GROUP PSYCHOTHERAPY &
INTERPERSONAL NEUROBIOLOGY
AN ATTACHMENT THEORY PERSPECTIVE
PHILIP J FLORES, PhD, ABPP, CGP, FAGPA
6065 LAKE FORREST DRIVE
SUITE 150
ATLANTA, GA 30328
flores-mahon@mindspring.com
(404)-250-9340
SCHEDULE
• 9:00 – 10:00 am: Intro to Interpersonal Neurobiology &
Group Therapy
• 10:00 – 10:30 am: Attachment Theory & Group Therapy
•
10:30 – 10:45: 15 Minute Break
• 10:45 - 12 Noon: Demo Group & Large Group Discussion
LUNCH: 12 NOON – 1:30
–
• 1:30 – 3:00 pm: Neurogenesis, Brain Plasticity,
Implicit Domain & Affect Regulation
•
3:00-3:15 pm: 15 Minute Break
• 3:15 – 4:30 pm: Demo Group & Large Group Discussion
• 4:30 – 5:00 pm: Wrap-Up & Evaluations
THREE IMPORTANT CONTRIBUTIONS
FROM THE NEUROSCIENCES
• ATTACHMENT & RELATIONSHIPS ALTER THE
NEUROBIOLOGY & STRUCTURE OF THE BRAIN.
– NEUROPLASTICITY & NEUROGENESIS
– “CRADLE TO GRAVE” (BOWLBY)
• MIND-BODY DUALISM IS NOT SUPPORTED BY
MODERN NEURO SCIENTIFIC EVIDENCE .
– IMPLICIT vs EXPLICIT DOMAIN, POLY VAGAL
THEORY & LIMBIC RESONANCE.
• A “BOTTOM UP” EXPLANATION OF BRAIN
FUNCTIONING & HUMAN BEHAVIOR IS MORE
ACCURATE THAN A “TOP DOWN” MODEL.
– VAST MAJORITY OF COMMUNICATION IS NON-VERBAL
THINGS THAT THE NEUROSCIENCES ARE
DISCOVERING THAT ARE BAD FOR THE BRAIN
• ALCOHOL & DRUGS (especially chronic use)
• TOXIC RELATIONSHIPS
• ISOLATION
• CHRONIC STRESS ( vs short term stress)
• PASSIVITY, INACTIVITY & IMMOBILITY (BDNF)
The conscious act of willfully acting changes the brain.
• *DULL, MONOTONOUS ENVIRONMENTS
• *INATTENTION & LACK OF EFFORT
•
“Attention is almost magical in its ability to physically
alter the brain.” (BEGLEY, 2011)
IMPORTANT CAVEATS
• I. EVERYTHING PRESENTED TODAY IS COMPLETELY
REDUCTIONISTIC & OVER SIMPLIFIED.
• II. THIS WORKSHOP SELECTIVELY HIGHLIGHTS
RELEVANT AREAS OF NEUROSCIENCE CONNECTING
THEM TO ATTACHMENT THEORY AND TO CLINICAL
APPLICATION.
• III. THE NEW DISCOVERIES IN THE NEUROSCIENCE
BOTH CHALLENGE AND CONFIRM OUR MOST
CHERISHED BELIEFS ABOUT WHAT DICTATES
EFFECTIVE PSYCHOTHERAPY
• IV. INFORMATION PRESENTED IS NOT ORIGINAL,
BUT SELECTED FROM LEADING NEUROBIOLOGISTS.
MODERN ATTACHMENT THEORY
A. SCHORE (2008) FONAGY (2010) STERN (2004)
•
MAT HAS EVOLVED OVER THE LAST 15 YEARS.
• RESULTING IN AN EXPANSION OF BOWLBY’S
ORIGINAL THEORY WITH ITS FOCUS ON CHILD
DEVELOPMENT, STRANGE SITUATIONS, SECURE
BASE & ATTACHMENT STYLES.
• BOWLBY’S CORE IDEAS HAVE BEEN EXPANDED
INTO A MORE COMPLEX & CLINICALLY
RELEVANT MODEL FOR ADULTS.
– REFLECTIVE FUNCTION, MENTALIZATION, ToM, IMPLICIT PROCESS.
• “MAT HAS BEEN TRANSFORMED INTO AN
AFFECT REGULATION THEORY.” (A. SCHORE)
ATTACHMENT: A DEFINITION
• HUMAN BEINGS ARE SOCIAL MAMMALS
& SOCIAL MAMMALS REGULATE EACH
OTHER’S PHYSIOLOGY & ALTER THE
INTERNAL STRUCTURE OF EACH
OTHER’S NERVOUS SYSTEM THROUGH
THE SYNCHRONOUS EXCHANGE OF
EMOTIONS. THIS INTERACTIVE
REGULATORY RELATIONSHIP IS THE
BASIS FOR ATTACHMENT.
