Jesse Viner, MD Laura Humphrey, PhD
Jesse Viner    Laura Humphrey

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Real-Time Treatment: Integrating Neuroscience and Psychoanalysis in the Intensive Treatment of Emerging Adults

Jesse Viner, MD, Founder and Executive Medical Director
Laura Humphrey, PhD


Developmental Neurobiology of Self-Organization

Advances in the neurobiology of interpersonal experience (cf., Daniel Siegel, 1999) show that the brain forms its neural connections within human connections. That’s right! In Siegel’s words, “Human connections shape neural connections”. The development of synaptic networks, which is how the brain expands and sustains the architecture for new learning, occurs within the context of relationships. The brain, not just the heart and soul, needs emotional relationships to grow. According to Allan Schore (2003), it has been demonstrated that it is built into our DNA such that primary caregivers act as psychobiological regulators of hormones that directly affect gene transcription.

Studies of the effects of trauma and abuse on the developing brain mirror our clinical experience. The overactive fear circuits of the amygdala have been shown to undermine the development of the orbito-frontal systems associated with healthy self-soothing during attachment experiences. For example, in f MRI studies, severely neglected and traumatized Romanian orphans ( ) have “hot amygdalas” which flare with subsequent separation and abandonment experiences. Research also shows that the brain is capable of storing attachment traumas in the right-brain’s sensorimotor, affective memory systems, completely split off from the as-yet-undeveloped left-brain’s verbal reasoning processes (Gaensbauer, 2002, p. 259; Joseph, 1982, p.243; Schore, 2003, p.74-75). These response systems remain vigilant to possible abandonment throughout life and produce a myriad of emotional, psychological, neuro-chemical, psycho-physiological and behavioral deficiencies and compensatory mechanisms.

Neuro-imaging studies show that traumatic emotional memories activate (Rauch et al., 1996), and are recalled through (Schiffer et al., 1995), predominantly right hemisphere operations. Hippocampal damage in abused individuals is associated with the clinical findings of impairment in affective and memory integration (cite?). There are many such psycho-neurobiological implications involved in working with individuals with seriously troubled and traumatized histories. Our clinical challenge is to creatively harness the therapeutic leverage that is available through the neuro-plasticity of the emerging adult’s brain.

April’s depression, anxiety and symptomatic misbehaviors create destabilizing and rigidified closed-loop, or “short-circuits”, within the brain. These must be interrupted in order to facilitate the other efforts to establish human relatedness that is required for emotional and dendritic growth. Aggressive pharmacologic treatment, to remission, of carefully diagnosed Axis I conditions, including sleep disorders, is a cornerstone of our neuro-psychoanalytic model. The fearful, depressed or sleep-deprived brain cannot engage, connect, or sprout new learning circuits. This view also speaks to the necessity of interrupting April’s self-destructive patterns of impulsive sexuality, substance abuse and bulimic behavior, not only because they are “bad for her”, but because these patterns affect brain activity in ways which soothe distress but interfere with the conditions for neuro-plastic regeneration of synaptic connections.

Problem behaviors such as binge-eating and vomiting affect brain function through the severe and enduring disruption of serotonin, dopamine, and opioid systems. This leads to further affective disorganization then dissociative somnolence. Vomiting in bulimia, for example, is associated with decreased serotonin binding in the hypothalamus, disrupting regulation of appetite, satiety, and mood (Kaye, 2001). Nutritional restriction in anorexia actually diminishes brain volume with corresponding cognitive impairment, obsessiveness and emotional dysregulation. (cite?) Substance abuse directly affects brain neurochemistry through down-regulation, over-stimulation, or dissociation.

Even April’s promiscuity may be a misguided effort to activate the neuro-chemical mediators of attachment. Research shows that orgasm is associated with increased attachment through hormonal regulation of dopamine, opiod and oxytocin mechanisms. At Yellowbrick, April can experience a safe and secure alternative where an authentic belonging and intimacy provide the emotional and neuro-chemical context for connectedness.