Newsletter

July 26, 2017

“We are all hallucinating all the time… It’s just that when we agree about those hallucinations, we call that reality.”

While this might be a surprising claim, Anil Seth’s TED Talk provides strong support for it. Seth is a cognitive neuroscientist whose research in consciousness leads him to the argument that perception is a controlled hallucination – the brain’s predictions are being reined in by sensory information.

We know from optical illusions that even such basic processes as the perception of colour and shape are highly dependent upon our brains’ manipulation of the sensory information that is being received. A colour will be seen as different, or an object seen as larger, smaller, closer, or farther, based on other cues and our experiences, and therefore expectations, of what “should” be happening in the real world given what we are seeing. This processing happens automatically, without our conscious awareness. In this way, Dr. Seth argues, perception is created from the inside out rather than the outside in.

As can be seen in one of the clips in this talk, overly strong perceptual predictions (e.g. being skewed in visual perceptual patterns to see dog faces) can take a normal visual scene – walking through a plaza – and turn it into something very different – walking through a plaza where dogs are coming out of everything around you. This type of perceptual skewing can be seen in the hallucinations of psychosis and altered states.

But this is an excellent analogy for what can happen in our emotional and cognitive experiences as well.

One way in which our subjective reality can differ from others’ (not to say objective reality) is via cognitive distortions – ways of thinking that can contribute to difficulties with mental health. Some examples of these include black-and-white thinking, catastrophising (making a mountain out of a molehill), and overgeneralising. When we use these filters to process our experiences, our conclusions can be very different than they would otherwise be. These thinking patterns are well-described and are often the target of discussion and “homework” in talking psychotherapy practices such as cognitive behavioural therapy (CBT).

However, in additional to filters in our thinking, there can be filters in our body’s experience that are more difficult to bring to awareness. If we look at the extreme (but all too-common) case of PTSD from combat or physical or sexual abuse, it is common knowledge that stimuli that might be neutral to others (e.g. a touch on the shoulder) can elicit a strong startle response. There are clear physiological measures of this heightened startle response and hyper-arousal in individuals with PTSD. There are similar, albeit more modest, responses in all individuals, particular to our own experiences. For example, when I smell chlorine, there are automatic reactions in my body that are likely traces of a frightening experience I had in a pool as a young child.

While awareness of the mind-body connection has long been an important part of many schools of psychotherapy, there is a growing field of somatic psychotherapy in which the therapist’s work specifically focuses on identifying and changing the client’s experiences in the body that correspond to emotional distress.

Just as our visual perception is created from the inside out, our social-emotional behaviour is as well – our brains and bodies process each situation through unique filters and respond based on those filtered perceptions. If I am prone to overgeneralizing, I may see a failure on a small task as proof that I am a failure as a human being, and give up activities that could be beneficial. If my body tenses up when I smell chlorine, I may be more likely to find time at the pool to be stressful, and get very upset when I get splashed. What filters are you using without realizing it?

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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February 1, 2017

What do we mean when we say the body drives behaviour? Doesn’t the brain drive behaviour? I think, “I’m hungry. I would like a sandwich,” and then I get out the items I need and make a sandwich. Simple, right?

But what if I can’t identify that feeling as hunger because I’m engrossed in work or play? What if I’m in too much pain? What if instead of getting hungry, I get “hangry” and identify the source of my distress as the idiot that cut me off in traffic rather than signals from my body that it needs nourishment?

This type of behaviour is run-of-the-mill for typical adults, and yet we often forget that the relationship between brain and body is bi-directional. We like to think our brains control our bodies, when in fact, each influences the other continually. If our bodies drive our behaviour, how does this change the way we view and attempt to shape the behaviour of our children or clients?

Please join us for a free workshop on February 15, 2017, to discuss some of the ways in which the body drives behaviour. We will discuss the complexity of behavioural conditioning (including reward and punishment and why they don’t always work), how a normal physiological response can result in behaviours seen as symptomatic, and why stable physiology is critical for learning.

