Neuropsychotherapy News
Mediros Clinical Solutions
Edition 5
July 2011
The challenge to understand the Brain
We live in exciting times!
Almost daily we read about
new discoveries in brain
research—many with fascinating possibilities in terms
of understanding the functions of the brain as well as
opportunities for treatment.
In this edition we focus on one
of the most profound theories of
the evolution of the brain—the
Triune Brain model developed
by American Neuroscientist Paul
D MacLean. MacLean worked at
the Yale Medical School and the
Inside this issue:
National Institute for Mental
Health. His theory proposed that
the brain is in reality three brains
in one.
These ―three brains‖ developed in
sequence and inform each other
in a unique way. Although modern
neuroscience indicated some difficulties in the MacLean model
there are also some significant
implications for neuropsychotherapy that need to be considered.
This model provides insight into
the discussion regarding topdown or bottom-up approaches in
therapy.
Further, we comment on a study
relating to sleep and depression
and the experience of quality of
life. From a neurobiological perspective the need for good sleep
hygiene is one of the cornerstones of well being and needs
to be effectively addressed in our
therapeutic work. Enjoy the read!
Pieter Rossouw
“Neuropsychotherapy News” - Readership 1000!
Editorial
1
Neuropsychotherpy
News—Readership 1000
1
The Triune Brain—
Implications for Neuropsychotherapy
2
Book review
5
Sleep, Depression and
Quality of life
6
Neuroscience workshops update
7
Regional Peer Discussion
Groups
8
We are quite surprised by
the huge jump in readership over the past 4
months. We started in
March this year with, what
we thought, was a great
readership number of just
over 300 clinicians.
This number quickly rose
to 500 in April and in May
it jumped further to nearly
700. Since the June edition
we mailed out 1027 Newsletters with clinicians
signing up on daily basis.
We will endeavour to continue to run this as an independant, free, neuropsy-
chotherapeutic newsletter
aiming to serve the large community of practitioners in
this field who wish to expand
their body of knowledge. It
also aims to provide information and guidelines to foster
higher levels of efficacy in
therapeutic practice.
Lastly we aim to become a
mouthpiece for our regional
peer discussion groups that
we are facilitating and hope
they will (eventually) take a
life of their own as soon as
they are up and running—
hopefully within a fewmonths! few months.
We must
recollect that all of
our
professional ideas
in
Psychology
will
presumably
one day be based
on an
organic substructure
Sigmund Freud
“On Narcissism”
Page 2
Neuropsychotherapy News 5 July 2011
The Triune Brain—Implications for Neuropsychotherapy
Pieter J Rossouw (MClin Psych PhD)
Between 1949 and 1990 neurologist Paul MacLean
developed a groundbreaking theory of understanding brain development – called the triune
brain (MacLean 1990). The triune brain is a model
of development that consists of a



Reptilian complex, the
Paleomammilian complex and the
Neomamillian complex.
The reptilian complex
Also known as the R-complex or ―reptilian brain‖,
MacLean contended that this complex is the first to
develop in the brain and is responsible for most basic
species typical behaviours involving bodily functions breathing, heart rate control, etc. and handles basic
motor planning, and basic affects including physiological aspects of aggression and anxiety. It involves
the brainstem, pons and diencephalon.
The Paleomammilian complex
MacLean first introduced the term ―limbic system‖ to
refer to the set of closely connected structures be-
The Triune Brain model —Paul D MacLean
The Neomamilian
Brain
(mental and cognitive
reasoning—make sense of
perceptions enable
complex emotions)
The Paleomamilian
Brain
(scans for novelty—keep
system safe, refines basic
affects— enable
development of social
emotions)
The Reptilian Brain
(regulate basic bodily functions, works instinctively, handles
basic motor planning)
tween the corpus callosum and the
brainstem and upper brainstem areas.
This complex includes the amygdala,
hippocampus, thalamus, hypothalamus, septum and cyngulate cortex.
MacLean indicated that these structures develop sequentially later than
the reptilian complex and they refine
basic affects and enables the development of social emotions and expanded
memory functions (MacLean 1990).
The Neomamillian complex
This complex consists of the cerebral
cortex, or neo cortex – found only in
mammals. MacLean maintained that
this is the most recent step in the evolution of the human brain – conferring
the ability for language, abstract cognitive processes, sequential planning
and perception. This complex has the
ability to down regulate other functions
if effectively activated.
In terms of human evolution – MacLean maintained the reptilian complex
precedes the other areas by millions of
years and the Paleomammilian complex precedes the Neomamillian complex by millions of years. This bottom
up development is profound in how the
brain expresses itself up to this day.
MacLean also indicated that human
brain development happens in line with
these three complexes (Newman
2009). Daniel Siegel shares the same
theoretical approach – the primitive
part of the brain develops first and is
fully developed at birth, the Paleomammilian complex develops later and
is semi developed at birth and the
Neomamillian complex develops even
later and is mostly undeveloped at
birth.
