Mistrust  to  Trust:    Helping  Defensive  Children  Learn  to    Trust

A  Brain-­‐based  Model  of  Attachment-­‐focused  Treatment

Jonathan  Baylin,  PhDCoauthor  with  Daniel  Hughes    of  Brain  Based  Parenting  (2012)and  forthcoming  The  Neurobiology  ofAttachment-­‐focused  Therapy  (Norton)

ATTACh Conference  2015  

SCIENCE-­‐PRACTICE  DIALOGUE:  THE  PATHWAY  TO  BETTER  TREATMENT

Brain-­‐Based  Integration:  The  Wheel  Model  of  Interpersonal  and  Intrapersonal  Processes

PACING  THE  CHILD’S  JOURNEYFROM  MISTRUST  TO  TRUST

SENSORIMOTORWORK

NEURO-­‐FEEDBACK

YOGA

MINDFULNESSPRACTICES

ENERGYTX:  TAPPING

OXYTOCIN“PRIMING”?

EMDR:  bilateralstimulation

MASSAGETX

TRAUMAPROCESSING:FEAREXTINCTION,RECONSOLIDATION

REAPPRAISALNARRATIVEWORK  ANDSTORY  TELLING

J  Baylin2014

TOPDOWN

BOTTOMUP

DDP

VAGALSTIM.

SAFEANIMALS

PLAY OPIOIDERGICMEDS.

BRAINS  IN  CONTEXT:    EXPERIENCE-­‐DEPENDENT  DEVELOPMENT

4

safe unsafe

SAFE  TO  BE  SEEN,HEARD,  “KNOWN”

NOT  SAFE  TO  DEPEND  ONCAREGIVERS

EXPRESS  GENES  FOR  BUILDINGTHE  SOCIAL  ENGAGEMENTSYSTEM

EXPRESS  GENES  FOR  BUILDINGTHE  SELF  DEFENSE  SYSTEM

“EXPERIENCE-­‐DEPENDENT”BRAIN  DEVELOPMENTAND  “EPIGENETICS”

TWO  BASIC  MODES  OF  SOCIAL:  BONDED  RELTAIONSHIPS  AND  HIERARCHICAL  RELATIONSHIPS(ATTACHMENT  VS  SOCIAL  RANK)

TWO  RELATIONAL  SYSTEMS:  CONNECTION  AND  SELF  DEFENSE

BONDED RELATIONSHIPS:OXYTOCIN, OPIOIDS, PROLACTIN,AND DOPAMINE

CONFLICT-BASED RELATIONSHIPS:STRESS HORMONES, CCK, NOREPINEPHRINE, “T”

GETTING CLOSE: SOCIALENGAGEMENT SYSTEM

KEEPING YOUR DISTANCE: SOCIAL AVOIDANCE/DEFENSESYSTEM

POOR TENDINGPROMOTES PREMATUREDEFENDING

GOOD TENDING PROMOTESDEVELOPMENT OF THE SOCIALENGAGEMENT SYSTEM

MIRROR  CELLS:  THE  NEUROBIOLOGY  OF  MIMICRY,  “MODELING”,  AND  EMPATHY……      A  ROLE  IN  

TRAUMATIZATION?

DO THERAPISTS NEED GOOD MIRRORCELLS?

ARE MIRROR CELLSINVOLVED ININTERPERSONALTRAUMATIZATION?

A MECHANISMFOR TRANSMITTINGSTRESSFUL STATESFROM PERSON-TO-PERSON

AUTISTIC PEOPLE HAVE UNDERACTIVEPEOPLE-MIRRORING CELLS

Parenting  Effects  on  the  Child’s  Neuroceptive System

8

IN

OUT

SAFE:    SOCIALENGAGEMENT

FREEZE:  WHAT’S  GOING  ON  HERE?      DO  I  APPROACH  OR  AVOID?

AMYGDALA

UNSAFE:Who’s  that  guy  and  where’s  myMother?J  baylin

SYMPATHETICLOWER  VAGALSYSTEM

Sensitive,  Attuned,  Contingent  Caregiving

OXYTOCINGOOD  PARENTINGHELPS  THE  CHILDREGULATE  STATES:ATTACHMENT  FIGUREAS  A  “CO-­REGULATOR”OF  INTERNAL  STATES

HIGHER  (SMART)  VAGALSYSTEM

STATE-­‐DEPENDENT  FUNCTIONING  AND  INTERSTATE  TRAVEL

vEMOTION

vBEHAVIOR

v COGNITION

vEMOTION

vBEHAVIOR

v COGNITION

vEMOTION

vBEHAVIOR

v COGNITION

INTERSTATE  TRAVEL:  COREGULATION  OF  STATES

ExecutiveSystem

ApproachSystem

RewardSystem

People-­readingSystem  (Mindsight  plusEmpathy)

