Mindsight Digital Journal, Issue No. 4, December 2013

Transcription

1 Topic Personality in Health & Dysfunction, by Daniel J. Siegel, M.D. In this 90-minute video, Dr. Dan Siegel explains how genetics, epigenetics, and attachment category integrate to influence the development of personality. These topics are then applied specifically to the symptoms associated with Borderline Personality Disorder. 1

2 Applications for all Professionals and General Interest A. DSM (1:08-7:23) a. Axis I Disorders: Thought, Mood, and Anxiety Disorders b. Axis II Disorders: Personality Disorders c. Health: A simplistic view of the absence of symptoms and diagnoses B. Defining Personality (7:23-23:20) a. There are multiple ways of viewing and labeling personality i. Genotype: The sequence of nucleic acids in genes ii. Phenotype: The expression of a genotype that is externally visible iii. Epigenetics: The way in which experience and environment can influence gene expression through non-nucleic acid regulatory molecules on the chromosomes 1. The term epigenetics is used to refer both to: a. the phenomenon, and b. the molecular process C. Attachment Research & Neuroplasticity (23:20-37:07) a. Attachment: How a mammal depends on an attachment figure for survival THE 4 S S OF HEALTHY ATTACHMENT Seen The child feels that his or her needs are being accurately perceived by a caregiver The mind of the child is seen beneath behavior Safe The child feels protected from harm The caregiver is not a source of terror Soothed The child can expect to be comforted and calmed by the caregiver in times of stress Secure The child feels able to explore his or her environment, relying on the caregiver as a safe-base 2

3 THE 4 ATTACHMENT CATEGORIES SECURE ATTACHMENT AVOIDANT ATTACHEMNT AMBIVALENT ATTACHMENT DISORGANIZED ATTACHMENT Attachment Category The child uses the parent as a safe-base for exploration. Distant emotional connection. The child learns not to depend on the caregiver for comfort. He or she may even detach from his or her bodily and emotional sensations. The child feels uncertain as to whether his or her own needs will be met by the caregiver because the caregiver is unreliable, inconsistent, or intrusive. The child experiences the activation of two opposing processes at the same time: % of Population 55-65% 20-25% 10-15% 5-15% Limbic System move toward caregiver for protection Brainstem Circuit move aware from source of terror This results in a desire to move both towards and away from the caregiver at the same time. D. Personality Development & Neuroplasticity (37:07-48:23) THE 4 F S OF REACTIVE STATES FIGHT FLIGHT FREEZE FAINT a. In a disorganized attachment relationship, two conflicting circuits are activated: i. Limbic System: Child wants to move towards caregiver for safety and comfort 3

4 ii. Brainstem Circuit: Child feels the drive to escape from caregiver iii. The result is dissociation the collapse in an organized adaptation to stress b. Personality development and brain development are dependent upon the integration of genetics, epigenetics, and experience, especially within attachment relationships i. The presence of personality disorders represents maladaptive patterns of firing within the brain E. Borderline Personality Disorder & Interpersonal Neurobiology (48:23-1:02:58) a. Diagnosed in about 1/100 people in the general population b. Diagnosed in about 1/5 people in the mental health treatment population c. Symptoms leading to diagnosis: i. Intense rejection sensitivity (real or perceived) ii. Difficulty with emotional regulation iii. Troubled relationships and difficulty maintaining relationships d. Difficult to point to causal factors; about half of those diagnosed with Borderline Personality Disorder would be categorized as having disorganized attachment relationships and a history of childhood trauma, while the other half would not e. Interpersonal Neurobiology: When the caregiver honors the difference between the child and his or her self, an integrative relationship forms, stimulating growth of integrative fibers in the brain (neural integration) this is the basis of health and resilience i. Well-being and integration give rise to: Kindness, Compassion, Connection, and Attunement ii. Abuse and neglect can impair development in the prefrontal cortex, limbic system, and corpus callosum, thereby affecting the development of neural integration 4

5 F. Reinforcing Personality (1:02:58-1:14:00) a. Hand Model of the Brain i. Limbic System 1. Emotion 2. Motivation 3. Appraisal 4. Memory 5. Attachment b. Caution in using diagnostic labels of personality disorders, especially with children i. Labels can become fixed, self-fulfilling prophecies; instead, consider childhood personality symptoms as an illustration of the pattern of brain development c. Experience can be consciously used to alter brain development i. Recursivity: The pattern of genetic expression, which then influences behavioral expression, which in turn can influence genetic expression 1. Research has associated recursivity to differential treatment of children in the classroom 5

