1. Interventions in Interpersonal Neurobiology Christine Schneider, Ph. D
Interventions in Interpersonal Neurobiology Christine Schneider, Ph.D., LCSW, Lead Therapist

2. What is Interpersonal Neurobiology?
Interpersonal Neurobiology is not a form of therapy – it is a way of understanding what it means to be human
Informed by physics, mathematics, attachment theory, social sciences and brain research
Freud: described energy in Newtonian terms (force and objects)
IPNB: describes energy in terms of Quantum Physics (energy is about probabilities)
Goal of IPNB: Strengthening the mind’s capacity to alter probabilities

3. What is Your Role as a Therapist?
Coach?
Validation?
Empathy?
SNAG:
Stimulate Neuronal
Activation and Growth

4. Goals of Interpersonal Neurobiology
To allow for a more “flexible, adaptive and coherent flow of energy” (Siegel 2009, p.137)
Focuses on the ability of the brain to ‘re-wire itself’ based on internal and interpersonal attunement (Siegel 2012).
Various parts of the brain serve specialized functions; therefore, extremes of rigidity or chaos are caused by regions of the brain being ‘clinically dissociated’ from one another, preventing the individual from developing a coherent sense of self (Siegel 2013, p. 7).

5. Bottom-Up vs. Top Down Processing

6. Goals of Interpersonal Neurobiology
Flexibility, then, is dependent on the neocortex to integrate information from various parts of the brain while achieving regulation of thoughts, emotions and behaviors (Siegel 2010; Van der Kolk 2006).
Mentalization: the ability to perceive our own minds while perceiving the minds of others
Response Flexibility: the ability of the mind to sort through a variety of mental processes including impulses, ideas, emotions and then come to a thoughtful, non-automatic response
Suffering = reduced state of integration
Interpersonal Attunement increases neural integration

7. Window of Tolerance/Activation

8. Basically…
1. The brain is “socially built” with different parts of the brain being wired during different periods of development
2. Connections going up from emotional systems are stronger than connections going down from logical systems
3. Big T or little t trauma leads to regulatory deficits resulting in hyper or hypo arousal. Too much arousal results in panic, rage, and fragmentation. Too little arousal manifests in numbing, shame, depression and dissociation.
4. Clients must access emotionally laden material while learning to regulate in order to heal. (Lapides, 2014)

9. So….
Healing and growth REQUIRES the re-wiring of the brain to allow for a more integrated function of increased regulation and flexibility
Therapy is not just about soothing in the moment, but rather about changing the brain wiring – the deeper (lower) the changes in the brain, the more transformational they will be.
The client MUST be emotionally activated without being flooded to achieve this!

10. caregivers to survive in early childhood
Attachment Theory
Connection to a primary caregiver is ESSENTIAL to survival – NOT A CHOICE
We must bond to our
caregivers to survive in early childhood

11. Attachment Theory
Children will make whatever adaptations are necessary to maintain this connection… and the brain will re-wire itself around this adaptation
Aspects that threaten the bond will be split off, or dissociated
Three “S’s” of attachment: To be seen, soothed and safe

12. Attachment Relationships
Attachment is a RELATIONAL process…
A baby could have a preoccupied attachment with one caregiver and a secure attachment with another
However, brain develops around one or more of these attachment figures and creates a dominant attachment style in adulthood

13. Bartholomew Adult Attachment Style
Secure
+ Model of Self
+ Model of Others
Preoccupied
- Model of Self
+ Model of Others
Avoidant
- Model of Others
Disorganized

14. Effects of Attachment “Styles”
Secure attachment: great sense of self-agency; better emotional regulation and flexibility in responses
Can be continuous-secure or earned-secure
Earned secure: the process of being able to revise attachment strategies to be more adaptive and “secure” – have to not only be able to “talk the talk” but also “walk the walk”

15. Effects of Attachment Styles
Insecure attachments: negative self-concept, make fewer social overtures; more likely to display cognitive impairment and display higher levels of aggression
More likely to anticipate negative responses from their partners due to their experience of neglectful, rejecting or inconsistent parenting
Disorganized attachment: biological paradox of needing caregiver in times of fear, but also scared of caregiver
Insecure attachments styles MAY have higher rates of PTSD

16. Attunement: The Building Blocks of Attachment
Contingent Communication
1. Perception of signal
2. Make appropriate meaning of signal
3. Respond in a timely and effective manner
Attunement: maintaining differentiation while connecting to the internal world of others (Tronick)
Both people being EMOTIONALLY PRESENT

17. THE BRAIN Limbic Brain Nervous System Neocortex Brain The Triune Brain
Neocortex Brain – Analytical Mind
Limbic Brain – Emotional Mind
Reptilian Brain – Instinctive Mind
Limbic Brain
Nervous System
Neocortex Brain

18. Limbic System: The Hypothalamus
“Below the Thalamus”
Regulates the autonomic nervous system
Triggers release of hormones like epinephrine (adrenaline)
Responsible for the “Four F’s”… fight, flight, feeding and… mating

19. Limbic System: Amygdala: The Aggression/Fear Center
Amygdala is the brain’s emergency alarm
Scans world for danger
Online at birth
“Primes” the nervous system to activate and prepare
Helpful for actual danger, but what does “priming” look like when you are in an argument with your significant other????
Hyperarousal can lead to PTSD, GAD, other anxiety disorders
Flashbacks: hyperarousal without explicit memory to separate out past from present
Early abuse/neglect (before explicit memory is onboard) can cause chronic hyperarousal

20. Dissociation happens when fight/flight fails!
Polyvagal Options:
1. Safety activates the “new” (ventral) vagal nerve… social engagement system is activated; open to relationship and influence from others; allows neural re-wiring
2. Danger activates a flight/fight response, allowing you to fight or run
3. Life Threat: When situation is overwhelming and it is determined that fight/flight will not be effective, the “old” (dorsal) vagal response will happen; lowers heart rate, blood pressure, feels numb – dissociation
Dissociation happens when fight/flight fails!