Meaning-­ MakingSystem  (“coherent”Story  about  self/Others/  relationships)

SELF-­DEFENSESYSTEM

“on”

“on”

“on”

“on”

“off”

THE  SOCIAL  BRAIN

amygdala

“safe”10

SOCIAL  BUFFERING  “…the  mother  acts  as  a  switch  for  amygdala-­‐mediated  fear  learning…”

“…the  mother  acts  as  a  switch  for  amygdala-­‐mediated  fear  learning,  and  can  move  around  the  timing  of  amygdala-­‐sensitive  periods  that  can  include  accelerated  transitions  into  the  mature  state.    Exposure  to  the  mother….at  older  ages  maintains  the  immature  state  of  the  amygdala,  whereas  early  maternal  absence  will  result  in  an  accelerated  development  of  the  amygdala  and  a  resultant  premature  adult-­‐like  phenotype”      Nim Tottenham,  2013,  p  8

Good  care  buffers  the  young  child’s    amygdala  by  triggering  releaseof  oxytocin  and  keeping  the  amygdala  from  activating  the  fear/stress/defense    systems

Deep,  visceral  safety    “It’s OK, Mom.You can eat me”

Playfulness,  Acceptance,  Curiosity,  Empathy

TRUST  BUILDING:CONSTRUCTINGSAFE  SHARINGOF  PERSONALSPACE:  “WESPACE”

OPTOGENETICS:  WATCHING  AND  CONTROLLING  THE  AMYGDALA  BRAIN  SWITCH  IN  REAL  TIME

DUAL  OPIOID  SYSTEMS:  COMFORT  AND  JOY  OF  GOOD  CONNECTIONS

JOY:  PLEASURE  FROM  PLAYFUL  COMPANIONSHIP

TOP  DOWN  INHIBITION  OF  THESTRESS/DEFENSE  SYSTEM

COMFORT:    CARING  RESPONSE  TODISTRESS  TRIGGERS  OPIOID  RELEASEIN  THE  AMYGDALA  AND  TURNS  OFFTHE  PAIN/DISTRESS  REACTION

Loseth,  G.,  Ellingsen,  D.,  &  Leknes,  S.(2014)  State-­‐dependent  mu-­‐opioidModulation  of  social  motivation.Front  Behav Neurosic,  8,  430.Doi:  10.3389/fnbeh.2014.00430

PAG

THINKING  ABOUT  COMFORT  AND  JOY

POOR  TENDING  ACTIVATES  PREMATURE  DEFENDING

AND……… THIS DEFENDING CAN BECOMEA CHRONIC PROCESS = BLOCKEDTRUST DEFENSE  SYSTEM/  SOCIAL  ENGAGEMENT

(POLYVAGAL  MODEL)                                

social  pain:  no  buffering  

Dorsal ACC and the Insula: the Suffering Circuit

Take a Tylenol andDon’t call me in the morning

Acetaminophen“squelchesBoth theseNeuralResponsesTo Ostracism”

Jaak Panksepp Lieberman  and  Eisenberg              Jim  Coan

BLOCKED  TRUST:  WHEN  KIDS  HAVE  TO  PLAY  DEFENSE  BY  SUPPRESSING  THE  JOY  AND  THE  PAIN  OF  CONNECTION

SELF  DEFENSE

SUPPRESSES  GROWTH  OF  THEHIGHER  BRAIN  REGIONS

HEALING  PROCESS:  HELPING  CHILDRENRECOVER  THE  ABILITY  TO  FEELTHE  JOY  AND  THE  PAIN  OF  CONNECTION

17

Attachment  and  the  Separation  Distress  System:  When  There  is  No  Social  Bufferer……….  

“When  we  begin  to  understand  the  nature  of  the    separation  distress  system  at  the  neurobiological  level,  we  may  learn  how  to  disentangle  the  damage  wrought  by  emotional  misfortunes”        Jaak Panksepp,  2001)

The  Separation  CallAnd  Maternal  ResponseSystem:    The  AnteriorCingulate  Cortex  (ACC)

