potential to foster the growth of new connections among each other. Neurons that fire together, wire together (Hebb).

These synaptic linkages are created by both genes and by experience. Nature requires nurture. Experience promotes new wiring & connections among neurons by how genes are activated, proteins produced, and interconnections established within our webbed neural system.

Much of the following information about the IPN approach which follows is taken directly from ” An Interpersonal Neurobiology Approach to Psychotherapy: Awareness, Mirror Neurons, and Neural Plasticity in the Development of Well-Being”, written by Daniel J. Siegel, M.D. , and downloaded from http://www.ithou.org/node/2730 on January 9, 2011.

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Interpersonal Neurobiology


http://www.ithou.org/node/2730%20on%20January%209

Well-Being

An interpersonal neurobiology (IPN) perspective of mental well-being views the mind as achieving self-organization by balancing the opposing processes of differentiation and linkage.

When separated areas of the brain are allowed to specialize in their function and then to become linked together, the system is said to be integrated.

This coherent flow is bounded on one side by chaos and on the other by rigidity. In this manner we can envision a flow or river of well-being, with the two banks being chaos on the one side, rigidity on the other.

This flow of well-being can be seen to reveal the correlations among an empathic relationship, a coherent mind, and an integrated brain as three points on a triangle depicting well-being.

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NEUROSCIENCE & SOCIAL WORK PRACTICE

NEUROSCIENCE & MINDFULNESS

Definition: Non-judgmental attention to experiences in the present moment (Kabat-Zinn, 1990). Involves attention on the experience of thoughts, body sensations, emotions and observing them as they arise and go away. Two central components: (1 ) regulation of attention to keep it on the immediate experience; (2) approaching experiences with curiosity, openness, and acceptance, regardless of whether they are positive or negative.

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.

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THE POWER OF INTENTIONAL ATTENTION

THE IMPACT OF MINDFULNESS


Mindfulness Research

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Content taken from: Holzel, B., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D., Ott, U.(2011). How does Mindfulness Meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 6 (6), 537-559.


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1. Attention Regulation

• Critical first skill• Repeated practice• Strengthened ability• ACC detects conflicts (distractions) & alerts other systems to

regulate• ACC with frontal insular cortex, involved in activation of different

brain networks, strengthening cognitive control• Cortical thickness of ACC greater in experienced mediators

NEUROSCIENCE & SOCIAL WORK PRACTICEMindfulness Research

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2. Body Awareness

•Ability to notice subtle bodily sensations

•Focus is usually on internal body sensations including sensations related to emotions or physical sensations

•Reports of better bodily awareness & of internal sensations

•Includes greater emotional awareness & ability to differentiate sensations

•Insula key player in this and some research to indicate increased insula and somatosensory activity in meditators

•Some research showing greater cortical thickness in right anterior insula of meditators

•By becoming more aware of bodily sensations, this can lead to better awareness of feelings, since bodily sensations are essential in having a sense of a feeling. So increased awareness of emotions and subsequent feelings are crucial to emotional regulation. Bodily awareness is connected to recovery process in borderline personality disorder, eating disorders and substance abuse disorders as examples.

•Regarding empathy, accurate internal awareness of one’s own sensations important precondition for empathic response.


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3.1 Emotion Regulation

•Mindfulness can result in improvement in emotion regulation.

•Can reduce emotional reactivity

•Decrease in negative mood states

•Improve positive mood states

•Reduce distractive and ruminative thoughts and behaviours

•Can increase left prefrontal activation leading to more positive emotions

•The ACC (monitors control processes)

•Typical pattern: increased PFC, decreased amygdala activation

•PFC projections to amygdala exert inhibitory top down control

•Improved emotion regulation underlying Mindfulness likely accounts for stress reduction & reducing depression symptoms.


