Attachment Goes to College - PowerPoint Presentation

Slide1

Attachment Goes to College

Basic Needs and College Counseling

Presented By:

David W. Eckert, LMHC, NCC, CRCSlide2

Overview of workshop

Introductions

Basic Neurobiological Theory: Defining ‘Normal’

Consistency Theory: Four Basic Needs

Attachment Theory and Research

Understanding Trauma

Client Self-understanding and Insight

From Insight to Interventions

Case Examples Slide3

DisclaimerSlide4

Defining ‘Normal’

Smoller

, J. (2012)

The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior

, Harper Collins

Advances in Neuroimaging have led to sophisticated techniques in studying brain structure and function

‘Normal’ exists along a continuum…

French physiologist

Francios

-Joseph-Victor

Broussais

: ”pathology is not different in kind from the normal; ‘nature makes no jumps’ but passes from the normal to the abnormal continuously.”Slide5

Key Themes

3 Key Themes

Darwin and Natural Selection: our neural circuits are shaped by the adaptive challenges of our evolutionary past

Our trajectory through life is influenced by our genetic make-up, our environmental influences, and chance

The biology of ‘normal’: What are the brain’s designed functions and what do they look like when they go awry?Slide6

Normalize Before you Pathologize

The rise of Multiple Personality Disorder and the absence of repressed memories in other cultures

The brain’s response to evolutionary challenges: adaptive, taken too far, becomes problematic: “exaggerated and inappropriate forms of detecting and responding to threats”

Most psychiatric disorders are extremes of normal quantitative traits

Examples: PTSD, OCD, anxiety, depressionSlide7

Biology of Temperament

Continuum from shy and anxious to bold and uninhibited

New born starts with

Built in drives to satisfy immediate needs

Tools to seeks out helpful and avoid harmful aspects of environment

Plasticity: Ability to form new neural pathways based on new experiences; to learn from experience

Temperament: “a set of cognitive, behavioral, and emotional biases that allow us to respond to (our) environment

The amygdala recognizes emotions and scans for threats

Inhibited and traumatized people have stronger amygdala response that uninhibited people

Temperament reflects hard wiring of personality created when genetics interact with environment Slide8

Big 5 Personality Types

Neuroticism

: Experience worry and unstable moods; not calm and emotionally stable

Conscientiousness:

Self disciplined and achievement-oriented; not disorganized and irresponsible

Openness:

Curious and creative; not close-minded and conventional

Extraversion:

Active, enthusiastic, outgoing; not shy and withdrawn

Agreeableness:

Compassionate, empathic, and cooperative; not antagonistic and unfriendlySlide9

TransitionSlide10

SeparationSlide11

How will it go?

Depends on many factors

…

The medical model often falls short as we attempt to understand problems with the transition to college

Symptoms

Barriers

Disorder or condition

Diagnosis

How do we better understand the symptoms? Slide12

Myth of “Chemical Imbalance”

Much research exists on the role of neural activators and chemical transmitters to understand the neurochemical basis of mental disorders.

Overgeneralization of the implications of the medical model have lead to the oversimplification of mental illness as a chemical imbalance, in spite of a lack of descriptors for the pathogenesis of mental disorders (at the molecular level).

Recent research on the medical model approach shows the risk of apoptis (death of neurons) with antidepressant (and many other) medications.

Epigenetic studies have determined the important role of neuroplasticity and the brains dependence on the environment for healing. Slide13

Neural plasticity

The changing of the structure, function, and organization of neurons in response to new experiences.

Strengthening or weakening nerve connections or adding new nerve cells.

Brain has great capacity to rewire itself!Slide14

Resilience

The creation of new neural pathways in the face of challenges is the biological evidence of resilience

Finding alternatives, problem solving, creating solutions, and overcoming obstacles require new thoughts and behaviors

Changing thoughts and behaviors lead to changing emotional states

This is also the central theory behind Cognitive Behavioral Therapy

Supportive relationships often act as catalysts for resilience Slide15

Interpersonal Neurobiology

The study of the ways our internal experience connects us with the internal experience of others

Combines neurobiology with the social sciences to find answers and strategies that improve our health and functioning

Dr. Dan Siegel

Harvard graduate

UCLA School of MedicineSlide16
Slide17

Evolution

“We will now discuss in a little more detail the Struggle for Existence”

Theory of Natural Selection:

“More individuals are produced each

generation than can survive. Phenotypic

variation exists among individuals and the

variation is heritable. Those individuals

with traits better suited to the environment

will survive.”Slide18

McClean’s

Triune Brain

Reptilian

: basal ganglia,

mid-brain, brainstem-

Eat, Sleep & Reproduce.