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Neuropsychotherapy News 5 July 2011
The implication of this theory is that the survival instinct is intact from birth, the emotional response to the survival instinct is active but its reaction to specific triggers is a
learned response and the higher cognitive
and emotional processing develops fully in
interaction with its environment. This theory
has far reaching implications on many levels
as well as for therapeutic interventions
(Lambert 2003).
The neurodynamics of secure attachment on
the one hand and insecure attachment on
the other, indicates that the violation of security in the early months after birth will have
significant implications on survival needs
and cause disruptions on the most primitive
complexes of the brain – the effect is physiological distress and even atrophy of critical
brain areas as research clearly show.
Current status of the Triune model
Recent behavioral studies do not fully support the view of MacLean regarding the evolution of the brain. For example - birds have
been shown to possess highly sophisticated
cognitive abilities, such as the tool making of
the Neo Caledonian crow and the languagelike categorization abilities of the African
Gray Parrot. Structures of the limbic system,
which MacLean contended arose in early
mammals, have now been shown to exist
across the whole range of modern vertebrates (Patton 2008).
The "Paleomammilian" trait of parental care
of offspring is widespread in birds and occurs in some fishes as well. Thus, like the
basal ganglia, the evolution of these systems presumably dates to a common vertebrate ancestor.
Finally, the third statement of the triune brain
hypothesis, which is that the neocortex appears in modern mammals, seems not to be
factually correct. All recent studies based on
paleontological data or comparative anatomy evidences strongly suggest that the
neocortex was already present in the earli-
est emerging mammals. Although nonmammals do not have a neocortex in the
true sense, their brains still make neuroanatomical connections with other brain
structures and mediate similar functions.
The MacLean Triune Brain model –
usable or unusable?
Does this mean the concepts of MacLean
are faulty and unusable? It seems that although we have more sophisticated models
of explaining brain functioning, the essence
of MacLean’s model is that there is a sequence present in brain development and
that this sequence has a profound effect on
the pathogenesis of mental disorders and
neural firing. We know without doubt that
children are born with a fully active
―primitive complex‖ - brainstem and pons
regions, as well as a fully developed limbic
awareness but the response to external
triggers needs to be learned in terms of
what constitutes danger.
These activities are activated long before
frontal cortical structures are fully formed
resulting in responses that, if unhealthy,
need to be addressed (down regulated) in
therapy. Further: PET scans clearly show
the effect of looping activity on cortical
blood flow which inhibits effective activation
of frontal cortical systems.
Implications for Neuropsychotherapy
Implications for therapy favour a bottom
up approach (instead of the cognitive
model of a top down approach)– initially
focussing on establishing good therapeutic
alliance (safety) and physiological symptoms to down regulate unhelpful neurotransmitter firing (norepinephrine, corticotrophin releasing factor, corticotrophin hormone, adrenalin and cortisol) and up regulate serotonin flow, dopamine release and
activation of the parasympathetic nervous
system as well as addressing the scanning
for novelty (danger) by the amygdala
(Blackford et al 2010).
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Neuropsychotherapy News 5 July 2011
This creates a safe positive environment for
clients to explore new strategies (cognitive
interventions) and behavioural change –
establishment of new neural highways with
effective limbic firing and less looping activities in the ACG (anterior cyngulate cortex) and OFC (orbito frontal cortex) (Hart
2011). Establishing these safety measures
first enhances cognitive interventions further down the therapeutic process.
A top down approach (cognitive model)
implies an activation of the frontal cortical
structures to down regulate the stress response, limbic firing and sub limbic structural activity (medulla and pons) to decrease the release of norepinephrine
(among other stress hormones and neurotransmitters– CRF, ACTH, cortisol and
adrenalin).
The implication of this approach is that
there is sufficient serotonin release to increase cortical blood flow to the left frontal
cortex to activate the cognitive abilities effectively. It further implies limited looping
activity limbic firing as well as enough emotional safety to activate these strategies.
These are significant assumptions – especially in light of the fact that initially in the
therapeutic process the pathology is fully
present with limited (if any) effective skills
to manage the presenting symptoms of distress – hence the need for therapeutic intervention.
This maturation process indicates the benefit of a bottom up therapeutic approach
which is linked with down regulation of
stress related neurotransmitters and neural
structures as a result of early activation
(gene expression and early experiences in
the first months post birth) and the need for
up regulation of safety triggers (oxytocin release, attachment, up regulation of the parasympathetic nervous system, increased
GABA release etc.) to maximise therapeutic
outcomes.