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3.1 Emotion Regulation (Reappraisal)

Cognitive Reappraisal

•Reinterpreting one’s meaning of a stimulus

•Mindfulness involves positive reappraisal

•Mindfulness reconstrues stimuli as beneficial, meaningful or benign

•Reappraisal involves dorsolateral PFC, orbito PFC and ACC

•Some dispute, findings suggesting Mindfulness involves non-appraisal


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3.2 . Emotion Regulation: Exposure, extinction, reconsolidation

•Mindfulness encourages exposure to the experience, welcoming it, refraining from engaging in internal activity towards it, bring acceptance to bodily and affective responses

•Turn towards negative emotions, which pass away leaving a sense of safety or well-being

•Mindfulness avoids enacting safety strategies (e.g, avoiding contact, blocking thoughts, feelings), and focuses attention on responses

•High level of relaxation (parasympathetic tone) and decreased sympathetic tone paired with negative stimuli may decrease negativity

•Extinction does not erase original association but is thought to form new memory trace or reconsolidate old memory with new (relaxed) contextual associations.

•Brain network crucial for extinction of condition fear responses and its retention. This network seems to strengthen through Mindfulness. VmPFC involved. Cortical thickness of vmPFC positive correlated with extinction recall.


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3.2 . Emotion Regulation: Exposure, extinction, reconsolidation (Cont’d)

•Hippocampus and VmPFC work together during extinction recall to inhibit fear.

•When people regulate their emotions, the hippocampus and the vmPFC involved. This suppresses fear allowing control over behavioural reactions to emotions. Neuroimaging studies have shown that the hippocampus and VmPFC are dysfunctional in PTSD and depression.

•Mediators show greater gray matter in the hippocampus for mediators vs non-mediators. Detectable within 8 weeks for new mediators using MBSR.


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4. Change in perspective on the self

•Buddhist teaching says there is no such thing as a permanent, unchanging self. Self is a product of ongoing mental processes. Paying close attention to the changing nature of self, leads to the deconstruction of the self. Changing perception of the self, leads to enduring happiness. It uproots clinging, attachment and hositility.

•More positive self-concept, more self-esteem and higher acceptance of self. Brain structures that support self-referential processing appear impacted by Mindfulness. Medial PFC, posterior cingulate cortex and the inferior parietal lobe are involved.


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Self-Compassion

•Involves self kindness (being kind and understanding towards oneself in situations of perceived inadequacy or suffering rather than being harshly self critical); common humanity (perceiving one’s experience as part of the larger human experience; and mindfulness, defined as holding one’s painful thoughts and feelings in balanced awareness, rather than over-identifying with them.

•Mindfulness & self-compassion are highly correlated. Cultivation of self-compassion viewed as explaining much of the success of Mindfulness-based interventions.

•Self-compassion scores increase with Mindfulness experience. Feeling compassion for oneself is an act of emotional regulation.


Mindfulness Meditation & Impact

• Enhanced immune system functioning

• Reduced blood pressure

• Reduces stress-related cortisol

• Increases activation of left frontal regions which lifts mood

• Thickens & strengthens frontal cingulate cortex & insula

• Enhances attention, empathy & compassion (Hanson, 2009)

• Improved psychological well-being

• Enhanced cognitive functioning

• Mindfulness-based interventions useful for clinical disorders: anxiety, depression, substance abuse, eating disorders and chronic pain.

• Holzel, B., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D., Ott, U.(2011). How does Mindfulness Meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 6 (6), 537-559

16http://www.youtube.com/watch?v=m8rRzTtP7Tc Neuroscientist, Dr. Sara Lazar


http://www.youtube.com/watch?v=m8rRzTtP7Tc

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Mindfulness implies a healthy relationship with oneself. It involves intrapersonal attunement (p.XIV). Attunement involves focusing attention on the internal world of the other. In this case, it is focusing on your own internal world. Interpersonal attunement allows two people to “feel felt” by each other. Attuned relationships promote resilience and longevity.

Mindful awareness is a form of self-relationship and an internal form of self-attunement. It causes neuroplasticity or a change in neural circuits.