2.

Paleomammalian

: limbic

system (hippocampus,

hypothalamus, amygdala)

Motivation, emotion, social behavior.

3.

Neomammalian:

Neocortex

-

Higher knowledge from sight, sound and touch.Slide19

Your Brain Has a Mind of Its Own!

Much of what happens in the brain happens beyond conscious awareness and the brain is built for multi-tasking

Memory is the method of information storage and creates context for conscious focus

Implicit vs. Explicit Memory

Implicit Memory

- Made beyond conscious awareness; can’t be verbalized

Explicit Memory-

We are aware of and can be verbalized.

Facilitates new learning

Vital to psychotherapy

Engages working memory

Can be pathway to changes in Implicit system (DiSalvo)

Neuroscientist Simon LeVay:

“The mind is just the brain doing its job.” Slide20

Neuropsychotherapy

Dr. Klaus

Grawe

(1942-2005)

Integrated neurobiology with clinical psychology and psychotherapySlide21

Consistency Theory

We are innately driven to get four basic needs met to maintain a sense of mental well-being or consistency:

We are wired to crave a sense of…

Orientation, Control, Coherence

- Safety, certainty & predictability in our environments

Attachment

-

Belonging & community

Pleasure/Avoid Pain

-

Enjoyment; Away from distress

Self-Esteem Enhancement

-

Mastery & self-worth

(

Grawe

) Slide22

Consistency Theory

Behavior is directed by motivational schemas developed to satisfy those needs through

…

Approach Behaviors

- that originate from cortical or Top-Down processes

Often evidence of stability and healthy attachment

Avoidance Behaviors

- that originate from limbic or Bottom-Up processes

Can be evidence of instability and insecure attachmentSlide23

Top-Down vs. Bottom-Up Processing

Bottom-Up Processing:

Driven by the emotionality of the limbic system and the “fight or flight” response of the HPA axis, actions are taken without including the brain’s executive functions.

Top-Down:

Mindful awareness of the present moment and use of the higher executive functions as information flows from sensation to processing.

Reacting vs. Responding

Indicates: Insecure vs. Secure AttachmentSlide24

Evolution and Attachment

Human infants have years of total dependency during which their brains grow, adapt, and are shaped by experience.

Children survive based on the abilities of their caretakers to meet their needs and keep them safe.

“Those that are nurtured best, survive best.” (Cozolino, 2006)

Children that are poorly attached, traumatized, abused and neglected are more likely to experience substance use, mental health, and medical problems.

What doesn’t kill us makes us weaker!Slide25

Need FulfillmentSlide26

Orientation and Control

Grawe

credited Seymour Epstein (1990) as citing orientation and control as fundamental human needs

We want our perceptions of the world to align with our goals and satisfy our needs

We experience a strong sense of control when we have many options available to us

Trauma is the experience of a total loss of control

Loss of control = stress and distress

Poverty is often experienced as a loss of control Slide27

Attachment

Social Synapse: Dr. Louis

Cozolino

https://www.youtube.com/watch?v=MYokFn1nw4Q

“…the brain is structured with an innate capacity to transcend the boundaries of…its own body in integrating itself with…the world of other brains.” –Daniel Siegel

Our reliance on others is one of our most basic and powerful neurobiological and psychological needs

Our early experiences and relationships shape our approach or avoidance schemas for our lifetime

Our attachment styles cause us to react or respond in particular ways Slide28

Pleasure/Avoidance of Pain

We are motivated to attain pleasant experiences and to avoid painful ones

We all define what constitutes ‘good’ and ‘bad’ experiences for ourselves

We are in a maximum state of consistency when our “current perceptions and goals are completely congruent with one another, and the transpiring mental activity is not disturbed by any competing intentions.” (

Grawe

, 2007)

We pre-consciously align our perception of experience with our intentions; the “Great Confabulator” (

Cozolino

, 2008) Slide29

Self-Esteem Enhancement

This need develops on the foundation of our sense of self; further along the developmental timeline

From a neurological point of view, this need reflects the complexity of functions

Similar to Maslow’s highest need, hierarchically

What about those who maintain a low sense of self-esteem?

