Neurobiology & Couple Therapy. Mona D. Fishbane, Ph.D. goodtherapy.org Webinar

Transcription

1 Neurobiology & Couple Therapy Mona D. Fishbane, Ph.D. goodtherapy.org Webinar

2 A journey

3 Interpersonal Neurobiology We are social creatures, wired to connect We need others throughout life Loneliness & unhappy relationships negatively affect health Couples co-regulate each other, for better or worse

4 Love & its Discontents Falling in love, long-term love Passionate love, companionate love Can love last? (Mitchell)

5 The Life cycle of Love (Helen Fisher) 3 stages of love: Lust, fired by Testosterone Romantic Love, fired by Dopamine, Norepinephrine, Oxytocin Attachment, fired by Oxytocin & Vasopressin

6 Cultural Beliefs about Love Happily ever after Entitlement to be loved Falling in love, falling out of love : A passive view of loving Values of individualism & competition: Impact on love

7 Happy & Unhappy Couples Happy couples: Equality, fairness, respect Emotional skillfulness, secure attachment Gottman: Friendship, positivity, constructive conflict, repair, trust, we-ness Practice relational virtues Unhappy couples: Dysregulation/flooding during conflict, negativity, poor repair Power struggles, me-vs-you Health consequences of happy/unhappy relationships

8 Automaticity-vs-Choice We live much of our life on automatic pilot The downside: Unproductive habits & emotional reactivity I think therefore I am (Descartes); I feel therefore I am (Cacioppo) Choice: A prefrontal process

9 Proactive Loving Active, not passive approach to love Relational empowerment Self-responsibility, relational responsibility Nurturing the we Thich Nhat Hanh: Water the seeds of love Fredrickson: Positivity Resonance

10 Couples in Distress Mutual activation process Reactivity, defensiveness Criticism, contempt, defensiveness, stonewalling (Gottman) Power struggles Sense of defeat, don t know how to get through to each other The Blame Game

11 The Blame Game Cultural Influences Competition, individualism, patriarchy/gender socialization, isolation of nuclear families Neurobiological Influences Fight/Flight: automatic, beneath awareness The Interpreter : Self-justifying part of our brain (Gazzaniga

12 Erik & Lisa Current relationship crisis History of relationship Family of origin of each partner

13 BRAIN: THE BASICS

14 Evolution We share 98% of our DNA with chimpanzees The biggest difference is in the human prefrontal cortex (PFC) Nature reuses older brain circuits for newer purposes The older brain circuits can overwhelm our higher functioning when we feel threatened

15 The Human Brain Tripartite Brain Brain Stem (Reptilian Brain) Limbic System (Mammalian Brain) Cortex/Prefrontal Cortex The brain is embodied Bidirectional flow between brain & body Hormones & neurotransmitters

16 Fishbane, M.D. (2013). Loving with the Brain in Mind: Neurobiology & Couple Therapy. NY: Norton

17 The Amygdala Emotional sentinel, scans environment for danger; Fear central Quick & dirty Sets off flight-or-flight response Stores emotional components of memories Couples dances of amygdalas

18 Middle Prefrontal Cortex (PFC) Response flexibility Self-regulation, self-control, judgment, thoughtfulness, self-awareness Social cognition, moral behavior Calms the amygdala

19 Interconnected Neurons Neurons that fire together wire together (Hebb s Theorem) Our habits create and are created by circuits of neurons The influence is circular, recursive Habits become ingrained as we become stuck in our own neural ruts

20 Myelin

21 Memory Implicit: Sensory, procedural, emotional, unconscious Most memory is implicit Early memories are implicit, preverbal; they drive our current reactivity, even though we don t consciously remember the original events Amygdala involved in emotional memory Explicit: Semantic, narrative, conscious Hippocampus involved; develops after first year

22 Stress & Trauma Stress & cortisol Hippocampus is damaged by chronic stress Abuse & neglect negatively affect the growing brain Trauma can leave implicit memories that are not available as explicit memory, but get retriggered in the present

23 CHANGE, HABITS, & THE BRAIN

24 We are creatures of habit The brain is an anticipation machine (Siegel), always predicting the next moment from the last The more we hike on a path, the deeper the rut becomes Habits become self-perpetuating

25 We are creatures of change The human brain is constantly adapting to changing circumstances Neuroplasticity: Ability of the brain to change throughout life Synaptogenesis Neurogenesis Myelinogenesis

26 Nature & Nurture Nature & nurture are intertwined Genetic predispositions & temperament Experience changes the connections between neurons Erik Kandel: Nobel Prize for showing how learning changes the brain Experience affects the expression of genes Importance of attachment & attunement for child s growing brain

27 Neuroplasticity in Adulthood Neuroplasticity can continue throughout life You are what you do What facilitates neuroplasticity: Physical exercise Paying attention Learning new things Neuroplasticity & change in therapy Fixed Mindset-vs-Growth Mindset (Dweck)

28 FROM HABITS TO CHOICE IN COUPLE THERAPY

29 Creating a Safe Space in Couple Therapy Safety Therapy office: a blame-free, shame-free zone Allying with both partners Multilateral partiality (Boszormenyi-Nagy) Accepting & challenging Collaborative approach; transparency

30 Erik & Lisa s Vulnerability Cycle Diagram

31 Transforming the Vulnerability Cycle Help couple get meta to their own cycle From a linear view to a circular view Both partners are victims of & co-creators of the cycle Notice when feel vulnerable & survival strategy is activated Speak from vulnerability Grow up own survival strategies Separate present from past: The Magic Question

32 Facilitating Relational Empowerment Power Over Power To Power With

33 POWER OVER Disempowerment may lead to Power Over behavior Power imbalances in couple relationship Power & gender Power struggles Challenging the Blame Game

34 POWER TO Emotional & social intelligence Power to be the person you want to be Self-regulation Relational empowerment: To live (and love) intentionally Tools for your relational toolbox

35 Making a Relational Claim Convey own feelings while making space for partner Stand up for self without putting partner down (Atkinson) Make partner an ally, not an enemy or stranger (Wile)

36 Seneca: Most powerful is the person who has himself in his own power Self-mastery: the power to self-soothe, make thoughtful choices Role of Middle PFC in Self-Regulation Individual differences in affective chronometry (Davidson)

37 Techniques for Emotion Regulation Identify own emotions; read body cues Name it to tame it (Siegel) Interoception-vs-Alexithymia Self-soothing Imagery work: Dialogue between amygdala & PFC Mindfulness meditation; breathing; journaling Reappraisal Soothing each other

38 POWER WITH Proactive loving: Shared relational responsibility Nurturing the we : Working as a team Respect, equality, accepting differences Empathy Attachment, care, generosity Repair

39 Facilitating Empathy in Couple Therapy 4 aspects of empathy: Resonance Cognitive empathy Self-regulation Boundary between self & other Eye contact Gender differences in empathy Techniques to enhance empathy in couple therapy Blocks to empathy

40 Boundaries Empathy & generosity are safe only if we have good boundaries Differentiation: Ability to be authentic and stay in connection The Fence Exercise

41 Nurture Friendship & Passion Skills of proactive loving Turn toward each other (Gottman) Importance of touch, sex, massage; oxytocin s magic charms Protection & care: Tend & Befriend (Taylor) Acceptance, generosity, gratitude Positivity

42 Rupture & Repair Connection-disconnection-repair Ruptures Repair: Apology Guilt & Forgiveness

43 CHALLENGES OF CHANGE Stability/change: A natural ambivalence Resistance The Giant Exercise Awkwardness of change Fork in the Road Facilitating neuroplasticity & relationship plasticity Maintaining change