SURPRISE! USING THE BRAIN AS A GUIDE TO HEAL BLOCKED TRUST

Transcription

1 Fostering Kids New Zealand Annual Conference September 28-29, 2017 Christchurch, New Zealand Courtney Rennicke, Ph.D. SURPRISE! USING THE BRAIN AS A GUIDE TO HEAL BLOCKED TRUST

2 From Mistrust to Trust: Stages in the Attachment Journey STAGE 1: AUTOMATIC PILOT, MISTRUST. I m bad. You re mean! STAGE 2: GOOD CONFUSION. Whoa this is weird! You understand why I don t trust you and you are not angry about it. STAGE 3: APPROACH/ AVOIDANCE CONFLICT. To trust or not to trust STAGE 4: PRACTICING TRUST OVER MISTRUST. Stroopin STAGE 5: RESOLVING THE CONFLICT. I can trust you and I am a good kid! THERAPEUTIC PARENTING 2 Thanks to Jon Baylin, Ph.D. & Julie Hudson, Ph.D.

3 THEORETICAL BASIS FOR DDP The brain is the why and P.A.C.E. is the how -Jon Baylin, Ph.D. 3

4 EPIGENESIS GOOD CARE turns ON, wakes up and activates the way genes behave in children s brains to support they development of all systems needed to feel safe and engage in social relationships. POOR CARE turns OFF, silences the expression of genes that support connections and social relationships. Instead it activates a system that is primed to be defensive and wary of others. 4 Baylin & Hughes, 2016

5 EPIGENESIS: WHAT GETS WIRED? EMOTIONALLY CHARGED INTERPLAY BETWEEN THE RIGHT BRAIN OF THE PARENT AND THE RIGHT BRAIN OF THE CHILD v FACE v VOICE (PROSODY) v TOUCH 10 INCHES: THE MAGIC SPACE 14 MILLISECONDS IMPLICIT ATTACHMENT MEMORIES INTERPERSONAL NEUROBIOLOGY: BRAIN-TO-BRAIN Thanks to Jon Baylin, Ph.D. 5

6 EPIGENETICS: POOR CARE PROMOTES GENE EXPRESSION FOR STRESS HORMONE RECEPTORS Good Care Promotes SOCIAL ENGAGEMENT SAFE: APPROACH, TRUST, ENGAGE Amygdala Poor Care Promotes SELF DEFENSE = OXYTOCIN = STRESS HORMONE (CRH, corticotropin releasing hormone) 6

7 INSECURE/DISORGANIZED ATTACHMENT: INADEQUATE CARE LACKS BUFFER FOR AMYGDALA Poor care may result in: > Amygdala reactivity Accelerated development of the amygdala Premature adult-like phenotype (e.g. pseudoindependent; Tottenham, 2013) Hypersensitivity of right amygdala to non-verbal social cues (face, voice, gesture, touch) Prefrontal Cortex (PFC) Uncinate Fasciculus (UF) Thanks to Jon Baylin, Ph.D./Dan Hughes, Ph.D. Amygdala 7

8 POOR CARE KEEPS YOU ON HIGH ALERT PRE-FRONTAL CORTEX LIMBIC SYSTEM SEE SAW: When one lights up the other turns down. 8

9 NEUROCEPTION & PORGES POLYVAGAL THEORY (2011) FEELING SAFE THREAT!!! 9

10 NEUROCEPTION aka Threat Detection VAGAL BRAKE Low vagal tone (ACT): no inhibition on the pacemaker to the heart and heart rate increases Without a functioning myelinated vagus, social behavior would be compromised, and more primitive defensive strategies, such as fight-flight mobilization and tantrums (mediated by the sympathetic nervous system) and shutdown behaviors (mediated by the unmyelinated vagal system) would be more frequently expressed. Neglect is kind of like draining your car s brake fluid makes stopping and slowing down/calming down more difficult. From Porges,

