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Presented by: Matthew Hedelius, Psy.D., LCSW, CSAT, Candidate Director The IRATAD and Paradise Creek Recovery Center.

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Presentation on theme: "Presented by: Matthew Hedelius, Psy.D., LCSW, CSAT, Candidate Director The IRATAD and Paradise Creek Recovery Center."— Presentation transcript:

1 Presented by: Matthew Hedelius, Psy.D., LCSW, CSAT, Candidate Director The IRATAD and Paradise Creek Recovery Center

2 The brain is the organ which controls all processes within the body. Cortex – This is the outer part of the brain that is responsible for all executive functions. It helps us to reason. Think about consequences. Make rational choices. Helps us to be future oriented. Helps us to problem solve.

3 The limbic system – This part of the brain is known as the “emotional brain”. Responsible for feeling all emotions. Helps to regulate the needs of the body and to get those needs met. Lets us know when we are hungry or thirsty. The first “responder” to let us know when danger is near. Responsible for the experience of all pleasure.

4 Nucleus Acumbens- The specific part of the limbic system that is responsible for the experience of pleasure. It is reinforced with neural-chemicals any time we engage in any life sustaining activities. It is reinforced by and large by a chemical called Dopamine.

5 The ability to alter the structure of the brain for good or bad. Trauma – Damages the structure and functioning of the brain and the tissue and cellular level. Effective Intervention –Alters the structure and functioning of the brain by facilitating dendritic branching and growth that ultimately facilitates positive behavioral and life change. This change is known as neural plasticity which can lead to neurogenesis.

6 The ability to make long term emotional and behavioral changes. The ability to transfer previous unconscious processes such as acting out as a result of stress into a conscious process of activating a new and healthier pathway in the brain when stress occurs. This is a result of new neuronal connections in the brain that include the cortex which is the rational brain.

7 Innate drive. Although a lot of energy is often spent thinking about sex, it is a rather unconscious process. It will happen without us having to “make it happen”. In other words, sexual behavior is highly connected to the mid and hind brain, which function unconsciously.

8 A Blue print of what we like and desire sexually. Highly influenced by early life experience. Can be altered by trauma. Is impacted by parental messages during childhood and adolescent development. Is also influenced by media messages, experiences with friends, childhood trauma, etc. Continues to be plastic into adulthood. Strongly influenced by early childhood and adolescent sexual experiences.

9 According to Dr. Patrick Carnes, the arousal template is “the total constellation of thoughts, images, behaviors, sounds, smells, sights, fantasies, and objects that arouse us sexually” (Carnes, 2010 pgs. 244-247).

10 Arousal – Function is to bring excitement and pleasure Numbing – Function is to bring reduction to pain and anxiety. Fantasy – Function is to escape and maintain the high that comes from anticipation. Deprivation – Function is to help the addict cope with feelings of fear, shame and disgust about their sexuality. (Carnes, 2010)

11 As mentioned, the template can continue to be altered into adulthood. The release of dopamine and firing of neurons during intense stimulation can facilitate the altering of ones arousal template. Deviant pornography use over time, has been shown to alter the ones template. Can lead to an inability to complete ejaculation or even obtain an erection in the absence of pornography.

12 “the plastic influence of pornography on adults can also be profound, and those who use it have no sense of the extent to which their brains are reshaped by it.” (Doidge, 2007 p. 103).(Referring to hard core and deviant pornography). Other intense sexual experiences can have significant impact upon the template long after one has reached adulthood.


14 Primary Sexual Experiences Cultural, Social and Family Influences Trauma and Psychological Influences Biological Influences Media and Technology Reinforcement Arousal Template

15 Sexual Trauma in adulthood. Experimentation of alternative sexual behaviors: Swinging Going to strip clubs Incorporating pornography into primary relationship Experimenting with cross dressing Having an affair Your Spouse having an affair Mixing alcohol/drugs with sex Degree of vulnerability greatly impacts the alterability of template.

16 The degree to which a persons template can be altered is greatly influenced by the following: The degree of novelty associated with the sexual behavior. Consistency, Frequency, Duration The degree of vulnerability one possesses at the time the sexual behavior is engaged in. Depression Shame Anxiety Stability of Primary Relationship Recent losses


18 Research shows that the release of dopamine is higher during the anticipation of a pleasurable experience than during or after the actual experience itself (Sapolsky, 2007). The release of neuro chemicals is what locks in long term memories. The more dopamine that is released, the greater the memory markers are and hence, the more likely the template can be altered.

19 Acetylcholine – Arousal, Excitation, Muscle Contraction Glutamate – Excitation, Long term learning and memory Norepinephrine – Arousal, Excitation Serotonin - Soother Dopamine – Pleasure reinforcement

20 Hypothalamic-Pituitary-Adrenal AXIS A Process of events with the function of modulating the impact of stress and trauma. Fight or Flight Response.

