Week 3 Flashcards
Life Course Health Development
- Approach to the cause of disease
- Is now focusing on biological psychological and social factors that contribute to disease
- Disease development is multifactorial and there is no “magic bullet” in treatment cure or cause
- Drugs were good for bacteria but not so much for complex chronic disease
Atherosclerosis
A disease that develops in middle age but has its origins in physiology, development social and psychological history
How is resilience Derived
- Multi-factorial
- Early environment, social support, genetics, epigenetics, and coping strategies,
- Also pharmacological and other therapeutic interventions
- Social workers and therapists are key to developing wholistic resilience
Brain at the nexus of stress
- Principle organ involved in identifying stress and managing it
- Can adapt own structure and function and genetics in response to stress or the environment
- This is done with Hormones and Trophic Factors
Trophic Factors
- Any molecule that supports the survival of cells
- Nerve growth factors are polypeptides that regulate the proliferation, survival, migration, and differentiation of cells in the nervous system.
Brain Derived Neurotrophic Factor (BDNF)
- Provides instructions for making a protein in brain and spinal cord
- Promotes the survival of nerve cells (neurons) by playing a role in the growth, maturation (differentiation), and maintenance of these cells.
Depression, PTSD Recovery and Brain Structure
Chronic Stress and Mental Illness causes changes in brain structure and function
These can recover to a certain extent using therapy and relief of stress
Recovery of Structural Markers
- Gene Expression and Epigenetics can rebuild structural makers of positive healing
Epigenetics
Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself
What Builds Resilience
- Epigenetics and Gene Expression
- Actively engaging in a positive response to stress and trauma is needed to recover structural markers
- Remaining rigid or lacking vulnerability does not allow for neural adaptation
Resilience
The ability to adapt and come to a successful outcome in the face of difficulty or adversity
Eustress
Stressful situations that produce positive outcomes
e.g. Military Boot Camp that pushes participants limits in order to make them more resilient in a combat situation
Allostasis
Returning to a neutral state after experiencing a stressful event
Neuroplastic Adaptation
- Recovery of stress induced changes in the brain’s architecture
- Not a reversal of traumatic damage
- An adaptation towards resilience that requires external intervention
- Impaired by mood disorder and ageing
Characteristics of Resilience
- Making positives out of adverse situations
- Ability to self regulate
- Moderated Locus of Control
Locus of Control
- Accurate perception about the underlying main causes of events in life.
- Accurately decide whether an outcome is contingent on our actions
Rapid activation and rapid, appropriate termination of the stress response are associated with resilience,
Blunted or exaggerated responses are associated with disease states
Neurotransmitters Associated with Resilience
- Neuropeptide Y
- Norepinephrine
- Corticotropin Releasing Hormone
- Endocannabinoid
- Oxytocin
- Glutamate - Most Significant
Resilience in children
- Increased by positive relations to caregivers
- Strong social support
- Community that provides meaningful response to adversity (faith based)
Actions to promote Resilience
- Faith Based engagement like prayer
- Meditation
- Active Coping Engagement
- Exercise
- Actions to develop mastery and self esteem
Absence of Adversity
- Does not necessarily contribute to resilience
- Exposure to controllable adverse events helps
- sheilding and not challenging children does not protect children or build resilience
Environmental Programming
How epigenetics are expressed during development
Two Methods of Inheritance
Slow: many changes across multiple generations
Fast: changes in genetic expression from mother to child
Genetic Expression
- The process by which a gene gets turned on in a cell to make RNA and proteins
- These changes can become heritable
Three Primary Ways Maternal Behaviour Impacts Brain Structure
- Learning and Plasticity
- Ability to cope with Stress
- Later Maternal Behaviour in Adulthood
Methylation of DNA
- An epigenetic modification or heritable change in DNA
- Does not modify the sequence of DNA.
- Alters expression of a gene during cell differentiation and causes a change that is heritable.
Increasing Receptors
- High Maternal attention facilitates the production of receptor cells
- This allows for greater ability to mediate sensation from the environment
- Can lead to dampening of fear and anxiety
- Can increase exploratory behaviour
NMDA Receptors
- N-methyl-D-aspartate receptor
- Play a crucial role in regulating neurological functions,
- e.g. breathing, locomotion, learning, memory formation, and neuroplasticity.
