Science of 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 is exceptional in having created a treatment center which has a coherent model based upon inter-disciplinary research and the clinical wisdom of experienced clinicians scholars. The pillars of the model include:
- Organizational integrity, commitment to excellence, innovation and outcome value.
- Physician owned and operated.
- Professional Staff directing and providing the treatment are senior, doctoral level and expert in their fields.
- Customized care and personal service.
- 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.
- Mindfulness as a foundational neuromodulation practice & technology.
- ReCognition for cognitive restoration and enhancement.
- 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.
- Core Competence Home Health: executive functioning, life skills, education & career skill development for facilitating experience of true competence; Staff continue with the patient and family through all levels of care.
- Intensive, multidimensional, developmentally attuned Family Model.
Yellowbrick has evolved its theoretical approach to assessment and treatment within the framework of developmental, interpersonal neurobiology. The model is founded on 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.
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,
- Resetting and 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)
Within this developmental framework, Yellowbrick’s treatment enhances brain neuroplasticity, removing interferences to neural growth, and otherwise facilitating the normative developmental maturation of the brain, mind and spirit during the window of emerging adulthood (late teens to early 30’s). In recognition of the vitally necessary foundation of nurturing relationships for neural and personal growth, all of Yellowbrick’s clinical services occur in the context of an Open Setting Therapeutic Community. This means that relationships are mutual, collaborative and transparent rather than based on power, control or responsibility for others’ choices. It is only under those conditions of interpersonal safety that authority can be located within the emerging adult and troubled parts of self will be willing to come forward.
Yellowbrick clinically operationalizes the power of research based neurobiological principles. Hope, which itself promotes neuroplasticity, is offered through explanation of the concepts of epigenesis and how adolescence through the third decade of life is a window of maturational opportunity due to enhanced neuroplasticity. Hippocrates understood something crucial about neuroplasticity over two millennia ago; “That which is used - develops; that which is not - wastes away”. Yellowbrick embraces this principle by offering repetitive experiences for learning and practicing of new skills and adaptive patterns in situ while living in the community. ReCognition is Yellowbrick’s brain gym utilizing neuropsychologist developed video games for enhancing neural growth in the network centers responsible for attention, concentration, working memory and processing speed. Most importantly, peer & staff as a Community encourage persistence and the taking of supported risks, both of which promote new neural networking. Donald Hebb in 1948 introduced the principle of “what fires together wires together”; “any two cells or systems of cells that are repeatedly active at the same time will tend to become 'associated' so that activity in one facilitates activity in the other”. This principle creates challenges as patient’s often have developed associative pathways which maladaptively link networks. Sexual arousal links with aggression from repeated viewing of pornography. Joy can only be experienced with substances. Power and connection to others becomes associated exclusively with videogame prowess. Yellowbrick works to undermine these pathways (ex: sobriety, Exposure Response Prevention) and create new pathways through experiences of connectedness, authentic intimacy and competence.
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 and thereby 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 impact is often incomplete and often takes weeks to months to have full effect.
Yellowbrick’s model initially prioritizes facilitating brain regulation as a precondition for introducing activating emotional learning. For those whom this approach remains insufficient, not just incomplete, after 12 weeks, a deeper neuro-psychoanalytic psychotherapy approach is required to bring the self-regulating power of the attachment systems further into the process.
Yellowbrick appreciates the level of personal and financial commitment required of families to secure world class care and personalized customer service. Treatment at Yellowbrick is customized. Individuals whose psychiatric condition has persisted for several years and/or created safety risks and/or a period of incapacity to function within a developmental continuum have better outcomes with a more extended support platform and continued intensive treatment at varying levels of care to sustain an enduring recovery (deMaat 2009, Webart 2012, Shedler 2010, 2018). While there is no minimum or maximum length of stay, Yellowbrick has created a flexible 8 month/34-week treatment plan which has three phases:
- Neuromodulation-Minding the Brain
- Self & Skill Consolidation
- Community Integration
Yellowbrick’s experience is that most individuals require a minimum of 12 weeks to regulate their brain, restrain from defeating behavioral patterns and practice new adaptive actions, establish sustaining collaborative connections with staff, peers and parents, and initiate actions consistent with values, interests and ambitions. Yellowbrick’s most intensive PHP level of care is therefore organized around a 12-week neuromodulation curriculum. Transition from The Residence to an apartment in Evanston supported by home visits often occurs successfully at the close of the Neuromodulation Phase of care.
Yellowbrick recommends for most individuals that there be a 4-week period of continued full-time programming following the Neuromodulation Phase with a shift to the full Life Strategies program within the Self & Skill Consolidation Phase. The next phase of treatment is an individualized 8-week extended period of Life Strategies IOP at a customized lower level of intensity. The last 8-week Community Integration segment of treatment involves individual and family work along with executive function and life-skill support while living in the community. Following transition from active treatment, Alumni in Good Standing are eligible for Tuesday and Friday night Community dinners, and Parents as Partners Sunday brunches with the Yellowbrick Community at no charge.
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
- CBT for insomnia
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 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.
- 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.
- Minding the Brain: a six-hour/day group program organized to restore neuro-regulation and associated command of behavioral impulsivity and symptoms. As described above this 12-week Partial Hospitalization program emphasizes Resetting the threat response and reward systems while beginning to establish new areas of emotional and instrumental competence.
- 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 (Soma-Self IOP).
- Center for Clinical Neuroscience (CCN) providing collaborative and genomically informed psychopharmacology, deepTMS, neurofeedback, and DTCS. All patients in all programs receive CCN services. CCN technologies are 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 is available for emerging adults receiving Partial Hosptalization or IOP sevices.
- Adolescent Services focused on emotional and behavioral regulation, identity formation and promoting individual and family resilience.
Yellowbrick hopes this description of our model and services can support trust and confidence in consideration of joining Yellowbrick in a partnership extending to the emerging adult, family, and the professional community. For those already working within Yellowbrick, it is out hope this description enhances your understanding and willingness to make full use of our model.
At Yellowbrick, emerging adults find their way home.
For more information, please contact Yellowbrick at 847-869-1500.