6 G. Integrative Functions of the Prefrontal Cortex (1:14:00-1:37:34) 9 PREFRONTAL FUNCTIONS 1. Body Regulation Sympathetic & Parasympathetic Branches of the Autonomic Nervous System Coordinated 2. Attuned Communication Interpersonal & Internal Attunement 3. Emotional Balance The self-organizing role of the mind 4. Response Flexibility Ability to halt an impulse and, instead, choose the best reaction 5. Fear Modulation Prefrontal cortex releases neurotransmitters (such as GABA) to inhibit the amygdala 6. Insight Ability to integrate the past, present, and future 7. Empathy Taking the perspective of another 8. Morality Viewing the self as part of the greater whole 9. Intuition Ability to access the wisdom of the body 1. Schema-Based Therapy 2. Transference-Based Therapy 3. Mentalization-Based Therapy EMPIRICALLY SUPPORTED TREATMENTS FOR BORDERLINE PERSONALITY DISORDER 4. Dialectical-Behavioral Therapy (DBT) 6

7 Annotated Bibliography of Books Referenced and for Further Reading 1. For All Professional Groups, Parents, and General Interest a. McGilchrist, I. (2009). The Master and His Emissary: The Divided Brain and the Making of the Western World. London: Yale University Press While this is a very dense text that took a quarter of a century for its author to write, it is an important document of the world s scientific literature on right/left brain differences and their implications for our individual and collective lives that we should all have available to us for review. b. Panksepp, J. & Biven, L. (2012). The Archaeology of Mind. New York: WW Norton This is an in-depth exploration of the sub-cortical influences on our emotional life. Written with the clinician and the general reader in mind, each chapter provides both the empirical background and the practical implications of the science of the brainstem and limbic influences on cortical processing of thought, decision, emotion, and behavior. c. Siegel, D.J. (2014). Brainstorm. New York: Tarcher/Penguin-Random House In this book written for both adolescents and adults, I provide an immersive experience that takes the reader through the foundational ideas of how the essence of adolescence is the essence of living a vital life as an adult. By rethinking the nature of adolescence as a period of essential changes in the brain, individuals on both sides of the generational divide may find a more constructive way of staying connected and present during this important time of our personal and collective lives. d. Siegel, D.J. (2010). Mindsight. New York: Random House This book offers an overview of the notion of the mind as a self-organizing embodied and relational process and then examines the notion that integration is the key to health. Providing in-depth stories of individuals confronting challenges to each of the eight domains of integration, the book reveals detailed examples of how to apply integrative techniques in moving from chaos and rigidity toward the harmony and ease of well-being. e. Siegel, D.J. (2012). The Developing Mind. New York: Guilford This is the first textbook introducing the notion of a consilient field of interpersonal neurobiology. This updated text explores the empirical support for the proposal that integration is the heart of health and the mechanism 7

8 beneath effective self-regulation. Filled with in-depth science explorations, the book serves as a text in both undergraduate and graduate courses. f. Siegel, D.J. (2010). The Mindful Therapist. New York: WW Norton Although entitled and written with the clinician in mind, this book is really about how relationships of all sorts promote healing. Using the notion of the PART we play, the book explores how transformative relationships build on presence, attunement, resonance, and trust. g. Siegel, D.J. (2012). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind. New York: WW Norton This is a non-linear book I wrote to offer the interested reader an experience of reading that paralleled the topic of the mind itself. Dive in anywhere and connect to anywhere else, the Pocket Guide is a create it yourself experience of interrelated ideas that provides a way to feel the interconnected nature of brain, mind, and relationships so that learning is deepened and strengthened through the journey of discovery. h. Siegel, D.J. (2007). The Mindful Brain. New York: WW Norton This is an adventure book that takes the reader on a journey from unknowing to the glimmers of understanding about the deep nature of mindful awareness. I wrote it as I experienced my own initial immersion in the mindfulness field, and offer both experiential reflections from a variety of mindfulness retreats to explications of the current science of the brain, the mind, and attunement. The proposal emerges is that mindfulness is a form of internal attunement akin to the interpersonal attunement we find in the field I come from, attachment research. The research outcomes for mindful awareness training and for secure attachment are amazingly similar, supporting the notion that each form of attunement catalyzes a state of integration at the heart of health. i. Sroufe, L.A., Egeland, B., Carlson, E.A., & Collins, W.A. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press This is a wonderful summary of the important long-term study of infants and their families that reveals how patterns of communication in the early years of life influence how kids are treated in school by teachers and their peers, and how young adults engage in self-reflection and in close relationships. A gold standard for longitudinal research, this discussion by the investigators of this key study provide fascinating discussions of the developmental implications of their findings. 8

