Linda Mayes: Attachment and Emerging Stress-Reward System ...

Links Across the Conference• Neurocircuitry of reward and stress systems(Weinberg & Krebs)• Long term impact of chronic stress (McEwan(McEwan)• How acute stress impacts prefrontal fx (Arnsten)• How social cues such as faces may elicitfear/stress (Walden)

Roots of Questions• Studies of earlyadversity and impact onemotional development• Prenatal drug use• Family PovertyIndividual developmental pathways• Meaning ofbehavior• Motivation• Relationships

Outline—Part 1• Basic propositions about early attachment• Relationship between stress, reward, andattachment• Special parenting minidset of earlypreoccupation• “Biology” of Parenting--oxytocin• Neural circuitry of parent-infant attachment

Outline—Part 2• Concept of mentalization—and and neural circuitry ofmentalization• Mentalization under Stress• How early and chronic stress impacts parenting• Clinical implications• Substance abuse and parenting• Parenting under economic deprivation• Conclusions

ORIENTING POINTS OF VIEW• Humans are inherently social—we need and seek other people• Over course of evolution, we have conserved a very specializedneural system dedicated to social relationships—loving loving and caringfor others• Falling in love with a new baby (or another person) is a very specialtime in life for which we have a special biology as well aspsychology• The initial stage of love (for an adult or a baby) is very differentbiologically and psychologically from later stages

Key Assumptions• Presence of a new person (e.g., infant or new loverelationship) activates specific neural circuitry involvedwith salience and reward• Underlying neural circuitry facilitates intense (andadaptive) parental preoccupation on new person• In parents, such a highly preoccupied state facilitatesparental protectiveness and care

BRAIN REWARD CIRCUITRYRelationships

Salience/Reward System• Reward system set to respond to what is mostsalient in environment (e.g., food, drugs,relationships); dopaminergically regulated• Reward may be used to downregulate stressand in times of increased stress, may turn tothose persons or behaviors that increase“reward input”• Relationships based in reward pathways

The Attachment System as aStress Regulatory SystemSecure attachment is confidencethat fear is temporary state andseeking comforting will reducediscomfortPerceivedthreatAttachmentBehaviourSysteminhibitsExplorationProximitySeeking(reward)Reduces

Rooted inAttachment Theory

Disruption in Balance of Stress/Reward SystemIncreasedDecreasedstressrewardSensitivitySensitivityBalance betweensystems Altered in• Early abuse/neglect• Chronic Trauma• Addiction“Intergenerational Risk Cycle”

“PREVIEW”Dysregulated balance between stress/rewardsystems may be1. a predisposing factor for a range of latermaladaptations including addiction, neglectful orabusive parenting2. an outcome common to a range of earlystressful events (e.g., trauma, neglect,deprivation, severe poverty, parentaldepression)

Biology of AttachmentSystemsTHE INITIATION OF THE PARENT-INFANT RELATIONSHIP

Genetic FactorsEnvironmentalInfluencesNeurobiologicalCircuitsParentalBehavior &Mental States

parenting

Primary Maternal (Parental)Preoccupation—A Special Early Stageof Parenting“I do not believe it is possible to understand thefunctioning of the mother at the very beginning ofthe infant’s life without seeing that she must be ableto reach this state of heightened sensitivity…almostan illness …and recover from it.”D. Winnicott, 1956

Initiation of Parenting• Unique behavioral characteristics and mental states inearly parent-infant and/or love interactions (e.g.,special language, increased vigilance)• Think of these as hallmarks of “social salience”/reward system being “turned on” by salient person(e.g., infant or adult love object)• Entering a “special mental and biological” transitionalstate (Winnicott(Winnicott) ) in the early stages of parenting

Affiliative “States of Mind”• Preoccupation about other(reverie)• Exclusivity of focus• Intrusive thoughts• Worries, doubts• Longing for reciprocity (andrelief when achieved)• Idealization/Perception of“perfection” (crystallization)

Affiliative “Behaviors”• Increased checking• Enhanced attention toappearance, body• “Grooming”• Preparation of space andplace• Intense, sustained looking• Change in speech and voice

