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An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 1
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel
Mindsight Institute
Mind Your Brain, Inc., (c) 2017
An Integrative Approach to Therapeutic Intervention
Consilience and IPNB
From Science to Subjectivity
Relationships, Mind, and Brain
The Centrality of Integration
Mind Your Brain, Inc., (c) 2017
Therapeutic Strategies of Intervention
The psychotherapeutic relationship “SNAGs” the brain toward integration:
S timulates
N euronal
A ctivation &
G rowth
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 2
Developmental
Trauma:
Abuse and
NeglectMind Your Brain, Inc., (c)
2017
The Six Interrogatives of the Mind:
WhatWhereWhoWhenHowWhy?
Mind Your Brain, Inc., (c) 2017
How does attachment shape the development of the mind?
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 3
What is Dissociation?
Mind Your Brain, Inc., (c) 2017
What is an “Integrated Self”?
Mind Your Brain, Inc., (c) 2017
A Surprising Notion
An often not discussed process is at the heart of both neural function and relationships. What do you think this might be?
In other words, what is the shared element between relationships and the brain?
And what does the “mind” have to do with these?
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 4
RELATIONSHIPS
(EMBODIED) BRAIN MIND
WHAT CONNECTS MIND, BRAIN, AND
RELATIONSHIPS?
Mind Your Brain, Inc., (c) 2017
An Overarching View:Energy and Information Flow is the basic “element” of the system of our lives
When this flow happens “inside of us” we are looking at the embodied brain
When this flow happens “between us” we are looking at our relationships
The Mind may emerge from this flow—and also regulate it!
Mind Your Brain, Inc., (c) 2017
The Mind—What is it?
1. Information Processing (Feelings, Thoughts, Memories …)
Subjective Experience we feel in Awareness
AND an...
“Embodied and relational, emergent self-organizing process that regulates the flow of energy and information”
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 5
Four Facets of MIND:
Subjective Experience
Consciousness
Information Processing
Self-Organization
Mind Your Brain, Inc., (c) 2017
A Working Definition of a core aspect of the Mind
An Embodied and Relational
Process that
Regulates the
Flow of Energy and Information
(An Emergent Property that arises from the interactions of elements of a system—i.e. from the flow of energy within embodied neural activity and relational communication)
Mind Your Brain, Inc., (c) 2017
The CLIFF of Energy
Contours
Location
Intensity (Amplitude and Density)
Frequency
Form
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 6
Integration: A simple but powerful framework
Integration is:
The
LINKAGEof
D I F F E R E N T I A T E D Parts
Mind Your Brain, Inc., (c) 2017
The River of Integration
Mind Your Brain, Inc., (c) 2017
Trauma and Impaired Integration
Trauma induces neural effects on the capacity for integration:� Linking fibers damaged
� Epigenetic changes
� Self-reinforcing interpersonal behaviors
� A “Trapped Mind” caught in a neurally and interpersonally reinforcing loop of potentially maladaptive, destructive, and addictive behaviors.
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 7
Major Interpersonal Neurobiology Principles
Mind viewed as a self-organizing emergent property or process that REGULATES energy and information flow
Harmony and Health emerge from integration—the linkage of differentiated elements of a system
Chaos and/or Rigidity result from impaired integration
The mind is both EMBODIED and RELATIONAL
Regulation entails MONITORING and
MODIFYING
Mind Your Brain, Inc., (c) 2017
Mind Your Brain, Inc., (c) 2017
Rethinking the DSM: integration as health and disorder as examples of "un-health”
Integration, Presence and Health
1. Studies of Well-Being reveal the interconnected connectome, or the linkage of differentiated regions best predictor;
2. Studies of impaired well-being reveal impaired integration in the brain (trauma and non-trauma related disorders);
3. Neural integration is the mechanism beneath regulation (mood, emotion , thought, attention,
behavior, relationships, morality)
4. Integrated Relationships � Neural Integration � Health
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 8
Mind Your Brain, Inc., (c) 2017
Integrative Prefrontal Functions�Bodily
Regulation
�Attuned
Communication
�Emotional
Balance
�Fear Extinction
�Flexibility
�Insight
�Empathy
�Morality
�Intuition
Mind Your Brain, Inc., (c) 2017
Trauma and the Brain
Neglect and Abuse impair the development of integrative fibers of the brain.
The timing of traumatic experience shapes which fibers are affected.
Integrative impairment leads to classic PTSD symptoms including dissociative processes.
