By Dave Ziegler, Ph.D.
It is the human brain that enables individuals to adapt to the world either in optimal or destructive ways. The choice of a positive or negative direction of adaptation depends on a variety of factors related to both nature and nurture. The nature element includes epigenetics or the genetic codes that lay dormant or become operational. The nurture involves the influence of the environment, which is substantial particularly related to adaptations to maximize safety. Most mental health therapy must take on the challenge of facilitating modifications of the brain’s negative adaptations that take the form of cognitive patterns getting in the way of a functional life. Effective therapies make an impact at the operational level of the brain, which includes individual neurons and neuro-templates (families of neurons that perform a function).
Altering the brain’s cognitions at the most basic level involves impacting the cellular neurology of brain development. Psychotherapies attempt to change cognitions or what could be called cognitive mental maps or inner working models. Both terms describe how the brain understands the conditions of the environment it operates in. How the brain perceives a situation says a great deal about how it responds. Another way to change the brain is through pharmacological interventions that change the brain on a chemical level, specifically the neurotransmitters of individual neurons.
When the brain is allowed to develop optimally it strives for positive adaptations to the challenges of daily living. However, when trauma or deprivation become part of the individual’s experience, the brain makes radical adaptive alterations focused primarily upon surviving rather than thriving. These negative adaptations become the symptoms of most mental health problems such as: anxiety, depression, fear, hypervigilence, trouble connecting with others due to mistrust, inability to properly read social cues, addictions, aggression, and a large variety of behaviors associated with the autonomic fight or flight response to stress.
The brain’s primary function is to promote the survival of the individual. An important additional function of the brain is to successfully negotiate the world it finds itself in. Successful mental health treatment involves the repair of the brain’s adaptive functions and optimal neurological processes to put more focus on thriving and not just on surviving. Brain research has found that the malleability of the brain works both in causing problematic symptoms due to negative adaptations as well as creating the conditions of health and self repair through the right external guidance. Such support and assistance from the outside forms the core of Neurological Reparative Therapy. This is a research based approach to making positive changes in the thinking, emotional expression and behaviors of young children. It can be described as the facilitation of nerve functioning to optimize integrated cognitive processes, thus an approach that impacts the refocus of brain systems on positive adaptations to self, others and the world the individual functions in. This approach is less an intervention than an orientation of holistic, ecological and environmental conditions needed to return the brain to its natural state of optimal adaptive functioning. Brain research has identified that unless damaged in some way, the brain strives for success and even happiness in life. Once damaged, the brain often needs external intervention to move beyond becoming stuck in negative patterns or putting exclusive focus on survival and reactivity to stress.
The Ten Fundamental Premises of NRT
The ten premises include both goals of this approach and steps that must be integrated into the treatment process. The first five premises are goals and the last five are intervention steps. Each goal and step will be explained in brain terminology and then in more practical language:
The Five Goals toward neurorepair are general in nature and are not necessarily sequential as the steps that follow the goals. One or more of the goals are addressed in each step of the process. The combination of the goals and steps constitute the ten premises of NRT.
1. Facilitate perceptual changes of self, others and the child’s inner working model
The individual’s experience in life is directly connected to his or her perceptions based upon the inner working model or how the person views self and others. Based upon the individual’s perceptions the cognitive mental maps plot a course the individual will take including emotions and behaviors. The first goal is to impact perceptions through altering cognitions in order to provide a more positive and optimistic orientation rather than a negative and depressive mind set. Therapeutic work is directed toward developing a sense of self efficacy and helping the individual view others as resources for support and assistance.
The individual must experience some successes, however small they may be in the beginning. The person must experience making a positive impact, having some positive influence on others, and is helped to begin to see the world as a more friendly and supportive place. An example would be to help a child see school as a fun place to learn rather than a scary place where social and academic problems produce failure.
2. Enhance neuro-integration
Executive functions of the frontal lobes of the neocortex require integration of functions in all parts of the brain. Neuro-integration is the brain’s ability to access component parts to be integrated into an understandable whole that promotes good decision making. Enhancing neuro-integration is also strengthening the hemispheric communication between the left (logical, analytic, verbal) and right (intuitive, artistic, emotive) hemispheres of the brain.
In the beginning the higher order thinking must come from the outside, from supportive people. The individual must learn to combine the logical and emotive regions of the brain through activities that simultaneously involve both hemispheres of the brain. For example, having a child listen to music and seeing a mental image (right hemisphere) while describing the image (left hemisphere).
3. Alter the region of the brain’s processing information system
A primary goal of all psychotherapy is to promote functioning of the higher reasoning centers of the brain. Many traumatized individuals primarily use the limbic region of the brain in daily life. This region contains the brain’s fear center, as well as traumatic memories and emotional response system. Combining these factors produces an individual reacting with fear and emotionality to reminders of previous negative experiences. The much more functional alternative is for the higher reasoning centers of the neocortex to access information from all aspects of the brain and process the information to inform decisions and choices.
The individual must learn to think first, feel second and act third and not the reverse order. The reactive limbic region of the brain cannot be the primary part of the brain used. The person must learn to act rather than react in all areas of living. For example, teaching a child when frustrated to go through a process such as – stop, take a deep breathe and make a request.
4. Facilitate Orbitofrontal Cortex activation
The optimal goal of brain processing is to activate the Orbitofrontal Cortex in the frontal lobes of the Neocortex. It is this complex part of the brain that accesses information from all other parts of the brain and enables deliberative and proactive mental activity. This is the opposite of the reactivity of the limbic brain region. This region of the brain can be viewed as the chief executive officer because it is the most complex and potentially productive neurological process that can result in effective consideration, planning, goal setting and accurately perceiving challenges, all of which are higher order executive functions.