REACTIVATING  THESEPARATION  DISTRESSSYSTEM  IS  CRUCIAL  FORHELPING  DEFENSIVECHILDREN  LEARN  TO  TRUST

I  feel  like  I’mAbout  to  cry

18

SOCIAL  PAIN  AND  THEOPIOID  SYSTEM:  RELATIONAL  PAINMANAGEMENT

Experience-­‐dependent  Gene  Expression  and  Brain  Construction

GOOD  CARE  AND  POOR  CAREHAVE  DIFFERENT  EFFECTS  ONGENE  EXPRESSION  IN  VARIOUSBRAIN  REGIONS

Ø AMYGDALAØ HIPPOCAMPUSØ PFC

jbaylin

BEHAVIORALEPIGENETICS

RELATIONAL  SAFETY  AND  TRUST:  THE  ROLE  OF  OXYTOCIN  and  the  Amygdala

OTOTOTOT

OT

CRH

CRH

CRH

CRH

AMYGDALA

GOOD                                              POORCARE                                                    CARE

SAFE:APPROACH,TRUST,ENGAGE

SOCIAL  ENGAGEMENTSELF  DEFENSE

OT  =  OXYTOCINCRH  =    STRESS

HORMONE(corticotropinreleasing  hormone)

Epigenetics:Good  CarePromotes  GeneExpression  forOT  receptors,  Poor  Care,  forCRH  receptors

BLOCKED  CARE:  SUPPRESSING  THE  PAIN  OF  FEELING  REJECTED  BY  A  CHILD  WITH  BLOCKED  TRUST

21

Social Apathy:DiminishedCaring, MaternalNeglect of“Offspring”

ACC DEACTIVATION MUST BEINVOLVED IN BLOCKED CARE

HOW CAN YOU “TURN OFF” THE ACC? RELEASE OPIOIDS INTO THIS REGION,THE BRAINS NATURAL PAIN SUPPRESSING SYSTEM (VERY RICH IN MU RECEPTORS)

DNIS:  DESCENDINGNOCIFENSIVE  INHIBITORY  SYSTEM(SEE  VOGT,  2008)

22

HIPPOCAMPUS

AMYGDALA

CINGULATE

REFLECT

REVISE

REVERSE

REGULATE

FIGHT/FLIGHT/FREEZE

PFC

A

C

C

22

SOCIAL  BUFFERING:SAFETY  MESSAGESTO  THE  AMYGDALA:FACE,  VOICE,  TOUCH

OXYTOCIN:  SAFE  ENOUGH

Very  Rapid  Ways  to  Reach  theAmygdala  and  Change  Its  FiringPatterns:    Neurofeedback,  Brainspotting,  Bilateral  stimulation,  Tapping,  Music

INTERSTATE  TRAVEL:  USING  YOUR  BRAIN  STATE  TO  PROMOTESTATE  SHIFTING  IN  THE  OTHER  PERSON  

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ADULT’S  BRAIN:  PARENT,  THERAPIST,PARTNER  IN  “SMART  VAGAL”  STATEOF  OPENNESS,  ENGAGEMENT,  MINDSIGHT

DEFENSE  “OFF”,APPROACH  “ON”

PACE

STATE-­‐DEPENDENT  FUNCTIONING  AND  INTERSTATE  TRAVEL

vEMOTION

vBEHAVIOR

v COGNITION

vEMOTION

vBEHAVIOR

v COGNITION

vEMOTION

vBEHAVIOR

v COGNITION

INTERSTATE  TRAVEL:  COREGULATION  OF  STATES

MUTUAL  DEFENSE  SOCIETY

BLOCKED  TRUST      +    BLOCKED  CARE

AAMUTUAL  DEFENSE

Adult’s  Compassionate  State  of  Mind  Can  Promote  a  Calming  Effect  on  the  Child’s  Brain,  targeting  the

child’s  hypersensitive  amygdala

Adult’s  compassionate  state  of  mind  towards  the  child  enablesThe  adult  to  send  calming  nonverbal  messages  to  the  child’sAmygdala,  facilitating  the  switching  process  in  the  child’s  brainFrom  defensiveness  to  engagement

PACE:  PLAYFULNESS,  ACCEPTANCE,  CURIOSITY,EMPATHY                        DANIEL  HUGHES,  PHD

SOCIAL  BUFFERING:SENDING  SAFETYMESSAGES  INTOTHE  BRAIN  OF  THEMISTRUSTING  PERSON

v FACE  (KIND  EYES)

v VOICE  (PROSODY)

v SOOTHING  TOUCH

Where’s  your  kid  in  your  parenting  brain?

Defensive  brain  

Loving  kindness  brain

Embracing  the  HULK:Compassion  for  the  sulky,Moody  teen

mPFC

COUPLED  BRAINS:  THERAPIST  AND  CLIENT

mPFC

SOCIAL  BUFFERING  OF  THE  CLIENT’S  LIMBIC  SYSTEMENABLES  CLIENT  TO  ACCESS  mPFC region  for  “Affective/Reflective”  Dialogue  and  Reappraisal  of  Old  Beliefs

amy

THERAPIST                                                                                                              CLIENT/  CAREGIVER

amy

REPROCESS,  REAPPRAISE,  REVISE:  NEW  MEANING

THE  TWO  STEP:    COREGULATE  AFFECT,  CO-­‐CONSTRUCT  NEW  MEANING

Shifting  From  Mistrust  to  Trust:  THE  ELEMENT  OF  SURPRISE

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CHILD’s Brain On MistrustAnd Defense-based Living