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 9
REGULATION
Monitoring
Modifying
Mind Your Brain, Inc., (c) 2017
Mind Your Brain, Inc., (c) 2017
Belonging, Attachment, and Disorganization
Reactivity (NO!) versus Receptivity (Yes…)
Threat state of REACTIVTY: Four F’s
� Fight
� Flight
� Freeze
� Faint
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 10
Parent-Child Relationships
How an “attachment figure” interacts with a child is how they share energy and information.
This E and I flow exchange shapes the activity and growth of the brain.
How does this happen, and what do we know from science about how to optimize that neural growth?
Mind Your Brain, Inc., (c) 2017
Temperament and Attachment
Temperament
An inborn feature of the child (not only genetic)
Inborn predisposition of the nervous system
May have lifelong impact that is influenced by experience – especially with caregivers
Attachment
The relationship of the child to the caregiver over time
Research has shown attachment shapes the developing mind
Attachment impacts self-regulatory circuits
Mind Your Brain, Inc., (c) 2017
Chess and Thomas’ Nine Aspects of Parental Report of Temperament: Matching
Activity Level (the motor activity)Rhythmicity (regularity of functions)Approach (positive response to new stimuli vs. withdrawal)Adaptability (ease with which responses are modified)Threshold of Responsiveness(sensitivity level)
Intensity of Reaction (the general energy level of a response)Quality of Mood (the intensity and nature of emotional responsiveness)Distractablity(responsiveness to extraneous stimuli altering ongoing behavior)Attention span/persistence(vigilance in attending to task)
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 11
The Brain is a Social Organ
The function of the brain is to engage with other people, other brains, in the shaping of its development over time and in shaping its activity in the present
Humans can have more than one attachment figure=“Alloparenting”
We “see” each others’ minds with reflective function, mentalization, “mindsight” and theory of mind
Mind Your Brain, Inc., (c) 2017
A simple but profound pattern
Integration (the LINKAGE of DIFFERENTIATED PARTS) may be the heart of well-being
Integration in Relationships is the basis for SECURE ATTACHMENT…and leads to:
Integration in the Brain, the basis for optimal SELF-REGULATION
Mind Your Brain, Inc., (c) 2017
Integration and Neuroplasticity
Integration creates Harmony
Impairments to Integration lead to Chaos and/or Rigidity
The Nine Domains of Integration
Strategies for Enhancing Neuroplasticity
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 12
The Mindful Therapist
What PART do we play as therapists?
John Norcross’ findings: The Presence, Empathy, and Openness to Feedback of the Therapist are crucial elements in therapeutic outcome in meta-analyses of psychotherapy research.
What is the Neurobiology of Presence?
Mind Your Brain, Inc., (c) 2017
Using the power of awareness and attention to catalyze neural integration
Mind Your Brain, Inc., (c) 2017
How do clinicians approach assessment using mindsight and integration?
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 13
The Part we play as therapists:
Presence
Attunement
Resonance
Trust
Truth
Tripod
Triception
Tracking
Traits
Trauma
Transition
Training
Transformation
Tranquility
Transpiration
Mind Your Brain, Inc., (c) 2017
Mindfulness, Mindsight, & Integration
“Mindfulness”
Self-Compassion: Mindfulness, Self-Kindness, and our Interconnected Humanity (K. Neff)
Mindsight: Perceiving energy and information flow within and between people and moving that flow toward integration � Insight
� Empathy
� Integration. Mind Your Brain, Inc., (c) 2017
Principles of Neuroplasticity
1. Relationships
2. Sleep
3. Nutrition
4. Aerobic Exercise
5. Humor
6. Novelty
7. Close Paying of Attention
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 14
Ways to Change a Brain
Mechanisms of Change:� Synaptogenesis
� Neurogenesis
� Myelinogenesis
� Epigenesis
Strategies of Change:� The Focus of Attention
activates specific circuits
� A Sense of Trust enhances receptive learning
� Memory Retrieval as a Memory Modifier
� Unlearning and Learning
� Deep Practice and Skill TrainingMind Your Brain, Inc., (c) 2017
The Brain in the Palm of Your Hand
Mind Your Brain, Inc., (c) 2017
The Brain: A Systems View of Brain Anatomy, Function, and
The Mind
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 15
Mind Your Brain, Inc., (c) 2017
An Example: The Low Road
Temporarily Disengaging the Middle Aspect of the Prefrontal Cortex dissolves the nine functions of the middle PFC including Body Regulation, Attunement, Emotional Balance, Response Flexibility, Fear Modulation, Insight, Empathy, Morality, and Intuition
Mind Your Brain, Inc., (c) 2017
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 16
The “Four S’s” of Attachment: Children Need to be:
Seen
Safe
Soothed
In order to develop “Secure Attachment”
Remembering REPAIR is essential, as ruptures may be common!
