NMT150 Health Psychology PDF Winter Term 2023

HEALTH PSYCHOLOGY WINTER TERM 2023 NMT 150 Naturopathic Therapeutics With acknowledgement to content developer, Dr. Allison Creech, M.ED, ND A CONTINUED FOCUS We will continue to develop the same themes and learning outcomes from the fall semester. There is a emphasis on experiential, reflective...

HEALTH PSYCHOLOGY WINTER TERM 2023 NMT 150 Naturopathic Therapeutics With acknowledgement to content developer, Dr. Allison Creech, M.ED, ND A CONTINUED FOCUS We will continue to develop the same themes and learning outcomes from the fall semester. There is a emphasis on experiential, reflective, and process-based learning + formative feedback. Content is offered to support naturopathic medical students in their understanding of human psychology as it relates to health and wellness. A CONTINUED FOCUS Students will be guided to: Deepen their awareness of psychological processes Recognize the role of individual factors as they relate to health and wellness Develop skills that advance social and emotional health A CONTINUED FOCUS BROAD LEARNING OUTCOMES: To develop skills that support therapeutic presence, effective communication, and the therapeutic relationship. To develop a knowledge base that supports a naturopathic doctor’s ability to assess the impact of psychosocial patterns in the lives of individuals A CONTINUED FOCUS: SPECIFIC LEARNING OUTCOMES: Demonstrate the role of the professional helper in the context of a naturopathic counselling relationship Demonstrate presence and effective communication in support of the therapeutic alliance Learn to conduct a naturopathic interview + obtain information relevant to the assessment of cognitive/emotional/relational patterns Practice the appropriate and effective use of questions and reflections within a naturopathic consultation Adopt an anti-oppressive, trauma-informed approach that builds safety into the doctor-patient dynamic Demonstrate a process of self-reflective awareness within the therapeutic context Identify areas of personal strength and areas for growth; support personal/professional development A CONTINUED FOCUS BROAD LEARNING OUTCOMES: To develop skills that support therapeutic presence, effective communication, and the therapeutic relationship. To develop a knowledge base that supports a naturopathic doctor’s ability to assess the impact of psychosocial patterns in the lives of individuals WEEKLY LEARNING OUTCOMES WEEKS 1-2-3: The first three weeks will focus on supporting students’ ability to recognize and assess the impact of significant psychosocial patterns in the lives of individuals. From a trauma-informed perspective, students will learn to recognize and assess significant patterns: CNS patterns: polyvagal determinants of health Relational patterns: attachment-based determinants of health Emotional patterns: emotional determinants of health Cognitive patterns: cognitive determinants of health WEEKS 1-2-3 The first three weeks will be a content-driven exploration and discussion that builds on foundation established in term 1 Safety vs stress as an autonomic, relational, and emotional setpoint On being a safe space: social engagement, active listening, and compassionate presence Determinants of health: CNS state/polyvagal, attachment and relationships, perception and cognition, emotion ACES and the impact of trauma Integration based on the individual patient before you WEEKS 4-6 + 9-13 These weeks will maintain a focus on practical skills: Practice communication skills within the context of a naturopathic consultation Practice the appropriate and effective use of questions and reflections within a naturopathic consultation Practice gathering information relevant to the assessment of psychosocial patterns Practice presence, safety, regulation, and effective communication in support of the therapeutic relationship WEEKS 4-6 + 9-13 Each week will begin with 30 mins of synchronous, whole-group learning. We will use this time to explore a specific content focus or provide a demonstration. We will then have 90 minutes for a practical focus. Groups will be split into small breakout rooms to practice skills, so that individual students can receive meaningful formative feedback. Each student will be in one of these practice rooms for 40 minutes. When not in the breakout room, students will be in the main room to continue a practical focus and explore psychosocial factors relevant to active NMT150 cases. WEEK 1 RECOGNIZE AND ASSESS PSYCHOSOCIAL PATTERNS: STRESS VS SAFETY Safety vs stress SAFETY VS STRESS Building on the foundation from term 1, lets expand on of the influence of safety vs stress: Safety vs stress as an autonomic setpoint à relevant in every person’s health The return to safety completes the natural stress cycle The experience of safety can be described as a physiologic state, a perception, and a relational experience; recall: “Safety is not the absence of threat, it is the presence of connection”. (Gabor Mate, MD) SAFETY VS STRESS “Neuroception” is an individualized, subconscious process that determines our state of activation Neuroception is based on both external (environmental) and internal (sensations, emotions, beliefs) cues that are developed through our lived experience. By paying attention to our bodies, we can get a good sense of what is happening at the subconscious levels à learn to observe, be curious, and help others to develop a verbal capacity to describe their bodily experience à Check in: what do you notice in your body in the present moment? What does that tell you about what’s happening in your ANS and your perceived sense of safety? Notice that input from the body, as well as input from the outside world, serve as cues to the brainstem (neuroception). Core regulatory networks then activate to communicate through neuroendocrine pathways (HPA axis), neuroimmune pathways, and through the autonomic nervous system. This is all activated prior to activation through the limbic system. Source: Dr. Bruce Perry The impact of chronic + toxic stress The science of safety ON SAFETY….. From Stephen Porges (2022) Polyvagal Theory: A Science of Safety. “Feelings of safety emerge from internal physiological states regulated by the autonomic nervous system” “Humans, as social mammals, are on an enduring lifelong quest to feel safe. This quest appears to be embedded in our DNA and serves as a profound motivator throughout our life. The need to feel safe is functionally our body speaking through our autonomic nervous system - influencing our mental and physical health, social relationships, cognitive processes, behavioral repertoire, and serving as a neurophysiological substrate upon which societal institutions dependent on cooperation and trust function are based.”  