21 “This kind of chaotic coping through addiction(with or without substances) seeks to influence the balance of neurotransmitters in the brain, altering function in the direction of feeling better. However, the substance or activity becomes the momentary salve that never actually soothes the underlying pain and fear.” (Badenoch, 2008 P. 149).

22 Can activate pathways that ultimately lead to over arousal or under arousal. Influenced by early template creating experiences. The intolerable state determines which pathway will be activated. Sympathetic Parasympathetic

23 Stress pathways become connected to reward pathways. Stress leads to the activation of the reward pathways in order to seek relief from the pain. Addictions artificially activate the reward pathways and ultimately cause the brains natural reward systems to decrease in spontaneous activation. A binge or “act out” is followed by a dramatic decrease in dopamine and serotonin (Koob & LeMoal, 2006). Leads to decrease in activity in the orbitofrontal cortex due to dopamine bursts (Volkow, 2007).

24 Early trauma and exposure to intense situations can alter the “sexual template” and future development of the brain. (Schwartz, 2008)


26 Novelty releases high amounts of dopamine. When an increased amount of dopamine is released greater learning and memory takes place. When an individual participates in novel and high arousal experiences, the template is at risk for being altered. High arousal experiences change the brains expectations. The brain than keeps pursuing these high arousal experiences in order to get to the same level of “pay off”.

27 An emotional, psychological, physiological and spiritual process between a mental health professional and one or more patients that has the efficacy, and is greatly influenced by the relationship, to facilitate healing in the recipients from mal adaptive behaviors, traumas and other psychological ailments that interfere with living peacefully in the world.

28 Occurs when the therapist/patient relationship follows a healthy developmental process of parent/child. Empathic listening. Appropriate and attuned voice fluctuations. Eye movements and gaze. Healthy self regulation (Therapist effectively managing own anxiety) Therapist being able to stay present. Therapist recognizing when ruptures occur and work towards repair.

29 “Attunement can be seen as the heart of therapeutic change. In the moment, such resonant states feel good as we feel ‘felt’ by another, no longer alone but in connection. This is the heart of empathic relationships, as we sense a clear image of our mind in the mind of another …. Here we see the notion of embodied simulation of the mirror neuron system (Siegel, 2007).

30 “…relationships of secure attachment between parent and child, and the effective therapeutic relationship between clinician and patient each promoted the growth of the fibers in this prefrontal area” (Siegel, 2007 p. 27).

31 “… interpersonal patterns of communication that are integrative stimulate the activity and growth of integrative fibers in the brain. And it is the integrative fibers in the brain that enable self-regulation because they are the circuits responsible for coordinating and balancing the internal and interpersonal elements of the individual” (Siegel, 2012, p. 34-2).

32 “… right hemisphere-based ways in which we connect with our patients…riding on the flow of an integrating brain, our tone of voice, our gestures of care, the rhythm of our breathing, the tenderness in our eyes, and the receptivity of our postures can help open the door to our patient’s implicit worlds (Badenoch, 2008 p. 157).

33 The patients autobiography. Empathy. Appropriate therapeutic attention. Therapist mindfulness and being present. Appropriate clinical knowledge. Therapeutic atmosphere. Therapeutic posturing.

34 1 st Assignment given in therapeutic process. Provides opportunity for therapist/patient attunement. Allows patient to reflect on past and to look inward. May be the first time the patient has ever truly been listened to. Allows patient vulnerability. Accesses Multiple parts of patients brain. Prefrontal Cortex Motor Cortex Limbic System Broca’s Area Wernicke’s Area

35 Neuroplasticity is the ability of the brain to change its structure in response to experience. Experience activates neurons, which then can turn on genes that enable structural changes to be made that strengthen the connections among activated neurons. Even the focus of attention is a form of experience that activates neurons, turns on genes, and makes structural changes to the connections among neurons. In this way, the mental process of focusing attention can change the physical structure of the brain. This is neuroplasticity (Siegel, 2012).

36 Connecting of different groups of neurons within the brain as well as the different parts of the body. Facilitates optimal self regulation. Developed as a result of secure attachment, optimally during infancy. Effective attunement in therapy can help to facilitate neural integration even after trauma and a history of pathology.

