Behavioral Health Training and Enterprises, P.C.

1. Behavioral Health Training and Enterprises, P.C. The Brain: Trauma and Addiction on a Cellular Level

2. Basic Assumptions of CNRT • All behaviors and emotional processes (both healthy and maladaptive) are a result of neural pathways that have developed within the brain. A neural pathway is a network of neurons within the brain (that controls the body), and are responsible for the automation of emotions and behaviors within the individual.

3. Assumptions of CNRT (Continued) • CNRT assumes that addictions are a result of the brain having been altered as a result of some traumatic process (however slight it may appear). • The brain develops in a use dependent fashion. Maladaptive coping mechanisms resulting from trauma, develop maladaptive neural pathways. These often lead to addictions.

4. Assumptions of CNRT (Continued) • Healing is a process of changing the brain at the cellular level, and hence, developing healthier neural pathways. Thus, it is not just enough to “know the steps of getting well.” Healing must take place on many levels within the brain. • As healthy pathways are used more frequently, they become more primary in the decision making processes of life.

5. Assumptions of CNRT (Continued) • As unhealthy pathways are used less frequently, they atrophy or become less important in the decision making process. • If the person returns to the addiction after a period of abstinence (regardless of how long that has been), the maladaptive pathway becomes reactivated, leading the person back into the addiction (in almost an automatic or trancelike state).

6. Assumptions of CNRT (Continued) • The maladaptive neural pathways that have been developed as a result of trauma, and as part of the addiction, will continue to exist in the brain (pruning stops). Treatment consists of helping the client develop more adaptive neural pathways around the old pathways, and helping them choose those newer pathways, rather than the addiction based pathways.

7. Assumptions of CNRT (Continued) • People engaged in an addictive or any other unhealthy process can change! • Healing requires a great deal of work and effort on the part of the patient. • If the individual can get to the core issue of what he/she is avoiding, without acting out, healing will begin to take place.

8. Assumptions of CNRT (Continued) • Effective treatment increases an individual’s ability to choose more healthy options. Treatment is about increasing their options. • CNRT assumes that the issue of what brings the client into therapy is not necessarily the issue that needs to be treated. “The issue is not necessarily the issue.”

9. What is Sexual Addiction? • The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) does not recognize sexual addiction as a diagnostic category. However, all of the criteria for substance dependence can be applied to sexual addiction and compulsivity. • The criteria are as follows:

10. What is Sexual Addiction (Cont.) • Tolerance as defined by: • A need for markedly increased amounts of the behavior. • A markedly diminished effect with the continued use of the same amount of the behavior. • Unsuccessful attempts to cut down or control the behavior.

11. What is Sexual Addiction (Cont.) • Withdrawal as manifested by either of the following: • The characteristic withdrawal syndrome for the behavior: • Sleepless nights • Intrusive dreams • High level of waking anxiety • Irritability • Emotional lability • The same behavior is engaged in to avoid withdrawal symptoms.

12. What is Sexual Addiction (Cont.) • Engaging in a behavior in greater amounts and for longer periods of time than was intended. • Large amounts of time dedicated to planning for, or engaging in the behavior. • Important social, occupational or recreational activities are given up or reduced because of the behavior.

13. What is Sexual Addiction (Cont.) • The behavior is continued despite knowledge of it having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the behavior.

14. What is Sexual Addiction (Cont.) • Sexual addiction is often known or referred to as sexual compulsivity. • Types of sexual compulsivity • Chronic pornography use • Voyeurism • Exhibitionism • Making obscene phone calls • (Song by Ray Stevens) • 1-900 Sexual Lines • Cybersex

15. What is Sexual Addiction (Cont.) • Types of sexual compulsivity (Cont.) • Sexual chat rooms • Multiple affairs • Prostitution/escorts/strip-club use • Song by Kenny Rogers • Compulsive masturbation • Frottage • Transvestic fetishism or cross-dressing

16. Brain Anatomy • Cerebral Cortex • The smart part of the brain • Future oriented • Can process consequences • This part knows what to do to avoid the addiction • Limbic System • The emotional brain and consists of the following main parts:

17. Brain Anatomy • Amygdala • Influences behavior and activities to meet body’s internal needs • Feeding, Sexual interests and emotions like anger • Can assume executive control of body in dangerous situations (fight or flight).

