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CSAR’s library includes articles and video lectures by thought leaders in the fields contributing to affect regulation theory.  The articles, videos and associated CE credits are free.
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Topics in Affect Regulation:

Attachment Theory

  • Affect regulation theory. A clinical model. Introduction
  • In this introduction to Dr. Hill’s book Affect Regulation Theory: a Clinical Model key concepts are introduced including affect, affect regulation, how affect is communicated unconsciously, the neurobiology of affect regulation and the primary and secondary affect regulating systems. It also introduces the reader to an understanding of how affect regulation is key for adaptive functions and why deficits in affect regulation manifest as psychiatric symptomatology and personality disorders.... (read more)

  • Affect regulation theory. A clinical model. Chapter 1
  • In Chapter 1 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents classic attachment theory. The Strange Situation and Adult Attachment interview are described along with the concepts of secure and insecure (avoidant, preoccupied and disorganized) attachment patterns. Additionally the reader is introduced to how each of the insecure patterns represent different deficits in affect regulating capacity in comparison to the robust affect tolerance and resiliency of secure attachment.... (read more)

  • Affect regulation theory. A clinical model. Chapter 2: Self-states
  • In Chapter 2 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of bodymind organized around the relational theory of self states. The central idea is that when regulated self states are integrated and when dysregulated self states are dissociated. Self states are conceived as assemblages of perceptual, attentional, representational, memory and reflective systems. Each system may be integrated or dissociated. Additionally, two types of dissociation – compartmentalization and altered states of consciousness are discussed.... (read more)

  • Affect regulation theory. A clinical model. Chapter 3: Neurobiology of the primary affect-regulating system.
  • In Chapter 3 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents the neurobiological substrate of the primary affect regulating system. The components of the limbic system (amygdala, insula, hippocampus and prefrontal cortex are discussed. Additionally the relationship between the limbic system, HPA axis, and autonomic nervous systems are outlined. Each is involved in the assessment of internal and external stimuli and in the automatic regulation of affect.... (read more)

  • Affect regulation theory. A clinical model. Chapter 4: Right brain, implicit processes and implicit self
  • In Chapter 4 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of the right brain understood to be the seat of the “Implicit self”; i.e. the unconscious processes that assess and respond involuntarily to internal and external events. Comparisons are made to the explicit processes mediated by the left brain. These processes include implicit vs explicit memory, implicit cognition and implicit communication. Together they comprise the implicit (unconscious) self.... (read more)

  • Affect regulation theory. A clinical model. Chapter 5: Classical attachment theory.
  • In Chapter 5 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes how optimal affect regulating capacity is developed in the secure attachment relationship. Classical attachment theory is presented including Bowlby’s ideas about the internal working model as a means of evaluating and predicting relationships and its assimilative function. Additionally, an understanding Adult Attachment Interview and presented from the point of view of affect regulation.... (read more)

  • Affect regulation theory. A clinical model. Chapter 6: Mentalization. The secondary affect-regulating system.
  • In Chapter 6 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes the processes of Mentalization which comprise the secondary (conscious) affect regulating system. The development of the system is discussed and each mentalizing mode (teleological, object equivalence, pretend, and full Mentalization) are described. Perhaps most importantly, the Mentalization of affect is discussed and the system secondary/ mentalizing affect regulating system is compared with the primary system.... (read more)

  • MBT Treatment: “What works for Borderline Personality Disorder?”
  • In this video Professor Fonagy explains the concept of mentalization: what it is, its uses in the relationship with others and the self, how it develops in the human mind and the risks of losing this capacity. He creates a multidimensional model with 4 dichotomies that need to be balanced for an optimal mentalization function. Using this model to understand BPD, he shows the several difficulties these patients have to access mentalization. While other therapeutic techniques ask the patient to use mentalization capacities they don´t have, MBT tries to balance the functioning in the 4 dimensions to help patients achieve mentalization. ... (read more)

  • Dysregulation of the Right Brain: a Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder
  • Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.... (read more)

  • Understanding Maltreating Mothers: A Synthesis of Relational Trauma, Attachment Disorganization, Structural Dissociation of the Personality, and Experiential Avoidance
  • Treatment options are limited for families in which the child has severe and intractable disturbances of emotion and behavior, in which there is suspected or confirmed maltreatment by the mother, and in which the mother has her own history of childhood neglect and abuse. This paper proposes a model for understanding mal- treatment in mother–child dyads, drawing upon the developmental psychopathology, behavior, and trauma literatures. At the core of this model is the hypothesis that a mother’s maltreating behav- ior arises from unconscious attempts to experientially avoid the reemergence of an attachment-related dissociative part of the per- sonality that contains the distress arising from her own early experiences of attachment relationships. The implications of this model for therapy are considered. ... (read more)

  • An Attachment Perspective on Psychopathology
  • In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology.... (read more)

  • An Ethological Approach to Personality Development – Ainsworth & Bowlby
  • This is a historical account of the partnership in which Bowlby and Ainsworth participated to develop attachment theory and research. Beginning with their separate approaches to understanding personality development before Ainsworth joined Bowlby's research team at the Tavistock Clinic in London for 4 years, it describes the origins of the ethological approach that they adopted. After Ainsworth left London, her research in Uganda and in Baltimore lent empirical support to Bowlby's theoretical constructions. The article shows how their contributions to attachment theory and research interdigitated in a partnership that endured for 40 years across time and distance. ... (read more)

  • The Nature Of The Child’s Tie To His Mother – Bowlby
  • Psycho-Analysts are at one in recognizing the child's first object relations as the foundation stone of his personality: yet there is no agreement on the nature and dynamics of this relationship. No doubt because of its very importance, differences are sharp and feelings often run high. In this paper I am taking it for granted that today we are all agreed on the empirical fact that within 12 months the infant has developed a strong libidinal tie to a mother-figure and that our differences lie in how this has come about. What in fact are the dynamics which promote and underlie this tie?... (read more)