Self-esteem can be jeopardized to

get other needs metSlide30

History of attachment Studies

Harlow’s monkey studies: baby monkeys would rather be comforted than fed

https://www.youtube.com/watch?v=_O60TYAIgC4Slide31

Ainsworth: “Strange situation”

Mary Ainsworth and the “Strange Situation” studies

https://www.youtube.com/watch?v=gIjyEHaD6B

Mother and 12-18 month old toddler in a room with 2 chairs

8 standardized periods lasting 1-3 minutes, child interacts with mother & stranger

For 2 periods, mother leaves

In one, child is with stranger

In one, child is alone

Researchers gauge how child responds to reunions

3 classifications of attachment resulted

Secure Attachment (55-60%)- Use mother as a secure base to explore environment

Insecure Attachment (20%)- Don’t engage with mother when she returns and may even avoid her

Disorganized/Disoriented (15%)- Seemed to lack any coherent strategy to deal with stressSlide32

Attachment Research (cont’d)

Romanian orphanages and the Bucharest Early Intervention Project (BEIP)

2000-2005

Divided 136 babies (age 6-31 months) into 2 randomized groups

Stayed in institutional care

Assigned to foster care (average age 21 months)

Included comparison group of children living with biological parents

Compared cognitive development in 3 groups- Clear Results:

Institutionalized group scored significantly worse than the other 2 groups on IQ, sensorimotor abilities, and language development

The institutionalized group scored in range of borderline developmentally challenged

The foster care group caught up with control group by 3.5 y/o

Developmental Psychologist John Bowlby notes central component of attachment as child’s development of “internal working models” based on what they can predict from mother’s behavior.

Healthy attachment creates an internal and portable sense of security which has lifelong importance. Slide33

Key Developmental Periods

Primary Emotions can be seen in the first month of life: Joy, distress, disgust, fear, and sadness

Secondary Emotions evidenced within the first 3 years of life: embarrassment, envy, and empathy (Feinberg, 2009)

The adolescent brain (12-18y/o) undergoes disorganization and reorganization, losing overall gray matter (neurons) and increasing white matter (myelinated fibers) connecting neural networks

Brainstorm: The Power and the Purpose of the Teenage Brain

http://www.youtube.com/watch?v=kH-BO1rJXbQSlide34

Stress and distress: Attachment is essential

Inconsistent, unempathic, or overly enmeshed parenting can lead to…

Separation stress from poor attachment releases stress hormones as well as oxytocin & opiates to help with coping (addiction?)

Separation/isolation leads to clear neurological impairments & stronger despair reactions when triggered in the future

Positive attachment is associated with the inhibition of aggression

More distress leads to increased symptomatology

(Grawe)

Trauma=Avoidance Attachment=Trust

Slide35

Attachment TypesSlide36

Secure Attachment

“

…

possess a representational model of attachment figure(s) as being available, responsive, and helpful” (

Bowlby

, 1980)

Trust is relatively easy and confortable with dependency

Gives us a portable, internal sense of security that we carry with us for a lifetime; don’t fear abandonment or intimacy

It leaves us more able to manage stress and less vulnerable to trauma

Approach behaviors and a feeling of personal efficacy are the norm

Important to note that attachments are essential throughout life

Secure Personality Style:

Have a positive view of themselves and others Slide37

Insecure/Avoidant attachment

Independent of the attachment figure both physically and emotionally

Uncomfortable being close to others

Difficulty with trust and depending on others

Others want more emotional intimacy than they are comfortable providing

Self-contained and self-protective

Dismissive Personality Style:

Cerebral; emotions are unimportant; respond to stress by distancing themselves from othersSlide38

Ambivalent/Anxious attachment

Inconsistent parenting leads to individuals being appropriate and nurturing sometimes, and intrusive and insensitive at other times

Confusing to be in a relationship with; partners don’t know what to expect

Can go from distrustful to needy and desperate

Can scare people away with unpredictability

Preoccupied Personality Style:

Present as self-critical and insecure. Seek approval but can’t trust positive messages; can be emotionally desperate. Slide39