Mind Your Brain, Inc., (c) 2017
Impaired Attachment: Developmental Trauma
Impaired growth of:
Corpus Callosum
Hippocampus
Prefrontal Cortex
The interconnections of the Connectome
Mind Your Brain, Inc., (c) 2017
THERE IS
NO SUCH THING
AS
PERFECT PARENTING!!!
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 17
The Importance of REPAIR
No such thing as a perfect parent
Secure attachment is based on showing up for a child, being present, and taking PART: Presence, Attunement, Resonance and Trust in the Parent-Child connection
REPAIR following ruptures is a crucial component of secure attachment
Mind Your Brain, Inc., (c) 2017
The PART we play as parents
Presence & Protection
Attention & Attunement
Resonance & Recognition
Time & Trust
Mind Your Brain, Inc., (c) 2017
The Basics of Attachment I
“Sensitive Caregiving” is the basis of secure attachment. This means parents tune in to the signals sent by a child and make sense of what the child is feeling and needing.
A signal for a baby is often a non-verbal cue such as crying, facial expressions, gestures, and states of alertness or sleepiness.
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 18
The Basics of Attachment II:
When a child has a consistent experience of being seen, of “feeling felt” by the caregiver, the child develops well in their emotions, thinking, and relationships.
Research suggests that these attuned, sensitive communications shape the healthy development of the brain in ways that support future functioning: Early Relationships Matter!
Mind Your Brain, Inc., (c) 2017
Making Sense: The Central Importance of Coherent Narratives“Earned Autonomous” State of Mind
How one has come to make sense of life experiences determines “adult state of mind with respect to attachment.”
“Coherent Self-Knowledge” involves an integration of past-present-future.
Coherent Autonoetic State vs. “Cohesive Narratives.”
Mind Your Brain, Inc., (c) 2017
What is a robust predictor of a child’s security of attachment?
How a parent has MADE SENSE of his or her life…
In other words, it’s not what has happened to a parent, but how that parent has taken the time to make sense of how the past has influenced his or her devleopment.
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 19
Relationships in Research Studies�Relationship Type
B - Secure ................
A - Avoidant..............
C - Ambivalent ..........
D - Disorganized.........
�Parenting Behavior
Responsive, Consistent
Rejecting, Distant
Inconsistent, Intrusive
Frightening, Confusing, Fearful
Mind Your Brain, Inc., (c) 2017
Adults Making Sense of Their Lives: What Science Reveals (Adult Attachment Interview)
Adult StoryFree/Secure-----------
Dismissing-------------
Preoccupied------------
Unresolved------------Trauma or Grief
�Child Attachment
---------------Secure
--------------Avoidant
-------------Ambivalent
---------Disorganized
Mind Your Brain, Inc., (c) 2017
How does Frightening Parental Behavior (Fr) and Unresolved Trauma or Loss (U) impact Disorganization (D) from the point of view of mind?
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 20
What do the different types of adult stories sound like?
