GROUP PSYCHOTHERAPY INTERPERSONAL NEUROBIOLOGY AN ATTACHMENT THEORY PERSPECTIVE

GROUP PSYCHOTHERAPY & INTERPERSONAL NEUROBIOLOGY AN ATTACHMENT THEORY PERSPECTIVE PHILIP J FLORES, Ph. D, ABPP, CGP, FAGPA 6065 LAKE FORREST DRIVE SUITE 150 ATLANTA, GA 30328 flores-mahon@mindspring. com (404)-250 -9340

AIM OF THIS MODULE IS TO TRANSLATE RECENT FINDINGS IN NEUROSCIENCES TO CLINICAL APPLICATIONS THE THINGS MOST HELPFUL ARE: 1. IMPLICIT REALM OVER EXPLICIT REALM 2. REJECTION OF MIND-BODY DUALISM 3. AFFECT OVER COGNITION 4. MOST COMPATIBLE WITH A INTERPERSONAL RELATIONAL APPROACH. ALL OF THIS IS BECAUSE OF THE RECENT DISCOVERY OF. . .

NEUROGENESIS & NEUROPLASTICITY VCL SAPOLSKY #9 C 0; 20 - 1: 20 • ATTACHMENT CHANGES THE • STRUCTURE & BIOLOGY – (SYNAPTIC STRENGTH, NEURONAL (NEUROTRANSMITTERS, PATHWAYS, ETC. ) DOPAMINE, CORTISOL, OXYTOCIN, ETC. ) – OF THE BRAIN

EARLY 1990’s DOGMA “THE BRAIN IS A NONE DIVIDING ORGAN”. • Last 10 years have over-turned the mistaken view that the brain does not make new neurons. • NEUROPLASTICITY: Experience & practice strengthens pre-existing synapses & alters neural networks. • NEUROGENESIS: The brain does make new neurons & synapses. – Hippocampus & Olfactory Bulb – Prefrontal, Temporal, & Posterior Parietal Cortex • ATTUNEMENT, CONGRUENCE & EMPATHY INCREASES REGULATION OF NEUROTRANSMITTERS & HORMONES. – Pour more juice into quiet circuits. – Damp down activity in buzzing ones.

HOW DO NEURO-NETWORKS GET ORGANIZED? • “NEURONS THAT FIRE TOGETHER WIRE TOGETHER. ” (HEBB, 1949) • When neurons fire simultaneously, their synaptic connections become stronger, raising the likelihood that the firing of one will trigger the firing of the other. • THE GOOD NEWS & THE BAD NEWS Behavior or thoughts repeated enough become habitual & automatic.

THE SYNAPTIC SELF: HOW OUR BRAINS BECOME WHO WE ARE • We all have the same brain systems. • The number of neurons in each brain system is more or less the same for each of us. • The particular way these neurons are connected is distinct, and that uniqueness, in short, is what makes us who we are. • “My notion of personality is pretty simple: your “self”-- the essence of who you are-- reflects patterns of interconnectivity between neurons in your brain. ” J. Le. DOUX (2002)

NEGATIVE PLASTICITY (N. DIODGE) • LATER LEARNING IS ENERGETICALLY UNFAVORABLE WITHIN A NEURAL NETWORK. • NEW LESSONS MUST FIGHT AN UPHILL BATTLE AGAINST THE PATTERNS ALREADY INGRAINED. • EXISTING ESTABLISHED NEURONAL PATTERNS CAN EASILY OVERWHELM & ABSORB MODERATELY NOVEL CONFIGURATIONS. • THE NATURE OF NEUROVIRTUALITY ENSURES THAT IT TRIMS THE AMBIGUITY FROM REALITY & PORTRAYS LARGELY WHAT ALREADY HAS BEEN SEEN. • A CHILD WHO KNEW & LOVED A DECEITFUL, SELFISH, OR JEALOUS PARENT DOES NOT OFTEN LEARN TO LOVE DIFFERENTLY AT AGE 20, 40, OR 60.

ADVANCES IN THE NEUROSCIENCES INDICATE TWO DIFFERENT, ANATOMICALLY LOCATED SYSTEMS IN THE BRAIN FOR: • LEARNING, KNOWLEDGE & MEMORY, • EXPLICIT MEMORY: Anatomically located specifically in the hippocampus. • EFFORT IS REQUIRED: Retrieval is slow & predominantly under the domain of left hemisphere (left temporal lobe). • IMPLICIT MEMORY: Anatomically located in the limbic area (amygdala) & predominantly under the domain of right hemisphere. • NO SENSE OF EFFORT: Retrieval is rapid (60 milliseconds), not easily explained & consciousness or awareness is not involved.