THE BIOLOGICAL LIMITATIONS OF SELF REGULATION
CNS IS AN OPEN FEEDBACK LOOP
• 1. EVIDENCE IS UNEQUIVOCAL: OUR CNS IS NOT
A SELF CONTAINED, CLOSED SYSTEM.
• 2. ALL SOCIAL MAMMALS REQUIRE EXTERNAL
REGULATION TO KEEP THEIR CNS UP &
RUNNING AT OPTIMAL LEVELS.
• 3. IF WE ARE NOT GETTING OUR CNS
REGULATED THE WAY EVOLUTION
DETERMINED (BY PEOPLE), WE WILL BE MORE
VULNERABLE TO EMOTIONAL
DYSREGULATION & PSYCHOPATHOLOGY
(DEPRESSION, ANXIETY & ADDICTION).
CHILDREN ARE GENETICALLY DESIGNED TO BE CARED FOR BY A
CARETAKER—OR MANY CARETAKERS AS IN A TRIBE OR CLAN—IN
ORDER FOR THE BRAIN TO DEVELOP & FUNCTION OPTIMALLY.
• BUT WHAT HAPPENS WHEN RAPID SOCIETAL CHANGES NO LONGER
PROVIDES THE FULL RANGE OF ATTACHMENT EXPERIENCES THAT
THE BRAIN IS GENETICALLY PRIMED TO EXPECT?
“THE LACK OF SOCIAL
INTEGRATION IS THE
BIGGEST PREDICTOR OF
PSYCHOPATHOLOGY.”
•
GEORGE VAILLIANT’S 60 YEAR LONGITUDINAL STUDY
EARLY INFANT STRESS INCREASES STRESS
SENSITIVITY RESULTING IN ENDURING
ABNORMALITIES IN HPA-AXIS REACTIVITY
(HYPOTHALAMIC-PITUITARY-ADRENAL)
•
•
INCREASED RISK FOR PSYCHOPATHOLOGY
IN ADULTHOOD IS NOT DUE TO
PSYCHOLOGICAL CONFLICTS AS MUCH AS IT
IS RELATED TO NEURO-BIOLOGICAL
DEFICITS PRODUCED BY SUB-OPTIMAL
ENVIRONMENTAL RESPONSIVENESS,
NURTURING, AND CONTAINMENT (INSECURE
ATTACHMENT).
SAPOLSKY & HIGH STRESS RESPONDERS & DIFFICULTY RETURNING TO
HOMEOSTATIC BASELINE.
“THE BRAIN IS A SURVIVAL MACHINE”
SAM WANG (2009)
•THE BRAIN, MORE THAN ANYTHING ELSE, IS
CONSTANTLY ADAPTING TO IT’S
ENVIRONMENT.
•ALL BRAIN ADAPTATIONS ARE ATTEMPTS TO
AID SHORT TERM SURVIVAL, OFTEN AT THE
COST OF LONG TERM SURVIVAL.
•THREAT & STRESS DURING INFANCY CREATES
MOLECULAR & NEUROBIOLOGICAL CHANGES
PREPARING THE ADULT BRAIN FOR SURVIVAL
IN A DANGEROUS WORLD.
•“HARD WIRED” NOT A “SOFTWARE PROBLEM.”
–ANGER, ANXIETY, IMPULSE CONTROL, DEPRESSION
NEW SCIENCE OF EPIGENESIS
EXPERIENCE CAN TURN GENES “ON OR “OFF”
• EPIGENETIC: “NEITHER GENES NOR
ENVIRONMENT DOMINATES DEVELOPMENT.
PHENOTYPES EMERGES AS A FUNCTION OF
THIS CONSTANT DIALOGUE, AND ANY EFFORT
TO ASCRIBE PERCENTAGE VALUES TO
ISOLATED VARIABLES IS LIKELY TO BE
BIOLOGICALLY MEANINGLESS.
(NATIONAL RESEARCH COUNCIL, 2001, pp 63-64.).
•
THE OLD “NATURE VERSUS NURTURE" DEBATE-FOCUSING ON WHETHER
HEREDITY OR ENVIRONMENT IS THE MAIN DETERMINANT OF HUMAN
CONDUCT IS NO LONGER RELEVANT TO SERIOUS DISCUSSIONS OF
DEVELOPMENT OR BEHAVIORAL CHANGE.
