NEUROSCIENCE AND SOCIAL WORK PRACTICE
PROFESSOR ROB MACFADDEN,
UNIVERSITY OF TORONTO
Robert.macfadden@utoronto.ca
www.robertmacfadden@utoronto.ca
Neuroscience & Intervention
Factor-Inwentash Faculty of Social Work
Continuing Education
University of Toronto
October 30th 2013
Module 3 Webinar
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NEUROSCIENCE AND SOCIAL WORK PRACTICE
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
Interpersonal Neurobiology
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.
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.
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NEUROSCIENCE AND SOCIAL WORK PRACTICE
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.
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NEUROSCIENCE & SOCIAL WORK PRACTICE
THE IMPACT OF MINDFULNESS
THE POWER OF INTENTIONAL ATTENTION
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
1. Attention Regulation
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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
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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
3.1 Emotion Regulation
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Mindfulness can result in improvement in emotion regulation.
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Can reduce emotional reactivity
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Decrease in negative mood states
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Improve positive mood states
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Reduce distractive and ruminative thoughts and behaviours
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Can increase left prefrontal activation leading to more positive emotions
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The ACC (monitors control processes)
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Typical pattern: increased PFC, decreased amygdala activation
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PFC projections to amygdala exert inhibitory top down control
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Improved emotion regulation underlying Mindfulness likely accounts for stress reduction & reducing depression
symptoms.
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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
3.2 . Emotion Regulation: Exposure, extinction, reconsolidation
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Mindfulness encourages exposure to the experience, welcoming it, refraining from engaging in
internal activity towards it, bring acceptance to bodily and affective responses
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Turn towards negative emotions, which pass away leaving a sense of safety or well-being
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Mindfulness avoids enacting safety strategies (e.g, avoiding contact, blocking thoughts, feelings),
and focuses attention on responses
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High level of relaxation (parasympathetic tone) and decreased sympathetic tone paired with
negative stimuli may decrease negativity
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Extinction does not erase original association but is thought to form new memory trace or
reconsolidate old memory with new (relaxed) contextual associations.
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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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
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.
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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
Mindfulness Meditation & Impact
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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.
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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
http://www.youtube.com/watch?v=m8rRzTtP7Tc
Neuroscientist, Dr. Sara Lazar
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NEUROSCIENCE & SOCIAL WORK PRACTICE
Mindfulness Research
INTRAPERSONAL ATTUNEMENT
Mindful Brain by Daniel Siegel
(2007) implies a healthy relationship with oneself. It involves intrapersonal
Mindfulness
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 selfattunement. 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.
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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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MINDFULNESS MEDITATION & NEUROSCIENCE
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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MINDFULNESS MEDITATION & NEUROSCIENCE
9 MIDDLE PREFRONTAL FUNCTIONS
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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MINDFULNESS MEDITATION & NEUROSCIENCE
9 MIDDLE PREFRONTAL FUNCTIONS
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 wellbeing.
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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MINDFULNESS MEDITATION & NEUROSCIENCE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
Learning & Teaching
Brain and Learning Findings
Implications for Therapy
Content needs to make sense to
learners
The therapist’s model has to make sense in explaining the client’s situation. This increases a
sense of bond and optimism.
Content has to be relevant
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.
Emotions drive attention & memory
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.
Action is important in learning
Doing things strengthens new & existing neural connections. Encourage clients to try things out,
homework, role playing, drawing, writing, etc.
Multi-sensory experiences improve
memory and utilization
When possible, engage clients in different sensory ways through use of
images, sound, video. The use of rich metaphors which activate thinking, imagination and
feelings use multi-sensory connections.
Learning optimized through relaxed
attention, avoiding excessive stress &
anxiety.
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.
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NEUROSCIENCE & SOCIAL WORK PRACTICE
Learning and Teaching
Brain and Learning Findings
Implications for Therapy
Build on existing learner’s knowledge &
beliefs.
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.
Foster positive emotions to aid in
thinking and remembering
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.
Work to develop learning at the
conscious and unconscious levels
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).
Encourage deep learning: memory &
retrieval, analysis, critique, action,
feedback and refinement
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.
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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
TAKE AWAYS
Most 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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NEUROSCIENCE & SOCIAL WORK PRACTICE
TAKE AWAYS
Powerful 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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NEUROSCIENCE & SOCIAL WORK PRACTICE
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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NEUROSCIENCE & SOCIAL WORK PRACTICE
TAKE AWAYS
Conditions that promote therapeutic change:
positive therapeutic alliance with resonance,
attunement, accurate empathy
naming feelings and integrating into self-narrative
feeling safe and feeling felt
working on highly relevant goals with tasks that make sense
incorporating self-soothing and co-soothing
repairing relationship ruptures
deliberately facilitating positives and positive emotions
monitoring 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.
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