CHARACTERISTICS OF MEMORY I. IMPLICIT PROCESSING SYSTEMS (EARLY MEMORY): PRESENT AT BIRTH. PATTERNS & “RULES” OF RELATIONSHIPS : (“IF I DO THIS, THAN THIS WILL HAPPEN. ”) II. EXPLICIT PROCESSING SYSTEMS (LATER MEMORY- COMES ON LINE AFTER AGE OF TWO): A. SEMANTIC, NARRATIVE: INITIALLY DEVELOPS AFTERT TWO YEARS OF AGE. B. AUTOBIOGRAPHICAL: PROGRESSIVE DEVELOPMENT WITH ONSET AFTER SECOND YEAR OF LIFE. Siegel (2002)

EXPLICIT MEMORY & HIPPOCAMPUS • HIPPOCAMPUS MORE INVOLVED IN RETRIEVAL OF MEMORY. (H. M. Removal of hippocampus) • MAYBE STORAGE? ? ? • MEMORIES ARE “NOMADIC”, TRAVEL OR ARE STORED THROUGHOUT THE BRAIN. • AFTER “ABOUT 10 YEARS”, MEMORIES NO LONGER REQUIRE THE HIPPOCAMPUS FOR RETRIEVAL. (10 YEARS or 10 THOUSAND HOURS) • THEY BECOME PART OF THE NEURAL SYSTEM ( INTUITIVE, IMPLICIT, CHARACTERLOGICAL, AUTOMATIC, HABIT) – BRAIN RULES (2008) JOHN MEDINA, MD,

MEMORY DOES NOT IMPLY CONSCIOUSNESS • IMPLICIT MEMORY USE TO BE THOUGHT OF AS JUST MOTOR OR MUSCLE MEMORY. • AND AS “OVER LEARNED BEHAVIOR THAT WAS ENCODED DIFFERENTLY IN A PERSON’S MIND. ” • IMPLICIT MEMORY IS MUCH MORE & IS RELATED TO ALL “HOW TO” MEMORY & KNOWLEDGE. – (DIFFICULT TO EXPLAIN, BUT EASY TO DEMONSTRATE). • NON-CONSCIOUS vs UNCONSCIOUS • 1. UNCONSCIOUS OFTEN IMPLIES REPRESSION. • 2. IMPLICIT IS INFORMATION THAT HAS BEEN ENCODED & PROCESSED SO RAPIDLY THAT IT HASN’T HAD TIME TO EVEN REACH CONSCIOUSNESS TO BE REPRESSED.

IMPLICIT PROCESSES KNOWLEDGE WITHOUT AWARENESS • • IMPLICIT NOT JUST MEMORY IMPLICIT KNOWLEDGE IMPLICIT COMMUNICATION IMPLICIT RECEPTION & PROCESSING OF INFORMATION. – (60 MILLISECONDS vs 250 MILLISECONDS) • IMPLICIT AFFECT REGULATION • IMPLICIT RULES OF RELATIONSHIPS

TESTING FOR KNOWLEDGE “I KNOW WHY” vs “I KNOW HOW” • I KNOW WHY - HIPPOCAMPUS: EXPLICIT MEMORY & KNOWLEDGE. – SELF REPORT: COGNITIVE, NARRATIVE • I KNOW HOW - AMYGDALA: IMPLICIT MEMORY & KNOWLEDGE. • DEMONSTRATED THROUGH INTUITION, BEHAVIOR, ACTION & EMOTIONS. (REFLECTED IN THE BODY) – VISIBLY REFLECTED IN GESTURES, POSTURE, PROSODY, FACIAL EXPRESSIONS (i. e. SMIRK, FLUSHING), EYE GAZE, & MOVEMENT HABITS.

THINKING FAST & SLOW DANIEL KAHNEMAN (2011) NOBEL PRIZE RECIPIENT • SYSTEM 1: IS FAST, INTUITIVE, EMOTIONAL & NON-CONSCIOUS. BOTTOM UP MODEL (IMPLICIT) • SYSTEM 2: IS SLOWER, DELIBERATE & LOGICAL. TOP DOWN MODEL (EXPLICIT) • DUAL PROCESS THEORY: Each system influences the other with mixed results. • System 1 dominates & effort is required before system 2 can exert any influence on system 1. (“You have to think”. ) • However, System 2 sometimes interferes with System 1, resulting in reduced efficiency.