Paul MacLean 1913—2007
Literature:




Summary

Although the triune brain model of Paul
MacLean has some flaws in fully explaining
the evolution of the brain, it provides a valuable explanation of the development of the
human brain in terms of the maturation of
key brain areas.

Blackford, J.U. et al. 2010. The unique
role of the human amygdala in novelty
detection. NeuroImage. 50: 1188-1193.
Hart, S. 2011. The Impact of Attachment. New York, W.W. Norton.
Lambert, K.G. 2003. The life and career of Paul MacLean: a journey toward neurobiological and social harmony. Physiology and Behaviour, 79:
343-349.
MacLean, P.D. 1990. The Triune Brain
in Evolution: Role in Paleocerebral
Functions. New York, Plenum Press.
Newman, J.D. 2009. The scientific contributions of Paul D. MacLean (19132007). Journal of Nervous and Mental
Disease. 197: 3-5.
Patton, P. 2008. One world, many
minds: Intelligence in the animal kingdom. Scientific American, 29 December.
www.mediros.com.au
Page 5
Neuropsychotherapy News 5 July 2011
Book Review
Susan Hart –
The Impact of Attachment
Combining theories of neurobiology, attachment, interpersonal relationships, and
intrapsychic concepts, The Impact of Attachment brings modern developmental
psychology into dialogue with recent developments in neuroscience, describing a
new, integrative approach to working with
clients: developmental neuroaffective psychology.
Hart explains how the dichotomies of
brain/mind, biology/experience, and nature/nurture hamper the development of a
theory that is capable of fully embracing
the complexity that characterizes human
psychological development. An interactive, neurobiological and interpersonal
perspective, she argues, will help develop
a common basis for helping clients in
therapy.
Each chapter demonstrates and explores
key aspects of the importance of attachment, and throughout, Hart reviews case
stories from her own clinical practice,
drawing from years of conducting psychological assessments of children, family
interventions, individual therapy, and professional supervision assignments.
As Hart explains at the outset, our brains
are sculpted, neuron by neuron, in close
interaction between genetic conditions
and environmental stimulation, and
thanks to their tremendous plasticity, they
are capable of reorganization.
In Part 1 she looks at children’s normal
development, brain maturation, and the
development of the various levels of mental organization in infants. She emphasizes the importance of interaction with
the primary caregiver for the child’s
neuroaffective development, including
the formation of internal representations
and mentalization capacity, and presents a model for levels of mental organization, or developmental stages
when the nervous system undergoes
qualitative changes with regards to personality development.
Part II looks at attachment and relational disorders – including dysregulation patterns and misattuned communication – and offers a new preliminary
understanding of psychopathology
based on a neuroaffective and developmental perspective.
Part III aims to integrate existing therapeutic approaches within a neuroaffective framework. Hart calls for a higher
degree of precision in the methods of
intervention related to symptom formation and therapy aimed at children and
adolescents.
She summarizes considerations concerning emotional attunement and its
impact on the therapist-client relationship, and discusses a complex approach to therapeutic intervention
based on a neuroaffective model. The
book concludes with a look into a dynamic system with both family and environmental therapy.
Part of the Norton Series on Interpersonal Neurobiology, The Impact of Attachment transforms complex neurobiological and behavioural theory into protocols that can be easily implemented
by the practicing clinician.
Susan Hart, 2011. The Impact of Attachment. New York, W.W. Norton.
From birth
onwards, the
infant is using its
expanding coping
capacities to
interact with the
social
environment
AN Shore 2001
Page 6
Neuropsychotherapy News 5 July 2011
The Good Life:
Good Sleepers Have Better Quality of Life and Less Depression
Getting six to nine hours of sleep per night is
associated with higher ratings for quality of
life and lower ratings for depression, suggests a research abstract that will be presented on June 14, in Minneapolis, Minn., at
Sleep 2011, the 25th Anniversary Meeting of
the Associated Professional Sleep Societies
LLC (APSS).
Results show that people with a "normal" sleep
duration of six to nine hours per night had higher
self-reported scores for quality of life and lower
scores for depression severity compared to short
and long sleepers. These differences were statistically significant in all comparisons. Among
patients who reported having perfect health,
there were a higher percentage of normal sleepers, who also had significantly lower scores for
depression severity compared to short and long
sleepers with perfect health.
"These results are important because they provide more information about the importance of
getting enough sleep, which is usually six to nine
hours per night," said principal investigator Dr.
Charles Bae, neurologist at the Cleveland Clinic
Sleep Disorders Center in Ohio. "People may
already expect that their quality of life could be
decreased when they do not get enough sleep,
but they may not realize that sleeping too much
can also have a negative impact."
Bae and colleagues analyzed data from 10,654
patient records, which were collected from January 2008 to May 2010. Study subjects had a
mean age of about 52 years. Quality of life was
assessed using the EQ-5D questionnaire, a
standardized measure of health outcome.