37 Aerobic Exercise Good Sleep Good Nutrition Relationships Novelty Paying Close Attention Mindfulness (Siegel, 2012)

38 There is definitive proof human beings continue to create new neurons in the brain. (Eriksson et al., 1998). The process of generating new and additional neurons that integrate with existing cellular circuits after early postnatal development has stopped. Occurs in the dentate gyrus (hippocampus) and the olfactory bulb (Aimone et al., 2007)

39 Neurogenesis: Must have support from nearby glial cells. Must have nutrients from the blood. Must be able to establish connections with already established neuronal networks. This allows for continued nutritional support. Neurogenesis appears to be regulated by exercise. (Pereira et al., 2006; Ratey, 2008)

40 Neurogenesis may help heal structures in the limbic system, specifically the hippocampus. Though addictive neural pathways cannot be pruned away, brain plasticity, aided by neurogenesis, allows the addicted individual to transfer a healthy way of coping into long term storage and therefore creates long term change.

41 Conditions for healing are created and supported by the following principles: Consistency Frequency Duration The addiction pathways will not be destroyed but they can in time, become less dominant.

42 Integrative scripting refers to the idea of mapping out an optimal outcome of an unhealthy process, specifically using the differing parts of the body including the prefrontal cortex, limbic system, brain stem and body proper. Builds upon the principles of neural integration. Takes a holistic approach to healing and recovery. Facilitates the building of confidence and hope within the patient.

43 Written in the first person, present tense. Written as if it were happening right now. About ½ to 2/3 of a page in length. Concretely identifies the pathway into the problem, recognizing it, choosing to remove self from the high risk situation followed by the optimal outcome. Specifically identifies processes of the brain and body in the overall outcome.

44 The same mechanisms which can lead to addiction can also be used for healing. “ Neurons that fire together wire together” (Carla Shatz as cited in Doidge, 2007).

45 “ In mindfulness we direct our attention to our intention. Where attention goes, neurons fire, And where neurons fire, they can rewire.” (Siegel, 2007 pg. 291). SNAG – Stimulate Neural Activation and Growth Actively practicing healthy thought patterns and behaviors to help facilitate new neural pathways. Using new words to describe feelings of being out of control sexually. Mindfully choosing new driving routes so as to avoid high risk areas. Journaling about sexually anorexic states for the purpose of attaching new meaning to the emotional states.

46 Psychopathology (Unconscious) Consciously identify corrective psycho- emotional and behavioral pattern. Therapeutic attunement. Integrative Communication. Scripting. Incorporation of SNAG. Exercise. Cognitive and behavioral rehearsal. Practicing the SNAG. Leads to consciousness and short term learning and memory. Internal Integration. Continued exercise. Apply principles of: Consistency, Frequency, and Duration. Long term learning and memory. Long term storage. Synaptogenesis and neurogenesis.

47 What is going on in each of these pictures? What is a ‘mind full’ like for you? What is being ‘mindful’ like for you? How can being ‘mindful’ be used to help us regulate our emotions in healthy ways?

48 Emotional Mind Logical Mind Wise Mind React Think Act purposefully

49 Vertical Integration Cognitively connecting the prefrontal area, limbic system, brain stem and the body so that they are working harmoniously with one another and aware of the others functions. Practicing desired skills so the new neural pathways are developed and strengthened. Reinforcing this process in patients by helping them become mindfully aware of the possibility. Inspiring our patients and their loved ones that deep, long lasting psychological and physiological changes can occur.

50 Mild to moderate levels of stress facilitates neuronal growth hormones that in turn, facilitates new learning (Galea & Fuchs, 1997 as cited in Cozolino, 2010). Managed exposure of stress during psychotherapy facilitates new learning and neuronal integration.

51 “As affect is repeatedly brought into the therapeutic relationship and successfully managed, the client gradually internalizes these skills by sculpting the neural structures necessary for autoregulation. As in childhood, the repeated cycle of attunement, rupture of the attunement, and its reestablishment gradually creates an expectation of reconnection (Lachmann & Beebe, 1996 as cited in Cozolino, 2010).”

52 “Affect regulation, especially the modulation and inhibition of anxiety and fear, allows for continued cortical processing in the face of strong emotions, allowing for ongoing cognitive flexibility, learning, and neural integration (Cozolino, 2010).” The learned anticipation of relief being in the future increases ones ability to tolerate more intense affect in the midst of the stressful moment (Cozolino, 2010).

53 People with sex addictions tend to lack the belief system that they can live “beyond the moment” without acting out. At an emotional level, addicts often believe survival is based on the relief that comes from sexually acting out. This is why an addict will risk such a high price to act out. Effective intervention helps the patient learn that one can survive without sexually acting out.

54 Empathy is an essential affective skill that addicts must acquire if they are to get sober. Empathy is the ability to put ones needs aside and jump inside the shoes of another. It is the ability to put off what my “emotional brain” wants right now. Requires cognitive flexibility and affect regulation (Cozolino, 2010).

55 Early life experience helps to shape our windows of tolerance. The closer we get to a state of being over aroused or under aroused, the closer we get to crossing our threshold and exiting our window of tolerance. Effective mindfulness and expanding our window of tolerance. Being present with the experience without judgment. Avoiding cognitive time and geographical travel.