BLINK –THE POWER OF THINKING WITHOUT THINKING M. GLADWELL • The primary message of the book by Malcolm Gladwell, addresses why many of us know in a few seconds who can be trusted, when something or someone is fake, etc. – OTHERS ARE HORRIBLE AT THIS. • WHY OUR BEST DECISIONS ARE OFTEN THOSE THAT ARE IMPOSSIBLE TO EXPLAIN TO OTHERS. • ex: Doctors diagnosing cardiac emergencies in the ER decreased in accuracy when given too much information – (Instilled a heart attack decision tree in the er)

INTUITION & SYSTEM 1 • Intuition is simply rapid (hundreds of milliseconds) cognition with the required knowledge partially swept under the carpet, all courtesy of emotion and much past practice (10, 000 hours or ten years). • The quality of one’s intuition depends on skill & how well we have reasoned in the past.

RECRUIT SYSTEM 2 TO HELP MAKE SYSTEM 1 WORK MORE EFFECTIVELY • HELP PEOPLE LEARN WHEN TO: – 1. TRUST THEIR IMPLICIT KNOWLEDGE » OR • 2. IF THEIR IMPLICIT RULES ARE ABERRANT, HELP THEM QUESTION THEIR ASSUMPTIONS & PERCEPTIONS.

THE NEUROSCIENCES ARE TEACHING US THAT THE MOST EFFICIENT WAY TO CHANGE A PERSON’S BRAIN IS NOT TO GIVE THE PERSON DRUGS THAT MIMIC, BLOCK, OR SUBSTITUTE FOR ENDOGENOUS NEUROTRANSMITTERS, • But rather provide the person with an ongoing opportunity for novel experiences & optimal emotional arousal within the context of a strong, supportive interpersonal relationship & affective bond. • In short, if you want to change a person’s mind, be emotionally attuned to him/her & talk with him in a meaningful, caring manner. • State of the art neuro-imaging techniques have confirmed this to be so. Dan Siegel, MD, 2007

FUNDAMENTAL TASK OF IMPLICIT TREATMENT • HOW TO WORK WITH WHAT IS BEING COMMUNICATED BUT NOT SYMBOLIZED WITH WORDS. • HOW DO WE RECOGNIZE MOMENTS OF BOTH SUBTLE & HEIGHTENED EMOTIONAL, BODILY BASED, IMPLICIT COMMUNICATION? • ATTACHMENT THEORY DESCRIBES HOW IMPLICIT SYSTEMS OF THERAPIST INTERACT WITH IMPLICIT SYSTEMS OF THE PATIENT. • PSYCHOTHERAPY IS NOT THE “TALKING” CURE, BUT THE “COMMUNICATING” CURE.

THE PROCESS OF CHANGE STUDY GROUP IN BOSTON (DAN STERN) • Is exploring the “something more” other than interpretation that is required for successful treatment. • The relational procedural domain is distinct from the symbolic domain. • Change occurs through the relationship & intersubjective moments (moments of meeting) between the interactants that create new organizations and alters implicit knowledge—the patient’s way of being with others.

“MOMENTS OF MEETING” CANNOT BE PLANNED, THEY HAPPEN. • JUST AS INTERPRETATION IS THERAPEUTIC EVENT THAT REARRANGES THE PATIENT’S CONSCIOUS EXPLICIT KNOWLEDGE, • THE “MOMENT OF MEETING” IS THE EVENT THAT REARRANGES IMPLICIT RELATIONAL KNOWING FOR BOTH THE PATIENT & THERAPIST. (D. STERN) – BUBER EX.

EXIT INTERVIEW RESEARCH • “It wasn’t anything that therapist said to me that stands out as much as it was the look on his face when i told him how i had been treated by my father and the tone of his voice when he responded to me. ” • I only remember being caught in the moment, feeling this kindness like i never known before. “ – CINDY M.

KOHUT, SELFPSYCHOLOGY & IMPLICIT COMMUNICATION • “Therapeutic change and growth takes place in an atmosphere evoked by therapist’s sustained empathic efforts. ” • Patients will recognize their therapist’s consistent efforts to understand & this is often more important than what therapist says. (Rutan & Stone, 2013)

EVOLUTION PROVIDED US WITH TWO PRIMARY TYPES OF AFFECT REGULATION • INTERACTIVE REGULATION (A. SHORE) • vs • SELF REGULATION (D. SIEGEL) – MINDFULNESS TRAINING • AVOIDANT/DISMISSIVE: A bias towards excessively reliance on auto-regulation techniques. (“Help ain’t coming”. ) • ANXIOUS/PREOCCUPIED: A tendency to under auto-regulate & rely excessively on interpersonal regulation. (Fear of abandonment & constant relational difficulties) • DISORGANIZED : Big problems arise when a person cannot do either or relies excessively on one strategy at the expense of the other. (Trauma)

“MEDICATION CAN HAVE A DEVASTATING EFFECT OF KEEPING PEOPLE SHUT OFF FROM OTHERS. ” (Bessel van der Kolb, MD, 2007) • Also prevents the person from developing more effective self-regulating or interactive regulation skills. • Do anti-depressants impair our ability to love?

