Attachment, Affect Regulation and Treating Dysregulated Couples The New Jersey Collaborative for Emotionally Focused Therapy is approved by the American Psychological Association to sponsor continuing education for psychologists. The New Jersey Collaborative for Emotionally Focused Therapy maintains responsibility for this program and its content Alan Groveman, PhD NJCEFT.ORG Certified EFT therapist and supervisor Learning Objectives • Name three neurological circuits involved in affect regulation • Describe two distinct theories of affect regulation and how they differ • Explain the role of the amygdala in emotional responses and what is meant by the amygdala hijack • Describe the DART (Direct Affect Regulation Techniques) process and how it can be used to regulate the hypo and hyper aroused couple • TO DOWNLOAD THIS POWERPOINT GO TO: • www.njceft.org/assets/AR.ppt 3 Couple Fighting Going Back to The Beginning Introduction • Bowlby and Ainsworth – attachment theory • Framework for understanding personality development and attachment styles, as well as the roots of affect regulation. Even the most sensitive parents do not always respond with attunement. However, their misattunements are followed by timely and empathic repair (Fonagy et al. 2002) as they find a way to calm and soothe the child. These repetitive interactions of attunement and repair are recorded implicitly in deep subcortical structures in the infant’s RH, as templates for how to be, and what to expect, in healthy, intimate relationships. When early relationships are insecure (non-contingent and non-attuned) less than optimal connections are made between these regulation and arousal centers in the brain. As a result, more periods and higher frequencies of dysregulation ensue (Schore 1994). How did your mother describe you as a baby – quiet, clingy, independent, etc. "Two distinct theories of affect regulation have been elucidated during the past twenty years . Regulation theory (Schore, 1994, Schore & Schore, 2008) explicates what I will call the primary affect regulation system. It consists of early-forming, automatic, fast, nonconscious, psychoneurobiological processes. Mentalization theory (Fonagy et al., 2002) illuminates the secondary affect regulation system. It consists of later-forming, verbal-reflective, slow, deliberate, conscious cognitive processes.“ (anger, sadness, happy, etc.) Hill (2015) Neurological circuits of affect regulation including the insula, the anterior cingulate (AC), and the orbital frontal cortex (OFC), create cortical and subcortical pathways down into the amygdala; these calm the child by turning down the neuromodulating autonomic nervous system (ANS) and the neurosteroid hormones (Cortisol) of the hypothalamus–pituitary–adrenal axis (HPA) stress response (Schore, 1994). Ideally, the caretaker and the child are in a modulation dance. The caretaker calming the child and the child calming the caretaker. This is a critical goal in working with couples- dyadic affect regulation "Affect is conducted nonconsciously from brain to brain— neuroceptively (Porges) —in, for example, an ever so slight pause or a barely perceptible change in pitch, or a split-second, subliminal facial expression. Such implicit transfers of affect transmit meaning. If we are defended against its reception or read it wrong, we suffer a costly social disadvantage. Affect tells us about another’s subjective state— crucial information for cooperation and competition.“ Hill, 2015) “When chronically hyperactivated and hypersensitized in critical periods of infancy, an individual’s stress response, especially in reaction to relational injuries, launches more quickly, reaches higher levels, and persist setting the stage for rapid bouts of dysregulated conflict in distressed adult couples. These eruptions are marked by anger, blame and defensiveness and may jeopardize or destroy relational intimacy and trust” (Lapides, 2011) While the earliest attachment relationships initially wire the brain for affect regulation (Schore 1994), new attachment relationships can reorganize neural circuits, enhancing this capacity. This wiring of one brain through resonant interaction with another brain is the psychoneurobiological basis for the healing potential of important adult relationships, including romantic partnerships, the deeply attuned dyad in psychotherapy (Safran and Muran 2000) and the triad of a couple and their psychotherapist (Lapides , 2010). When couples merely disagree, the brain has time to route its findings cortically where they can be assessed more carefully, permitting attentive listening and the capacity to empathetically hold the partners point of view (Fonagy et al. 2002). At such times, communication occurs more or less calmly frontal lobe to frontal lobe. But