Hallmarks of Early LoveOut of blueNot understandableto others

A LongitudinalStudy ofTransition toParenting

Degree ofPreoccupationAITHAB10864207m504030201008m Birth 1m 2m 3m 4m8 mos 2 wks 3 mosTimeLeckman et al. , 1999Mothers FathersN 31 27Age (yrs) 33+ 5 35+ 5First child (%) 60 56

Early Parenting Phase—Summary ofInterview Findings• Between 2 wks and 3 mos: : preoccupation and anxious thoughtsdecrease, positive thoughts and feeling of personaltransformation increase• Experience makes a difference (? Sensitization phenomenon inhumans); experienced parents less preoccupied in beginning,behaviorally more like first time parents at three months• Individual differences in the level of preoccupation• Similar patterns between mothers and fathers• Greater intensity of preoccupation = greater perception of“transforming experience”

Genetic FactorsEnvironmentalInfluencesNeurobiologicalCircuitsParentalBehavior &Mental States

WHAT DO WEKNOW ABOUTTHE BIOLOGY OFLOVE?

Neurobiology of Parental Behavior• Extensive data from Preclinical Models:• Medial preoptic area (MPOA), bed nucleus of the striaterminalis (BNST)—salience/reward• Associated approach/avoidance pathways involving especiallyamygdala and ventral tegmental area• Modulation by oxytocin, , estrogen, prolactin and bymonoaminergic system• 9 genes identified (fosB(fosB, prolactin & estrogen receptors,oxytocin, , DBH) as playing a role in initiation of parentingbehavior

Features of Oxytocin• Genetic sequence uniquely mammalian• Best known function—milk ejection and uterinecontraction (mammalian traits)• Distribution of receptors in brain same for malesand females but marked change from infancy toadulthood

Oxytocin Initiates Maternal Behavior in Virgin,Steroid Primed RatsPedersen et al.,1979

Role of Oxytocin in MaternalBehavior• Onset of maternal behavior can beblocked by oxytocin antagonists• Blocking oxytocin does not interfere withalready established maternal behavior.Initiation phase more vulnerable

Oxytocin and Maternal Care• Delivery-linked linked increases in central OT related to behavioral andphysiological changes critical for maternal success• enhanced memory of pup-specific olfactory and auditory cues• increased pup-directed nurturing (pup licking, retrieving, nestbuilding, nursing).• reduced aversive response to pups• Oxytocin facilitates reward sensitivity in earlyattachment

Oxytocin and Human Relationships• OT is elicited in response to sensory cues that strengthen socialbonds:• Massage• light stroking• Pleasant sounds and smells• Linked to increased calmness and reduced anxiety, aggression,and pain (Uvnas(Uvnas-Mobert, , 1997, 1998, 1999).• Lowers activation of HPA and sympatho-adrenoadreno-medullarystress response systems• ‘Calm and connect’ response (Uvnas(Uvnas-Moberg, , 1999)

Oxytocin and Parent-infantRelationship (Human model)• Higher plasma OT levels=greater “calmness” in newmothers (Carter, Altemus, Chrousos, , 2001)• Breast feeding mothers with higher OT have lower BP,less HR increase and greater vagal control of HR inresponse to stress (Altemus(Altemus, , et al, 2001)• Maternal BP lower in hour following infant feeding(breast > bottle) (Light, et al., 2000)• Plasma OT levels increase during mother-infantseparation (Light, et al., 2000)

Oxytocin and Parent-Infant Relationship(Light, et al., 2000)• Mothers listening torecordings of theirdescribing an eventthat made them angryand a stressful eventSystolic BP (mmHg)130120110100OTDecreaseBaby DayMinimal OTChange130120110100No Baby DayOTIncrease• Sessions with andwithout baby present90BASEPREPSP1SP2REC1REC290BASEPREPSP1SP2REC1REC2• Three groups—OTincrease, decrease, orminimal change• OT increase mothers showed lower diastolic BPacross all conditions and on both days• Breast feeding mothers more likely to show OTincrease• Lower BP reactivity to speech task when with baby

PROPOSITIONBy maintaining calm state with lesscardiovascular reactivity, is oxytocin acomponent of the early preoccupied statethat helps parents focus on learning abouttheir infant’s s cues?