THE BRAIN: AFTER TWENTY YEARS OF ACCUMULATED RESEARCH EVIDENCE T. INSEL (2011) DIRECTOR OF NIMH • “IT IS CLEAR THAT WHAT CAN BE ACCOMPLISHED BY PHARMACEUTICAL INTERVENTIONS HAS BEEN CLEARLY OVERSOLD. ” • “IT IS ALSO CLEAR THAT WHAT CAN BE ACCOMPLISHED BY PSYCHO-SOCIAL INTERVENTIONS HAS BEEN CLEARLY UNDERSOLD. ”

EMOTIONAL PAIN ASSOCIATED WITH REJECTION EVOLVED AS A SURVIVAL MECHANISM TO KEEP US ATTACHED TO THE LARGER GROUP

“COGNITION IS MORE THAN KNOWING THE EXTERNAL WORLD. IT IS ALSO KNOWING THE INTERNAL WORLD OF ONE’S BODY”. ALAN SCHORE (2007) • IT IS CRUCIAL THAT A PERSON BE ABLE TO RECEIVE & UNDERSTAND INFORMATION FROM HIS/HER OWN BODY. • THE ABILITY TO EXPERIENCE & READ INTEROCEPTIVE CUES FROM THE BODY AS WELL AS EXTROCEPTIVE CUES FROM THE ENVIRONMENT IS CRUCIAL. • “CHILDREN, WHO HAVE BEEN TAUGHT BY EXPERIENCE, TO NOT TRUST THEIR INTERNAL EMOTIONAL SIGNALS, WILL BE AT A DISADVANTAGE AS AN ADULT. ” (LEWIS, AMINI & LANNON, 2000).

THE POLYVAGAL THEORY & THE SOCIAL ATTACHMENT SYSTEM S. W. PORGES • The degree to which we experience attachment as uncomfortable or threatening, rather than rewarding and pleasurable, is determined primarily by the neurobiological adaptations our CNS makes as a result of our earliest attachment experiences. • Why do some people lack responsiveness to soothing voices & smiling faces of people who care for them, input that helps most people calm down?

NEUROCEPTION: THE BRAIN IS ALWAYS RECEIVING INFORMATION FROM THE BODY, COURTESY OF THE VAGUS NERVE THE BRAIN IS A LIKE A CEO THAT DOESN’T LIKE TO MICROMANAGE

“HE GIVES ME THE CREEPS”. • A GOOD EXAMPLE OF INTROCEPTIVE COMMUNICATION & GOOD VAGAL TONE. • PRIMITIVE INTERNAL COMMUNICATION THAT ENHANCES SURVIVAL FOR ALL SOCIAL MAMMALS. • PROSODY: LOW GROWL, HIGH PITCHED SHRIEK. MUSIC TO SET THE TONE IN A SCARY MOVIE. • SMELL: A SINGLE SYNAPTIC LINK FROM AMYGDALA • FACIAL MUSCLES: FROWN, SMIRK, SMILE, COLD BLANK EYES, GAZE AVERSION, FLAT FACIAL AFFECT. • GESTURES: HEAD MOVEMENT, BODY POSTURE • INCONGRUENCE & EXPECTATION: SURPRISES & INCONSISTENCIES

EVOLUTION, VAGAL TONE & THE PHYSIOLOGICAL REGULATION OF EMOTION • While all mammals with vertebrates have vagus nerves, only social mammals have a myelinated vagus nerve. – Evolution & reptiles • Without conscious awareness it detects safety & acts as a “vagal brake”, promoting the down regulation of the sympathetic nervous system & activation of the parasympathetic nervous system. – fight, flight & freeze response are moderated, thus reducing metabolic demands & strain on the body & brain. • This vagal brake is wired to muscles of the face & head, allowing social mammals to detect safety & be comforted by smiles, eye contact, prosody & gestures of the face.