“RISKY GENES” & ENVIRONMENTAL (SECURE
ATTACHMENT) PROTECTIVE FACTORS
SECURE ATTACHMENT PRIMES THE BRAIN
FOR A WHOLE HOST OF ADVANTAGES
• 1. PROTECTIVE FACTOR FOR RISKY GENES THAT ARE
VULNERABLE TO THE DEVELOPMENT OF PHYSICAL &
MENTAL HEALTH PROBLEMS.
• 2. REQUIRED FOR THE DEVELOPMENT OF
MENTALIZATION & THEORY OF MIND (ToM).
• 3. ENHANCED CAPACITY FOR CORRECTLY READING
SOCIAL CUES.
• 4. INCREASE RESILIENCY TO LOSS, TRAUMA & STRESS.
• 5. INCREASE OPTIMISM (“HIGH PLACEBO
RESPONDERS.”) WHICH LEADS TO HIGHER LEVELS OF
ENDOGENOUS OPIATES, OXYTOCIN & DOPAMINE.
II. ADVANTAGES OF SECURE ATTACHMENT
• 6. PROMOTES DEVELOPMENT & MAINTENANCE
OF SYNAPTIC STRENGTH.
• 7. INCREASED FLEXIBILITY IN THE
REGULATION OF PSYCHOBIOLOGICAL
EMOTIONAL STATES THROUGH INTERACTIONS
WITH OTHERS. (DISAGREE W/O BEING DISAGREEABLE)
• 8. BETTER STRATEGIES FOR SELF-REGULATION.
• 9. INCREASED VAGAL TONE WHICH PROMOTES:
• 10. INCREASED CAPACITY TO DERIVE
PLEASURE FROM HUMAN INTERACTIONS.
– RESULTS IN MORE OXYTOCIN & VASOPRESSIN RECEPTORS
IN BRAIN.
• 11. MORE SATISFYING SEXUAL RELATIONSHIPS.
“MENTAL HEALTH IS A
SUBSTANCE THAT
ATTRACTS ITSELF AS
READILY AS MONEY OR
POWER: THE MORE YOU
HAVE, THE MORE YOU
GET” (Lewis, Amini, & Lannon 2000)
Jekyll Island
MENTALIZATION – SELF-REFLECTIVE FUNCTION, READING THE MENTAL STATES OF
OTHERS, COOPERATION, EMOTIONAL & SOCIAL INTELLIGENCE, ETC.
SECURE ATTACHMENT IS NOT
AN END IN ITSELF
• I. SECURE ATTACHMENT = INCREASED
AFFECT REGULATION
– AUTO-REGULATION & INTERACTIVE REGULATION
• II. AFFECT REGULATION = LEADS TO
MENTALIZATION & ToM (THEORY OF MIND)
• III. MENTALIZATION & ToM = EMPATHY &
COOPERATION
• IV. EMPATHY & COOPERATION =
SURVIVAL OF SPECIES.
MENTALIZATION & ToM IS NOT A
GIVEN, IT IS A HARD WON
DEVELOPMENTAL ACQUISITION.
• ATTACHMENT IS NOT AN END IN ITSELF, BUT EXISTS
IN ORDER TO ALLOW A REPRESENTATIONAL SYSTEM
TO DEVELOP THAT AIDS HUMAN SURVIVAL BY
EQUIPPING AN INDIVIDUAL FOR THE COLLABORATIVE
AND COOPERATIVE EXISTENCE WITH OTHERS FOR
WHICH THE HUMAN BRAIN WAS DESIGNED.
• THE EVOLUTIONARY FUNCTION OF ATTACHMENT IS
TO EQUIP THE PERSON WITH THE KIND OF
ENVIRONMENT NECESSARY WHICH ALLOWS THE
UNDERSTANDING OF MENTAL STATES OF SELF AND
OTHERS (ToM) TO FULLY DEVELOP.
INSECURE ATTACHMENTS IS A
SIGNAL OF LIMITATION IN
MENTALIZING SKILLS.
• “SUBOPTIMAL EARLY EXPERIENCES OF
CARE AFFECT LATER DEVELOPMENT
BY UNDERMINING THE INDIVIDUAL’S
CAPACITY TO PROCESS OR INTERPRET
INFORMATION ABOUT MENTAL STATES
OF OTHERS THAT IS ESSENTIAL FOR
FUNCTIONING IN A STRESSFUL SOCIAL
WORLD.”