relational conflict, especially in the primary attachment of a romantic pair, can feel deeply threatening and can trigger an emergency response that shuts down the frontal lobes leaving only a subcortical appraisal system with no input from higher cortical centers to evaluate or regulate that energy. The amygdala has, in essence, hijacked the brain into a self-protective flight, flight or freeze response (LeDoux 2002) that threatens the couple’s intimacy. The ventromedial prefrontal cortex (vmPFC), one of whose functions is to inhibit the amygdala, is not engaged. Here, partners likely fall back upon their more primitive internal working models of relationship learned in childhood (Bowlby 1988). THE AMYGDALA HIJACK The technical definition: The amygdala is an almond shaped mass of nuclei (mass of cells) located deep within the temporal lobes of the brain. The amygdala hijack is an immediate, overwhelming emotional response with a later realization that the response was inappropriately strong given the trigger. Daniel Goleman coined the term amygdala hijack based on the work of neuroscientist Joseph LeDoux, which demonstrated that some emotional information travels directly from the thalamus to the amygdala without engaging the neocortex, or higher brain regions. This causes a strong emotional response that precedes more rational thought. The amygdala hijack basically equates to “freaking out” or seriously overreacting to an event in your life. . You want to tell your partner how you are feeling, but you are anxious. The prosody of your voice– tone, rhythm, pitch, may communicate annoyance, anger Your body language may appear to be aggressive, you lean forward, squint, make your hands into fists. You do not mean to be aggressive, but your partner reacts, not to your words, but to what appears to be a threat You instantly perceive your partner as aggressive. Your immediate, unconscious reaction, by way of the amygdala, is fight, flight or freeze The amygdala screams danger and the thinking part of your brain goes off-line. You respond with an overwhelming emotional reaction, which triggers your partner’s amygdala. AMYGDALA HIJACK YOU THINK YOU ARE APPROACHING YOUR PARTNER LIKE THIS: YOUR PARTNER SEES YOU APPROACHING LIKE THIS: Affective styles in couples are often different. When both are hyperactivate, conflict can erupt quickly. When both tend toward hypoactivation, the relationship will likely have a deadened quality as conflicts are collusively avoided and conversations kept superficial and polite (Tatkin 2005). And where the neuroaffective styles are mixed, we might see a fearful or angry pursuit of a partner who is perceived as abandoning, and/or an avoidant retreat away from a partner who threatens to overwhelm. Many couples who seek therapy have experienced a type of relational trauma that precipitates a partially dissociative response each to the other. Early attachment injuries are replicated in the relationship and the interpersonal reactions do not follow a “self as adult” script, but rather a primitive response reflective of childhood. A scowl, a cutting tone of voice, or a rolling of the eyes can evoke anger, blame and defensiveness at lightning speed in that “bottom-up hijacking“ of the brain by the amygdala (LeDoux 2002). Reactions are outside the window of tolerance (WOT) These proto-relationship behaviors serve to distance and reinforce a negative narrative about the partner. There is no safety and the dyadic interaction may be viewed as disorganized. That is, when a primary figure is the source of pronounced distress, when the person we reach out to for comfort intensifies our stress, rather than ameliorates it, our feelings of detachment increase. This may happen at both a visceral as well as a cognitive level. Hill (2015) has noted that "Dissociated self-states are automatic in the sense both that they are activated involuntarily and that we are reduced to a scripted set of behavioral and psychological responses. When one or both partners are outside the WOT the first job of the couples therapist is to reestablish dyadic homeostasis. Where to Begin "The goal is to enhance patients’ capacity to regulate affect and allow development to resume. There must be a buildup of tolerance for fear and shame associated with the relational trauma. The affect-regulating procedures of the insecure internal working model, based in expectations of misattunement and shame, must be supplanted by procedures established by therapeutic affect-regulating experiences that engender trust, a valued sense of self, and positive expectations. The primary affect-regulating system must be reorganized.