IMMOBILIZATION WITHOUT FEAR • NEUROCEPTION & GOOD VAGAL TONE REFLECTS THE CAPACITY -- WITHOUT CONSCIOUS AWARENESS -- TO ASSESS SAFETY. • WHEN SAFETY IS DETECTED, VAGUS SYSTEM INHIBITS THE SNS, WHICH ALLOWS SOCIAL ENGAGEMENT & “IMMOBILIZATION WITHOUT FEAR. ” – Attachment, bonding, sex, spooning with your partner, etc. • IF RISK IS DETECTED, THE INHIBITION FOR FLIGHT/FREEZE IS REMOVED. • When confronting danger, the first part of the nervous system will try to • negotiate by using face, vocalizations & language. If this fails, fight or flight mobilization kicks in. If fight or flight is impossible, the freeze response gets activated (dissociation, fainting). • TRAUMA & INSECURE ATTACHMENT RESULTS IN POOR VAGAL TONE & & THE SYSTEM MALFUNCTIONING. SCOTT, L. & KITCHENS

GOOD VAGAL TONE HELPS DETECT FRIEND FROM FOE • WHEN VAGAL SYSTEM IS WORKING CORRECTLY, IT DETECTS IF THE ENVIRONMENT IS SAFE OR DANGEROUS. • DETECTING RISK WHEN THERE IS NONE KEEPS THE HPA SYSTEM OVER ACTIVE. • PEOPLE WITH IMPAIRED SOCIAL ENGAGEMENT SYSTEMS ARE PRONE TO MISINTERPRET SAFETY AS THREAT & OBJECTIVE DANGER AS SAFETY. • GOOD VAGAL TONE IS LIKE GOOD MUSCLE TONE, IT REQUIRES A SECURE BASE IN WHICH TO EXERCISE & PRACTICE RECIPROCAL INTERACTION.

AMYGDALA = FEAR: EARLY WARNING SYSTEM OF THE BRAIN. RUN FIRST, EVALUATE SECOND. • SIGHTS, SOUNDS & SMELLS HAVE DIRECT IMMEDIATE ACCESS TO THE AMYGDALA. – OFTEN JUST A SINGLE SYNAPSE AWAY • TRIGGERS A BODY WIDE REACTION IN MILLISECONDS, IGNITING THE HYPOTHALAMUS WHICH PUMPS OUT A CASCADE OF HORMONES THAT – – RAISES HEART RATE, PUMPS BLOOD TO MUSCLES, SHUTS DOWN NON-EMERGENCY FUNCTIONS LIKE IMMUNITY & DIGESTION. • ALL THIS OCCURS W/O PASSING THROUGH THE NEOCORTEX & REQUIRING RATIONAL THOUGHT OR “MAKING” A DECISION.

WHAT INFLUENCES THE AMYGDALA’S FAST TRACK? • THREAT • THE STARTLE RESPONSE IS THE FASTEST REFLEX WE HAVE IN THE BODY (5 MILLISECONDS) • EAR HAS THE LARGEST DIRECT NEURON TO THE LIMBIC SYSTEM & MOTOR STRIP. – (3 MICRONS) • STRESS (WHY ARE YOU SO JUMPY? ) • PAIN (THE DENTIST BARELY TOUCHES THE DRILL TO YOUR TOOTH)

PRE-FRONTAL CORTEX IS PART OF THE LIMBIC SYSTEM • CONFIRMS WHY THOUGHTS CAN EFFECT FEELINGS (CBT THERAPY, INTERPRETATION @ PSYCHODYNAMIC). • HOWEVER, EVIDENCE ALSO EXISTS THAT FEELINGS STIMULATE & TRIGGER THOUGHTS. – “Cognitive science may be turned on it’s head once academicians realize how profoundly human thoughts are influenced by affective feelings. ” THE ARCHAEOLOGY OF MIND. (PANKSEPP, 2012, P. 5) • “AN EMOTION CAN ONLY BE MEDIATED BY ANOTHER CONTRARY OR STRONGER EMOTION. ” SPINOZA (1630) • THE BEST WAYS TO INFLUENCE FEELINGS IS WITH STRONGER, MORE POWERFUL EMOTIONS. – Ex: MAN & DOG

WHEN EMOTION & REASON COLLIDE, EMOTION INVARIABLY WINS “PASSION ALWAYS WINS OVER REASON. ” SPINOZA (1630) “It is understandable that many wish to envision our affective lives as being completely intertwined with our cognitive abilities, but from a neuro-evolutionary perspective, this is not correct. ” PANKSEPP, THE ARCHAEOLOGY OF MIND. (2012, P. 5)