CHILD’s Brain On TrustAnd Connection

v PLAYFULNESSv ACCEPTANCEv CURIOSITYv EMPATHY

PACE

SURPRISING THE MISTRUSTINGBRAIN BY VIOLATINGEXPECTATIONS ABOUTCAREGIVER’S REACTIONS

PACE AS A FORMULA FOR THERAPEUTIC CONFUSION:DISCOMBOBULATING THE CHILD’S NEGATIVE EXPECTATIONSAND ACTIVATING THE CHILD’S CURIOSITY…… “YOUR WEIRD”

PPEs:  Positive  Prediction  ErrorsVIOLATING  THE  AUTOMATIC,  MINDLESS  EXPECTATIONS/PREDICTIONSOF  BEING  TREATED  HARSHLY

PPEs

dACC or  aMCC:In  the  cingulate  cortex

DOPAMINE  SYSTEM:    A  LEARNING  SYSTEM  THAT  CAN  GENERATE  ERRORSIGNALS  WHEN  EXPERIENCES  “VIOLATE”  EXPECTATIONS

OFC:  REVERSAL  LEARNING

PARENTRESPONDSWITHPACE

PARENTRESPONDSWITHPACE

PACING  THE  KID  AND  CREATING  THE  ESSENTIAL  EXPERIENCE  OF  SURPRISE:    “YOU’RE  WEIRD”              POSITIVE  PREDICTION  ERRORS  (PPEs)

PACE PROMOTING “INTERSTATE”, AFFECTIVE TRAVEL: FROMANGER TO SURPRISE TO CURIOSITY TO SADNESS

PARENTRESPONDSWITHPACE

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REAWAKENING  THE  BLOCKED  POTENTIAL  FOR  THE  KID  TOSAFELY  FEEL  SAD  AND  RECOVER  THE  ABILITY  TO  SEEK  COMFORT

Story  Power:    Combining  Coregulation of  the  Child’sAffect  with  Cocreation of  New  Meaning

A

MPFC

Story  Voice

Story  Content TOP  DOWN

INHIBITION  

A  =  amygdalaMPFC  =    middle  prefrontal  cortex

PAUL  ZAK:  DRAMATIC  STORIES  ON  THE  BRAIN

CORTISOL  PLUSOXYTOCIN  (AND,  IWOULD  BET,  OPIOIDS)

BOTTOM  UP  COREGULATION  OF  AFFECT

STORY  TELLING  VOICE:    WOW,  YOU  WON'T  BELIEVE  THIS  ONE…..

CAPTURINGTHE  LISTENERSAND  HOLDINGTHEM  IN  THESTORY  SPACE

TRUST  BUILDING:  MINDFUL,  COMPASSION-­‐BASED  PARENTING

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Ø CULTIVATE  COMPASSION  FOR  YOUR  MISTRUSTING  CHILDØ MUSTER  WARMTHØ TAKE  DELIGHT  IN  SOME  ASPECT  OF  YOUR  CHILDØ “STAY  IN  THE  GAME”:    IT’S  NOT  A  SPRINT,  IT’S  A  MARATHON  Ø ENDURE  WHAT  FEELS  LIKE  REJECTION  AND  KNOW  IT  FOR    WHAT  IT  IS:  

MISPLACED  MISTRUSTØ IT’S  NOT  TRULY  PERSONAL;    IT’S  GENERALIZED  MISTRUSTØ ENHANCE  YOUR  “APPROACHABILITY”:    WORK  AT  MAKING  YOURSELF  

SAFE  TO  BE  NEARØ PRACTICE  CATCHING  AND  RELEASING  YOUR  OWN  DEFENSIVE  REACTIONSØ STRENGTHEN  YOUR  CAPACITY  FOR  DEEP  RELAXATION  AND  EXHALINGØ IDENTIFY  AND  DESENSITIZE  YOUR  “HOT  BUTTONS”:  TRIGGER  WORKØ MAINTAIN  A  GOOD  SUPPORT  SYSTEMØ REMEMBER  TO  PLAY

Jonathan  Baylin,  PhD      coauthor  with  Daniel  Hughes  ofBrain  Based  Parenting,  Norton,  2012

The  Mindful  Brain:  Reflection  and  

Attunement  in  the  Cultivation  of  Well-­‐

BeingDaniel Siegel

mPFC:10/32

amygdala

AWAKENINGS  AND  STORIES

vHENRYvDIRT  GIRLvTHE  HULKv“S”:  RESILIENCEvTWO  COOKS