Affect Regulation Therapy (ART)for the treatment of cognitive and

health disorders

Mitchell R. Slutzky, Ph.D.CHE Senior Services

March 27, 2011Alzheimer’s Disease International,

Toronto

Conflict of Interest Disclosure Mitchell Slutzky, Ph.D.

Has no real or apparent conflicts of interest to report.

Key Concepts

Affect Regulation Therapy (ART) can improve cognitive functioning and physical health of persons with dementia

Catastrophic affect upsets the balance of the immune system and creates or exacerbates memory disturbances

Positive emotions benefit cognitive, emotional and physical health by reregulating the immune system

Many people with dementia can improve positive emotions with practice, even if cognitive memory is impaired (as long as emotional circuitry is better preserved)

What is Affect Regulation Therapy? Built upon work of Allan Schore Empathy and secure attachment reduces catastrophic affect

extremes Hyperactivation: Fight-Flight Hypoactivation: Dissociation

Teaches one to recognize extreme affect states Re-evocation of traumatic event recalled in context of safety

leads to a more positively-valenced affective response Positive affect state strengthened with each reinforcement in

context of safety Improves brain neuroplasticity Improves endocrine and immune system Has direct application to improve functioning

Even with cognitive impairment or health disorders

Allan Schore: Affect Regulation Theory

Early social environment, mediated by primary caregiver, influences developing brain structures

Maturation of the right orbitofrontal cortex is dependent upon dyadic interactions of the attachment relationship

Predicts the child’s future capacity to:self-regulate emotionsappraise others’

emotional states

Polyvagal Theory: Evolution of Three Survival Strategies (Stephen Porges)

Dorsal Vagus Nerve/Primitive Parasympathetic NS In response to threat perceived as life threateningPrimitive, not myelinated

Role: Shuts down to conserve metabolic functions Sympathetic Nervous System

In response to perceived danger (escape possible)Role: Activates fight-flight

Ventral Vagus Nerve/Evolved Parasympathetic NSArises only in the context of secure attachment SafetyOnly in mammalsMyelinatedRole: can calm in face of danger by inhibiting fight-flightAllows for attachments, well-being, balanced health

Safety: Balanced well-being Stilling and Stimulating both in balance

Occurs only when feeling safemaximizes brain health and function

memory and other cognitive functionsmaintains capacity for positive emotionsmaximizes capacity for

compassionsocial connectionindividuality

improves immune system functioningregulates appetite and sleep

Whole is greater than sum of the parts

How ART reduces cognitive impairment Cognitive and emotional

systems develop parallel to each other

Emotional memory remains relatively preserved in the amygdala after cognitive memory fades with damage to the hippocampus

Build up amygdala’s emotional memory systems when hippocampal cognitive memory erodes

Key Memory Areas Lay Under the Neocortex In the Limbic System

Two ways emotional trauma leads to dementia Step 1: Response to perceived danger is Fight Flight

Amygdala initially becomes hyper-activated Plaques and tangles accelerate Too much cortisol erodes the hippocampus Hippocampal deterioration accelerates memory loss

Step 2: If perceived as life threatening leads to Dissociation Amygdala becomes underactive Metabolic preservation of hippocampus β-endorphin numbs and enhances reality distortions Functional deficit: memory loss but hippocampus is preservedEither way:

When faced with cues that re-evoke earlier trauma, the original affect state is triggered accelerating injury

Amygdala continues to record memories and the emotional significance of related events

Explicit Memory deteriorates but Implicit Memory remains intact longer

Cycles of dysregulated affectHyper-activation to dangerFight-Flight Reflex: Anger/fear(Over-stimulating sympathetic NS)Cortisol dysregulation

Hypo-activation when life threateningDissociation/withdrawal/detachment(Over-stilling Dorsal Vagus Nerve)Beta-endorphin dysregulation

Normal emotionalrange

Slutzky’s theory, 2010adapted from Fosha and Schore, 2009

Safe/ConnectedVentral Vagus nerve Right frontal orbital lobe both optimizedRegulated alpha-msh

Acute Hyper-activationIn Response to Stress

Increased Sympathetic NS (Fight/Flight)Hyper-recording of memory

“light bulb burning too bright”Increased cortisol secretion and burnDecreased inflammationSuppressed immune response

Do not appear sick even if have a germGet sicker when immune system finally kicks in

Chronic Hyper-activationChronic high cortisol levels:

Damages hippocampus memory (Alzheimer's and other dementias)

Underactive immune systemIncreased risk of cancer or immunodeficiency

or:Depleted supply of cortisol from chronic

hyperactivtionIncreased inflammatory responseImmune system overactive Increased risk of autoimmune disorders

Osteoarthritis Crohn’s DiseaseMultiple Sclerosis Parkinson’s Disease

Acute Hypo-activationIn Response to Stress

Fewer memory frames per second“light bulb not burning bright enough”

Increased Parasympathetic NS decreasesHeart rateRespiration/O2 requirementsBlood pressure

Other Effects:Increased Endorphins/EnkaphalinsDecreased sensation of pain

Chronic Hypo-activation

Chronic flooding of beta-endorphin:Dissociative disorders

DID, somatoform disorders, emotional numbing, fuguesOr:

Depleted supply of endorphins while hypoactivated:DepressionChronic painSubstance abuseSocial isolation

Memory impairment either way

Neuroplasticity through A.R.T.

Positive stimulation through A.R.T. improves

ThinkingLearningActing Changes Brain:Physical StructureFunctional OrganizationFrom Top to BottomNeuroplasticity continues to occur at any age

Dr. Michael Merzenich

Major Researcher in Neuroplasticity

All you need is LOVE

Look empathically: contain fight-flight & prevent dissociation (Auxiliary Amygdala)

Organize emotional and cognitive memory (Auxiliary Hippocampus)

Validate feelings to re-integrate affective and cognitive memory and to enhance reasoning (Auxiliary Right Prefrontal Cortex)

Evaluate effectiveness of intervention

(R)epeat (modify if necessary) to reduce catastrophic affect, consolidate memory and establish a polysemantic context that enhances encoding and retreival

© Mitchell Slutzky, 2011

Affect Regulation and Brain Exercises

Progressively challengingUse the Goldilocks

principle: “just right”Strengthen:

AttentionSpeed of processingRecent memoryPlanning skills

Affect Regulation through Aromatherapy: essential oils

Lavender: StillingCalms anxiety, fear or anger

Sandalwood: ConnectingMaintains positive emotions

Ylang-Ylang: StimulatingBrightens mood Increases energy

Myrrh: MotivatingReduces apathy

Aromatherapy appears to trigger changes in neurochemistry especially in the emotional brain

Never use full strength: Put a few drops in a “carrier oil”

or buy it in dilution “ready to use”

Conclusions:Affect Regulation Therapy reduces intensity of

negative emotionsNegative emotions harm all aspects of lifePositive emotions heal the whole person:

CognitivelyEmotionallyPhysically

Positive emotions can be cultivated through a balance of stilling and stimulating

Even in persons with dementia

All you need is LOVE

Look empathically: contain fight-flight & prevent dissociation (Auxiliary Amygdala)

Organize emotional and cognitive memory (Auxiliary Hippocampus)

Validate feelings to re-integrate affective and cognitive memory and to enhance reasoning (Auxiliary Right Prefrontal Cortex)

Evaluate effectiveness of intervention

(R)epeat (modify if necessary) to reduce catastrophic affect, consolidate memory and establish a polysemantic context that enhances encoding and retreival

© Mitchell Slutzky, 2011

Thank you

Mitchell R. Slutzky, Ph.D.

CHE Senior Services

mslutzky@gmail.com