- Are Glutamate Sensitive
- Can help regulate Long Term Depression
Neuroplasticity and Depression
- It may be that hippocampus reduction is the result and not the cause of depression
- This is a physical expression of the shutdown of neuroplasticity
Grandmother Gene Hypothesis
- Human women go through early menopause to be available to help raise grandchildren
- This reduces the risk of childbirth which increases with age for both mothers and babies
- Early menopause could be shaped by natural selection to increase species survival
- Could be that women live longer due to greater involvement in nurturing and caring for young
Experience Dependent Plasticity
- Found in prefrontal cortex & hippocampus
- Dependent on close relationships
- Romantic Relationships can cause movement from disorganized attachment to more secure attachment
Therapy and Reparenting
- Counselling can sometimes can be viewed as reparenting
- It can create the epigenetic benefits that may have been missed in infancy
- Attention, care and nurturing can be gained through and give the client the biological interventions they need
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- Orbito-Medial Pre-Frontal Cortex
- Sits at apex of the limbic system
- Sometimes called the Basal Forebrain
- A place where polysensory, somatic and emotional information is processed
- Co-ordinates activation of sympathetic and parasympathetic nervous systems
Basal Forebrain
- OMPFC, Insula, Cingulate Cortices
- Most evolutionarily primitive cortexes of the brain
- Sits at apex of Limbic System
- Deals with senses, somatic and emotional information
Cingulate Cortex
- Primitive association of visceral, motor, tactile and emotional information
- Damage here is connected with mutism, loss of maternal responses, neglect and autonomic instability
Spindle Cells
- Spindle shaped neurons in humans and ages the regulate divergent streams of information
- Emerge after birth and are dependent on experience
- Neglect can impact lifelong cognitive deficits
Social Brain
- The bigger the cortex the more social primates became
- AS this happened need for language and problem solving grew
- This led to task specialisation
Social Synapse
Language is verbal and non-verbal
In Polyvagal terms non-verbal communication signals threat or safety
Early Bonding
Co-regulation
the ability to build secure attachment makes way for the ability to self regulate
Attunement and Reciprocity
- Mutual Awareness, turn taking and emotional resonance
- Early regulation established by mother/child synchrony
- Supports building of neural networks
- Basis for self-regulation in children’s
Mirror Neurons
- Neurons fire in response to the actions of others
- This explains why we learn from observing others
- May be the basis for the way we empathise
- Bonnie Badenoch 2016 - EMDR
Lack of Attunement and Shame
- Shame appears in the second year of life
- can be activated due to loss of attunement
- Prolonged shame causes dysregulation
- Affects attachment needs negatively
- disrupts healthy neural networks
Rupture and Repair
- Ed Tronick
- Parents need to attune 33% of the time
- As long as there is repair after a problem
- Misattunement with repair could be just as necessary to demonstrate how we regulate
Attachment Theory
- Developed by John Bowlby
- Attachement based on 3 concepts
- Need for attachment figures
- Proximity seeking behaviour for protection
- Safety of knowing there is a secure base to return
Attachment Schemas
- Implicit memories based on experience
- Safe experiences with positive caregivers create functional schemas
- Disorganised attachment has the opposite effect
- Effectively the narrative we tell ourselves about our safety
Attachment and the ANS
- Secure attachment creates optimal balance of SNS & PNS
- Established early in life
- Results in enduring patterns in response to arousal & stress
- Poor Attachment leads to over or under arousal through the body & brain
Childhood Trauma
Trauma Events by themselves do not predict attachment schema
Working through experiences to construct a coherent narrative can form secure attachment
Narrative Co-Construction
- Blueprint for organised, integrated neural circuitry
- Emotional attunement helps set the base for
- Feelings, behaviours, sensations
- With integration of an experience we can develop healthy schemas
Therapist Reparenting
- Therapy can produce the neural connections we need if it was missed in development.
- Care and Nurturing influences our brain structure
Polyvagal Theory
- Stephen Porges 1990s
- Emphasis on bidirectional communication between brain and visceral organs
- These organs such as gut & intestines could influence brain processes like cognition and emotions
Vagal Brake
- The way the vagal pathways inhibit heart rate
- Involved in down-regulating defense mechanisms
- Promotes social engagement and coregulation
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Window of Tolerance
- The ability to stay connected to our pre-frontal cortex
- Occurs in response to stress arousal
- Ventral Vagal pathway is not accessible at this time
- Positive social connections support the return to Ventral Vagal
Neuroception
- How the nervous system evaluates risk
- Is automatic and implicit
- Sometimes get a “gut feeling” or intuition
Faulty Neuroception
- Adaptive survival reaction that detects risk when there is no risk
- Often found in people with trauma history
- Also called Biased Neuroception
Vagus Nerve Activation
- Stress decreases vagal activation
- This triggers sympathetic nervous system arousal and Fight/Flight
- Vagal Break fine tunes our fear response to stop us from overwhelm
- Positive attachment supports our ability to discern threat and stay calm
Safe and Sound Protocol
- An acoustic frequency range with cues of safety
- High pitched sounds usually signify distress
- Deep, low sounds might sound like predatory animal and cause a freeze response
Vagal Tone
- How the Vagus nerve regulates the heart and other organs
- Poor vagal tone connected to poor emotional regulation, and high attention demand
- This can make social engagement and attention difficult
Vagal Regulation
- Allows us to be distressed or anxious without withdrawing or becoming physically aggressive
- It is possible that perpetrators may not have had secure early attachment that allows vagal regulation