57 Acetylcholine – Plays a role in arousal, Excitation, Muscle Contraction (Neuromodulator, does not work directly at synaptic cleft. Help patients learn to regulate arousal) Help patients find new interests and pursue them. GABA also serves as a modulator and inhibitor. Norepinephrine – Arousal, Excitation Help patients find activities that activate excitation pathways (i.e. exercise, healthy risks, etc.)

58 Serotonin – Soother Help patients find and regularly engage in soothing behaviors. Dopamine – Pleasure reinforcement Help patients look forward and plan for future healthy activities. Put it on the calendar.

59 Seek internal attunement and integration. Live a mindful life. Learn the language of interpersonal neurobiology. Become a friend with the brain. Have a passion for brain based models. Teach patients using the language and theory. “Buy” into the brain based models. Seek learning and training.

60 “ We use a combination of empathy, affect, stories, and behavioral experiments to promote neural network growth and integration…Through all of this work, sub cortical networks that store memories of fears, phobias, and traumas are activated and made accessible for integration with cortical inhibitory circuitry.” (Cozolino, 2010 p. 341).

61 Narrative integration facilitates us making sense of the story of our own life. Brings fragmented chunks into an integrated whole. Allows our patients and ourselves to leave the past and yet remember it while being in the present. Hence, the need for longer term therapy. We must give time for the healing to take place.

62 The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice (Norton Series on Interpersonal... by Diana Fosha, Daniel J. Siegel and Marion Solomon (Nov 16, 2009) The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice (Norton Series on Interpersonal...Diana Fosha The Social Neuroscience of Education: Optimizing Attachment and Learning in the Classroom (Norton Books in Education... by Louis Cozolino (Jan 7, 2013) The Social Neuroscience of Education: Optimizing Attachment and Learning in the Classroom (Norton Books in Education... Cognitive Neuroscience: The Biology of the Mind by Michael S. Gazzaniga, Richard B. Ivry and G. R. Mangun (Jan 2002) Cognitive Neuroscience: The Biology of the MindMichael S. Gazzaniga

63 The Science of the Art of Psychotherapy (Norton Series on Interpersonal Neurobiology) by Allan N. Schore (Apr 2, 2012) The Science of the Art of Psychotherapy (Norton Series on Interpersonal Neurobiology) Allan N. Schore The Neuroscience of Human Relationships: Attachment And the Developing Social Brain (Norton Series on Interpersonal... by Louis Cozolino (Nov 17, 2006) The Neuroscience of Human Relationships: Attachment And the Developing Social Brain (Norton Series on Interpersonal... The Science of Addiction: From Neurobiology to Treatment (Norton Professional Books) by Carlton K. Erickson (Feb 17, 2007) The Science of Addiction: From Neurobiology to Treatment (Norton Professional Books) Carlton K. Erickson Neurobiology for Clinical Social Work: Theory and Practice (Norton Series on Interpersonal Neurobiology) (Norton... by Jeffrey S. Applegate and Janet R. Shapiro (Aug 17, 2005) Neurobiology for Clinical Social Work: Theory and Practice (Norton Series on Interpersonal Neurobiology) (Norton...Jeffrey S. Applegate

64 Society for Neuroscience – The Journal of Neuroscience –

65 Aimone, JB, Jessberger, S., & Gage, FH. (2007) Adult neurogenesis. Scholarpedia, 2(2):2100. Badenoch, B. (2008). Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology. W.W. Norton & Company. New York. Carnes, P.J. (2010). Facing the Shadow: Beginning Sexual and Relationship Recovery. Gentle Path Press. Carefree, Arizona. Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain. 2 nd Ed. W.W. Norton & Company. New York. Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. New York: Penguin Group.

66 Eriksson, P., Perfilieva, E., Björk-Eriksson, T., Alborn, A., Nordborg, C., Peterson, D., et al. (1998, November). Neurogenesis in the adult human hippocampus. Nature Medicine, 4(11), 1313. Kolb, B., & Whishaw, I. (1998). Brain plasticity and behavior. Annual Review Of Psychology, 49, 43-64. Pereira, A., Huddleston, D., Brickman, A., Sosunov, A., Hen, R., McKhann, G., et al. (2007, March 27). An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proceedings of the National Academy of Sciences of the United States of America, 104(13), 5638-5643. Sapolsky, R. (2007). Schwartz, M. (2008, December). Developmental psychopathological perspectives on sexually compulsive behavior. Psychiatric Clinics of North America, 31(4), 567-586.

67 Siegel, D.J. (2007). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. W.W. Norton & Company. New York. Siegel, D.J. (2012). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind. W.W. Norton & Company. New York. Volkow, N.D. et. al (2007). f

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