Boston Change Process Study Group

  • Non-Interpretive Mechanisms in Psychoanalytic Therapy: The Boston Change Process Study Group
  • It is by now generally accepted that something more than interpretation is necessary to bring about therapeutic change. Using an approach based on recent studies of mother-infant interaction and non-linear dynamic systems and their relation to theories of mind, the authors propose that the something more resides in interactional intersubjective process that give rise to what they will call implicit relational knowing. This relational procedural domain is intrapsychically distinct from the symb... (read more)

Categorical/Declarative Affect

  • Enjoyable Emotions
  • This is a chapter from Paul Ekman’s book Emotions Revealed: Recognizing Faces and Feelings to improve Communication and Emotional life. This and the other chapters from the book available in CSAR’s library are a wonderful starting place for a deeper understanding of the categorical affects (aka declarative affects) — the ones with names. Dr. Ekman’s work follows on Darwin’s proposal that there are 7 emotions found across all cultures and each has a corresponding, wired in, facial expression. They are the hyper- aroused affects of anger, surprise, fear and pride, and the hypo-aroused affects of sadness, shame and disgust. This chapter is a discussion of enjoyable emotions. ... (read more)

  • Behaving Emotionally
  • This is a chapter from Paul Ekman’s book Emotions Revealed: Recognizing Faces and Feelings to improve Communication and Emotional life. This and the other chapters from the book available in CSAR’s library are a wonderful starting place for a deeper understanding of the categorical affects (aka declarative affects) — the ones with names. Dr. Ekman’s work follows on Darwin’s proposal that there are 7 emotions found across all cultures and each has a corresponding, wired in, facial expression. They are the hyper- aroused affects of anger, surprise, fear and pride, and the hypo-aroused affects of sadness, shame and disgust. This chapter is a discussion of behaving emotionally. ... (read more)

  • Anger
  • This is a chapter from Paul Ekman’s book Emotions Revealed: Recognizing Faces and Feelings to improve Communication and Emotional life. This and the other chapters from the book available in CSAR’s library are a wonderful starting place for a deeper understanding of the categorical affects (aka declarative affects) — the ones with names. Dr. Ekman’s work follows on Darwin’s proposal that there are 7 emotions found across all cultures and each has a corresponding, wired in, facial expression. They are the hyper- aroused affects of anger, surprise, fear and pride, and the hypo-aroused affects of sadness, shame and disgust. This chapter is a discussion of anger. ... (read more)

  • Surprise and Fear
  • This is a chapter from Paul Ekman’s book Emotions Revealed: Recognizing Faces and Feelings to improve Communication and Emotional life. This and the other chapters from the book available in CSAR’s library are a wonderful starting place for a deeper understanding of the categorical affects (aka declarative affects) — the ones with names. Dr. Ekman’s work follows on Darwin’s proposal that there are 7 emotions found across all cultures and each has a corresponding, wired in, facial expression. They are the hyper- aroused affects of anger, surprise, fear and pride, and the hypo-aroused affects of sadness, shame and disgust. This chapter is a discussion of surprise and fear.... (read more)

Complex/Developmental Trauma

  • Sex Addiction as Affect Dysregulation
  • Dr. Katehakis gives a historical perspective on the evolution of the understanding of sex addictions. She explains the theory of regulation developed by Dr. Schore and explains sex addiction as a regulatory process to deal with chronic states of dysregulation. A successful therapy is the one that accomplishes the integration of the right and left brains. In her practice, she uses CBT techniques and ART.... (read more)

  • The Body Keeps the Score: Brain Mind and Body in the Healing of Trauma
  • Dr. van der Kolk describes the effects of trauma in the body, brain and mind. A particular emphasis is put in the bodily manifestations of trauma and the fact the traumatic past events remain in the body as a present threat. He discusses the uselessness of traditional therapeutic techniques and introduces EMDR as a successful treatment for PTSD, explaining its technique, how it works and presenting some data that supports its effectiveness. As a conclusion, Dr. van der Kolk says that the aim of treating PTSD is to deactivate trauma and reset the limbic system, allowing for a reconnection with the body.... (read more)

  • Developmental Trauma Disorder: Towards a Rational Diagnosis For Children With Complex Histories
  • Childhood trauma , including abuse and neglect, is probably our nation’s single most important public health challenge, a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year over 3,000,000 children are reported to the authorities for abuse and/ or neglect in the United States of which about one million are substantiated. Many thousands m o re undergo traumatic medical and surgical procedures, and are victims of accidents and of comunity violence. However, most trauma begins at home: the vast majority of people (about 80 %) responsible for child maltreatment are children’s own parents. One of van der Kolk’s most important contributions has been his effort to alert the field to the frequent occurance of developmental trauma (aka complex trauma) and his (still frustrated) attempts to have it become a recognized diagnosis. In this article he describes the central role of affect regulation, the dynamics of childhood trauma, it’s prevalence in the etiology of psychiatric illness and treatment implications. ... (read more)

  • Working with the Neurobiological Legacy of Early Trauma
  • The author describes how the brain reacts to trauma. She then discusses the long-term effects of trauma on a person’s neurobiology; she uses neurobiology, in turn, to inform how therapy should be conducted for those affected by trauma. Sensorimotor Psychotherapy is offered as a means to help clients overcome their trauma.... (read more)

  • An Attachment Perspective on Psychopathology
  • In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology.... (read more)

  • Adverse Childhood Experiences Video
  • Dr. Vince Felitti presents the results of his ground breaking study on adverse childhood experiences. No study has had greater impact on the understanding of the impact of developmental trauma on adult psychological and medical pathology and age of death. Being aware of these findings is crucial for work.... (read more)

  • Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond VIDEO
  • Dr. Ruth Lanius, from the University of Western Ontario, discusses the broad physical effects of adverse childhood experiences and their role in posttraumatic stress disorder. An overview of the neurobiology of posttraumatic stress disorder is presented as well as implications of findings on attachment and intergenerational transmission of trauma.... (read more)