11 BLOCKED TRUST: IMPACT ON UF Nurtured child Window of Tolerance For Social Engagement LEFT RIGHT Window of Tolerance for Social Engagement Thanks to Jon Baylin, Ph.D. Neglected child 11 Eluvathingal, T.J. et al. (2006)

12 BLOCKED TRUST: A-SOCIAL vs. ANTI-SOCIAL CHILDREN WITH ATTACHMENT PROBLEMS RELATED TO INSTITUTIONAL EARLY REARING HISTORY: LEFT UNF REDUCED PSYCHOPATHS: RIGHT UNF REDUCED 12 Thanks to Jon Baylin

13 BLOCKED TRUST: A-SOCIAL VS. ANTISOCIAL DISTINCTION Are attachment disordered kids antisocial? This blocked trust thing is a nice therapist thing to say, right? No! Its in the BRAIN Attachment disordered kids are: A-SOCIAL vs. Overactive amygdala ANTISOCIAL Small amygdala Underactive Left UF Small/reduced Right UF Thanks to Jon Baylin 13

14 MUTUAL DEFENSE SOCIETY (MUTUAL MISTRUST SOCIETY) BLOCKED TRUST + BLOCKED CARE I don t trust you!!!! CHRONIC MISTRUST MUTUAL DEFENSE SOCIETY I don t trust you! PAG PAG NO CHANGE: NO SURPRISES, NO VIOLATION OF EXPECTATIONS, NO NEWS OF A DIFFERENCE TO TRIGGER REVERSAL LEARNING, ETC. Thanks to Jon Baylin, PhD. NO POSITIVE PREDICTION ERRORS (PPES) TO GET THE DOPAMINE SYSTEM INTERESTED IN LEARNING NEW THINGS ABOUT RELATIONSHIPS 14

15 THERAPEUTIC PARENTING IN DDP The brain is the why and P.A.C.E. is the how -Jon Baylin, Ph.D. 15

16 P.A.C.E. When in doubt Playful Accepting Curious Empathic PACE IT! 16

17 P.A.C.E.: PLAYFUL PLAYFULNESS Having a light tone - not about being funny. Build sense of camaraderie and reciprocal enjoyment. Activate different part of the brain than is activated when experiencing shame. 17

18 P.A.C.E.: ACCEPTING ACCEPTANCE: While it is easy to accept the behavior of a young child, beyond infancy this changes. As a social species, we evaluate one another s behaviors with regard to whether or not these are in accord with our group s values. (Golding & Hughes, 2012) 18

19 P.A.C.E.: ACCEPTING Challenge: To simply accept the child s thoughts feelings, or wishes with regard to the situation, WITHOUT trying to change them. If I ACCEPT the feeling/behavior then my child will become MORE selfish? aggressive? rude? 19

20 P.A.C.E.: CURIOUS Wondering rather than interpreting. An attitude of not knowing. Make guesses, but happy to reject them. Taking the lead in exploring possible thoughts wishes and feelings. 20

21 P.A.C.E.: EMPATHY 21

22 P.A.C.E.: EMPATHY EMPATHY is the motivates us to relate to others. It is the ability to identify what someone else is thinking and feeling and to respond to their thoughts and feelings with an appropriate emotion (Simon Baron-Cohen, 2011). Connects us Empathy communicates P.A.C. Non-judgmental Feeling WITH vs. for someone CURIOUS EMPATHIC ACCEPTING PLAYFUL 22

23 Thanks to Jon Baylin, Ph.D. THERAPEUTIC PARENTING

24 THERAPEUTIC PARENTING: STROOPIN 24

25 THERAPEUTIC PARENTING: STROOPIN ATTITUDE: PACEFUL! WHATEVER, B. CONNECT/ DON T DEFEND WHATEVER, B COMPASSION ATTACK!!! (200 MSEC) Thanks to Jon Baylin, Ph.D. 25

