The Science Behind Yellowbrick
This introduction is an effort on Yellowbrick’s part to present to prospective emerging adults, their families, and professional referents with the scientific basis for Yellowbrick’s clinical model. Yellowbrick has evolved its theoretical approach to assessment and treatment within the framework of developmental, interpersonal neurobiology. The model is founded on a state of the art integration of current research and scholarship in the areas of evolutionary biology, neuroscience, developmental psychology, the full range of cognitive-behavioral & interpersonal (neuro-psychoanalytic) psychotherapies, and executive functioning/life-skills approaches in treatment. Within this developmental framework, Yellowbrick’s treatment attempts to enhance brain neuroplasticity and specifically to remove interferences to and otherwise facilitate the normative developmental maturation of the brain during the window of emerging adulthood (late teens to early 30’s).
The desired developmental outcomes of treatment with emerging adults are:
- Connected and coherent self,
- Resilience and effective self-regulation of emotion and behavior,
- Interpersonal effectiveness across a range of intimacy; build a support system,
- Maturation of motivation and reward systems,
- Effective self-care & wellness, executive function and life-skills,
- Renegotiate relationship with family towards connected autonomy.
(Arnett 2003, Schore 2012, Siegel 2012, Cozolino 2015)
A fundamental evidence-based premise of Yellowbrick’s model is that acute and/or complex psychiatric patients live in a state of brain dysregulation which defaults to automatic symptomatic and behavioral systems which negatively reinforce the dysregulation (Solms, Panksepp). The preponderance of treatment programs attempt to intervene with what are essentially learning and coping skill strategies at a time when the brain is too dysregulated to be fully receptive to these approaches. Medication alone is an insufficient neuromodulation effort in complex conditions because the automatic, default behaviors continue to undermine brain regulation and medication often takes weeks to months to have full effect. Yellowbrick’s model primarily targets facilitating brain regulation as a precondition for introducing (non-activating) learning through interpersonal, experiential and cognitive approaches. For those whom this approach remains insufficient, not just incomplete, after 6-8 weeks, a deeper neuro-psychoanalytic psychotherapy approach is required to bring the self-regulating power of the attachment systems further into the process.
Yellowbrick is exceptional in having created a treatment center which has a coherent model based upon research and the clinical wisdom of experienced clinicians and scholars. Professional Staff directing and providing the treatment are senior, doctoral level and expert in their fields. Staff continue with the patient through all levels of care. The pillars of the model include:
- Organizational integrity, commitment to excellence, innovation and outcome value,
- Physician owned and operated,
- Immersion in an Open Therapeutic Community of sober, age-related peers engaged in Real-Time Treatment rather than an as-if institutional compliance,
- Center for Clinical Neuroscience offering neuromodulation technologies,
- ReCognition for cognitive restoration and enhancement,
- Core Competence Home Health: executive functioning, life skills, education & career skill development for facilitating experience of true competence,
- Comprehensive array of supportive, skills-based, educational, experiential and in-depth neuro-psychoanalytic (Ginot, Schore) psychotherapies delivered by experienced and expert doctoral level professional staff.
Yellowbrick’s developmental, interpersonal neurobiological model is designed to calm the threat response (limbic) system, and thereby open receptivity to techniques for increasing cortical governance resulting in new learning and emotional growth. The model also facilitates the natural maturation of those brain systems which are coming “on-line” in the developmental window from age 16 into the young 30’s (Siegel 1999, Giedd 2012, Schore 2017). Yellowbrick’s intensive treatment program targets four dimensions of brain functioning necessary for disrupting maladaptive automatic default systems and behavioral patterns.
- Resetting the threat response (limbic) system.
Complex psychiatric conditions, often arising out of cumulative trauma, derail the functioning of the limbic system such that ordinary life creates ongoing anticipation of or actual re-experiencing of threats to physical and emotional safety. Individuals are in continual fight/flight (hyper) mode or have succumbed to a detached, dissociative state (hypo) of being shut down. Yellowbrick employs multiple evidence and research-based technologies to address these states of hyper/hypo arousal. These technologies include:
Increasing Cortical Governance
- Deep Transcranial Magnetic Stimulation (Brainsway)
- Direct Transcranial Stimulation(Alpha-Stim)
- Mindfulness embedded within the Yellowbrick culture
- DBT embedded within the Yellowbrick culture
- Mentalization (Fonagy 2010) embedded within the Yellowbrick culture
- Somato-sensorimotor psychotherapy (Ogden 2017), mind-body, drama and movement therapies
- Prescriptive exercise
- Support for sobriety & restraint from compulsive behavior patters
Yellowbrick’s assessment procedures using quantitative EEG and cognitive testing (CANTAB) dramatically demonstrate the derailing of cortical governance in complex psychiatric conditions. The latest research puts particular emphasis on the role of impaired cognitive functioning leading to poor response to treatment with subsequent chronicity and disability. Yellowbrick employs multiple evidence and research-based technologies to support the return of cognitive functioning while also not reactivating traumatic experiences early in the treatment. These technologies include:
Re-networking the reward/motivation system
- ReCognition; a brain gym using video games which target core cognitive functions such as attention, working memory and processing speed.
