1. NEUROBIOLOGY, ATTACHMENT, AND GROUP PSYCHOTHERAPY INTERPERSONAL

2. FACT

4. ULTIMATELY WE ARE TALKING ABOUT… Being with others and the potential to change and transform through such a medium Wednesday, 11

5. NEUROBIOLOGY CONFIRMS The AA premise of ninety meetings in 90 days It appears that it takes about a month for the neuron to get inspired and another two or three months to get established

6. NEUROSCIENCES ARE AFFIRMING THAT EFFECTIVE THERAPY REQUIRES Three essential components 1. A novel experience 2. A significant amount of emotional arousal to prime the brain 3. Support

7. THE NEUROPHYSIOLOGY OF ATTACHMENT Attachment is an inborn system in the brain that evolves in ways that influence and organize motivational, emotional, and memory processes vis a vis significant caregiving figures Motivates us to seek proximity to others increasing the potential for meaningful communication (recovery is more often accomplished in relationship with) At the level of mind, attachment is responsible for the possibility to establish a therapeutic alliance that helps (the addicted self) use group leaders/members to organize its own processes

8. THE NEUROPHYSIOLOGY OF ATTACHMENT (CONT.). Modulation of mood through attachment attunement to verbal and nonverbal signals create secure base from which addicted self can soothe/adapt to negative states Repeated experience encode implicit memory toward developing mental models or schema from which to internalize and operationalize “being” “in” in the world

13. EMOTIONS ARE BASIC BRAIN FUNCTIONS Not an epiphenomenon of psychodynamic conflicts (according to attachment theory) A part of the flight fight response Emotional responses also directly impact memory of experience(s) and become important organizers of mental activity that shape priorities, beliefs, and convictions in life Have far reaching socialization impacts

14. TWO TYPES OF MEMORY Explicit memory - small percentage of memory, is the conscious, intentional recollection of previous experiences and information (can be autobiographical, also can be what educate ourselves about) Implicit - divorced from comprehension and thought, muscle memory, its relational, (emotionally loaded, can be immediate, earliest of memory before development of language) hardwired for emotions and tied to limbic system mediates attachment

15. FOR A MOMENT OR TWO Let’s have some fun…

16. EMOTIONAL IDENTIFICATION EXERCISE - ROUND 1

18. EMOTIONAL IDENTIFICATION EXERCISE - ROUND 2

19. ANSWERS!

20. EMOTIONAL IDENTIFICATION EXERCISE - ROUND 3

21. ANSWERS!

22. MEMORY IS IMPORTANT BECAUSE The rules that determine how I will behave in relation to you are not readily available to explicit memory Behavior then is self-perpetuated if it is not brought to awareness Experiences, behaviors, that remain under the influence of powerful emotions that govern implicit memory lead to a heighten distortion of “now” (especially when triggered in group) More often than not - rules from the past become rules by which I then act on in group

23. VISUALIZATION AND REGRESSION EXERCISE IWM What was your internal working model? How did it get set up? What were the rules? If you didn’t follow the rules... what would happen? What became predictable? How would you seek attention, love, how would you stay safe?

24. SELF-CARE AND SUPPORT The brain has the capacity for the gene expression for caring, it’s expression or inhibition depends on whether the social environment promotes its expression Caring behavior is tied to biological motivations other than mere survival or reproduction. When care seeking behavior [empathy and attunement] is met by the caregiver, a sense of relief and satisfaction is experienced by both parties. This satisfaction reflects the need all developmentally mature adults have – the need to give and receive in relationships.

25. CARING, DOPAMINE, OXYTOCIN Caring does good things for the brain, whether the person is receiving or providing it Persistent positive social bonding or attachment experiences increases levels of oxytocin (mediates affect regulation, bonding, social family connections Since supportive social attachments tend to increase oxytocin levels and decreased levels of stress hormones such as cortisol, it is a no brainer that group psychotherapy is a chosen choice of treatment for addicts Release of Oxytocin also appears to moderate drug craving

26. PROLONGED SUBSTANCE ABUSE AND OTHER COMPULSIVE ADDICTIVE BEHAVIOR Motivational systems become comprised, resulting in denial and a lost capacity for awareness or “that this is happened”... Lying is different than denial, whereas denial is more specific to motivational systems in the brain that have been hijacked and much of an addicts behavior is not under their volitional control or choice We are speaking about a disease in the sense of pathophysiological drug induced change at the molecular level Addiction from this perspective then, has to do with conditioned responses due to powerful, emotional reward experiences and deficits and cognitive and emotional functioning Wednesday, 11

27. CONCLUSIONS If abstinence and recovery are to be achieved and maintained, the addicted individual must develop the capacity to establish healthy emotionally regulatory relationships Group therapy is the ideal vehicle for accomplishing this end Individuals do not recover, groups recover, helps explain why addiction treatment cannot be successfully accomplished unless the addicted individual makes a commitment to be in a relationship with someone or something other than his her drug of choice Simply stated, from a neurobiological perspective addiction is a disease that was designed to interfere with attachment