26 THERAPEUTIC PARENTING: "YOU'RE WEIRD! P.A.C.E. P.A.C.E. P.A.C.E. P.A.C.E. JIGGLES THE KID S ANTERIOR CINGULATE CORTEX (ACC) INTO ACTION AS SHE EXPERIENCES A CONFLICT BETWEEN HOW SHE EXPECTED YOU TO REACT AND HOW YOU ACTUALLY REACTED, RAMPING UP ATTENTION, ENGENDERING A BRAIN STATE OF THERAPEUTIC CONFUSION, AND TRIGGERING PROCESSES OF REVERSAL LEARNING, EXTINCTION, AND SET SHIFTING Thanks to Jon Baylin, Ph.D.

27 THERAPEUTIC PARENTING: SURPRISE! Positive Prediction Error (PPE): When a parent/ caregiver creates surprising moments by using PACE and challenges the child s expectation of being invalidated, neglected, hurt, feared 27

28 THERAPEUTIC PARENTING: SURPRISE! Stay open to the STRUGGLE The battle between being open and engaging in relationships and selfprotection, defensiveness and hypervigilance. Vs. DAVID (Safe, Open, Engaged) GOLIATH (Blocked Trust, Defensiveness) 28

29 THERAPEUTIC PARENTING: STROOPIN From To The End of June (2013) By: Cris Beam: Dominique (17 y/o foster daughter) threw up her hands in disgust and looked at the sky. A gurgling sound escaped her throat, and then she sucked her teeth. Well, I don t argue with people I don t love. Bruce (foster parent) jumped up from the step, a look of glee widening across his face. He bounded down the stairs and out into the street. The other [foster] sisters, who had been gossiping together on the bottom of the step, exchanged embarrassing glances. Bruce was ecstatic. She loves me, she loves me Dominique said she loves me! Bruce was shouting and doing a kind of football touchdown dance in the street. A passing car had to stop and wait for him to finish. It s only been 3 months, and she says she loves me! NO, I DIDN T! Dominique shouted back. I said I only fight with people I love. I didn t say I love you. Same thing! Bruce retorted, skipping around. 29

30 PFC REVISE CINGULATE REFLECT REVERSE A C C AMYGDALA REGULATE SOCIAL BUFFERING: SAFETY MESSAGES TO THE AMYGDALA: FACE, VOICE, TOUCH OXYTOCIN: SAFE ENOUGH HIPPOCAMPUS Very Rapid Ways to Reach the Amygdala and Change Its Firing Patterns: Neurofeedback, Yoga, Brainspotting, Tapping, Music, Dancing PAG Thanks to Jon Baylin, Ph.D. 30

31 From Mistrust to Trust: Stages in the Attachment Journey STAGE 1: AUTOMATIC PILOT, MISTRUST. I m bad. You re mean! STAGE 2: GOOD CONFUSION. Whoa this is weird! You understand why I don t trust you and you are not angry about it. STAGE 3: APPROACH/ AVOIDANCE CONFLICT. To trust or not to trust STAGE 4: PRACTICING TRUST OVER MISTRUST. Stroopin STAGE 5: RESOLVING THE CONFLICT. I can trust you and I am a good kid! THERAPEUTIC PARENTING 31 Thanks to Jon Baylin, Ph.D. & Julie Hudson, Ph.D.

32 THANK YOU. Courtney Rennicke, Ph.D. Dyadic Developmental Psychotherapy Institute Board Member at Large for United States & Treasurer 530 Broadway, 4 th Floor New York, NY Admin: Missy Allan admin@ddpnetwork.org ddpnetwork.org Rennicke & Associates Director 530 Broadway, 4 th Floor New York, NY CR@rennickeassociates.com Admin: Missy Allan info@rennickeassociates.com Adoption/Foster Care Therapist Network (AFCTN) President, Co-Founder info@afctn.org Listserv Referral resource Professional trainings 32