Paying attention to the present moment improves the functioning of the body, brain and relationships. It harnesses the social circuitry of the brain to develop an attuned relationship within our own mind.

Mindful Brain by Daniel Siegel (2007)

INTRAPERSONAL ATTUNEMENT


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MINDFULNESS MEDITATION & NEUROSCIENCE

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.

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.

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9 MIDDLE PREFRONTAL FUNCTIONS

A wide array of independent studies in basic brain research reveals that the middle prefrontal area of the brain is crucial for generating nine aspects of life which reflect important dimensions of mental health:

1. Body regulation: Balance of the sympathetic (accelerator) and parasympathetic (brakes) branches of the autonomic nervous system.

2. Attuned communication: Enables us to tune into others’ states and link minds.

3. Emotional balance: Permits the lower limbic regions to become aroused enough so life has meaning, but not too aroused that we become flooded.

4. Response flexibility: The opposite of a “knee-jerk” reaction, this capacity enables us to pause before acting and inhibit impulses giving us enough time to reflect on our various options for response.

1. Empathy: Considering the mental perspective of another person.

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6. Insight: Self-knowing awareness, the gateway to our autobiographical narratives and self-understanding

7. Fear extinction: GABA (an inhibitory neurotransmitter) fibers project down to the amygdala and enable fearful responses to be calmed.

8. Intuition: Being aware of the input of our body, especially information from the neural networks surrounding intestines (a “gut feeling”) and our heart (“heartfelt feelings”) enables us to be open to the wisdom of our non-conceptual selves.

9. Morality. The capacity to think of the larger good, and to act on these pro-social ideas, even when alone, appears to depend on an intact middle prefrontal region.


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These nine middle prefrontal functions can be seen to emerge not only with mindful meditation awareness practices, but at least the first seven are ALSO associated with the outcome of secure attachment between child and caregiver.

This finding may suggest that experiences of “mental attunement” – interpersonal in the case of attachment or internal in the practice of mindful awareness – may be at the heart of developing an integrated brain and well-being.

Healthy self-regulation, through relationships and self-reflective observation, may depend on the development of the integrated circuits of these prefrontal regions.

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Intentional Attention

Enhancing receptive awareness in the present moment is sometimes called “mindful awareness.” Mindfulness is defined as paying attention, in the present moment, on purpose, without grasping onto judgments. Mindful awareness has the quality of receptivity to whatever arises within the mind’s eye, moment to moment.

Recent studies of mindful awareness practices reveal that it can result in profound improvements in a range of physiological, mental, and interpersonal domains of our lives. Cardiac, endocrine, and immune functions are improved with mindful practices. Empathy, compassion, and interpersonal sensitivity seem to be improved. People who come to develop the capacity to pay attention in the present moment without grasping on to their inevitable judgments also develop a deeper sense of well-being and what can be considered a form of mental coherence.

Neural plasticity, the change in neural connectivity induced by experience, may be the fundamental way in which psychotherapy alters the brain.

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Brain and Learning Findings Implications for Therapy

Content needs to make sense to learners

Content has to be relevant

Emotions drive attention & memory

Action is important in learning

Multi-sensory experiences improve memory and utilization

Learning optimized through relaxed attention, avoiding excessive stress & anxiety.

The therapist’s model has to make sense in explaining the client’s situation. This increases a sense of bond and optimism.

The goals have to be the clients’ goals. They have to be owned and important. Identifying and working on relevant goals strengthens the therapist’s connections with clients. Working on a problem should always involve an important approach goal. Relevance activates emotions.

Therapist needs to work with emotions of clients to engage motivation and to explore underlying feelings and to develop attachment. Client needs to feel felt. A positive alliance is built on positive emotions.

Doing things strengthens new & existing neural connections. Encourage clients to try things out, homework, role playing, drawing, writing, etc.

When possible, engage clients in different sensory ways through use ofimages, sound, video. The use of rich metaphors which activate thinking, imagination and feelings use multi-sensory connections.

