Neurobiology & Couple Therapy

Mona D. Fishbane, Ph.D.

goodtherapy.org Webinar

www.monafishbane.com

A journey…

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

Love & its Discontents

• Falling in love, long-term love

• Passionate love, companionate love

• “Can love last?” (Mitchell)

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

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

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

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

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

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

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

Erik & Lisa

• Current relationship crisis

• History of relationship

• Family of origin of each partner

BRAIN: THE BASICS

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

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

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

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’

Middle Prefrontal Cortex (PFC)

• Response flexibility

• Self-regulation, self-control, judgment, thoughtfulness, self-awareness

• Social cognition, moral behavior

• Calms the amygdala

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’

Myelin

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

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

CHANGE, HABITS, & THE BRAIN

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

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

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

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)

FROM HABITS TO CHOICE IN COUPLE THERAPY

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

Erik & Lisa’s Vulnerability Cycle Diagram

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’

Facilitating Relational Empowerment

• Power Over

• Power To

• Power With

POWER OVER

• Disempowerment may lead to Power Over behavior

• Power imbalances in couple relationship

• Power & gender

• Power struggles

• Challenging the Blame Game

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’

‘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)

• 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)

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

POWER WITH

• Proactive loving: Shared relational responsibility

• Nurturing the “we”: Working as a team

• Respect, equality, accepting differences

• Empathy

• Attachment, care, generosity

• Repair

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

Boundaries

• Empathy & generosity are safe only if we have good boundaries

• Differentiation: Ability to be authentic and stay in connection

• ‘The Fence Exercise’

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

Rupture & Repair

• Connection-disconnection-repair

• Ruptures

• Repair: Apology

• Guilt & Forgiveness

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