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Affect Regulation Therapy (ART)for the treatment of cognitive and
health disorders
Mitchell R. Slutzky, Ph.D.CHE Senior Services
March 27, 2011Alzheimer’s Disease International,
Toronto
Conflict of Interest Disclosure Mitchell Slutzky, Ph.D.
Has no real or apparent conflicts of interest to report.
Key Concepts
Affect Regulation Therapy (ART) can improve cognitive functioning and physical health of persons with dementia
Catastrophic affect upsets the balance of the immune system and creates or exacerbates memory disturbances
Positive emotions benefit cognitive, emotional and physical health by reregulating the immune system
Many people with dementia can improve positive emotions with practice, even if cognitive memory is impaired (as long as emotional circuitry is better preserved)
What is Affect Regulation Therapy? Built upon work of Allan Schore Empathy and secure attachment reduces catastrophic affect
extremes Hyperactivation: Fight-Flight Hypoactivation: Dissociation
Teaches one to recognize extreme affect states Re-evocation of traumatic event recalled in context of safety
leads to a more positively-valenced affective response Positive affect state strengthened with each reinforcement in
context of safety Improves brain neuroplasticity Improves endocrine and immune system Has direct application to improve functioning
Even with cognitive impairment or health disorders
Allan Schore: Affect Regulation Theory
Early social environment, mediated by primary caregiver, influences developing brain structures
Maturation of the right orbitofrontal cortex is dependent upon dyadic interactions of the attachment relationship
Predicts the child’s future capacity to:self-regulate emotionsappraise others’
emotional states
Polyvagal Theory: Evolution of Three Survival Strategies (Stephen Porges)
Dorsal Vagus Nerve/Primitive Parasympathetic NS In response to threat perceived as life threateningPrimitive, not myelinated
Role: Shuts down to conserve metabolic functions Sympathetic Nervous System
In response to perceived danger (escape possible)Role: Activates fight-flight
Ventral Vagus Nerve/Evolved Parasympathetic NSArises only in the context of secure attachment SafetyOnly in mammalsMyelinatedRole: can calm in face of danger by inhibiting fight-flightAllows for attachments, well-being, balanced health
Safety: Balanced well-being Stilling and Stimulating both in balance
Occurs only when feeling safemaximizes brain health and function
memory and other cognitive functionsmaintains capacity for positive emotionsmaximizes capacity for
compassionsocial connectionindividuality
improves immune system functioningregulates appetite and sleep
Whole is greater than sum of the parts
How ART reduces cognitive impairment Cognitive and emotional
systems develop parallel to each other
Emotional memory remains relatively preserved in the amygdala after cognitive memory fades with damage to the hippocampus
Build up amygdala’s emotional memory systems when hippocampal cognitive memory erodes
Key Memory Areas Lay Under the Neocortex In the Limbic System
Two ways emotional trauma leads to dementia Step 1: Response to perceived danger is Fight Flight
Amygdala initially becomes hyper-activated Plaques and tangles accelerate Too much cortisol erodes the hippocampus Hippocampal deterioration accelerates memory loss
Step 2: If perceived as life threatening leads to Dissociation Amygdala becomes underactive Metabolic preservation of hippocampus β-endorphin numbs and enhances reality distortions Functional deficit: memory loss but hippocampus is preservedEither way:
When faced with cues that re-evoke earlier trauma, the original affect state is triggered accelerating injury
Amygdala continues to record memories and the emotional significance of related events
Explicit Memory deteriorates but Implicit Memory remains intact longer
Cycles of dysregulated affectHyper-activation to dangerFight-Flight Reflex: Anger/fear(Over-stimulating sympathetic NS)Cortisol dysregulation
Hypo-activation when life threateningDissociation/withdrawal/detachment(Over-stilling Dorsal Vagus Nerve)Beta-endorphin dysregulation
Normal emotionalrange
Slutzky’s theory, 2010adapted from Fosha and Schore, 2009
Safe/ConnectedVentral Vagus nerve Right frontal orbital lobe both optimizedRegulated alpha-msh
Acute Hyper-activationIn Response to Stress
Increased Sympathetic NS (Fight/Flight)Hyper-recording of memory
“light bulb burning too bright”Increased cortisol secretion and burnDecreased inflammationSuppressed immune response
Do not appear sick even if have a germGet sicker when immune system finally kicks in
Chronic Hyper-activationChronic high cortisol levels:
Damages hippocampus memory (Alzheimer's and other dementias)
Underactive immune systemIncreased risk of cancer or immunodeficiency
or:Depleted supply of cortisol from chronic
hyperactivtionIncreased inflammatory responseImmune system overactive Increased risk of autoimmune disorders
Osteoarthritis Crohn’s DiseaseMultiple Sclerosis Parkinson’s Disease
Acute Hypo-activationIn Response to Stress
Fewer memory frames per second“light bulb not burning bright enough”
Increased Parasympathetic NS decreasesHeart rateRespiration/O2 requirementsBlood pressure
Other Effects:Increased Endorphins/EnkaphalinsDecreased sensation of pain
Chronic Hypo-activation
Chronic flooding of beta-endorphin:Dissociative disorders
DID, somatoform disorders, emotional numbing, fuguesOr:
Depleted supply of endorphins while hypoactivated:DepressionChronic painSubstance abuseSocial isolation
Memory impairment either way
Neuroplasticity through A.R.T.
Positive stimulation through A.R.T. improves
ThinkingLearningActing Changes Brain:Physical StructureFunctional OrganizationFrom Top to BottomNeuroplasticity continues to occur at any age
Dr. Michael Merzenich
Major Researcher in Neuroplasticity
All you need is LOVE
Look empathically: contain fight-flight & prevent dissociation (Auxiliary Amygdala)
Organize emotional and cognitive memory (Auxiliary Hippocampus)
Validate feelings to re-integrate affective and cognitive memory and to enhance reasoning (Auxiliary Right Prefrontal Cortex)
Evaluate effectiveness of intervention
(R)epeat (modify if necessary) to reduce catastrophic affect, consolidate memory and establish a polysemantic context that enhances encoding and retreival
© Mitchell Slutzky, 2011
Affect Regulation and Brain Exercises
Progressively challengingUse the Goldilocks
principle: “just right”Strengthen:
AttentionSpeed of processingRecent memoryPlanning skills
Affect Regulation through Aromatherapy: essential oils
Lavender: StillingCalms anxiety, fear or anger
Sandalwood: ConnectingMaintains positive emotions
Ylang-Ylang: StimulatingBrightens mood Increases energy
Myrrh: MotivatingReduces apathy
Aromatherapy appears to trigger changes in neurochemistry especially in the emotional brain
Never use full strength: Put a few drops in a “carrier oil”
or buy it in dilution “ready to use”
Conclusions:Affect Regulation Therapy reduces intensity of
negative emotionsNegative emotions harm all aspects of lifePositive emotions heal the whole person:
CognitivelyEmotionallyPhysically
Positive emotions can be cultivated through a balance of stilling and stimulating
Even in persons with dementia
All you need is LOVE
Look empathically: contain fight-flight & prevent dissociation (Auxiliary Amygdala)
Organize emotional and cognitive memory (Auxiliary Hippocampus)
Validate feelings to re-integrate affective and cognitive memory and to enhance reasoning (Auxiliary Right Prefrontal Cortex)
Evaluate effectiveness of intervention
(R)epeat (modify if necessary) to reduce catastrophic affect, consolidate memory and establish a polysemantic context that enhances encoding and retreival
© Mitchell Slutzky, 2011