When: 6-8 pm February 15, 2017

Where: Glen Eden Multimodal Centre

#190-13151 Vanier Place, Richmond BC V6V 2J1

featuring

Glen Eden Executive Director - Dr. Rick Brennan, PhD

Glen Eden Director of Applied Research - Dr. Bhavana Vishnubhotla, PhD

Glen Eden Elementary Teacher - Laura Robertson, BEd, SPED

Tea, coffee, and snacks will be provided. Please RSVP to reserve a spot.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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January 13, 2017

Why do we find it so difficult to be kind when we are stressed? Why do we sometimes “freak out” under stress, and collapse at other times? The Polyvagal Theory, proposed and developed by Stephen Porges over the past 20 years, helps us understand how interactions between our brain and the rest of our body drive our social behaviour.

The classical view of the autonomic nervous system positions the sympathetic nervous system (mediating fight or flight) against the parasympathetic nervous system (mediating rest and digest). In this simple model, the sympathetic nervous system mobilizes action and the parasympathetic nervous system inhibits it.

The work of Porges calls this model into question. He emphasizes the function of vagal circuitry in regulating the body’s state. The vagus nerve decreases heart rate, but there are two distinct vagal circuits that do this in different ways. The evolutionarily older dorsal vagal branch (which exists in reptiles) elicits a complete shut-down response (e.g. freezing, collapsing) when the animal is facing something perceived as life-threatening. The ventral vagal branch (which evolved more recently, in mammals) modulates heart rate but preserves the ability to interact socially. This newer circuit is thus considered the “social engagement system” by which mammals can respond to stress in cooperation with others. If we do need to fight or flee, releasing this newer vagal brake allows us to take action without over-activating the sympathetic nervous system (which would take a toll on the body).

However, this “social engagement system” can only be activated when the individual feels safe in a given social context. For example, if the people around you have the intention to hurt you, it would not make sense to attempt to engage with them to get yourself to safety. The constant evaluation of risk in the environment is called ”neuroception” by Porges to emphasize its unconscious and non-cognitive nature. Depending on the presence or absence of safety cues in your environment, your physiological state will be different, and therefore your response to stress can vary dramatically.

In this video, Porges speaks about the implications of the polyvagal theory for our understanding of compassion. While the theory is quite complex, he is a clear speaker and there are notes and visuals that make the content easier to understand.

A few key points which are relevant when we work to support individuals who struggle with self-regulation:

  • Compassion and prosocial behaviour are incompatible with defensive states (which are triggered by neuroception of danger or threat). What does this particular individual need to feel safe? The same strategy can be successful or unsuccessful depending on neuroception of safety or danger (and the related physiological state).
  • Keep in mind the individual is “wearing a physiograph, or polygraph, on their face” – flat affect indicates the individual is (consciously or unconsciously) feeling unsafe or in pain. We often feel insulted when we are speaking to someone and their face goes blank – they must be ignoring us! How rude! What if we read blank affect instead as an indication that they are feeling scared or lost? How would that shift our response?
  • The “heart-brain connection” is bidirectional – interventions that decrease heart rate (e.g. long exhalations) increase a feeling of safety.
  • Our movements, affect, and tone are all evaluated in the individual’s neuroception and help determine if we are perceived as safe or threatening.
  • The environment that neuroception evaluates includes the internal environment. As a simple example, sudden pain in an extremity would be incompatible with neuroception of safety. What may the individual be feeling in their body that may predispose them to a particular physiological state?

The polyvagal perspective is a powerful one in re-framing how we view social-emotional difficulties. For those wanting more information, this article on neuroception is a good place to start (probably the easiest read of Porges’ written work).

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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August 26, 2016

A different kind of school (Richmond News)

Founded in 1984, Glen Eden Multimodal Centre is a unique school and clinical treatment centre for children with complex needs. In order to build individualized programs for each student, Glen Eden draws on the skills and experience of its own diverse staff as well as outside professionals. We asked these outside professionals what makes Glen Eden different.

Rob Padgham is a speech and language pathologist who has been working with Glen Eden students for over four years. One of the things that impresses him the most is Glen Eden’s detailed tracking system, developed by Dr. Rick Brennan, Founder and Executive Director.

“The data system allows Glen Eden staff to prevent behaviour rather than reacting to it,” Mr. Padgham says. “Other programs do have tracking systems, but I have noticed that Glen Eden’s is powerful and preventative.” He notes that other programs may not focus on physiology – the body that is driving the behaviour. “The reason the students are able to make so much progress at Glen Eden is because the staff track their physiology and really understand how to help them function best.”

