The Healing Brain: How Understanding Neuroscience Enhances Treatment Compliance

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The Healing BrainHow Understanding Neuroscience
Enhances Treatment Compliance

• Ralph E. Carson, PhD, RD
• Pine Grove

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Ambitions of Women

• To grow up
• To fill out
• To slim down
• To hold it in
• To hell with it

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Stages of Recovery

• Denial
• Resistance
• Exploration
• Commitment

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Stress Response
Neo Cortex Limbic System Hind Brain

• Humans
• Vertebrates
• Reptiles

Wllpower
Emotion
Musculoskeletal
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Brain Imaging

• CT computer topography
• PET positron emission topography
• SPECT single photon emission computed topography
• MRS magnetic resonance spectroscopy
• fMRI functional magnetic resonance imaging
• EEG electroencephalograph

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Limbic System

• Mood
• Motivation
• Memory

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REWARD CASCADE

• HYPOTHALAMUS SEROTONIN

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Hypothalamus Serotonin(Jimerson, DC. Ann NY
Acad Sci (1990) 600532) Lebowitz, SF. Drug
(1990) 333)

• Function
• Regulates Sleep
• Improves Mood
• Calms Nerves
• Impulse Control
• Carbohydrate Cravings

• Deficiency
• Mood Swings Depression Anxiety
• OCD/Self harm
• Restricting, Binging Purging

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High Serotonin LevelsWH Kaye (2005) BT Walsh
(2006) UF Bailer (2007)

• Anxiety and obsessions
• Starvation
• Prevent TRP from entering the brain
• Reduces serontonin activity
• Creates a sense of calmness
• Receptors
• Increased activity of 5T1A
• Reduced function of 5HT2A

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Changes in Serotonin(Dorsey Dysert, MD, 2006)

• Reduced
• PTSD
• Self-mutilation
• Impulsiveness
• Cravings

• Variable (High/low)
• Anorexia
• AN/BP
• A D

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Failure to respond to SSRIs

• Malnourished
• Increased 5HT1A binding
• Odansteron (Zofran)
• Recovery
• Low serotonin levels persist
• Reduced 5HT2A binding persist
• Relapse prevention

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We Know Very LittleAnd What We Do Know is
Controversial

• Circuit CSF Limbic Cortex
• Receptors 5HT1A 5HT2A
• SNP (single nucleotide polymorphism) G14663A
• AN-R AN/BP BN, BED
• Medications SSRIs
• Comorbidities
• Plasticity (dendrites)
• Nerve cell regeneration

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REWARD CASCADE

• HYPOTHALAMUS SEROTONIN

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Dopamine Innervated Circuits(Nuckols, C. C. The
Science of Recovery)

• Reward Circuit
• NAc Nucleus Accumbens

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DOPAMINE(Wang G-J. J Add Dis (2004) 2339)

• Taq IA allele for D2 receptor
• Link genetics with environment
• D2 receptor
• Correlated with obese and addictions
• Reduced with drug use
• Delta FosB Transcription factor

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NaC Reward CenterDopamine

• Function
• Reward
• Pleasure
• Euphoria

• Depleted
• Apathy
• Anhedonia
• Helplessness

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Bio-balancing Limbic System

• Unpleasant
• ? Serotonin
• Hypothalamus
• Stress

• Pleasant
• ? Dopamine
• N. Accumbens
• Addiction

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1 - Letting Go

• Freedom from -
• Self-defeating lifestyle
• Compulsive control of our present
• Emotional bonds of our past
• 2 - Fill Void
• Substitute

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Dopamine Innervated Circuits(Nuckols, C. C. The
Science of Recovery)

• Memory/Learning
• Amygdala Hippocampus

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Hippocampus

• Function
• Memory
• Learning
• Modulates amygdala

• Damage
• Trauma
• Atrophy dysfunctional learning memory
• Not inhibiting amygdala

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Amygdala

• Function
• Incoming events
• Attaches Emotions
• Gatekeeper

• Damage
• Depression Anxiety
• Trauma

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Dopamine Innervated Circuits(Nuckols, C. C. The
Science of Recovery)

• Motivational Circuit
• OfC Occipital Frontal Cortex

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OfC(Relationships/ Herd)

• Function
• Motivation/Drive
• Decision making
• Social behavior
• Regulates Interpersonal relationships
  connectedness
• Emotional processing

• Damaged
• Apathetic/Helpless
• Impulsive
• Detached
• Mood swings
• Fear, Anxiety, Disgust
• Anhedonic

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Dopamine Innervated Circuits(Nuckols, C. C. The
Science of Recovery)

• Control Self-directed / Hopeful
• PfC (prefrontal cortex)
• ACG (anterior cinglulate gyrus)

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ACG(Responsible/Self-directed)

• Function
• Initiate decision making
• Prioritize competing inputs
• Inhibit inappropriate behavior
• Disrupted
• Self-directed behavior is removed in favor of
  sensory driven behavior

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PfC(Happiness Hope)

• Left
• Happiness Determines general outlook on life
• Modulates emotions mood and temperament
• Reasoning

• Right
• Controls negative
• Distress Fear Disgust
• Anxiety
• Hypervigilent

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CRF, Cortisol Glutamate

• Destroys Brain Tissue
• Toxic to Hippocampal, PfC OfC neurons
• Hippocampal cortex volume reduced
• Affects connections between cell
• Harmful effect on mood, motivation memory

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Bio-balanceFrontal Lobe

• Fear
• Right Prefrontal Cortex
• Amygdala
• Overactive Unchecked
• Cortisol / CRF

• Happiness
• Left Prefrontal Cortex
• Underactive
• Neural regeneration

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Neural Regeneration Plasticity (J Clin Invest
7/06)

• Antidepressants
• Meditation
• Exercise
• CBT
• Positive Therapy
• 12 Step Model

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AntidepressantsRegeneration of nervous tissue

• Serotonin works longer _at_ nerve cell junctions
  (Blood (2006) 101010)
• Increased Dendritic Growth and the flow of
  information between neurons (Braun 2000)
• Triggers new brain cell growth (Proc Nat Acad Sci
  (2006) 1038223 Science (2003) 301757)

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Meditation(S. Sharpiro (2002) Davidson
(2006)Scheinder (2005).

• Blood flow in general is reduced
• Blood flow is increased in the limbic system
• Generates memory and emotion
• Regulates HR, Respiratory rate, metabolism
• Shifts activity in the prefrontal cortex from
  right hemisphere to the left
• Modulates the amygdala Reoriented from a
  stressful flight or flight mode to one of
  acceptance and contentment

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Exercise

• Serotonin
• Stimulate release
• Extend time or receptor adherence
• Trigger endorphins
• Improve restorative sleep
• Rids the body of cortisol
• ? BDNF
• Brain derived neurotropic factor

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Positive PsychologyM. Seligman. Authentic
Happiness (2002)

• Hope
• Identify Strength Virtues
• Forgiveness
• Meditation (prayer)
• Gratitude Altruism
• Relationships

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Positive Psychology12-STEP

• Positive Psychology
• Hope
• Identify Strength Virtues
• Forgiveness
• Meditation
• Gratitude/Altruism
• Relationships

• 12-Step
• Steps 1 3
• Steps 4,5, 10
• Steps 6 9
• Step 11 Meditation
• Step 12 Service
• Support

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