Free - flexible, coherent, self-reflective, balanced perspective
Dismissing - incoherent, inflexible, minimize emotional significance, insist on lack of recall
Preoccupied- preoccupation with past intrudes on present, intense idealization
Unresolved - disorganization, disorientation around issues of grief or trauma
Mind Your Brain, Inc., (c) 2017
Brain Development: Inspire to Rewire
Repeated Activation Creates, Strengthens and Maintains Connections:
� “Neurons which FIRE together WIRE together”
� Where Attention Goes, Neural Firing Flows and Neural Connection Grows
Development across the lifespan: plasticity AND self-organization:
A simple idea: “Human connections shape neural connections”
Mind Your Brain, Inc., (c) 2017
Secure Attachment Promotes:
Flexible self-regulation
Prosocial behavior
Empathy
Positive sense of emotional well-being and self-esteem
Coherent life-story
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 21
The Central Role of the Integrating Prefrontal Cortex:
� Bodily Regulation
� Attuned Communication
� Emotion Regulation
� Response Flexibility
� Fear Modulation
� Insight
� Empathy
� Morality
� IntuitionMind Your Brain, Inc., (c) 2017
STRENGTHENING THE MIND:
Enhancing Regulation:
Monitoring
Modulating
Mind Your Brain, Inc., (c) 2017
Presence and “Mindful Awareness”
� “A form of awareness that comes from paying attention, on purpose, non-judgmentally to the present moment” (Kabat-Zinn)
� Mindful Practice involves:
� A Loving Awareness and a Kind Attention (Goodman-Kornfield/Kornfield; Shapiro)
� Focusing Attention on Intention
� Awareness of Awareness itself
� “Training the Mind” to focus on inner experience
� Fundamentally Integrative: Differentiating Sensory Awareness from Observing/Narrating Awareness and Linking with Attentional Practice
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 22
Mindfulness: Using awareness & the
focus of attention to transform:
The Brain (Davidson et al) (Holzel, et al)
The Immune System (Davidson et al)
Sense of Well-Being (Kabat-Zinn et al)
Physician Burn-Out (Reduction: Epstein, et al)
Attention (Jha, et al)
Relational Function (Shapiro, et al)
Epigenetic Regulation (Fredrickson, et al)
Telomerase Levels (Epel, et al)
Mind Your Brain, Inc., (c) 2017
Domains of Integration
Consciousness
Bilateral
Vertical
Memory
Narrative
State
Interpersonal
Temporal
Identity (Transpirational)
Mind Your Brain, Inc., (c) 2017
Time and the Brain
Integration as Embracing of Opposites
�Certainty versus Uncertainty
�Permanence versus Transience
�Immortality versus Mortality
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 23
The Wheel of Awareness
Mind Your Brain, Inc., (c) 2016
The Plane of Possibility
Mind Your Brain, Inc., (c) 2017
Implications and Applications of the Wheel of Awareness
10,000 person study: Universal findings across wide range of backgrounds;
Shift in relationships with others and self;
Reduction in Chaos and Rigidity;
Illumination of Nature of Awareness itself:
� Quotes: “Clarity, Joy, Expansiveness, the infinite, eternity, God, Love, Peace, Sense of being a fundamental part of the whole, connected to others, the world, the universe
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 24
Identity, In-Group/Out-Group
Evolution of In-Group versus Out-Group distinctions
Reactivity (NO!) versus Receptivity (Yes…)
Threat state of REACTIVTY: Four F’s
� Fight
� Flight
� Freeze
� Faint Mind Your Brain, Inc., (c) 2017
Integration, Presence and Health
1. Studies of Well-Being reveal the interconnected connectome, or the linkage of differentiated regions best predictor;
2. Studies of impaired well-being reveal impaired integration in the brain;
3. Neural integration is the mechanism beneath regulation (mood, emotion , thought, attention, behavior, relationships, morality)
4. Integrated Relationships � Neural Integration � Health
Mind Your Brain, Inc., (c) 2017
Ruptures in Our Parenting and Flipping Our Lid: The Low Road and the Vital Importance of Repair
Temporarily Disengaging the Aspect of the Prefrontal Cortex……..
dissolves one or more of the nine integrative
functions of the PFC including:
Body Regulation, Attunement, Emotional Balance, Response Flexibility, Fear Modulation, Insight, Empathy, Morality, and Intuition
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 25
Secure Attachment and Compassionate Connections
Integration and Self-awareness allow us to meet life’s challenges with more resilience flexibility, and joy in our internal and interpersonal worlds…
And a bonus realization:
We are ultimately connected to each other as part of a larger whole
Mind Your Brain, Inc., (c) 2017
“SELF”:
Singular Noun
or
Plural Verb?Mind Your Brain, Inc., (c)
2017
The Optical Delusion of Isolation
Albert Einstein had a sense of the importance of this issue when he stated: “A human being is a part of the whole, called by us ‘Universe,’ a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest, a kind of optical delusion of his consciousness.
Mind Your Brain, Inc., (c) 2017
An Interpersonal Neurobiology Approach to Trauma and its Treatment
Daniel J. Siegel, M.D. 26
This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. Nobody is able to achieve this completely, but the striving for such achievement is in itself a part of the liberation and a foundation for inner security."
Mind Your Brain, Inc., (c) 2017
“MWe”
Mind Your Brain, Inc., (c)
2017
Integration
Made Visible
Is
Kindness and Compassion
Mind Your Brain, Inc., (c) 2017