Mr. Padgham also says Glen Eden is unique in integrating his techniques and strategies into the classroom, and in how quickly the program can adapt to new research.  “They invite me to train their staff and teach classes to students, for example in Social Thinking skills. Other schools may not be as willing to have me involved,” says Mr. Padgham.  “In other schools it might take time to adapt to new approaches and research. I have noticed that Glen Eden can be flexible and incorporate new models and evidence-based research quickly.”

Julia Johnson Baker, a certified yoga instructor and the director of Yoga It Up, an organization dedicated to bringing the benefits of yoga into schools, has been teaching weekly sessions at Glen Eden for two years. “We focus on physical improvement, empowerment…. how to calm, breathe and self-regulate their bodies in moments of high emotion and stress. Our sessions on the mat provide that mind-body connection that is huge for school.”

“To me it is a place that respects the needs of each child, and family, individually,” Johnson Baker says.  “The staff work hard to discover and develop a plan for each child so they he or she can feel respected, valued and cared for. Every staff member is exceptional and students have a wonderful rapport and respect for their leaders. (Staff at Glen Eden are) always taking current research into consideration and applying it where appropriate to support decisions for each child.”

Because of Glen Eden’s small class sizes, and detailed data collection system, the school is able to offer highly personalized programming. “Glen Eden provides a unique and essential service,” says Dr. Robin Friedlander, Clinical Head of the Neuropsychiatry Clinic at BC Children’s Hospital, who has worked with several Glen Eden students over the years. Each child gets a program specifically designed to meet their needs, help them to improve their functioning, and ultimately meet their long-term goals, whether that be returning to mainstream school, going to post-secondary, or simply finding a greatly improved quality of life.

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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July 22, 2016

The school for kids who don’t like school (Richmond News)

Dr. Rick Brennan, Founder and Executive Director, has applied scientific thinking and research as a basis for the personalized treatment and care of these individuals.  With this approach, Glen Eden has successfully treated and educated many children for whom there were no other options.

“Typically, schools use reinforcement or punishment of behaviours or cognitive strategies that require a great deal of self-awareness. Their aim is to eliminate challenging behaviours and replace them with socially acceptable ones, but, in doing so, they do not consider the internal functioning of a child,” explains Dr. Brennan, who opened Glen Eden’s original program in Tsawwassen in 1984. “We do the opposite here. We consider the dynamics of a child’s development, and their internal and adaptive functioning. Our goal is to systematically change the physical and mental health of the child internally before we expect to change their external behaviour.  What we have found is that social and academic success emerges from internal wellbeing.”

Glen Eden Multimodal Centre  is a one-of-a-kind clinical/educational program in North America; and has, for 30-plus years, taken– and transformed – students once deemed as unworkable in all other school-based special programs.

“In most school programs, there’s a reliance on protocol and procedure. Doing the right thing is defined as following procedures, establishing behavioural goals and possibly having a safety plan. If a child does not meet expectations, the problem is seen as something inherent in the child, not a deficiency in their approach” says Dr. Brennan. “At Glen Eden, the physical and mental well-being of the child is of paramount concern. If a child is not responding in a manner that we would anticipate, we need to change our hypothesis, investigate further and modify our approach.”

Glen Eden Multimodal Centre’s school program is accredited by the B.C. government and  is suitable for children and adolescents with complex psychological, neuropsychiatric, socio-emotional and/or developmental difficulties. “Our students have not been able to fit into other programs. Rather than try to make the child fit a pre-determined program, we completely build the program around the child and see all behaviours not as good or bad, but as expressions of self.” says Dr. Brennan.

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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June 14, 2016

How do you talk to your teenager?

We know that teenagers are more impulsive and risk-taking than adults AND younger children. Not only does a teenager’s brain operate in a way that makes risk more rewarding, but his prefrontal cortex, which is a brain region that helps us inhibit our urges, is still developing. See more about the brains of adolescents in this TED talk.

Teenagers are also more self-conscious than kids or (well-adjusted) adults. In the talk above, neuroscientist Sarah-Jayne Blakemore tells an anecdote in which a parent singing the kid’s favorite song in public, considered a reward when the child is younger, becomes a punishment once the child is a teenager. In this interview, neuroscientist Ron Dahl speaks to the power of social evaluative threat – the fear one feels that someone is going to evaluate you – in adolescence.

