Tuesday, December 4, 2007

Affect Regulation

Schore, A.N. (2002). Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder, Australian and New Zealand Journal of Psychiatry, 36, 9-30.

This article is by Allan Schore, a doctor in UCLA’s department of Psychiatry and an impressively well-published author. Schore’s style is to assimilate interdisciplinary literature into unified theories of brain function. This review article does well to illustrate his approach by integrating the latest thinking from attachment theory, affective neuroscience, developmental stress research, and infant psychiatry into a theory on post-traumatic stress disorder (PTSD). The article drives home several key points:

(1) The individual response to stressful stimuli may or may not be adaptive.

(2) Current evidence shows that the neural circuitry of the stress system is located in the early developing right brain, the hemisphere that is dominant for affect regulation and inhibitory control.

(3) The development of the right brain is highly experience-dependent, and this experience is primarily mediated by the dyadic attachment relationship that develops between caregiver and infant. Simply put, the mother plays a key role in co-regulating the infant’s postnatally developing nervous system, particularly its stress responses. At a very early age, we thereby rely on and learn strategies from our mothers on self-regulation of emotion. As such, if either the mother or the child is improperly psychobiologically attuned to the body-based states of the self or the other (for whatever reason), this can have detrimental effects on the child’s autoregulatory mechanisms which are still under construction.

(4) This point I will offer more parenthetically. Social stressors are far more detrimental than non-social aversive stimuli. As an example, abuse or neglect would be likely to have a much more deleterious effect on the infant brain than assaults from the nonhuman or inanimate, physical environment. From this, I think one can conclude our brains are more specially honed to social cues than to other types of input.

(5) Due to the shape of the human developmental arc, early experiences in life may be particularly important in shaping an individual’s responsiveness later in life. As developmental effects are almost always cumulative, building on the brick and mortar that has already been laid by previous developmental processes, later growth is “limited by the adequacy of already-formed, underlying networks, and therefore maturation is optimal only if the preceding stages were installed optimally”.

(6) Stress effects are also shown to be cumulative. Whereas acute stress produces short-term and reversible deficits, repeated, prolonged, chronic stress can lead to irreversible or only partially reversible enduring effects.

Add it all up and essentially Shore has conceived of a vignette in which the experiences of the maturing infant can establish inefficient coping mechanisms and individual “dissociation” in times of stress, seen behaviorally even many years later in adulthood. The crux of it… “Optimal attachment experiences allow for the emergence of self-awareness, the ability to sense, attend to, and reflect upon the dynamic changes of one’s subjective self states, but traumatic attachments in childhood lead to self-modulation of painful affect by directing attention away from internal emotional states.” More impressive yet are the 246 citations he makes in an 18-page article!

What is personally interesting to me is the take-away that our development – and in this case, our emotional development – is so unambiguously externally mediated, especially by close parental and familial relationships. (We actually see a reasonable case for the intergenerational transmission of regulation and coping strategies.)

But more importantly, we are essentially “propped” or “wired up” to learn via social mechanisms from people with whom we have intimacy. Said another way, certain parts of the brain may be more receptive to reprogramming by social “interfacing” than by other mechanisms, perhaps even in adulthood. This idea is central to Schore’s thinking on the therapist-patient relationship, which he expounds upon in his three-book-set on Affect Regulation.

1 comment:

Joanna said...

Nice summation of Schore's basic concepts in easy to understand language. His research is bringing deeper information and fresh insight into the social sciences. Happily this work is helping to provide more effective ways to ease some human suffering.

I have the good fortune to be a participant in one of his Los Angeles ongoing seminars. To work with him is inspiring. It's as if we see the process of evolution in action.

The learning is helpful to me in the treatment of eating disorders.
Right brain development and the establishment of a trustworthy sturdy relationship during the psychotherapy work is essential for the work to be effective.

Thank you for bringing this important information so clearly and gracefully to the blogging population!

Joanna Poppink, MFT