18. Brain Anatomy • Hippocampus • Involved in learning and memory and recognition of novelty. • Helps in identifying spatial differences. • Helps to sort out relevant aspects of situations that will be stored in long term memory.

19. Brain Anatomy • The Thalamus • The relay station of the brain. • Sorts, interprets, and directs sensory signals received from the spinal cord and the midbrain to the cerebral cortex.

20. Brain Anatomy • The Nucleus Accumbens • This is the “pleasure center” of the brain. • This part of the brain rewards us for doing things that are life sustaining and perpetuating. • The primary neurotransmitter in this part of the brain is the chemical Dopamine.

21. The Brain and Addiction • The Hijacked Brain • Dr. Patrick Carnes refers to the neuro-chemical process of sexual addiction as the “hijacked brain.” (Carnes, 2004). • The emotional part of the addicted brain can receive information from a trigger before the cortex can interpret what the trigger is (Gibson, 2000). • This process helps to maintain the addiction. • This is why relapse is so common.

22. The Brain and Addiction • If treatment is to be effective, the clinician must help the client to strengthen the communication between the Limbic system and the Cortex. • CNRT is a model to facilitate this process. • The process of neural change within the brain is known as neural plasticity.

23. The Science of Brain-Plasticity • Discussions of Neural plasticity began as early as 1783 between Charles Bonnet (Prominent Naturalist) and Michele Vincenzo Malacarne (Anatomist). • Published in 1793 in Journal de Physique. • Indicated that trained animals showed more folds in the Cerebellum than the untrained.

24. The Science of Brain-Plasticity • The hypothesis that exercise and training can enlarge a particular part of the brain was promoted in the nineteenth century (Well, 1847, Acherknecht & Vallois, 1956). • Alexander Bain (1872), a philosopher, suggested that memory formation involves growth of what we now call synaptic junctions.

25. The Science of Brain-Plasticity • “The theory of free arborization of cellular branches capable of growing seems not only to be very probable but also most encouraging. A continuous pre-established network - a sort of system of telegraphic wires with not possibility for new stations or new lines – is something rigid and unmodifiable that clashes with our impression that the organ of thought is, within certain limits, malleable and perfectible by well-directed mental exercise, especially during the developmental period. If we are not worried about putting forth analogies, we could say that the cerebral cortex is like a garden planted with innumerable trees – the pyramidal cells – which, thanks to intelligent cultivation, can multiply their branches and sink their roots deeper, producing fruits and flowers of ever greater variety and quality” (Cajal, 1894).

26. The Science of Brain-Plasticity “We can now identify a large range of neural changes associated with experience. These include increases in brain size, cortical thickness, neuron size, neuron size, dendritic branching, spine density, synapses per neuron, and glial numbers. The magnitude of these changes should not be underestimated...we consistently see changes in young animals in overall brain weight on the order of 7-10% after 60 days...It would be difficult to estimate the total number of increased synapses, but it is probably on the order of 20% in the cortex, which is an extraordinary change! (continued)

27. The Science of Brain-Plasticity “Typical experiments showed that the dendritic fields of these neurons increased by about 20% relative to cage-reared animals (Kolb& Whishaw, ) • The above experiments were done on animals with visually and motorically enriched environments, versus just being in a cage with normal cage stimulation.

28. The Science of Brain-Plasticity • We also know that early learning and development effect dendritic development. • The following pictures show synaptic density at ages 5 days, 6 years and adult. They also show metabolism of sugar at the same ages (brain activity).

30. 5 days 6 years Adult

31. Brain Plasticity • Most dense synapses are at about age 6-9 years old. • By age 19-24 years old, the brain loses the ability to prune unused synapses and the brain can only form new synapses and neural pathways beyond this point. • With this knowledge, we can understand that early trauma and exposure to intense situations can alter the “sexual template” and future development of the brain. • Damage occurs to the hippocampus with trauma victims causing a significant decrease in volume and a change in perception.