Disorganized/ Disoriented attachment

Abusive and neglectful parenting leads them to distrust the person they depend upon to get their needs met

The individuals they attach to are seen as the cause of their internal distress

This leads to internal disconnections and detachment from their internal experiences and emotions

Fear of abandonment and feeling of not being loved

Emptiness associated with Borderline Personality Disorder

Want more intimacy than others are comfortable with

Prone to extremes of emotion and behavior

Trauma Bonds:

People who have been victimized can be drawn to victimizers. History of both self-harm and harm from others. Slide40

Promoting InsightSlide41

Dr. Dan Seigel’s and the Adult Attachment Interview (AAI)

“Parents’ expectations and patterns of relating are profoundly influenced by their own attachment history.” (Seigel, 2012)

Security does not guarantee anything and insecurity is not synonymous with dysfunction.

Originally developed by Dr. Mary Main in 1982.

The AAI assesses an adult’s “state of mind with respect to attachment” derived from their experiences.

It is a semistructured autobiographical narrative; answers to a series of questions about their childhood.

Main’s Research: In 1978, children’s responses to the Strange Situation test were compared to the parents’ AAI, administered in 1983.

Results: In a field where a 20% correlation is considered significant, the match of the parents’ 1983 AAI security with how securely their babies behaved 5 years earlier was 70%. Subsequent studies in 4 countries have elicited a secure/insecure correlation of 75%. Slide42

Adult Attachment Interview (AAI)

Sample Questions

What was growing up and your relationship with each parent like?

What was the experience of being separated, upset, threatened, or fearful?

Was there an experience of loss and what was the impact on the individual and family?

How did the person’s relationship with her parents change over time?

How have all of these things shaped the development into adulthood of their personality and parenting approach? Slide43

Adult Attachment Interview Scoring

Each parent is scored on perceived ratings of being loving, rejecting, involving/role-reversing, neglecting when present, and pressuring to achieve.

Most critical- the process and the subject’s ways of presenting and evaluating their history.

The AAI rater also examines the transcript for the pattern of communication between the interviewer and the speaker.

How we talk to people reflects our internal “state of mind with respect to attachment.”

Domains include: overall coherence of transcript, idealization of parent, insistence on lack of recall, level of anger, vagueness, fear of loss, dismissing derogation, metacognitive monitoring, and overall coherence of mind.

Goal: Utilize parental insight and empathy to target behavioral change that promotes positive attachment in quantifiable ways

.Slide44

Attachment Explains Future Relaitonships

https://www.youtube.com/watch?v=VNOgXv7zTLA

Aaron Gilbert of Boston Evening TherapySlide45

TraumaSlide46

Adverse Childhood Experiences (ACE) Study

Anda & Felitti, et al: Strong positive correlation between health risk behavior & disease in adulthood to exposure to childhood emotional, physical, or sexual abuse, & household dysfunction

Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4-to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, >50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity.

The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.

(American Journal of Preventative Medicine, Vol 14, #4)Slide47

Adverse Experiences

Emotional abuse; insults & threats

Physical abuse

Sexual abuse

Emotional neglect

Basic neglect

Substance abuse

Divorce

Witness Domestic Violence

Mental Illness

PrisonSlide48

The Effect trauma on the brain

Danger- coping skills are overwhelmed and we experience a complete loss of control

Pre-conscious mind triggers the body to continue to react as if this past trauma is still occurring

Loss of integration of neural networks controlling cognition, sensation, affect, and behavior

Leads to confusion, poor memory, impaired learning, mood swings, and impulsive behavior

“Fight or flight” response and the ‘worried brain’ is on alert

Trauma = Avoidance

Essential needs remain unmetSlide49

Damage caused by distress

When stress reactions are terminated by cognitive, emotional, or behavioral reactions, neural circuits are facilitated leading to a sense of security/mastery/ consistency/control

If stress exceeds ability to cope; glucocortoid release increases, arousal rises, harms hippocampus, can erase previously learned adaptive behaviors, & destabilizes mental functioning

Uncontrolled threats lead from anxiety to depression & repeated violations of need lead to mood disorders

Overloading the stress cycle over time has very lasting and damaging effects on the brain

(Grawe)

Physical disorders associated with stress: diabetes, heart disease, arthritis, fibromyalgia, multiple sclerosis, chronic obstructive pulmonary disease

Slide50

Trauma-informed Therapy

“What happened to you?” and not “What’s wrong with you?”