WHAT HAPPENS TO THE BRAIN WHEN AN EVENT IS TOO TRAUMATIC? DISORGANIZED ATTACHMENT: STRESS, CORTISOL & THE DIFFERENTIAL IMPACT ON HIPPOCAMPUS vs AMYGDALA ATROPHY INCREASE IN VOLUME

FEAR & LONG TERM POTENTIATION AMYGDALA NEURONS UNDERGO SPECIFIC CHEMICAL & STRUCTURAL CHANGES THAT FORM AN IMPRINT, OR MEMORY, OF THE SENSORY IMAGE THAT ACCOMPANIES A PARTICULAR THREAT. IN NEUROSCIENCE LINGO, THE SENSORY INPUT IS “POTENTIATED. ” IN PLAIN LANGUAGE: THE PREVIOUSLY UNREMARKABLE STIMULUS (i. e. . MUGGER’S FACE, CAR BACKFIRE, HELICOPTER) NOW EVOKES TERROR STATES. (CHRISTINE & DARK BEDROOM)

TRAUMA & BRAIN ADAPTATIONS: • “RESEARCH HAS DEMONSTRATED THAT AFTER 24 HOURS, MEMORY OF THE FEAR RESPONSE HAS CONSOLIDATED & CANNOT* BE ERASED. ” (MICHAEL DAVIS, MD, 2009)

WHY OUR ISSUES REMAIN OUR ISSUES • HOW MANY TIMES HAVE WE HEARD OUR PATIENTS LAMENT, “WHAT IS WRONG WITH ME? WHY AM I STILL STRUGGLING WITH THESE FEELINGS AFTER ALL THESE YEARS OF THERAPY. ”

LIMBIC IMPRINTING & INTROJECTION OF BAD OBJECT • AMBIVALENT/DISORGANIZED ATTACHMENT & INTROJECTION • THE HAUNTING PRESENCE OF THE INTERNALIZED ATTACHMENT TO THE SELF/OBJECT REPRESENTATION.

AMYGDALA & IMPLICIT PROCESS • ACTIVATED DURING THE ENCODING OF UNPLEASANT OR AROUSING EMOTIONAL SENSORY MATERIAL. • ALSO RESPONSIBLE FOR THE INDIVIDUAL’S ABILITY TO PROCESS PROSODY (THE EMOTIONAL INTONATION IN VOICES). – PROSODY CONVEYS DIFFERENT SHADES OF MEANING. • ACTIVATED DURING PERCEPTION OF EMOTION, NOVEL STIMULI, FEAR, ANXIETY, EMPATHY, AND MOTOR INITIATION. – JULIE M. EX • GREATER ACTIVATION DURING FEARFUL OR ANGRY FACES AS OPPOSED TO HAPPY FACES.

• WHY FAKING EMPATHY DOESN‘T WORK. “EMOTIONS COME FROM PHYLOGENIC, ANCIENT TIMES & THE ABILITY TO READ & DISPLAY THEM IS AN INBORN GIVEN, THAT IS HONED BY MILLIONS OF YEARS OF EVOLUTION. • CONTRIVED FEELINGS, MIMICKING EMOTIONAL STATES, AND IN-AUTHENTICITY ON THERAPIST’S PART, NO MATTER HOW WELL INTENDED, ARE WORST THAN USELESS. • THE PATIENT’S INBORN ABILITY TO READ EMOTIONS CORRECTLY FAR EXCEEDS THERAPIST’S ABILITY TO DECEIVE. ” (Lewis, Amini & Lannon, 2000)

PAUL EKMAN & FACIAL EXPRESSIONS • YOU CANNOT HAVE AN EMOTION WITHOUT A COROLLARY EXPRESSION IN THE BODY. • EMOTIONS ARE HARDWIRED, INSTINCTUAL, NOT LEARNED (i. e. BLIND BABIES) • FACIAL EXPRESSIONS ARE IDENTICAL ALL OVER THE GLOBE IN EVERY CULTURE.

TOMPKINS’S 9 PRIMARY AFFECTS 1. SHAME, 2 ANGER, 3. FEAR, 4. DISGUST, 5. SURPRISE, 6. EXCITEMENT, 7. CONTEMPT, 8. JOY & 9. DISTRESS • • EMOTIONS ARE HARD WIRED, HIGHLY PATTERNED CIRCULATORY & MUSCULAR ACTIONS (i. e. STARTLE RESPONSE), OF WHICH ONE FREQUENT DISPLAY IS A “FACIAL EXPRESSION” (i. e. BLUSHING, FROWN). WHEN WE ACCEPT OR RECOGNIZE AN EMOTION THAT HAS BEEN TRIGGERED BY A STIMULUS, IT IS USUALLY ASSOCIATED WITH WHAT WE CONVENTIONALLY CALL A “FEELING”.