“ (Hill, 2015) EFT is a powerful therapeutic model for establishing a secure dyadic attachment , but can be enhanced by more specifically targeting the underlying affect regulating neuro-behavioral system, particularly those reactions that are outside the WOT The DART (Directed Affect Regulation Techniques) Model 1. 2. 3. 4. Assumptions Effective couples therapy requires that each partner is functioning within the WOT, and feels safe When dysregulation occurs the goal is to quickly reestablish interactions within the WOT and feelings of safety Reactions outside the WOT are seen as temporary dissociation and as attempts to protect the self from danger, or a profound threat Attunement with the other produces dyadic affect regulation Hyperarousal – Sympathetic Nervous System – Fight/Flight 1. Uncontrollable Crying 2. Hands in fists, desire to punch, rip 3. Flexed/tight jaw, grinding teeth, snarl 4. Fight in eyes, glaring, fight in voice 5. Restless legs, feet /numbness in legs 6. Anxiety/shallow breathing 7. Uses metaphors like bombs, volcanoes erupting DART Techniques for Hyperarousal Hypoarousal – Dorsal Vagal - Freeze 1. 2. 3. 4. 5. Prosody - Deepens Gaze- Fixed Facial expressivity- Flat Posture- Flaccid Sound- hypo-sensitive Copyright © 2015 Stephen W. Porges DART Techniques for Hypoarousal If a client begins to not interact in session, sits in a non-verbal state of withdrawal, disinterest and non-interaction, consider the possibility that they are stuck in a freeze (a form of dissociation) rather than assuming that they are being resistant or rude or difficult. 1) Ask if they are able to talk? If not, they may need to respond by nodding or shaking their heads. 2) If a client is in a freeze they will be “stuck” in their right brain. To learn to get out of a freeze, they must get their verbal, thinking, left brain working. 3) Ask them to look around the room and name the colors, count the windows or chairs, find an object starting with A, then B, then C, 4) Hold and describe an object 5) Count backwards from ten to. 6) Once they are speaking again, walking around can help them to move further out of the freeze state. It can be a real relief for clients to have the freeze response identified and then be taught how to get out of the freeze response. It is likely that sessions are not the only place they go into a freeze. DART Interventions The interventions listed below are not meant to replace the EFT model, but rather to add to the EFT therapist’s armamentarium and reestablish a homeostatic interaction. 1. Breathe –Breathe in for a count of four,(elevate heart rate) breath out for a count of seven (decrease heart rate), repeat several times. 2. Mirror face and body posture of the other to communicate what you imagine is going on for him/her at this moment 3. Hold hands and look in each other’s eyes – Process 4. Mirror posture, body shaping – safe posture – establish synchronicity 5. Throw a ball back and forth 6. Welcome Home Hug References Atkinson, B. (1999, July/August). Brain storms: Rewiring the neural circuitry of family conflict. The Emotional Imperative. Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge. Cozolino, L. (2002). The neuroscience of psychotherapy: Building and rebuilding the human brain. New York: W. W. Norton. Ein-Dor, T, Mikulincer, M, and Shaver, P.R. Attachment Insecurities and the Processing of Threat-Related Information: Studying the Schemas Involved in Insecure People's Coping Strategies. Journal of Personality and Social Psychology . 101(1):78-93 Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press. Hill, D (2015) Affect Regulation Theory: A Clinical Model. New York: W. W. Norton & Company Johnson, S. (2004). Attachment theory a guide for healing couple relationships. In W. S. Rholes & A. Simpson (Eds.), Adult attachment (pp. 367–387). New York: Guilford Press. Lapides, F (2011) The Implicit Realm in Couples Therapy: Improving Right Hemisphere Affect-Regulating Capabilities. Clinical Social Work Journal, 39(2)2: 161-169 LeDoux, J. (2002). Synaptic self: How our brains become who we are. New York: Viking. Porges, S (2007). The Polyvagal Prespective. Bio Psychol, 74(2): 116–143 Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press. Schore, A. N. (1994). Affect regulation and the origin of the self; the neurobiology of emotional development. New Jersey: Erldbaum Associates. Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36, 9–20. Siegel, D. (1999). The developing mind. New York: Guilford Tatkin, S. (2005). Psybiological conflict management of marital couples. Psychologist-Psychoanalyst, 25 (1), 20–22. Before You Go • To Receive APA approved CE for this Webinar: • 1. Send an email to me at: njceft@gmail.com • I will send you the evaluation, with instructions on how to fill it out and email it, or fax it, back to me. This is a requirement to meet APA’s standard for CE. 32 Thank You Contact information: njpsych@gmail.com www.njceft.org