32. How Trauma Forms Addiction • Ron Gibson describes this process in terms of High and Low roads. • Our senses are hard wired to the thalamus. The same sensory messages are sent to the cortex and the amygdala, but due to this hard wiring, the message gets to the amygdala about 20 milliseconds earlier than the cortex. • This time lag allows the amygdala to take control or executive function over our behavior and utilize most or sometimes all of our cognitive resources to respond to the perceived threat (fight or flight response).

33. How Trauma Forms Addiction • Under these conditions, memories become lodged in the implicit system and are not stored in the explicit memory of the frontal cortex. • These implicit memories will be “pre-verbal” in nature, and may be recalled only as emotional responses which can be irrational or inappropriate to the current situation (Gibson, 2000).

34. How Trauma Forms Addiction • When these pre-verbal emotional states are activated by triggers, environmental states or high emotional states, high arousal conditions are instituted in our mind and body. Since there is no logical or apparent danger, we begin to seek ways to reduce this aroused state. The activation of the pleasure center of the brain (the Nucleus Accumbens), gives us the desired effect

35. The Body’s #1 Priority • The most important priority in our body next to survival itself, is that of Homeostasis. • Homeostasis is the body’s priority to maintain the “status quo” or to keep everything the same. • This is such an important priority that when any change occurs, the body immediately begins to work on countering that change.

36. The Body’s #1 Priority • For example, if we put a stimulant into our body, it will immediately begin producing a depressant drug to counter the arousal produced from the stimulant.

38. The Body’s #1 Priority • The problem is that this race to produce equilibrium also causes a lot of fluxuation and so the body begins to learn.

39. The Body’s #1 Priority • The body (in an effort to minimize the impact of the drug to the body’s equilibrium), begins to recognize the surroundings, people and situations that drugs are used in, and then begins to introduce the “anti-drug” before we actually introduce the drug to get high. This insures that the drug does not get us as “high” and produces “tolerance.”

41. The Body’s #1 Priority • With this we see that the body actually begins to drive the cravings and addictive process. • The same process goes for what is called “process addictions.” • Process addictions are those compulsive behaviors that are not dealing with externally introduced drugs or alcohol, they are internal chemicals that are triggered by certain behaviors (sex, gambling, food, cutting, relationships, exercise, etc.).

42. The Body’s #1 Priority • The process for these “process addictions” are basically the same as drug use, except it is that we are becoming addicted to our body’s own “drugs.” • Every substance that allows us to get “high” has a counterpart that our body produces naturally. These chemicals either directly connect to neuron receptor sights, or cause the body to release neural chemicals that produce the “high” or euphoric feelings.

43. The Body’s #1 Priority • These are the same chemicals that are over-produced in the body by either substance use or compulsive behaviors. • The body gets used to having intense amounts of these chemicals and resets the body’s equilibrium.

44. Summary • Addiction , or compulsive behavior comes in two forms: Substance and Process addictions. • Substance addictions use chemicals that act directly on the dopamine receptors in the pleasure center of the brain • Process addictions deal with a learning process that allows the brain to learn from the environment and produce dopamine on demand.

45. Summary • Trauma and maladaptive coping skills can pre-dispose a person to a particular form of addiction or compulsive behavior. • Homeostasis is the #2 priority in the body and contributes to a person staying in an addictive pattern once he/she is there. • Healing from addiction is about change on the cellular level and changing the brain’s neural-pathways to enhance new patterns of behavior.

46. How CNRT Addresses Brain Changes • These are some of the techniques that CNRT brings to brain change. • Scripting • Duration, Frequency, Consistency • Treatment Pillars • Biofeedback/Neurofeedback • Mind Mapping • Assessment Phase • Changing Associations • Visual Reinforcement-learning • Music • Intensity • Remapping/Inner Child Work