Disorders of Affect Regulation

  • Addictions and Trauma Recovery
  • The author addresses the role that addiction plays in the lives of trauma survivors. Furthermore, she points out how addictions act as a coping mechanism and what happens during abstinence. The therapist, she claims, must be aware of the reasons behind why the addiction started in order to best be able to help the patient as he or she begins to overcome the addiction. Additionally, she explains how helping the patient understand how the addiction aided him or her and how the therapies will help him or her cope in a different way is necessary for a true recovery.... (read more)

Dissociation

  • Dissociative Phenomena in the Everyday Lives of Trauma Survivors
  • Interest in dissociation, as a mental ability and as a set of symptoms secondary to trauma, has re-vitalized in the past ten years following a one hundred year hiatus between the work of Janet and the work of the pioneers in the field of trauma in the 1980s and 90s (van der Kolk, 1997; Putnam, 1999; Chu, 1998). Although we have a better understanding of dissociation now than we did ten years ago, it is still a very controversial subject in the field of mental health because it is so routinely equated with Dissociative Identity Disorder. As a result, even experienced clinicians miss the frequent more subtle presentations that appear in our offices on a daily basis. If we look instead to understand dissociation as we would any other mental state phenomenon, we will begin to see that all human beings dissociate, and much of our dissociativeness is adaptive.... (read more)

  • The Contribution Of Hughlings Jackson To An Understanding Of Dissociation –Meares
  • The author provides a preliminary framework for a systematic and dynamic understanding of dissociation through a consideration of the theories of Hughlings Jackson. Jackson’s ideas are briefly reviewed. He saw the proper scientific investigation of mental illness as an experimental investigation of mind. Accordingly, his argument begins with this fundamental concept. His views of the brain-mind relationship and of mind, or self, resemble modern conceptions. He viewed the self as double and focused on those disruptions of the self system which he called the “dreamy state.” This state involves an “uncoupling” of normal consciousness, resulting in the loss of the most recently developed forms of memory and of the stream of consciousness. Dissociation is seen here as analogous to the dreamy state. Jacksonian theory predicts the main features of dissociation, i.e., constriction of consciousness, a particular form of amnesia, disaggregation of perceptual phenomena, depersonalization, derealization, and hallucinosis. It leads to the view that dissociation can be seen, in essence, as an uncoupling of consciousness.... (read more)

  • Dissociation & The Fragmentary Nature of Traumatic Memories: Overview & Exploratory Study
  • Since trauma is an inescapably stressful event that overwhelms people's coping mechanisms it is uncertain to what degree the results of laboratory studies of ordinary events have relevance to the understanding of traumatic memories. This paper first reviews the literature on the differences between recollections of stressful and of traumatic events. It then reviews the evidence implicating dissociative processes as the central pathogenic mechanisms that give rise to PTSD. We present the results of a systematic exploratory study of 46 subjects with PTSD which indicates that traumatic memories are retrieved, at least initially, in the form of dissociated mental imprints of sensory and affective elements of the traumatic experience: as visual, olfactory, affective, auditory and kinesthetic experiences. Over time, subjects reported the gradual emergence of a personal narrative that can be properly referred to as "explicit memory". The implications of these findings for understanding the nature of traumatic memories is discussed.... (read more)

  • On Trauma – Allan Schore Group
  • Following a summarizing introduction by Allan Schore Richard Carr presents a case vignette that demonstrates the clinical relevance of a construct that is now central to stress models in biology and neuroscience, allostasis. This concept, the process by which physiological stability is maintained in the face of change, has not yet appeared in the psychoanalytic literature, thus highlighting the import of Carrs contribution. This is followed by an article in which Jane R. Wheatley-Crosbie focuse... (read more)

Early/Infant Relational Trauma

  • Dysregulation of the Right Brain: a Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder
  • Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.... (read more)

Interpersonal Neurobiology

  • Beyond Words: A Sensorimotor Psychotherapy Perspective
  • Ogden highlights the importance of non-verbal communications. The awareness to indicators such as prosody, eye contact, facial expression, preparatory movements, arm movements, posture, proximity and locomotion can provide us with important information about the patient´s implicit self and their implicit relational knowing. She presents clinical examples to understand how this is played out in therapy and what can the therapist do to help patients be aware of their non-verbal communications. ... (read more)

  • Modern attachment theory: the enduring impact of early right-brain development
  • Dr. Schore centers his talk on the importance of the early right brain development for the future functioning and well-being of a person. He describes a shift in science that currently gives emotions and to the regulation of emotions a privileged place. The attunement and co-regulation in the relationship between the mother and the baby has a fundamental impact on the regulation of emotions. Current research shows that emotional dysregulation and problems in the right brain are present in every pathology. ... (read more)

  • Human Nature and Early Experience
  • The Polyvagal Theory provides a new perspective to explore how autonomic nervous system function relates to social behavior, emotional regulation, and health. The Polyvagal Theory links the evolution of the autonomic nervous system to affective experience, emotional expression, facial gestures, vocal communication, and contingent social behavior. The theory, by being informed by the phylogeny of the autonomic nervous system, expands our understanding of normal and atypical behavior, mental health (e.g., coping with stress and novelty), and psychiatric disorders (e.g., autism, anxiety disorders, PTSD). The theory emphasizes that the core deficit in behavioral and affective regulation that is associated with several psychiatric disorders, especially disorders diagnosed in children, is related to neural regulation of the autonomic nervous system. By incorporating a developmental perspective, the theory explains how typical and atypical maturation and regulation of autonomic function forms the neural “platform” upon which social behavior and the development of safe trusting relationships are based. The theory explains how the nervous system evaluates risk in the environment, without awareness and often independent of a cognitive narrative, through a process labeled “neuroception.” Neuroception attempts to support adaptive behaviors by matching autonomic state with the neuroceptive state of risk (i.e., safe social environment, danger, and life threat). Abuse and trauma may reset neuroception to protect the individual from others when there is no “real” danger resulting in defensive and often aggressive responses to friends and caregivers... (read more)