(FONAGY, 2002)
WHEN WE ARE ABLE TO
MENTALIZE, WE ARE ABLE TO
RECOGNIZE THAT THE INTERNAL
WORLD IS SEPARATE FROM, BUT
RELATED TO EXTERNAL REALITY.
BECAUSE WE FEEL BAD OR FEEL
GREAT DOESN’T MEAN THAT WE
ARE BAD OR GREAT.
EX: FRANK B
STUDIES HAVE SHOWN THAT BPD DO HAVE
“RADAR” FOR EMOTIONS (ANGER).
• EXPERIENCE HAS “ETCHED IN” A WELL
PRACTICED NEURAL PATHWAY FOR
DETECTING THREAT OR REJECTION (i. e.
FACIAL, PROSODY, ETC).
• HOWEVER, THEIR INTERPRETATION OF
THE INFORMATION THEY DETECT IS
RIGIDLY DYSFUNCTIONAL.
– THEY DO NOT HAVE A WELL DEVELOPED
ASSOCIATIVE NETWORK THAT ALLOWS THEM TO
RECOGNIZE THAT OTHERS CAN HAVE ALTERNATIVE
OR DIFFERENT MEANING & EXPERIENCES (ToM).
fMRI SCAN: MENTALIZING PATHWAYS ARE
INHIBITED DURING EMOTIONAL AROUSAL
• ASK TO THINK ABOUT A PAINFUL EVENT.
– SECURE ATTACHED = REACTION MINIMAL
– INSECURE ATTACHED = REACTION MAXIMIZED
• ASK TO THINK ABOUT POSITIVE EVENT.
– INSECURE = BRAIN DOESN’T CHANGE
– SECURE = BRAIN LIGHTS UP
• INSECURELY ATTACHMENT INDIVIDUALS
HAVE MORE DIFFICULTY:
– 1. MANAGING NEGATIVE EMOTIONS.
– 2. PROMOTING & SUSTAINING POSITIVE EMOTIONS.
JEREMY HOLMES (2008)
NEUROCHEMISTRY OF
ATTACHMENT & STRESS
• DIFFERENCE BETWEEN
NEUROTRANSMITTERS &
HORMONES.
• NEUROTRANSMITTERS = FAST
(SECONDS)
• HORMONES = MINUTES, HOURS,
DAYS, WEEKS, MONTHS, YEARS, &
DECADES.
LIMBIC SYSTEM: THE SOCIAL BRAIN
FRONTAL LOBE
EXECUTIVE FUNCTION
ATTENTION
HIPPOCAMPUS
EXPLICIT MEMORY
LEARNING
AMYGDALA
EMOTION
FEAR/ANXIETY
IMPLICIT PROCESSES
HYPOTHALAMUS
IMPACTS THE EFFICIENCY
OF THE OTHER THREE.
*HORMONES: CORTISOL &
OXYTOCIN
THE NEURAL PATHWAYS OF ATTACHMENT & SOCIAL ENGAGEMENT SHARE THE SAME
NEURAL PATHWAYS THAT SUPPORT NEURONAL GROWTH, RESTORATION & HEALTH
HORMONES & HYPOTHALAMUS
ANTERIOR PITUITARY = GLUCOCORTICOID (CORTISOL)
POSTERIOR PITUITARY = OXYTOCIN
• CORTISOL: BIGGEST INHIBITOR OF NEUROGENESIS & PLASTICITY
OXYTOCIN: PROMOTES TRUST, ATTACHMENT & COOPERATION
CORTISOL vs. OXYTOCIN
THE BATTLE FOR CONTROL OF THE PFC
HIGHER THE OXYTOCIN, THE HIGHER THE
BONDING & MONOGAMY LARRY YOUNG, PhD
• NATURAL CHILDBIRTH + BREAST FEEDING PRODUCES
A HUGE OXYTOCIN RELEASE.
• OXYTOCIN GIVEN TO HUMAN SUBJECTS PRODUCES
NURTURING BEHAVIOR & INCREASED TRUST.
• HIGH OXYTOCIN DECREASES THE STRESS RESPONSE.
– DAMPENS THE RESPONSE INTENSITY OF AMYGDALA.
• HIGHER LEVELS HELPS THE BRAIN PAY CLOSER
ATTENTION TO SOCIAL INFORMATION.
• INCREASED SKILLS AT PICKING UP FACIAL CUES LEADS
TO MORE SATISFACTION & LESS CONFLICT IN
RELATIONSHIPS.
• INCREASED REWARD IN RELATIONSHIPS LEADS TO
GREATER OPPORTUNITY FOR ENDOGENOUS OPIOID
RELEASE.