Over time the goal is to have the individual process most information in the most advanced area of the neocortex. It is this region that optimally provides goal setting, delaying gratification, moral and ethical reasoning and empathy for others among many other executive functions. Every intervention that promotes thoughtful consideration, exercises the Orbitofrontal Cortex.
5. Neuro-template development through repetitive practice
Networks of communication in the brain are made possible by neuro-templates and their individual component parts—neurons. Neurons have a use dependent developmental process where neurons that are frequently used become larger and stronger as well as do more work and do this work faster. In contrast, neurons that are never used may atrophy and die, and if seldom used they gradually deteriorate. One key goal of exercising the brain is repetition, since it is in repeated use that neurons and neuro-templates, composed of millions of individual neurons, get more frequent use. The more use, the stronger and more capable the brain functioning.
The expression ‘practice makes perfect’ refers to the importance of repetitive efforts to improve the results. The brain changes gradually over time through the repetitive use of families of neurons that help us to do daily tasks such as: play the piano, type on the computer, or hear critical feedback without reacting with anger. The more practice the brain has, the more the brain changes.
The Five Steps toward neurorepair are outlined below and provide a process where each step builds upon another. It is important that each step occur in the proper order to enable the process to build in an optimal healing fashion.
1. Assess the extent and causes of neurological impairment
All information available should be used to determine the extent of neurological impairment as well as the primary causes. Traumatic events are the most common causes of serious impairment. It is not essential to use complex medical scans to identify impairment. Most problem areas have identifiable symptoms that point to both the level of intensity and the causal factors. A good evaluation and history will normally provide sufficient information. A variety of psychological rather than medical instruments are available to assist in the assessment phase.
Start at the beginning with a good assessment of history and current functioning in all areas. There are a variety of formats and approaches to a good assessment and this model has room to approach this step in multiple ways.
2. Identify specific cognitive, emotional and behavioral problematic symptoms
This is an extension of Step 1. When specific problem areas are identified it is critical to accurately identify the right problem rather than the most obvious problem and consider the likely causes. Frequently with neurological impairment the representation of the problem area on the surface can look like an entirely different issue than it really is. For example, the symptoms of ADHD are nearly identical to the observable impacts of trauma on young children. To have the right problematic symptoms is important to be able to link these symptoms with the interventions in the next step. This is the second part of the initial neurological assessment.
Insure that the initial assessment includes a careful focus on what the real issues are and what has caused them. Only when we know the right problem do we have a chance at finding the right solution. For example, most fire setters have problems other than pyromania (fascination with fire) such as needing attention, expressing a cry for help or reflecting unresolved anger.
3. Implement interventions addressing the identified problematic emotional and behavioral symptoms
Once it is clear what the causes of the neurological impairment are, the next step is to design interventions that address the emotional and behavioral symptoms. Since behavior is an observable sign of the individual’s perceptual beliefs, or inner working model, cognitions are the focus of treatment as well as emotional and behavioral interventions. There are many possible approaches that can be used for specific interventions including a large number of evidence based practices.
While behaviors are the most observable problem areas, they arise from how the child thinks and feels about everything in the environment. The best way to make lasting change is to start with perceptions, and then move to emotional responses and the combination of these two result in externalized behaviors. Interventions can include a wide range of approaches including many evidence based practices. This model allows for a multiple of approaches to specific interventions.
4. Decondition the child’s stress response cycle through multiple forms of relaxation and allostatic training
The most common problems associated with neurological impairment are the wide range of negative influences of neurological adaptations to traumatic experiences. A fundamental negative adaptation is hyperarousal and loss of self-regulation due to the stress response leading to a systemic fight/flight activation of the autonomic nervous system. Research has identified that many forms of relaxation are the most effective tools to decondition the overactivation of the stress response cycle. Allostatic training involves assisting the individual to return to a state of calm after arousal, which is the allostatic response. Stress is a constant in life and the ability to self soothe and regain an inner state of calm is critical to handling the ever present stresses of life.
Reactions to stress are the key factors in emotional and behavioral problems. Turning down the volume and learning how to produce a state of calm is the brain’s best weapon in the life long struggle with stress. Find one or more of the many methods of relaxation that will fit best with each individual.
5. Environmental enhancements promoting the building blocks of brain development
The most effective external impacts on neurological functioning are environmental in nature. Every aspect of the child’s world should support the goals of enhancing neurological repair including: family, school, community, church, and youth activities among others. Environmental supports should be in place to provide the building blocks of: safety, security, acceptance, belonging, trust, relationship, self understanding and personal worth throughout the environment the child is working within. These building blocks enable the child to build personal growth on a predictable and solid personal foundation.
The individual either reacts to or asks for support from the world they experience. The best interventions to produce the all important building blocks of social success are not individual, isolated and brief approaches, but instead are multi-faceted and coordinated approaches that involve all aspects of the individual’s world. Environmental interventions for a child might include adjustments at school, at home, expanding involvement in community activities like sports/crafts/hobbies, assigning a mentor, or providing individual and family therapy.
Neurological Reparative Therapy has assisted Jasper Mountain to understand and help some of the most damaged and neurologically impaired children in our system of care. Outcome data from our work has shown that the vast majority of children reduce serious external behavioral problems, modify emotional disorders, and after leaving our treatment the children usually get much better over time. We believe these atypical results of intensive treatment are the result of significant impact on the brain’s processing system enabling the individual to successfully face the challenges and stresses of life. Due to a change in the cognitive mental maps of the child, it becomes possible to rely on others rather than push others away. Said another way, Neurological Reparative Therapy can return the brain to its natural state of health and thriving.
For additional information about Neurological Reparative Therapy, please refer to Dave Ziegler’s newest book Neurological Reparative Therapy: A Roadmap to Healing Resiliency and Well-Being.