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The Neuroscience of Depression: New Opportunities for Effective Treatment; and the Developing Brain and the Neuroscience of Memory and Trauma

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The Neuroscience of Depression: New Opportunities for Effective Treatment; and the Developing Brain and the Neuroscience of Memory and Trauma applied neuropsychotherapy Childhood Trauma and Neural Development Indicators for Interventions with Special Reference to Rural and Remote Environments Pieter J Rossouw (MClin Psych; PhD; MAPS; MCClin) Unit for Neuropsychotherapy; School of Psychology, School of Social Work and Human Services, The University of Queensland urrent Neurobiological research indicates that most men- tal illnesses begin earlier in life than was previously believed (Insel, Fenton 2005). An alarming epidemiological study of 10,000 adolescents in the USA indicates that one in every four to five youths meets the criteria of a mental disorder with se- Cvere impairment across the lifetime (Merikangas et. al. 2010). The study indicates the need for strategies that are based on prevention and early intervention. Studies indicate the need for enhancing neural develop- ment by decreasing exposure to unhelpful stressors that up regulate the HPA (hypothalamus-pituitary-adrenal) axis (Schonkoff 2011). Schonkoff and colleagues (2011) indicate that interventions that enhance execu- tive function and self-regulation and enhance the abilities of vulnerable mothers (beginning as early as pregnancy), offer promising markers to protect the developing brains of their children from detrimental neural development. 2 Neuropsychotherapist.com Dr Pieter Rossouw Neural development & attachment significant resilience against the expres- sion of genetic risk. Animal studies by Shen The attachment relationship is central and Battersby clearly indicate protection in the development of early intervention against expressions of genetic risk through programs (Schore & Schore 2008). The neu- enriched environments (Shen & Battersby robiological basis of John Bowlby’s attach- 2000). Programs to enhance secure attach- ment theory (Bowlby 1969,1973,1980,1988) ments and the down regulation of stress re- points towards its biological nature – the sponses are highly indicated to reduce the structural connectivity of the right hemi- risk and onset of mental illness. sphere, limbic connectivity and neural fa- cilitation of the implicit self (Schore 2008). Whereas Bowlby focused on the behaviour- Childhood trauma & neural growth al and cognitive development in early child- Childhood trauma violates the basic hood, modern attachment theory focuses needs of attachment and control. Abuse on neural connectivity. Down regulation of (physical and/or emotional) up regulates the limbic alertness plays a vital role in the de- survival response and inhibits frontal corti- velopment of a safe, secure attachment re- cal sprouting. Early interventions to address lationship whereas unstable patterns (that is these needs are highly indicated. Effective unstable emotional or physical attachment) programs need to be based on two key prin- lead to insecure, ambivalent or disorganised ciples of neural anatomy and neural devel- attachment. opment: These attachment patterns tend to stabi- lise into long term patterns of functionality 1 The principle that the brain devel- or disfunctionality, depending on the initial ops from the bottom to the top: trajectory, with an alarming stability of sev- enty percent twenty years post initial as- o The first phase of neural develop- sessment (Waters et.al 2000). This study is ment involves the formation of the primi- in line with the trend projected by the study tive brain – the brain stem, pons and the of Merikongas 2010. cerebellum (the survival systems). Large Violations of the basic human needs numbers of precursor (stem) cells activate for attachment and control (Epstein 1993; the production of specific neurons in target- Grawe 2007), lead to the onset of up-regu- ed areas (up to 250,000 per minute). Violations of the basic human needs for attachment and control, lead to the onset of up-regulated limbic alertness, down regulation of cortical neural sprouting, and decreased right frontal cortical development lated limbic alertness, down regulation of o The second phase of neural devel- cortical neural sprouting, and decreased opment involves the development of the right frontal cortical development – the paleomammallian brain - limbic structures key risk factors for the onset of mental ill- – thalamus, amygdala, hypothalamus, hip- ness. It is a well-established fact that the pocampus and basal ganglia (the stress and right frontal cortex is in a critical growth emotional response systems) period from the last trimester of pregnancy o The third phase of neural develop- to ten months post birth and in a second- ment is the development of the cortical re- ary growth period from ten months to