  • Working with the Neurobiological Legacy of Early Trauma
  • The author describes how the brain reacts to trauma. She then discusses the long-term effects of trauma on a person’s neurobiology; she uses neurobiology, in turn, to inform how therapy should be conducted for those affected by trauma. Sensorimotor Psychotherapy is offered as a means to help clients overcome their trauma.... (read more)

  • Embryonic & Neural Development: Setting the Stage for the Lifespan
  • Dr. Charles A. Nelson, from the Children's Hospital Boston, gives a detailed discussion on the process of embryonic and neural development. He begins with a chronological discussion of the process involved in pre-natal development, followed by an overview of the stages of brain development. The presentation concludes with a thorough discussion of neural plasticity and its relationship to environmental experiences.... (read more)

  • Factors Influencing Brain Development
  • Dr. Bryan Kolb, from the University of Lethbridge, gives an in-depth lecture on the neurology behind brain development. He says different experiences build different brain structures, which in turn function differently. Contrary to what was long thought, our genes are not set in stone. Environments and experience change the expression of our genes, and those changed genes can be passed along to the next generation.... (read more)

  • Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond VIDEO
  • Dr. Ruth Lanius, from the University of Western Ontario, discusses the broad physical effects of adverse childhood experiences and their role in posttraumatic stress disorder. An overview of the neurobiology of posttraumatic stress disorder is presented as well as implications of findings on attachment and intergenerational transmission of trauma.... (read more)

Mentalization

  • Affect regulation theory. A clinical model. Chapter 6: Mentalization. The secondary affect-regulating system.
  • In Chapter 6 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes the processes of Mentalization which comprise the secondary (conscious) affect regulating system. The development of the system is discussed and each mentalizing mode (teleological, object equivalence, pretend, and full Mentalization) are described. Perhaps most importantly, the Mentalization of affect is discussed and the system secondary/ mentalizing affect regulating system is compared with the primary system.... (read more)

  • MBT Treatment: “What works for Borderline Personality Disorder?”
  • In this video Professor Fonagy explains the concept of mentalization: what it is, its uses in the relationship with others and the self, how it develops in the human mind and the risks of losing this capacity. He creates a multidimensional model with 4 dichotomies that need to be balanced for an optimal mentalization function. Using this model to understand BPD, he shows the several difficulties these patients have to access mentalization. While other therapeutic techniques ask the patient to use mentalization capacities they don´t have, MBT tries to balance the functioning in the 4 dimensions to help patients achieve mentalization. ... (read more)

  • Mentalization Based Treatment For Borderline Personality Disorder
  • Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. It has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with moderate levels of supervision. This supports the general utility of MBT in the treatment of BPD within generic mental health services.... (read more)

Personality Disorders

Psychoanalysis

Psychopathology

  • An Attachment Perspective on Psychopathology
  • In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology.... (read more)

  • Mentalization Based Treatment For Borderline Personality Disorder
  • Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. It has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with moderate levels of supervision. This supports the general utility of MBT in the treatment of BPD within generic mental health services.... (read more)

Regulation Theory

  • Affect regulation theory. A clinical model. Introduction
  • In this introduction to Dr. Hill’s book Affect Regulation Theory: a Clinical Model key concepts are introduced including affect, affect regulation, how affect is communicated unconsciously, the neurobiology of affect regulation and the primary and secondary affect regulating systems. It also introduces the reader to an understanding of how affect regulation is key for adaptive functions and why deficits in affect regulation manifest as psychiatric symptomatology and personality disorders.... (read more)

  • Beyond Words: A Sensorimotor Psychotherapy Perspective
  • Ogden highlights the importance of non-verbal communications. The awareness to indicators such as prosody, eye contact, facial expression, preparatory movements, arm movements, posture, proximity and locomotion can provide us with important information about the patient´s implicit self and their implicit relational knowing. She presents clinical examples to understand how this is played out in therapy and what can the therapist do to help patients be aware of their non-verbal communications. ... (read more)

  • Affect regulation theory. A clinical model. Chapter 1
  • In Chapter 1 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents classic attachment theory. The Strange Situation and Adult Attachment interview are described along with the concepts of secure and insecure (avoidant, preoccupied and disorganized) attachment patterns. Additionally the reader is introduced to how each of the insecure patterns represent different deficits in affect regulating capacity in comparison to the robust affect tolerance and resiliency of secure attachment.... (read more)

  • Affect regulation theory. A clinical model. Chapter 2: Self-states
  • In Chapter 2 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of bodymind organized around the relational theory of self states. The central idea is that when regulated self states are integrated and when dysregulated self states are dissociated. Self states are conceived as assemblages of perceptual, attentional, representational, memory and reflective systems. Each system may be integrated or dissociated. Additionally, two types of dissociation – compartmentalization and altered states of consciousness are discussed.... (read more)

  • Affect regulation theory. A clinical model. Chapter 3: Neurobiology of the primary affect-regulating system.
  • In Chapter 3 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents the neurobiological substrate of the primary affect regulating system. The components of the limbic system (amygdala, insula, hippocampus and prefrontal cortex are discussed. Additionally the relationship between the limbic system, HPA axis, and autonomic nervous systems are outlined. Each is involved in the assessment of internal and external stimuli and in the automatic regulation of affect.... (read more)

  • Affect regulation theory. A clinical model. Chapter 4: Right brain, implicit processes and implicit self
  • In Chapter 4 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of the right brain understood to be the seat of the “Implicit self”; i.e. the unconscious processes that assess and respond involuntarily to internal and external events. Comparisons are made to the explicit processes mediated by the left brain. These processes include implicit vs explicit memory, implicit cognition and implicit communication. Together they comprise the implicit (unconscious) self.... (read more)

  • Affect regulation theory. A clinical model. Chapter 5: Classical attachment theory.
  • In Chapter 5 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes how optimal affect regulating capacity is developed in the secure attachment relationship. Classical attachment theory is presented including Bowlby’s ideas about the internal working model as a means of evaluating and predicting relationships and its assimilative function. Additionally, an understanding Adult Attachment Interview and presented from the point of view of affect regulation.... (read more)