AFFECT, EMOTION, & FEELING CLARIFICATION IN TERMINOLOGY A. DAMASIO (1999) THE FEELING OF WHAT HAPPENS • ALTHOUGH FEELINGS, EMOTIONS & AFFECT ARE ROUTINELY USED INTERCHANGEABLY, IT IS IMPORTANT TO NOT CONFUSE AFFECT OR EMOTIONS WITH FEELINGS. • AFFECT AS A DRIVE. – TOMPKIN’S NINE PRIMARY AFFECTS. • EMOTIONS AS BODILY PROCESSES. (Damasio) • FEELING AS A SECONDARY REACTION TO A PRIMARY EMOTION/AFFECT – SOCIAL COMPONENT RELATED TO JUDGMENTS ABOUT THE PHYSICAL DEMONSTRATION OF AFFECT.

EACH OF US HAS THE SAME NINE AFFECTS, BUT OUR LIFE EXPERIENCE MAKES OUR INTERPRETATION OF FEELINGS QUITE DIFFERENT. • AFFECT OR EMOTION IS ALWAYS BIOLOGY. • FEELINGS ALWAYS REPRESENTS BIOGRAPHY.

THE ROLE OF EMOTION & AFFECT REGULATION IN PSYCHOTHERAPY RESULTS FROM A FOUR YEAR NIMH STUDY (2009) D. H. BARLOW, Ph. D • INITIAL EMOTIONS ARE USUALLY NOT THE PROBLEM; IT’S THE SECONDARY JUDGMENTS ABOUT THE FEELINGS THAT BECOMES THE PROBLEM – (THE WAY A PERSON FEELS ABOUT EMOTIONS). • MOST PEOPLE WITH ANXIETY OR DEPRESSION RESPOND TO THEIR EMOTIONS IN A SIMILAR WAY: • 1. CANNOT ACCEPT “NEGATIVE” EMOTIONS LIKE ANGER, SADNESS, ANXIETY & SHAME. • 2. THEY TRY TO SUPPRESS OR GET RID OF EMOTIONS. • 3. THEY HAVE TROUBLE REGULATING THEIR AFFECT OR LETTING GO. • 4. BY CONTRAST: HEALTHY CONTROL SUBJECTS ARE BETTER ABLE TO ACCEPT, LET GO, OR MOVE ON FROM THEIR NEGATIVE EMOTIONS.

Effects of Reappraisal Goals Ochsner, Ray, Robertson, Cooper, Gabrieli & Gross (2004) up-regulate/increase negative emotion • worry, anxiety, rumination, judgment Aversive Emotion Re-appraise The feeling or judgment we have about the emotion Altered Response • down-regulate/decrease negative emotion • acceptance without panic or judgment

FEELINGS vs EMOTIONS (MIND) vs (BODY) • IN MOST CASES, EMOTIONS THEMSELVES ARE USUALLY NOT THE PROBLEM. • IT IS THE PERSON’S FEELINGS ABOUT THEIR EMOTIONS & THEIR JUDGMENTS ABOUT THEIR EMOTIONS THAT END UP CAUSING A BIGGER PROBLEM.

NEW IMPLICIT INHIBITORY LEARNING • BECAUSE MANY BRAIN ADAPTATIONS ARE DIFFICULT, IF NOT IMPOSSIBLE TO ERASE, MOST CHANGES RESULTING FROM PSYCHOTHERAPY ARE BECAUSE OF “NEW IMPLICIT INHIBITORY LEARNING. ” • “NEW IMPLICIT INHIBITORY LEARNING” IS: • 1. NEUROPLASTICITY INDUCED BY NEW REPETITIVE EXPERIENCES & ACTIONS THAT STRENGTHEN & REARRANGE EXISTING NEURAL PATHWAYS • 2. NEUROGENESIS IS THE BIRTH & REWIRING OF NEW PATHWAYS WHICH RESULTS IN MORE EFFECTIVE RESPONSES TO OLD PSYCHO-SOCIAL STRESSORS.