- Neurofeedback protocols prescribed by national expert
- Deep Transcranial Magnetic Stimulation (Brainsway)
- Sleep hygiene (CBTI)
- Nutritional planning
- Dialectical and Behavioral Therapy (DBT)
- Acceptance and Commitment Therapy (ACT)
- Cognitive Behavioral Therapy (CBT)
- Education about the brain in health and illness
- Reintegration into college, work or community service while in treatment
Trauma, repetitive disappointments and frustrations, persistent suffering, and the insidious impact of the maladaptive automatic default compulsive behavior patterns ultimately either demoralizes, thereby shutting down a sense of reward from daily life satisfactions, or it kidnaps the reward system such that only highly overstimulating, novel pursuits such as substance abuse bring any sense of vitality and relief of well-being (Bloom 2013). Having discussed this issue with multiple international clinician-scholars (Schore, Ginot, Ogden, van der Kolk, Solms), this is one of the most difficult challenges in our field; how to transform motivation from dopamine to oxytocin mediation. For this reason, Yellowbrick employs multiple evidence and research-based technologies to restore motivation including:
Facilitating Secure Attachment
- Facilitating experiences of competence (van der Kolk 2017)
- Eliciting authenticity over compliance
- Relationally co-created experiences of joy (Ogden, Panksepp, Davidson)
- Connection to Community
- Connection to education, career, community service
- Spirituality; facilitating a vision for a life that matters
- Interrupting compulsive behaviors with satisfying alternatives
- Connecting to and savoring one’s physical, sensory experience through mindfulness (Garland 2013)
- Nutraceutical supplementation (Bloom 2013)
- Relief from depression, anxiety and trauma symptoms
- Psychotherapy which restores hope through self-integration (Frank 1973)
- Expert family therapy to promote connected autonomy (i.e., supportive connections with family that facilitate healthy independence and growth)
Since the paradigm changing work of John Bowlby which was dramatically validated by the Harlow monkey and Romanian orphan studies, it has been increasingly evident that all human growth and development requires secure, safe and nourishing attachments. It has now been replicated by neuroimaging studies demonstrating that effective psychotherapy enhances neuroplasticity. Neuroplasticity is the molecular engine for creating new synapses which are the structural architecture of learning, healing and growth. In addition to cortical governance, attachments are a fundamental vehicle for effectively addressing emotional distress.
For the less troubled among us who seek mental health care, supportive and cognitive psychotherapy approaches activate latent potentials for secure attachment which had been suppressed during times of significant stress. In contrast, complex psychiatric conditions are embedded within persons whose attachment patterns and development have been arrested, derailed and distorted by trauma, illness, chronicity, the resultant distortion of family and community support systems, and the malignant consequences to one’s personhood from persistently living in terror, helplessness or pain. For these individuals, relationships become threats or at best barely useable for the emotional nutrients of emotional healing and growth. Tragically, relationships often become weapons of re-traumatization.
Yellowbrick’s experience is that for those individuals who have experienced a significant psychiatric occurrence (ex: singular trauma, onset of psychosis, major depression or mania, suicide attempt, etc.) but whose self-development has achieved some degree of secure attachment, transition to office outpatient care with enduring outcome and functioning can be achieved within the 12 week curriculum of care of Yellowbrick’s Neuromodulation Intensive Treatment Program as described above. For those with complex psychiatric disorders and severe personality disorders who need a more in-depth neuro-psychoanalytic psychotherapy approach (Schore 2012, Ginot 2015, Cozzalino 2017), length of stay in the most intensive levels of care averages 3-4 months and optimally extends at lower levels of care for another 4-8 months.
Yellowbrick’s Open Therapeutic Community model (Muller 2006) is the optimal platform for both supportive and in-depth psychotherapy. In contrast to traditional settings which operate on the basis of authority, power and subtle iatrogenic coercion, the Open Setting emphasizes transparency and collaborative relationships as the basis for safety and individual responsibility. This allows the deeper parts of the troubled self to come forward rather than hide in the face of others’ power.
Yellowbrick has 12 years of outcome data demonstrating the value of this model (L. Viner, 2019).
Yellowbrick’s services are offered to enable customization of level of care spanning residential to home health visits. Transitions best derive collaboratively from Family Rounds strategic planning meetings involving emerging adult, parents, Professional Staff and the Medical Director. Patients are followed by the same care team throughout their treatment regardless of level of care. Services include:
- The Assessment Center: 3-day comprehensive or 1-day focused specialty assessment.
- The Residence: 24 hour care living in a supported apartment building owned and staffed by Yellowbrick while attending a Partial Hospitalization level of care. The Residence also functions as a Community Center for all patients within all programs.
- Life Strategies Program (LSP): A six-hour group program organized to address the specific developmental challenges of emerging adulthood. Embedded within LSP are the neuromodulation principles of mindfulness, mentalization, DBT/ACT/CBT self-regulation skills, sensorimotor embodiment in tandem with direct neuromodulation technologies being offered within the Center for Clinical Neuroscience. LSP can be accessed at either a Partial Hospitalization or IOP level of care. Individual psychotherapy occurs 3x/week.
- Separate 3 1/2 hour specialty IOP Programs for adolescents, trauma recovery, addictions, eating disorders along with conditions presenting a troubled relationship between the body and self-experience.
- Center for Clinical Neuroscience (CCN) providing collaborative and genomically informed psychopharmacology, deepTMS, neurofeedback, and DTCS. All patients in all programs receive CCN services. CCN is also available as a standalone intervention for patients not in other Yellowbrick programs.
- Core Competence Home Health providing home visitation, cognitive enhancement, occupational therapy, executive function and life skills training, education & career counseling, nutritional counseling, activity and exercise prescription, wellness education.
Yellowbrick hopes this description of our model and services can support your trust and confidence in consideration of joining Yellowbrick in a partnership consisting of the emerging adult, family, and the professional community.
At Yellowbrick, emerging adults find their way home.
For more information, please contact Yellowbrick at 847-869-1500.