  • Affect regulation theory. A clinical model. Chapter 6: Mentalization. The secondary affect-regulating system.
  • In Chapter 6 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes the processes of Mentalization which comprise the secondary (conscious) affect regulating system. The development of the system is discussed and each mentalizing mode (teleological, object equivalence, pretend, and full Mentalization) are described. Perhaps most importantly, the Mentalization of affect is discussed and the system secondary/ mentalizing affect regulating system is compared with the primary system.... (read more)

  • Playing on the Right Side of the Brain: An Interview with Allan N. Schore
  • An extraordinary interview with Allan Schore where among other things he discusses the personal origins of his theory how it came out of his own play. There are no CE credits for this. Think of it as play. It’s one of the most interesting interviews of Schore that I’ve seen. I wish to thank the American Journal of Play for allowing us to publish this extraordinary interview. ... (read more)

  • Modern attachment theory: the enduring impact of early right-brain development
  • Dr. Schore centers his talk on the importance of the early right brain development for the future functioning and well-being of a person. He describes a shift in science that currently gives emotions and to the regulation of emotions a privileged place. The attunement and co-regulation in the relationship between the mother and the baby has a fundamental impact on the regulation of emotions. Current research shows that emotional dysregulation and problems in the right brain are present in every pathology. ... (read more)

  • Sex Addiction as Affect Dysregulation
  • Dr. Katehakis gives a historical perspective on the evolution of the understanding of sex addictions. She explains the theory of regulation developed by Dr. Schore and explains sex addiction as a regulatory process to deal with chronic states of dysregulation. A successful therapy is the one that accomplishes the integration of the right and left brains. In her practice, she uses CBT techniques and ART.... (read more)

  • Human Nature and Early Experience
  • The Polyvagal Theory provides a new perspective to explore how autonomic nervous system function relates to social behavior, emotional regulation, and health. The Polyvagal Theory links the evolution of the autonomic nervous system to affective experience, emotional expression, facial gestures, vocal communication, and contingent social behavior. The theory, by being informed by the phylogeny of the autonomic nervous system, expands our understanding of normal and atypical behavior, mental health (e.g., coping with stress and novelty), and psychiatric disorders (e.g., autism, anxiety disorders, PTSD). The theory emphasizes that the core deficit in behavioral and affective regulation that is associated with several psychiatric disorders, especially disorders diagnosed in children, is related to neural regulation of the autonomic nervous system. By incorporating a developmental perspective, the theory explains how typical and atypical maturation and regulation of autonomic function forms the neural “platform” upon which social behavior and the development of safe trusting relationships are based. The theory explains how the nervous system evaluates risk in the environment, without awareness and often independent of a cognitive narrative, through a process labeled “neuroception.” Neuroception attempts to support adaptive behaviors by matching autonomic state with the neuroceptive state of risk (i.e., safe social environment, danger, and life threat). Abuse and trauma may reset neuroception to protect the individual from others when there is no “real” danger resulting in defensive and often aggressive responses to friends and caregivers... (read more)

  • Dysregulation of the Right Brain: a Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder
  • Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.... (read more)

  • Affect regulation theory. A clinical model. Chapter 12: Therapeutic Aims
  • In Chapter 12 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses how affect regulation therapy treats the arrest of self development that results from relational trauma. Primary concerns are the development of affect tolerance, affective resilience and, ultimately, a secure working model . Top down vs bottom up approaches are depicted and primary vs secondary change are distinguished.... (read more)

  • On Trauma – Allan Schore Group
  • Following a summarizing introduction by Allan Schore Richard Carr presents a case vignette that demonstrates the clinical relevance of a construct that is now central to stress models in biology and neuroscience, allostasis. This concept, the process by which physiological stability is maintained in the face of change, has not yet appeared in the psychoanalytic literature, thus highlighting the import of Carrs contribution. This is followed by an article in which Jane R. Wheatley-Crosbie focuse... (read more)

Relational / early attachment Trauma

  • Modern attachment theory: the enduring impact of early right-brain development
  • Dr. Schore centers his talk on the importance of the early right brain development for the future functioning and well-being of a person. He describes a shift in science that currently gives emotions and to the regulation of emotions a privileged place. The attunement and co-regulation in the relationship between the mother and the baby has a fundamental impact on the regulation of emotions. Current research shows that emotional dysregulation and problems in the right brain are present in every pathology. ... (read more)

  • Sex Addiction as Affect Dysregulation
  • Dr. Katehakis gives a historical perspective on the evolution of the understanding of sex addictions. She explains the theory of regulation developed by Dr. Schore and explains sex addiction as a regulatory process to deal with chronic states of dysregulation. A successful therapy is the one that accomplishes the integration of the right and left brains. In her practice, she uses CBT techniques and ART.... (read more)

  • Dysregulation of the Right Brain: a Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder
  • Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.... (read more)

  • Understanding Maltreating Mothers: A Synthesis of Relational Trauma, Attachment Disorganization, Structural Dissociation of the Personality, and Experiential Avoidance
  • Treatment options are limited for families in which the child has severe and intractable disturbances of emotion and behavior, in which there is suspected or confirmed maltreatment by the mother, and in which the mother has her own history of childhood neglect and abuse. This paper proposes a model for understanding mal- treatment in mother–child dyads, drawing upon the developmental psychopathology, behavior, and trauma literatures. At the core of this model is the hypothesis that a mother’s maltreating behav- ior arises from unconscious attempts to experientially avoid the reemergence of an attachment-related dissociative part of the per- sonality that contains the distress arising from her own early experiences of attachment relationships. The implications of this model for therapy are considered. ... (read more)