MIND FLIGHT: THE PHOBIA OF INNER EXPERIENCE • AVOIDANCE OR ESCAPE FROM ONE’S OWN INNER EXPERIENCES (Steele, 2009) • REFERRED TO AS “PHOBIA OF INNER EXPERIENCE” OR “PHOBIA OF MENTAL ACTIONS” (Steele, 2009; Steele et al. , 2005; Van der Hart et al. , 2006) • SOMETIMES REFERRED TO AS “EXPERIENTIAL AVOIDANCE: ” THE RELUCTANCE TO REMAIN IN CONTACT WITH PAINFUL PRIVATE EXPERIENCES (Hayes, Strosahl, & Wilson, 2003) • GENERALLY BASED ON FEAR OR SHAME, AND/OR BEING OVERWHELMED BY THE EXPERIENCE. (ex: Sally S. & Ma. W)

• “KEY TO AROUSAL MODULATION IS ‘BEFRIENDING’ INTERNAL SENSATIONS, AND GAINING AWARENESS OF THE TRANSITORY NATURE OF ALL SENSORY EXPERIENCE. ” • B. van der KOLB (2001)

WE CAN’T CONTROL OUR EMOTIONS, BUT WE CAN LEARN TO CONTROL OUR FEELINGS ABOUT OUR EMOTIONS • IF WE ARE SAD, WE CAN’T WILL OURSELVES TO BE HAPPY. • BUT WE CAN MAKE AN EFFORT TO NOT PANIC OR BERATE OURSELVES FOR BEING SAD.

PROMOTING SELF REGULATION. ASSESS BOTH WHAT AN EMOTION IS & WHAT AN EMOTION DOES • ASSESS THE RELATIONSHIP THE PERSON HAS TO HIS OR HER INTERNAL EXPERIENCE. – INCREASE THEIR AWARENESS OF THEIR BODILY BASED EMOTIONS. • DOES THE PERSON VIEW EMOTIONS AS GOOD, SAFE, HELPFUL OR AS BAD, THREATENING & INTERFERING. • HOW DO THEY FEEL ABOUT THEIR EMOTIONS? – ASSESS HOW THEY RESPOND TO OTHER’S EMOTIONS. • DO THEY EMPLOY ADAPTIVE OR MALADAPTIVE STRATEGIES FOR AFFECT REGULATION?

MINDFULNESS: Model for breaking the vicious cycle of the exacerbation of emotions Emotion perceived as intolerable/ unacceptable Efforts to suppress Emotion perceived as tolerable/ acceptable No suppression Suppression Fails, Leading to Panic, Somatization or Obsessive Rumination Stimulus Triggers a Negative Affect From: Campell-Sills, L. , & Barlow, D. H. , (2007). Mood recovers naturally

LEARNED SAFETY (KANDEL & POLLAK, 2008) • TRAINING MICE TO TAKE ADVANTAGE OF SOURCES OF SAFETY & SECURITY IN THEIR ENVIRONMENTS RESULTED IN: • REDUCED STRESS RESPONSE • INFLUENCED THE DEVELOPMENT OF NEWBORN CELLS IN THE HIPPOCAMPUS. (NEUROGENESIS). • INCREASED BDNF IN HIPPOCAMPUS & INCREASED DOPAMINE LEVELS.

THE REPARATIVE EXPERIENCE & LEARNING HOW NOT TO BE AFRAID • M. MAIN IDENTIFIED A SUBGROUP OF SECURE PATIENTS WHO DESCRIBED PROBLEMATIC & PAINFUL CHILDHOOD HISTORIES ORDINARILY ASSOCIATED WITH INSECURE ATTACHMENT. • THESE ADULTS OFTEN HAD EMOTIONALLY SIGNIFICANT REPARATIVE RELATIONSHIPS WITH CLOSE FRIENDS, ROMANTIC PARTNERS AND/OR THERAPISTS.

“LEARNED SAFETY IS A LITTLE BIT LIKE PSYCHOTHERAPY. ” ERIC KANDEL (2008) NOBLE PRIZE NEUROSCIENTIST, NOT A THERAPIST. • RE-CONDITIONING YOUR BRAIN: THE “INHIBITION OF THE FEAR RESPONSE” REQUIRES AN ABILITY TO IDENTIFY, DEVELOP & EXPLOIT CONDITIONS OF SAFETY & SECURITY IN ONE’S ENVIRONMENT. – STAY CLOSE TO PEOPLE THAT HELP YOU FEEL SAFE. • EARNED SECURITY DAMPENS THE STRESS RESPONSE. • REDUCES CORTISOL • INCREASES NEUROGENESIS IN HIPPOCAMPUS – WHICH PROMOTES NEW LEARNING & MEMORY & • INCREASES BDNF, DOPAMINE & OXYTOCIN LEVELS