9 2. More Reading For Mental Health Professionals Executives, and Coaches a. Allen, Jon, Fonagy, Peter and Batemen, Anthony (2008). Mentalization in Clinical Practice. Washington, D.C.: APA Press. A helpful introduction to the clinical use of the mentalization approach that emerged from the initial work on reflective function in attachment research in the early nineties. Now mentalization is also used for treatment of individuals with Borderline Personality. b. Bateman, A. and Fonagy, P (Eds) (2012): Handbook of Mentalizing in Mental Health Practice. Washington D.C.: APA Press. A comprehensive edited volume on applying mentalization in clinical work, with a special focus on personality disorders. c. Cassidy, J and Shaver P (Eds) (2008). Handbook of Attachment, Second Edition, New York: Guilford. Mary Ainsworth and John Bowlby s work as the originators of attachment theory and research is extensively reviewed in the wide range of chapters in this important volume. d. Hayes, S., Follette, V.M., Linehan, M. M. (Eds) (2004). Mindfulness and Acceptance: Expanding the Cognitive Behavioral Tradition. New York: Guilford Press. This edited volume provides fascinating explorations of a number of important approaches, including ACT and DBT, and their application to a range of clinical challenges. e. Hrdy, Sarah (2011). Mothers and Others, Cambridge, MA: Harvard. Anthropologist Sarah Hrdy provides an illuminating discussion of how our shared child-rearing practices created a foundation in collaboration that has shaped our evolution and shapes our inherent nature. The implications for not only child-rearing but for our larger culture are explored in this eye-opening work. f. Iacoboni, M. (2009). Mirroring People. New York: Farrar, Straus & Giroux One of the important researchers in the study of mirror neurons in human beings provides an accessible review of the empirical studies and their practical implications. 9

10 g. Yeomans, F.E., Clarkin, J.F., and Kernberg, O (2002). A Primer of Transference- Focused Psychotherapy for the Borderline Patient. Northvale NJ: Aronson. A clear and fascinating application of the core psychoanalytic technique of transference focus in the treatment of individuals with borderline personality disorder. h. Lieberman, M. (2013). Social. New York: Crown One of the leaders in the field of social neuroscience provides an accessible view of the research and implications of this important empirical work. i. Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: WW Norton The originator of the theory that explores the social engagement system provides an overview of the origins of this framework and its implications for understanding our internal and interpersonal experiences. j. Teicher, M., Andersen, S.L, Pocari, A. Anderson, C.A., Navalt, C.P. and Kim, D.M. (2003): The neurobiological consequences of early stress and childhood maltreatment. Neuroscience and Biobehavioral Reviews, 27 (1-2): An important research review about the neurobiological consequences of childhood abuse and neglect by Martin Teicher and colleagues. k. Josephine Giesen-Bloo, MSc; Richard van Dyck, MD, PhD; Philip Spinhoven PhD; Willem van Tilburg MD, PhD; Carmen Dirksen, PhD; Thea van Asselt, Msc; Ismay Kremers, PhD; Marjon Nadort, MSc; and Arnoud Arntz, PhD. (2006): Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy. Archives of General Psychiatry, Vol. 63, No. 6, pp This article summarizes a comparison study of Jeffrey Young s Schema-Based Therapy with transference-based therapy for individuals with Borderline Personality Disorder. 3. More Reading for Educators a. Cozolino, L. (2013). The Social Neuroscience of Education: Optimizing Attachment and Learning in the Classroom. New York: WW Norton. An intensive exploration of the field of social neuroscience and how this perspective can be applied in a practical and illuminating way in the classroom. 10