Sequelae of Relational Trauma

  • Modern attachment theory: the enduring impact of early right-brain development
  • Dr. Schore centers his talk on the importance of the early right brain development for the future functioning and well-being of a person. He describes a shift in science that currently gives emotions and to the regulation of emotions a privileged place. The attunement and co-regulation in the relationship between the mother and the baby has a fundamental impact on the regulation of emotions. Current research shows that emotional dysregulation and problems in the right brain are present in every pathology. ... (read more)

  • Sex Addiction as Affect Dysregulation
  • Dr. Katehakis gives a historical perspective on the evolution of the understanding of sex addictions. She explains the theory of regulation developed by Dr. Schore and explains sex addiction as a regulatory process to deal with chronic states of dysregulation. A successful therapy is the one that accomplishes the integration of the right and left brains. In her practice, she uses CBT techniques and ART.... (read more)

  • Affect regulation theory. A clinical model. Chapter 11: Pervasive dissociated shame
  • In Chapter 11 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses pervasive, dissociated shame as sequela of relational trauma. He shows the centrality of shame (and pride) in our mental economy, the importance of processing it for psychological maturation, the role of unprocessed shame in psychopathology and shame’s role in the treatment of disordered affect regulation... (read more)

  • Adverse Childhood Experiences Video
  • Dr. Vince Felitti presents the results of his ground breaking study on adverse childhood experiences. No study has had greater impact on the understanding of the impact of developmental trauma on adult psychological and medical pathology and age of death. Being aware of these findings is crucial for work.... (read more)

Trauma

  • The Body Keeps the Score: Brain Mind and Body in the Healing of Trauma
  • Dr. van der Kolk describes the effects of trauma in the body, brain and mind. A particular emphasis is put in the bodily manifestations of trauma and the fact the traumatic past events remain in the body as a present threat. He discusses the uselessness of traditional therapeutic techniques and introduces EMDR as a successful treatment for PTSD, explaining its technique, how it works and presenting some data that supports its effectiveness. As a conclusion, Dr. van der Kolk says that the aim of treating PTSD is to deactivate trauma and reset the limbic system, allowing for a reconnection with the body.... (read more)

  • Developmental Trauma Disorder: Towards a Rational Diagnosis For Children With Complex Histories
  • Childhood trauma , including abuse and neglect, is probably our nation’s single most important public health challenge, a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year over 3,000,000 children are reported to the authorities for abuse and/ or neglect in the United States of which about one million are substantiated. Many thousands m o re undergo traumatic medical and surgical procedures, and are victims of accidents and of comunity violence. However, most trauma begins at home: the vast majority of people (about 80 %) responsible for child maltreatment are children’s own parents. One of van der Kolk’s most important contributions has been his effort to alert the field to the frequent occurance of developmental trauma (aka complex trauma) and his (still frustrated) attempts to have it become a recognized diagnosis. In this article he describes the central role of affect regulation, the dynamics of childhood trauma, it’s prevalence in the etiology of psychiatric illness and treatment implications. ... (read more)

  • Working with the Neurobiological Legacy of Early Trauma
  • The author describes how the brain reacts to trauma. She then discusses the long-term effects of trauma on a person’s neurobiology; she uses neurobiology, in turn, to inform how therapy should be conducted for those affected by trauma. Sensorimotor Psychotherapy is offered as a means to help clients overcome their trauma.... (read more)

  • Dissociative Phenomena in the Everyday Lives of Trauma Survivors
  • Interest in dissociation, as a mental ability and as a set of symptoms secondary to trauma, has re-vitalized in the past ten years following a one hundred year hiatus between the work of Janet and the work of the pioneers in the field of trauma in the 1980s and 90s (van der Kolk, 1997; Putnam, 1999; Chu, 1998). Although we have a better understanding of dissociation now than we did ten years ago, it is still a very controversial subject in the field of mental health because it is so routinely equated with Dissociative Identity Disorder. As a result, even experienced clinicians miss the frequent more subtle presentations that appear in our offices on a daily basis. If we look instead to understand dissociation as we would any other mental state phenomenon, we will begin to see that all human beings dissociate, and much of our dissociativeness is adaptive.... (read more)

  • Adverse Childhood Experiences Video
  • Dr. Vince Felitti presents the results of his ground breaking study on adverse childhood experiences. No study has had greater impact on the understanding of the impact of developmental trauma on adult psychological and medical pathology and age of death. Being aware of these findings is crucial for work.... (read more)

  • Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond VIDEO
  • Dr. Ruth Lanius, from the University of Western Ontario, discusses the broad physical effects of adverse childhood experiences and their role in posttraumatic stress disorder. An overview of the neurobiology of posttraumatic stress disorder is presented as well as implications of findings on attachment and intergenerational transmission of trauma.... (read more)

  • Trauma Reveals the Roots of Resilience — Fosha
  • After September 11, a friend sent me the following quote from Hemingway, a gift I want to share it with you."The world breaks everyone and afterward some are strong at the broken places." I cannot think of a better way to capture what our aim is than to say that through our work, we try to help our patients –and ourselves-- become stronger at the broken places. In the process of doing the work, we also sometimes discover amazing places that have always been strong and were never broken. Not so infrequently, in the course of dealing with tragedy, with destruction, with misfortune, and evil, we are taken aback by the miracles that we are privileged to witness. Steeled for the worst, we encounter the best. It is not only that some are strong at the broken places; it is also that, through trauma, others become strong, and discover they’re strong in ways they never knew. For sometimes trauma awakens extraordinary capacities that otherwise would lie dormant, unknown and untapped. Without the trauma, they would never see the light of day.... (read more)

  • Exposure To A Traumatic Event Does Not Automatically Put A Person On A Path To Develop PTSD: The Importance Of Protective Factors To Promote Resiliency
  • This article presents a principle that is essential to building a wellness approach that uses public health prevention strategies to prevent Post Traumatic Stress Disorder (PTSD) and other psychiatric disorders that come from exposure to trauma. First, we learn that exposure to a traumatic stressor does not automatically put a person on a path to develop PTSD. Second, scientific documentation is provided that protective factors decrease the risk of being exposed to a traumatic stressor from generating PTSD or other disorders such as depression and suicidal or violent behavior. Finally, a theoretically-sound, evidence-based, common sense model is offered as a "directionally correct" way to ensure that at-risk populations obtain protective factors to prevent a potential traumatic stressor from generating poor health and mental health outcomes.... (read more)