Safe, caring, warm, nonjudgmental environment

Respectfully allowing the client to lead the process

Provide

psychoeducation

about the effects of trauma

Person-centered and solution-focused approaches increase client’s sense of control

Shift from “victim” to “survivor”

Emphasize that trauma that happened

then

is not happening

now

and is not likely to happen in the

future

Teach mindfulness and distress tolerance to increase top-down processing

Recognize the mind-body connection and promote wellness through healthy sleep, nutrition, and exercise Slide51

Quick Review

Person-centered; “normalizing” approach

Assessing for trauma,

Exploring unmet needs (safety/predictability, attachment, pleasure/distress, and self-esteem)

Understanding client’s basic attachment type,

…

In the context of the “Family/Social History” part of the assessment, including their status as a student

As part of our treatment planning process,

To promote insight and explore alternative thoughts, behaviors, and emotions. Slide52

Therapist’s role

Dr. Dan Siegel: “On Recreating Our Past in our Present”

https://www.youtube.com/watch?v=HzI5vLBrX8ASlide53

Sequencing interventions

Address Distress First

For clients that are coping with trauma…

Down-regulate distress through mindfulness, progressive relaxation, systematic desensitization, deep breathing, meditation, yoga, etc.

Then…

Provide

psychoeducation

about the effects of trauma on the brain

When the client and tolerate emotions related to the trauma, CBT and other cognitive approaches can be effectiveSlide54

Client Example

Client:

Amanda, 22y/o bisexual, Caucasian woman presents as casually dressed in loose jeans and a hooded jumper at times appeared unkempt in her grooming.

Problem:

psychomotor agitation, restlessness, hyper- vigilance, low energy levels, intense eye contact, and flat/depressed affect. Pre-occupied with being criticized or rejected by others and fears having a physical illness in spite of medical reports to the contrary.

Diagnostic Impression

: depression, generalized anxiety, avoidant behaviors, and somatic symptoms. Slide55

Client example

History:

Client reports invalidating, distant, and emotionally abusive relationship with her mother and sister who she describes as “exactly like” her mother. Parents divorced when Amanda was 12y/o related to mother’s affair and this devastated Amanda’s passive-aggressive father who was custodial parent

Coping Technique:

“ I learned to put parts of myself away and to focus on being as perfect as possible.” Avoidance of most social situations and a high level of dependency in her current relationship. Her current significant other told her to “get herself together and learn to trust and relax” because client’s neediness is exhausting.

Slide56

Summary of treatment

Focus on reducing symptoms of anxiety and depression

Identification of concerns related to insecure attachment and fear of abandonment.

Address avoidance and heighten distress tolerance and emotional regulation skills

Distress tolerance skills, mindfulness, systematic desensitization through approach behaviors, CBT focus, and promote wellness (routine, diet, and exercise) Slide57

Response to treatment

Self-harm decreased significantly as therapist developed safety plan and stated clearly priority of keeping client safe

Enhanced insight and recognition of the negative impact of parenting and trauma of divorce

Siegel: “Name it to tame it”

Establishing healthy relationship boundaries; partner included in collateral sessions and relationship issues decreased

Improved sleep habits, nutrition, and exercise routine

Decreased anxiety and depressionSlide58

References

Smoller

, J. (2012)

The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior

, Harper Collins

Cozolino

, L.J. (2006)

The Neuroscience of Human Relationships: Attachment and the Developing Social Brain.

New York, NY: W. W. Norton & Company, Inc.

Siegel, D.J., (2012)

The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are.

New York, NY: The Guilford Press

Feinberg, T.E. (2009)

From Axons to Identity: Neurological Explorations of the Nature of the Self.

New York, NY: W. W. Norton & Company, Inc.

Grawe, K. (2007)

Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy

. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Brandt, K., Perry, B.D., Seligman, S., and Tronick, E. (2014)

Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice. Washington, D.C.:

American Psychiatric Publishing.

Ogden, P., Minton, K., and Pain, C. (2006)

Trauma and the Body: A Sensorimotor Approach to Psychotherapy.

New York, NY: W. W. Norton & Company, Inc.