Feelings of safety are operationally the product of cues of safety, via neuroception, downregulating autonomic states that support threat reactions [fight/flight/freeze]and upregulating autonomic states that support interpersonal accessibility and homeostatic functions. [ventral vagal, social engagement] When humans feel safe, their nervous systems support the homeostatic functions of health, growth, and restoration, [Vis mediatrix naturae] while they simultaneously become accessible to others. [connection, co-regulation, empathy] “Research supports the conceptualization that the mental and physical health consequences of adversity are reflected in a retuned autonomic nervous system, locked into states of defense, that limit access to the calming pathways through the ventral vagus associated with sociality” (Williamson et al., 2013, 2015; Kolacz et al., 2020b).  Neuroception: “’Neuroception’ was introduced to emphasize a neural process, distinct from perception, capable of distinguishing environmental and visceral features that are safe, dangerous, or life-threatening (Porges, 2003, 2004). A form of neuroception can be found in virtually all living organisms, regardless of the development of the nervous system.”  “Although we are often unaware of the stimuli that trigger different neuroception responses, we are generally aware of our body’s reactions (i.e., visceral feelings) embodied in autonomic signatures that support adaptive behaviors (i.e., social engagement, fight/flight, shutdown).” à How does this help us support our patients? THE BODY has the answers. We can go to, connect with, and get curious about what is happening in the body.  Social engagement as a neuromodulator: “Although both defensive strategies [fight/flight and freeze] have adaptive value in protecting the individual, they are dependent on different neural pathways (i.e., high sympathetic tone or high dorsal vagal tone). Activation of these systems, independently or simultaneously, will interfere with interpersonal interactions, co-regulation, accessibility, trust, and feeling safe with another person. In the presence of cues of safety, which we associate with positive social interactions, the mammalian social engagement system can downregulate our innate reactions to threat, whether the threat is tangible and observable or imagined and invisible.  “Social connectedness is a core biological imperative for humans… That survival is dependent on trusted others is wired into our genetics and is expressed throughout the lifespan starting from the moment of birth. An optimally resilient individual has opportunities to co-regulate physiological state with a safe and trusted other.”  Cues of safety both reflect [one’s] autonomic state and directly impact the nerves that regulate the [other’s] autonomic nervous system. Our capacity for connectedness requires an active social engagement system, which broadcasts [our] accessibility through voice and facial expressivity… [We] project positive cues regarding our autonomic state through prosodic voice, warm welcoming facial expressions, and gestures of accessibility.” à Why is is so important for us to be aware of our own state when we are engaging with a patient? How can our presence be a resource for patients? What should we check in with about the way we are showing up?  The ANS provides a platform for subsequent emotions and behaviours: “The autonomic state of an individual serves as a functional map for emergent behavioral, emotional, and physiological reactivity that an individual may have in response to threat or alternatively to positive experiences. The state of the autonomic nervous system provides a neural platform for an expanded range of feelings, from threat to safety, that in turn provide a neurophysiological substrate for higher brain structures to elaborate these feelings. If the feelings are negative and dependent on autonomic states supporting defense, the feelings may evolve into diffuse states of anxiety or specific emotions such as fear or anger. Alternatively, if the feelings are positive and dependent on an autonomic state of calmness, thus enabling interpersonal accessibility and co- regulation, then these feelings may be associated with trust, love, and intimacy.”  Stress, threat, and resilience: ”Stress is: triggering a bodily state of threat and reorganizing the autonomic nervous system to promote survival. Stress must be conceptualized not only in terms of the stressor and the observed response but also in terms of the physiological state or vulnerability of the organism at the time of exposure to the stressor.”  “Similar to threat, stress results in a retuned autonomic nervous system to support defense, while disrupting optimal bodily processes. Stress and threat have the same autonomic signature, in which the autonomic state is disrupted and metabolic resources are diverted from homeostatic functions to survival needs. We could succinctly propose that feelings of safety would describe recovery to both stress and threat, since feelings of safety are dependent on a return to an autonomic state that would support homeostatic function. The ability to move, following a challenge, into an autonomic state that supports feelings of safety could also operationally define resilience.” “Resilience reflects a physiological state, which is sufficiently resilient to recover from disruptions, support feelings of safety, and connect with others via an active social engagement system” Functionally, this quest to feel safe is the product of… neuroception, the powerful role of co-regulation, and other attributes of sociality as a neuromodulator that can optimize health, growth, and restoration. Porges SW (2022) Polyvagal Theory: A Science of Safety. Front. Integr. Neurosci. 