The nine-item Patient Health Questionnaire was
used as a screening tool for depression. Generalized estimating equations were used to account for multiple visits per patient, and a multivariable logistic regression model adjusted for
demographic differences such as age, gender,
race and marital status. Short sleep was defined
as less than six hours per night, and long sleep
was classified as more than nine hours per
night.
"It was surprising to see that sleeping less than
six hours and more than nine hours is associated with a similar decrease in quality of life
and increase in depressive symptoms," said
Bae. "I thought that there would be changes in
quality of life and degree of depressive symptoms for short and long sleepers, but did not
expect that those changes would be similar in
both groups."
The American Academy of Sleep Medicine reports that individual sleep needs vary. However, most adults need about seven to eight
hours of nightly sleep to feel alert and well
rested during the day.
ScienceDaily (June 15, 2011)
Comment
This study is consistent with research indicating the need for people to go through all
four sleep cycles for effective hippocampal
discharge. Hippocampal discharge happens
during fast ripple oscillations—REM sleep
and is crucial in memory consolidation
linked with the frontal cortex.
The fourth sleep cycle is normally the longest with potentially the most significant effect on hippocampal discharge— missing
this sleep cycle (not enough sleep on regular
basis) effects good hippocampal functioning
and may result in agitation (over active limbic structures), concentration lapses (non
effective hippocampal functioning) and lack
in problem solving skills (under activation
of left pre frontal cortical functioning and
reduced cortical blood flow. (PJR)
Page 7
Neuropsychotherapy News 5 July 2011
Upcoming Neuroscience Workshops
As mentioned in the previous newsletter we are running two workshops this year, the first of
which, The Brain and Anxiety, has been running for several months now. Since our last edition we ran the Brisbane and Adelaide workshops. Both were very enjoyable to present,
and thank you to all who attended. For more information on our upcoming workshops, or to
register, please visit our website.
We are looking forward to the remaining two workshops on the Brain and Anxiety. In total
over 1000 clinicians and academics have attended the Brain and Anxiety workshops.
The Remaining Brain and Anxiety Workshop dates are:
1 - 2 July – Perth
12 - 13 August - Launceston
Neuroscience of Depression Workshop
In September we commence our brand new workshop on Depression. The content of this
workshop is quite different from the Brain and Anxiety workshop although there is about
10% overlap in Brain based information. The focus however, is on how these structures
play a role in various forms of Depression.
The rest of the workshop content focuses on neuroscientific models of understanding depression and various schemata that play a crucial role in depression— both in terms of the
pathogenesis of depression and the treatment. Specific focus and discussion is dedicated
to treatment application regarding these fundamental schemata:





The Attachment Need
The Need for Orientation and Control
The need for Self-Esteem and Self-Esteem Enhancement
The need for Pleasure Maximization
The need for Consistency Regulation vs Trauma
Specific emphasis is on treatment strategies for Depression in light of these schemata.
Times:
9 - 10 September – Perth
23 - 24 Sep - Melbourne
30 Sep - 1 Oct – Adelaide
7 - 8 October - Brisbane
21 - 22 October – Canberra
4 - 5 November – Sydney
For more information please see our website
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Neuropsychotherapy News 5 July 2011
Regional Neuropsychotherapy Peer Discussion Groups
We are progressing very well to activate
our state wide regional peer discussion
groups for clinicians interested in regular
ongoing discussion regarding the applications of neuropsychotherapy in their therapeutic environments.
We asked attendees at the Melbourne,
Sydney, Canberra, Brisbane and Adelaide
workshops if they would be interested in us
facilitating local discussion groups and the
reaction was very positive. As soon as the
Perth Brain and Anxiety workshop is completed (early July) we will have a comprehensive list of clinicians interested to join
these peer discussion groups in the various
key locations in the country.
A number of key clinicians indicate that
the would be willing to facilitate these regional meetings. The lists will be forwarded
to these key clinicians and they will do
mail outs to those on the lists to arrange
meeting times.
We will also assist with publishing details in
the Newsletters and hope to provide information regarding these meetings.
This is a very exciting development for clinicians interested in Neuropsychotherapy and
we trust this will add a lot of benefit to your
therapeutic work.
A additional plus of these groups would be
that it also addresses the need for peer discussion/supervision in terms of Professional
Development.
There are no obligations to attending these
groups but at least it will provide a unique
opportunity to be part of this exciting new
development in psychotherapy.
If you are not sure if you signed up for a local
discussion group—please drop us an e-mail
at [email protected].
We will keep you posted.
Contact us:
If you have any further questions or comments about the newsletter or interest group,
or to unsubscribe, please contact us at [email protected]
You can also phone us on 07 3294 3220.
A word of thanks to Ros Purkiss for assisting with proof reading of the materials.
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www.mediros.com.au