thirty gions – the neocortex (the executive control six months (Schore 2012). Genetic factors systems). are expressed, through the interaction with the environment (experiences) and long 2 Second: the principle of neural de- term patterns of response to environmen- velopment and proliferation. The principle tal stimuli are facilitated during this time in of neural development indicates that the neural patterns. A secure attachment pro- brain is not fully developed at birth. vides an enriched environment to facilitate Neuropsychotherapist.com 3 Childhood Trauma & Neural Development The first area of the brain to fully devel- bic” structures (MacLean 1990) – the thala- op is the brainstem and then the lower part mus (chamber), the amygdala (almond) the of the midbrain. These areas control bod- hypothalamus (below-chamber) and the ily functions necessary for life – sometimes hippocampus (sea horse). These structures referred to as the autonomic functions, At evolve on each side of the brain as it begins birth, these lower functions are fully devel- to development towards the two hemi- oped and functional facilitating basic sur- spheres in the cortical regions. vival responses: breathing, eating, sleeping, The limbic areas are fully developed at seeing, hearing, smelling, making noise, birth but do not function optimally (in com- By year three the young brain has up to three trillion neural connections feeling sensations and recognising people. parison to the brain stem areas that are fully These are crucial functions – all needed operational at birth. These areas need en- for basic survival. Violation of any of these vironmental interaction to assist with the functions will compromise survival. This is activation process. During the first ten to the area that MacLean named the primitive twelve months of the newborn’s life most of / reptilian brain – a capability shared with the expressions of these functions occur. In- all living creatures. This neurological ability put from the environment shapes the limbic is crucial in the quest to understand mental structures. well-being and disorders. Recent findings in The infant brain comprises around one neuroscience indicated that synaptic con- hundred billion neurons. Each neuron has up nections (synaptic potentials) form the ba- to ten thousand synapses – resulting in a ca- sis of what constitutes “an individual” and pacity of one trillion connections. During the when neural connections change, the neu- first ten months post birth synaptogenesis ral networks change resulting in the indi- is facilitated at blistering pace. By year vidual “changing” – emotionally, cognitively three the young brain has up to three tril- and behaviourally. These changes facilitate lion neural connections. Then the process healthy development (given safe, enriched turns around – the neural connection re- environments) or pathology (in situations duces at an even more blistering pace – mil- where there are violations of basic needs). lions of connections stop connecting every The second region that develops in the minute – reducing the connections back to prenatal brain is the region that involves around one trillion within a few years. And the structures on top of the brain stem and whist this reduction is happening the brain lower midbrain – the areas in the upper mid- is still developing through the process of brain section. McLean coined the term “lim- neural pruning as the neural network be- 4 Neuropsychotherapist.com Dr Pieter Rossouw comes stronger. Effective pruning is vital for connections. These activities lead to chang- effective growth but it can only activate ef- es in cortical blood flow from the upper neu- fectively in a down regulated limbic system ral (cortical) regions to the deeper neural re- facilitated by a healthy, supportive and rich gions to ensure effective ability to maximise environment. the survival response. Over activation of this Violation of the safe environment (any survival mechanism leads to inhibition of threat to basic safety, or basic needs) also neural sprouting to the cortical areas. Ongo- leads to changes in the synaptic connec- ing activation of this pattern has an inverse tions. These changes result in closed neural relationship with long term neural sprouting systems of protection that are facilitated and proliferation (Rossouw 2012). In severe by the overproduction of stress hormones cases of violation, atrophy occurs in key lim- (adreno-corticotrophin hormone, adrenalin bic areas (especially the hippocampus), and and cortisol) which push the brain into con- cortical regions (anterior cingulate and sub- stant hyper alertness and closed neural fir- genual areas of the prefrontal cortex), and ing – altering the networks of healthy neural hinders the ability of the individual to man- patterns. age even low intensity stress. Cognitive, and The third phase of neural development especially emotional, development is also
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