So, how do you talk to your impulsive, risk-taking, hyper-sensitive teenager?

You know, probably through personal experience, that telling them what they’re doing wrong will at best, get a superficial “I know” and at worst, result in a breakdown of your relationship with them.

Dr. Dahl emphasizes the importance of catching them when they’re doing well: I love the quote by Maya Angelou: ‘People will forget what you said, they will forget what you did, but they will never forget how you made them feel.’ I think that’s particularly true of kids this age. To feel expanded has tremendous salience. As soon as you catch them taking a positive step in the right direction, you’ve got to recognize it and admire it, and not step in and tell them, “You’re going in the wrong direction.” As you soon as you do that, you lose them.

This is a key aspect of our strengths-based approach at Glen Eden. We want to observe each individual closely enough that we are able to catch their moments of stability, their moments of engagement and openness, and expand those, rather than trying to eliminate challenging behaviour.

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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May 8, 2015

Dr. Christopher Gillberg (Univ. of Göteborg, Sweden) is an accomplished researcher in areas such as autism spectrum disorders, ADHD, epilepsy, intellectual disability, oppositional defiant disorder/conduct disorder, Tourette syndrome and anorexia nervosa. He recently came to Vancouver and I had the opportunity to attend talks he gave at BC Children’s Hospital and SFU (the latter through Autism Community Training) about his research and perspective. For decades, he has argued that categorical psychiatric diagnoses such as Autism and ADHD are not accurate representations of the clinical population, and that overlap between diagnoses is the rule rather than the exception. He has coined the acronym ESSENCE to describe the population that presents at an early age with impairing symptoms in multiple areas including general development, communication and language, social inter-relatedness, motor coordination, attention, activity, behaviour, mood, and sleep. He has observed that the first clinician that the child sees (e.g. SLP or psychiatrist) will often determine which diagnosis is initially given.

In his paper The ESSENCE in child psychiatry: Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations, Dr. Gillberg states “The overlap of problems encountered in the field of ESSENCE indicates that we are not dealing with discrete disorders of syndromes, but with brain dysfunctions/neurodevelopmental problems that reflect circuitry breakdown, network dysfunctions and decreased/aberrant/increased connectivity, or, indeed, in quite a number of cases, “normal” brain function variants, and, that, therefore, it would be inappropriate to diagnose one problem and not consider the implication of the other(s). Currently, there is a trend towards compartmentalization, services and clinics being developed specifically for ASD or ADHD or Tourette syndrome. This does not appear to be a helpful approach.” (emphasis mine).

For over 30 years, Dr. Rick Brennan, Glen Eden’s Executive Director, has similarly proposed that psychiatric nomenclature, with its lack of relation to mechanistic physiology, does not accurately reflect the presentation or the needs of the population we serve. In our work, we take the focus off the diagnostic labels and instead focus on the child – What are the specific symptoms that we observe? What is the child showing us or telling us that can help us understand their internal functioning and what is driving those symptoms? What is their physiological presentation – for example, is their breathing well-regulated; what is their level of arousal (external and internal) at baseline and when presented with stressors?

Most of our students come to us with laundry lists of diagnoses, and with a history of interventions offered in “silos” by individual clinicians without any integration. Often these perfectly good interventions have been offered at the wrong time, when the child is not stable enough to benefit from them and therefore rejects them. How do you help these kids? First, you must establish a solid therapeutic rapport in which you are not trying to control them. Then, when they have developed sufficient trust in you, you can begin to guide them in using strategies that can help them when they are struggling. We posit that it is best that all interventions are offered within an integrated therapeutic milieu, as session therapies can be very stressful and any benefits can be more difficult to generalize. As such, our school program has clinical services integrated throughout. Counseling techniques, social skills education, Speech Language Pathology, and other strategies are discussed regularly with all of our teachers and support staff, who adapt these strategies as necessary to use within the context of the relationships they have with each student. We are fortunate to have amazing consulting practitioners – an SLP and a Yoga Instructor – who provide on-site individualized services for our students. We provide parent support in appointments with psychologists, psychiatrists, neurologists, etc. to provide integrated case management. We want to see the whole child from multiple perspectives so we can improve his or her functioning from the inside out.