  • On Trauma – Allan Schore Group
  • Following a summarizing introduction by Allan Schore Richard Carr presents a case vignette that demonstrates the clinical relevance of a construct that is now central to stress models in biology and neuroscience, allostasis. This concept, the process by which physiological stability is maintained in the face of change, has not yet appeared in the psychoanalytic literature, thus highlighting the import of Carrs contribution. This is followed by an article in which Jane R. Wheatley-Crosbie focuse... (read more)

Treatment

  • Beyond Words: A Sensorimotor Psychotherapy Perspective
  • Ogden highlights the importance of non-verbal communications. The awareness to indicators such as prosody, eye contact, facial expression, preparatory movements, arm movements, posture, proximity and locomotion can provide us with important information about the patient´s implicit self and their implicit relational knowing. She presents clinical examples to understand how this is played out in therapy and what can the therapist do to help patients be aware of their non-verbal communications. ... (read more)

  • The Body Keeps the Score: Brain Mind and Body in the Healing of Trauma
  • Dr. van der Kolk describes the effects of trauma in the body, brain and mind. A particular emphasis is put in the bodily manifestations of trauma and the fact the traumatic past events remain in the body as a present threat. He discusses the uselessness of traditional therapeutic techniques and introduces EMDR as a successful treatment for PTSD, explaining its technique, how it works and presenting some data that supports its effectiveness. As a conclusion, Dr. van der Kolk says that the aim of treating PTSD is to deactivate trauma and reset the limbic system, allowing for a reconnection with the body.... (read more)

  • MBT Treatment: “What works for Borderline Personality Disorder?”
  • In this video Professor Fonagy explains the concept of mentalization: what it is, its uses in the relationship with others and the self, how it develops in the human mind and the risks of losing this capacity. He creates a multidimensional model with 4 dichotomies that need to be balanced for an optimal mentalization function. Using this model to understand BPD, he shows the several difficulties these patients have to access mentalization. While other therapeutic techniques ask the patient to use mentalization capacities they don´t have, MBT tries to balance the functioning in the 4 dimensions to help patients achieve mentalization. ... (read more)

  • Technique and Beyond: Therapeutic Enactments, Mindfulness, and the Role of the Body
  • The article two simultaneous clinical journeys to discover the implicit self: the conscious and the unconscious. The explicit, conscious journey pertains to what the therapist believes she is doing as a clinician, supported by theory and technique. Therapeutic methods, meant to be learned but then be set aside and not reflected upon in the therapy hour, guide interventions that emerge spontaneously within the dyad. With somewhat predicable outcomes, this journey can easily become conscious, and thus explained, rationalized, reflected upon, and voluntarily changed mid-stream. For the explicit journey, body-oriented, mindfulness interventions from Sensorimotor Psychotherapy bring to light the implicit self of the patient, and new physical actions that foster integration between explicit and implicit parts of the self can be discovered and executed.... (read more)

  • Addictions and Trauma Recovery
  • The author addresses the role that addiction plays in the lives of trauma survivors. Furthermore, she points out how addictions act as a coping mechanism and what happens during abstinence. The therapist, she claims, must be aware of the reasons behind why the addiction started in order to best be able to help the patient as he or she begins to overcome the addiction. Additionally, she explains how helping the patient understand how the addiction aided him or her and how the therapies will help him or her cope in a different way is necessary for a true recovery.... (read more)

  • Understanding Maltreating Mothers: A Synthesis of Relational Trauma, Attachment Disorganization, Structural Dissociation of the Personality, and Experiential Avoidance
  • Treatment options are limited for families in which the child has severe and intractable disturbances of emotion and behavior, in which there is suspected or confirmed maltreatment by the mother, and in which the mother has her own history of childhood neglect and abuse. This paper proposes a model for understanding mal- treatment in mother–child dyads, drawing upon the developmental psychopathology, behavior, and trauma literatures. At the core of this model is the hypothesis that a mother’s maltreating behav- ior arises from unconscious attempts to experientially avoid the reemergence of an attachment-related dissociative part of the per- sonality that contains the distress arising from her own early experiences of attachment relationships. The implications of this model for therapy are considered. ... (read more)

  • Affect regulation theory. A clinical model. Chapter 12: Therapeutic Aims
  • In Chapter 12 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses how affect regulation therapy treats the arrest of self development that results from relational trauma. Primary concerns are the development of affect tolerance, affective resilience and, ultimately, a secure working model . Top down vs bottom up approaches are depicted and primary vs secondary change are distinguished.... (read more)

  • Affect regulation theory. A clinical model. Chapter 13: Therapeutic actions
  • In Chapter 13 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses the therapeutic actions that modify the capacity to regulate affect. Explicit actions (psychoeducation, observations and the mentalization of affect states are understood to be processed by the left brain and supportive of the primary effects of implicit actions which are processed by and change right brain structures. Transference, countertransference and the therapeutic alliance are understood to be mediated by implicit communications that are fundamental to enduring change.... (read more)

  • Mentalization Based Treatment For Borderline Personality Disorder
  • Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. It has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with moderate levels of supervision. This supports the general utility of MBT in the treatment of BPD within generic mental health services.... (read more)

  • Trauma Reveals the Roots of Resilience — Fosha
  • After September 11, a friend sent me the following quote from Hemingway, a gift I want to share it with you."The world breaks everyone and afterward some are strong at the broken places." I cannot think of a better way to capture what our aim is than to say that through our work, we try to help our patients –and ourselves-- become stronger at the broken places. In the process of doing the work, we also sometimes discover amazing places that have always been strong and were never broken. Not so infrequently, in the course of dealing with tragedy, with destruction, with misfortune, and evil, we are taken aback by the miracles that we are privileged to witness. Steeled for the worst, we encounter the best. It is not only that some are strong at the broken places; it is also that, through trauma, others become strong, and discover they’re strong in ways they never knew. For sometimes trauma awakens extraordinary capacities that otherwise would lie dormant, unknown and untapped. Without the trauma, they would never see the light of day.... (read more)