While some level of stress improves motivation, clients should also feel safe and secure to be open and to share feelings & thoughts. This will improve both making & retrieving memories, & thinking abilities. Encouraging Mindfulness Meditation, self-hypnosis & other ways to relax and to regulate attention & emotion may be useful.

NEUROSCIENCE & SOCIAL WORK PRACTICELearning & Teaching

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Brain and Learning Findings Implications for Therapy

Build on existing learner’s knowledge & beliefs.

Foster positive emotions to aid in thinking and remembering

Work to develop learning at the conscious and unconscious levels

Encourage deep learning: memory & retrieval, analysis, critique, action, feedback and refinement

Start where client is at. This involves understanding the client’s world view’s, beliefs & preferences & building from there. Previous learnings, preferences are already part of the client’s understanding. New learnings that connect with these pre-existing realities are easier to build on and will likely be accepted, acted on, and prevail.

While first acknowledging & listening to client’s problems, move quickly to generate positive emotions. A strong, positive alliance, discussion of strengths and solution talk, positive life/relationship review, relaxation training, positive imaging, increasing social support can improve the client’s experience of positive emotions.

Besides working consciously on challenging & refining client beliefs & ideas, consider exploring ways to impact implicit knowledge such as use of metaphor, experiences without discussion (right brain to right brain), vigorously interrogating unconscious beliefs and substituting positive conscious beliefs. Change in psychotherapy can happen in at least two ways: working at the implicit level to promote change at the explicit level of functioning (e.g., the attunement within a positive attachment relationship leads to a conscious change in the client’s positive self-evaluation or a conscious CBT focus on self-worth leads to unconscious changes in the self-worth schema within the right brain).

Clients need to process new learning. Explore it, try it out, refine it, continually use it. Have others support it. Develop new stories that support the positive changes. This is deep processing of change that is more like to promote and maintain desired changes.

NEUROSCIENCE & SOCIAL WORK PRACTICELearning and Teaching

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TAKE AWAYS

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.

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TAKE AWAYS

Social workers 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).

The brain is Teflon for positives and Velcro for negatives. We are slanted towards overestimating risk and being cautious. In a crowd of people we will pay most attention to those with expressions of fear on their faces. John Gottman has found that the appropriate balance of positive to negatives in relationships that last is 5:1 .

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TAKE AWAYS

Social workers 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 promotes healthy relationships and individual well-being.

Positivity and positive emotions, the foundation of Positive Psychology, is extremely important. See the new book Flourish by Martin Seligman. 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 positives.

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TAKE AWAYS

Broaden and Build. Barbara Fredrickson has conducted research that supports positive emotions as broadening one’s awareness, encouraging new thoughts, actions and exploring the environment.

This promotes new learning, skill development & a more optimistic view of reality. It can increase creativity, psychological resilience & flourishing leading to more satisfying lives.

Fredrickson, BL (2001). "The Role of Positive Emotions in Positive Psychology". American Psychologist 56 (3): 218–226.

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TAKE AWAYS

After acknowledging and honouring the client’s problems, move towards identifying goals and tasks and experiencing positive emotions.

Both therapeutic change and learning have the same foundation: neural change. Emotion is central to feelings and thinking and to learning. Social workers need to help clients emotionally regulate. Social workers also need to know how to engage client’s emotions to involve them in therapy and learning (e.g., goals need to be highly relevant to the client).

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TAKE AWAYSMost mental activity is unconscious. Client decision-making is heavily influenced by pre-existing and frequently unconscious knowledge. Emotions help stamp experiences with positive (important to survival) and negative (unimportant) valences. Stereotypes and biases, for instance, are frequently implicitly held, strongly felt, unconscious and resistant to change.

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).

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TAKE AWAYSPowerful 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.

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.

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TAKE AWAYS

Social workers are physical agents. The relationships they establish with clients engage a range of neurotransmitters that impact behaviour, emotion and thought.

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.

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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TAKE AWAYS

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 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.

neuroscience & intervention 1 neuroscience and social work practice professor rob macfadden,...

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