As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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March 12, 2015

A concept that has come up several times in discussions I’ve had recently with parents and staff is one of arousal (internal energy) vs. valence (positive or negative) of emotional state.

“It is often forgotten that affects have two dimensions, valence (positive-negative, pleasant-unpleasant, approach-avoidance of discrete emotions) and arousal (intensity, energy, calm-excited). My sense is that clinicians have focused too much on the former, which has impacted clinical models. But arousal – especially somatic, peripheral, autonomic arousal – is what is essentially transmitted and regulated in a relational context…” – Allan N. Schore, excerpt from foreword to Neurobiology Essentials for Clinicians by Arlene Montgomery, 2013

We focus a lot of attention on arousal level in our data collection and staff discussion. Why is that the case? One of the reasons is that context, which we can adjust, will be a major factor in the student’s interpretation of their internal signals of arousal, over which we may have no control. For example, if John is experiencing a high arousal state with his favorite teacher during a lesson on his favorite topic, he may be more likely to cognitively label this arousal as “excitement” than if he is in a context in which he has a less successful history. Context includes the physical context (noise, visual input, size of area, number and type of objects) and the relational context (who is present, that person’s relationship with the student, requests of the student, tone and response).

If a student is experiencing a high arousal state with negative valence (upset, angry), sometimes we can shift the valence to positive first (often with redirection or humour), after which the student may be in a better position to regulate his/her arousal. This is a change in relational context. Other times, a change in physical context or “change of scenery” can be very effective – going to a less busy space, for example. These adjustments are generally more effective than attempting to directly calm the person down by, for example, talking about what’s wrong, because any such cognitively-based discussion is likely to take on the intensity of the person’s high arousal state.

Recommended articles:

Monitoring Emotions: Valence vs. Arousal on the The Thinking Zygote blog

A slightly silly but very clear and accurate description of the interplay between the two. 

Recommended books:

Scattered Minds by Gabor Maté

An excellent and very accessible read, from a neurophysiological, developmental, and first-person perspective, about the development, presentation, and treatment of ADHD. I believe his model is relevant to many sensitive, complex individuals, not just those diagnosed with ADHD, and his recommendations are in line with Glen Eden’s clinical approach. Some chapters are available to read for free online: http://drgabormate.com/book/scattered-minds/ 

Please keep in mind that any strategies recommended in these sources are tools that we can choose from based on each individual’s needs – nothing is a panacea. As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org

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January 20, 2015

As we individualize everything we do to the needs of each child we serve, it can be challenging to explain our model and methods concisely. Do we work on social-emotional learning? Yes (but that looks different for every child). Do we teach self-regulation? Yes (but that looks different for every child). Are we evidence-based? Yes (but we draw from a broader set of research literature than many educational models).

In the interest of sharing some of the background and perspectives that inform our model, I will be sending out a newsletter periodically to share articles, lectures, and books that I think you will find accessible, interesting, and informative.

Articles:

The Risks of Rewards by Alfie Kohn

Many parents wonder why we minimize the use of punishment and reward in our work. This article explains a bit about the unintended side effects of external positive reinforcers (i.e. rewards).

Anatomy of a Bad Mood by Robert Sapolsky

A brief, funny article explaining how your body can tell your mind how to feel.

Lectures:

Attachment and Brain Development – by Gabor Maté

A 45-minute talk on various factors that can contribute to ADHD. Yes, his voice might be boring but his insights are wonderful!

Recommended books:

The Boy Who Was Raised as a Dog by Bruce Perry

Vignettes of trauma cases with a discussion of relevant neurobiology and Dr. Perry’s therapeutic approach for each. Please note that this book contains details of trauma that many readers will find disturbing. I found Ch. 1 and 2 the most difficult to read.

Why Zebras Don’t Get Ulcers by Robert Sapolsky

A book about stress, stress-related disease, and coping. 

Please keep in mind that any strategies recommended in these sources are tools that we can choose from based on each individual’s needs – nothing is a panacea. As always, please feel free to contact me with questions or if you would like to discuss further.

Bhavana Vishnubhotla, Ph.D.
Director of Applied Research
bvishnubhotla@gleneden.org