16:871227. doi: 10.3389/fnint.2022.871227 à How does this understanding of safety, social engagement, and resilience advance our practice of naturopathic medicine? à What does it mean to you t be resilient? à What in our lives supports resilience? Relational impact WHEN OUR LIVED EXPERIENCE IS SAFE: SECURE ATTACHMENT Recall: interpersonal neurobiology Our brains are shaped through our relationships with significant others. A securely attached relationship early in life shapes the brain and nervous system in health- promoting ways. When children are held in a secure relationship, they receive consistent nurturing from a parent who is present and available for the child. Children learn that they are loved, noticed, and understood. They experience safety. They develop a sense of trust in themselves, others, and the world. Social engagement systems flourish and the child’s nervous system calibrates into a state of ventral vagal responsiveness. SAFETY THROUGH SECURE ATTACHMENT The parent co-regulates and supports the child as the child learns to ride out the waves of big feelings. Over time, the child’s physiology becomes capable of self- regulating, and the child is comfortable with a range of emotional expression. As they grow, children develop a positive sense of self and are able to express their needs and feelings. When adversity comes, the relationship provides safety, comfort, holding, and connection. As a result, the child’s brain and body completes the natural stress cycle and their ANS stays fluid and responsive to the present moment. Neuroceptive cues accurately recognize threat and reorient towards safety. WHEN OUR LIVED EXPERIENCE IS NOT SAFE When our lived experience is stressful, when our basic needs aren’t met, and when there is a lack of a nurturing environment, neuroception can become organized towards survival as a default. ACES (adverse childhood experiences), developmental and relational trauma, a lack of a nurturing environment, and chronic stress can lead to changes in the architecture of the brain. Our ANS loses its ability to easily move between states and dysregulation/survival mode becomes our default. This can lead to numerous negative health outcomes. TRAUMA AND THE NERVOUS SYSTEM: A POLYVAGAL PERSPECTIVE “Trauma is an experience, not an event– its our response to an event rather than the event itself.“ https://www.youtube.com/watch?v=ZdIQRxwT1I0 9 min video explaining how the ANS (autonomic nervous system) adapts in the experience of trauma, and how this is related to health outcomes. DEVELOPMENTAL TRAUMA “Trauma is not what happens to a person, but what happens within them. Trauma induces a defensive tensing of body and psyche, a constriction, a triggering of pain out of keeping with the present stimulus. Whenever we experience significant bodily or psychic tension, we are likely experiencing a traumatic implicit memory. In line with its Greek origins, trauma means a wound—an unhealed one, and one the person is compelled to defend against by means of constricting his/her own ability to feel, to be present, to respond flexibly to situations. Nothing overtly dramatic needs to happen to a young human being to induce trauma: it is sufficient that she or he is wounded without an immediate capacity to heal the wound. Thus, a parent’s emotional distance or depression, in the absence of any intended or implied abuse, is enough. Young children can be traumatised simply when their need for attuned attention and responsive interaction with the parent is unmet— often due to no conscious awareness on the part of the parent.”  DEVELOPMENTAL TRAUMA “We are born connected to our gut feelings, our natural and necessary way of being. When the pain of the traumatic event is unbearable and the child has no support to experience and move through the pain, one mode of self-protection is to disconnect from our feelings. Now we no longer experience ourselves authentically and fully. Early experience is also the template for our lifelong view of the world, our unconscious window through which we see and understand our environment. If the early environment is unreliable or hurtful, we may develop a limited view of the world in which we perceive threat even when there isn’t any or, conversely, in which we defensively deny or misperceive threat when it is present. In short, our view of the world is skewed away from actual reality.” WE CANNOT SEPARATE THE BIOLOGICAL FROM THE EMOTIONAL AND SOCIAL “The essence of it is simply the scientific fact that our emotional system is inseparable from the physiological apparatus responsible for our nervous system, gut, immune defenses and hormonal functioning. And all this is impacted by our social relationships, since we are intensely and innately biopsychosocial creatures. We cannot be cut into parts, not in real life.” (excerpted from: Trauma, resilience and addiction: Hoffman interviews Dr Gabor Maté. https://www.hoffmaninstitute.co.uk/trauma-resilience-and-addiction-hoffman- interviews-dr-gabor-mate/ ) THE WOUND OF TRAUMA CAN BE HEALED https://www.youtube.com/watch?v=nmJOuTAk09g (2min video – Gabor Mate speaking about trauma as a wound that can be healed) Merck, Amanda. Salud America, Feb 2021. Healthcare Strategies for Preventing and Addressing ACEs and Toxic Stress. QUESTIONS-COMMENTS-DISCUSSION à What is coming up for you as you take in this perspective on safety, relationships, stress, trauma, and health? à How can a trauma-informed perspective support us in building healthy relationships with our patients?