Uploaded by Alan Groveman

AR

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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
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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.
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