Video

  • Embryonic & Neural Development: Setting the Stage for the Lifespan
  • Dr. Charles A. Nelson, from the Children's Hospital Boston, gives a detailed discussion on the process of embryonic and neural development. He begins with a chronological discussion of the process involved in pre-natal development, followed by an overview of the stages of brain development. The presentation concludes with a thorough discussion of neural plasticity and its relationship to environmental experiences.... (read more)

  • Adverse Childhood Experiences Video
  • Dr. Vince Felitti presents the results of his ground breaking study on adverse childhood experiences. No study has had greater impact on the understanding of the impact of developmental trauma on adult psychological and medical pathology and age of death. Being aware of these findings is crucial for work.... (read more)

  • Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond VIDEO
  • Dr. Ruth Lanius, from the University of Western Ontario, discusses the broad physical effects of adverse childhood experiences and their role in posttraumatic stress disorder. An overview of the neurobiology of posttraumatic stress disorder is presented as well as implications of findings on attachment and intergenerational transmission of trauma.... (read more)

Books Accredited for CE (by chapter):

Affect Regulation Theory: A Clinical Model

  • Affect regulation theory. A clinical model. Introduction
  • In this introduction to Dr. Hill’s book Affect Regulation Theory: a Clinical Model key concepts are introduced including affect, affect regulation, how affect is communicated unconsciously, the neurobiology of affect regulation and the primary and secondary affect regulating systems. It also introduces the reader to an understanding of how affect regulation is key for adaptive functions and why deficits in affect regulation manifest as psychiatric symptomatology and personality disorders.... (read more)

  • Affect regulation theory. A clinical model. Chapter 1
  • In Chapter 1 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents classic attachment theory. The Strange Situation and Adult Attachment interview are described along with the concepts of secure and insecure (avoidant, preoccupied and disorganized) attachment patterns. Additionally the reader is introduced to how each of the insecure patterns represent different deficits in affect regulating capacity in comparison to the robust affect tolerance and resiliency of secure attachment.... (read more)

  • Affect regulation theory. A clinical model. Chapter 2: Self-states
  • In Chapter 2 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of bodymind organized around the relational theory of self states. The central idea is that when regulated self states are integrated and when dysregulated self states are dissociated. Self states are conceived as assemblages of perceptual, attentional, representational, memory and reflective systems. Each system may be integrated or dissociated. Additionally, two types of dissociation – compartmentalization and altered states of consciousness are discussed.... (read more)

  • Affect regulation theory. A clinical model. Chapter 3: Neurobiology of the primary affect-regulating system.
  • In Chapter 3 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents the neurobiological substrate of the primary affect regulating system. The components of the limbic system (amygdala, insula, hippocampus and prefrontal cortex are discussed. Additionally the relationship between the limbic system, HPA axis, and autonomic nervous systems are outlined. Each is involved in the assessment of internal and external stimuli and in the automatic regulation of affect.... (read more)

  • Affect regulation theory. A clinical model. Chapter 4: Right brain, implicit processes and implicit self
  • In Chapter 4 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he presents a model of the right brain understood to be the seat of the “Implicit self”; i.e. the unconscious processes that assess and respond involuntarily to internal and external events. Comparisons are made to the explicit processes mediated by the left brain. These processes include implicit vs explicit memory, implicit cognition and implicit communication. Together they comprise the implicit (unconscious) self.... (read more)

  • Affect regulation theory. A clinical model. Chapter 5: Classical attachment theory.
  • In Chapter 5 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes how optimal affect regulating capacity is developed in the secure attachment relationship. Classical attachment theory is presented including Bowlby’s ideas about the internal working model as a means of evaluating and predicting relationships and its assimilative function. Additionally, an understanding Adult Attachment Interview and presented from the point of view of affect regulation.... (read more)

  • Affect regulation theory. A clinical model. Chapter 6: Mentalization. The secondary affect-regulating system.
  • In Chapter 6 of Dr. Hill’s book Affect Regulation Theory: a Clinical Model he describes the processes of Mentalization which comprise the secondary (conscious) affect regulating system. The development of the system is discussed and each mentalizing mode (teleological, object equivalence, pretend, and full Mentalization) are described. Perhaps most importantly, the Mentalization of affect is discussed and the system secondary/ mentalizing affect regulating system is compared with the primary system.... (read more)

  • Affect regulation theory. A clinical model. Chapter 11: Pervasive dissociated shame
  • In Chapter 11 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses pervasive, dissociated shame as sequela of relational trauma. He shows the centrality of shame (and pride) in our mental economy, the importance of processing it for psychological maturation, the role of unprocessed shame in psychopathology and shame’s role in the treatment of disordered affect regulation... (read more)

  • Affect regulation theory. A clinical model. Chapter 12: Therapeutic Aims
  • In Chapter 12 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses how affect regulation therapy treats the arrest of self development that results from relational trauma. Primary concerns are the development of affect tolerance, affective resilience and, ultimately, a secure working model . Top down vs bottom up approaches are depicted and primary vs secondary change are distinguished.... (read more)

  • Affect regulation theory. A clinical model. Chapter 13: Therapeutic actions
  • In Chapter 13 of Affect Regulation Theory: a Clinical Model Dr. Hill discusses the therapeutic actions that modify the capacity to regulate affect. Explicit actions (psychoeducation, observations and the mentalization of affect states are understood to be processed by the left brain and supportive of the primary effects of implicit actions which are processed by and change right brain structures. Transference, countertransference and the therapeutic alliance are understood to be mediated by implicit communications that are fundamental to enduring change.... (read more)

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