21. Limbic System: The Hippocampus
Develops about 2 years old but can turn off under stress
Creates explicit memories that allow for meaning in the event, separating out emotions from past and present
Things that can block memories from going through the Hippocampus
1. Adrenaline/cortisol release
2. Dissociation or “divided attention”

22. The Hippocampus – Types of Memory
Implicit Memory – No Hippocampus
Explicit Memory -- Hippocampus
Does not require the hippocampus
May not have conscious awarenesss but still effects nervous system
Priming: “primes” the nervous system for the event; may or may not have conscious awareness of why the arousal happens
May not have awareness that the event is a memory and not currently happening… ie. a combat vet who feels as though it is happening right now; a rape victim who becomes hypervigilant despite the absence of danger
Doesn’t develop until 18 to 20 months of age
Requires hippocampus
Separates past from present

23. Aspects of Memory 1. Emotions
2. Perceptions – what you saw, heard, felt
Includes “mental models” or “schemas”
“Immaculate Perception” is impossible! (Siegel)
3. Bodily Memories

24. Limbic System Dominance
What is the result of being “Limbic System Dominant”?
If the Limbic System is calling the shots….
More connections coming up straight from the emotional system
Try to make logical meaning of the emotional experience, ie. “I feel scared all of the time, so my life must be in danger, I just don’t know how or why!” Instead of “I have anxiety but I’m actually safe”
Trouble inhibiting thoughts or regulating affect
Difficulty with planning of long term goals or moral decision-making
Health implications from chronic stress

25. The Orbitofrontal Cortex: The Witness
The “observing”, “witnessing” mind
Integration and regulation center of brain
12 months to 25 years in development
Incredibly plastic
Allan Schore:
The orbitofrontal cortex depends on stimulation from the emotional connections of the attachment figure in the form of eye contact, face-to-face communication, and affective attunement

26. Prefrontal Cortex
“The portal through which interpersonal relationships are established” (Siegel, 2015)
Emotional Regulation Functions of the Medial Prefrontal Cortex
Bodily Regulation SNS/PNS, Affect Regulation
Empathy
“Gut Reaction”
Mediates response flexibility: switching from stimulus-response associations to creative and flexible behavioral and emotional responses
State dependent rather than trait dependent
The prefrontal cortex plays a critical role in these attentional and emotional modulations and allows neural responses to reflect the significance rather then the surface properties of sensory events” (Mesulam, 1998)

27. Left vs. Right Hemisphere of Cerebral Cortex
Left Hemisphere – To Describe
Right Hemisphere – To Explain
Later Development
Linear
Linguistic: words and concrete definitions
Logic: looks for cause and effect relationships
Literal: concrete
Develops first 2-3 years of life
Holistic – looks at the gestalt
Sends and Perceives non-verbal signals
Eye contact
Facial expressive
Tone of Voice (Prosody)
Posture
Gesture
Timing and Intensity of response
Will look at ambiguous language

28. Neurological Summary
Regulating Up: Amygdala senses danger, hypothalamus releases adrenaline/cortisol, assumption there is danger with a sudden and impulsive need to react
Regulating Down: Orbital Frontal Cortex and Anterior Cingulate assess situation, observes fear-based reactions and works to soothe amygdala (ie. reassure, deep breathing)
Which is more effective in life? In which situations?
What happens if client is regulating up and therapist is regulating down? Misattunement!!!
CONNECT, THEN REDIRECT

29. Client Implications How do you know which system a client is in?
Social Engagement System:
Eye contact; facial expressivity
Prosody
Emotional Engagement
Fight/Flight or Dissociative State:
Shallow breath; eye glaze; frozen face
Immobilization
Violation of face to face paradigm
Auditory hypersensitivity
MUCH MORE COMMON THAN WE REALIZE… especially in mild forms
80% of people dissociate… not pathological dissociation

30. What is Necessary for Neural Integration?
Social Engagement System is activated (New vagal nerve engagement)
Bottom-Up rather than Top-Down
Window of Tolerance: Being emotionally present without being flooded

31. Presence PRE-SENSE – Portal for integration
Experience before you make judgments; open and engaged
Time spent with emotional presence has been linked to
Increased Telomerase – Telomerase is an enzyme that is attributed to chromosome regeneration and “anti-aging”
Epigenetic Regulation – emotional regulation in ways that may allow for protection against immunological disease
Improve relationality: Ability for intra and inter personal attunement
Open to intra-personal and inter-personal attunement

32. State of Presence FACES Flexible: Not in rigidity or chaos
Adaptive: Open to experience and flexible in response
Coherent: Hold sense of self and coherent narrative over time
Energized: engagement of nervous system while new vagal nerve is activated
Stable: Predictable while being flexible