PARENTAL BRAIN• Recent human studies using fMRI and salient infant cue(auditory and visual)• Overlapping with preclinical findings• Limbic, hypothalamic, and midbrain regions reflectingadaptation to homeostatic demands associated with maternalcare (e.g., hippocampus, superior/medial temporal,hypothalamus)

OWN BABY VISUAL CUES ACTIVATEDOPAMINE REGULATED REWARD CIRCUITSSTRATHEARN, et al., 2008

Own Baby Images Activate Orbitofrontal CortexOFCappraisal ofpositive/negativeaffective valueNitschke, , 2004,Neuroimage

CRY AS SALIENT SIGNAL FOR ACTIVATINGATTACHMENT SYSTEMSEffect of Time with Infant and OverallParenting Experience

Infant Cries Relative to Matched NoisePoint 1: Both novice and experienced mothers activate superior temporal tregionsPoint 2: By 3-434 months, for both, increased R medial temporal lobe activationPoint 3: For novices, increase in R hippocampal activation by 3 mos; ; forveterans present at 2 weeks already & no change by 3 mos

Infant Cries Relative to Matched Noise Use Functional Connectivity Analysis to test for inter-regionalregionalcorrelations in activity across group (novice/veteran) and time (2wks-3 mos) (L.Jacobsen,, M.D.) between hippocampus (affiliation)and other regions Increasing connectivity fornovice mothers between 2 wks-3 mos More modest increase forveteran mothers ? Reflective of earlysensitization of circuits

1st Mom’s - OWN BABY CRY - Time 1Striatum8Own Baby Brain Activity6420-2R = 0.39N=14; Talairach z=-5 p

1st Mom’s - OWN BABY CRY5Left AmygdalaOwn Baby Brain Activity0-5Time 2, R = 0.62-10 Time 1, R = 0.66.4.6.81.01.2Postpartum Preoccupations (AITHAB)1.4

1st Mom’s - OWN BABY CRY - Time 1Right Amygdala6Own Baby Brain Activity420-2R = 0.64N=14; Talairach y=-9 p

TAKE HOME MESSAGE• Neurocircuitry mediating maternal attachment undergoessignificant change during the initial postpartum months in newmothers, with increased activation in reward circuitry andincreased functional connectivity between components of thisreward circuit and other brain regions during the early postpartumperiod.• Observations in veteran mothers suggest that these changes inconnectivity may be longlasting, , and undergo relatively modestincreases in strength with subsequent births.• Initial activation of reward circuitry essential to early preoccupationwith greater activation in reward circuitry = more intenseexperience of preoccupied state of mind

WHERE WE’VE GONE SO FAR• Relation between reward and regulation of fear/stress• Balance of sensitivity to fear/worry and to reward/attachment• Early parental preoccupation as a common (and ? essential)early mindset• Neural substrates of early parental behavior with attention tooxytocin (“calm and connect)• Converging preclinical and human literature on basic circuitry of oearly parental affiliation• Neural circuitry of parental response to infant signals—ventralstriatum (reward), superior temporal gyrus and R medialtemporal

AFTER THE BREAK• THINKING ABOUT OTHER’S S MINDS-MENTALIZATION AND RELATION TOPARENTING• STRESS and LONG TERM IMPACT ONPARENTING• CLINICAL IMPLICATIONS

INTERMISSION

WHERE WE’VE GONE SO FAR• Relation between reward and regulation of fear/stress• Balance of sensitivity to fear/worry and to reward/attachment• Early parental preoccupation as a common (and ? essential)early mindset• Neural substrates of early parental behavior with attention tooxytocin (“calm and connect)• Converging preclinical and human literature on basic circuitry of oearly parental affiliation• Neural circuitry of parental response to infant signals—ventralstriatum (reward), superior temporal gyrus and R medialtemporal

WHAT’S S COMING IN PART 2• Concept of mentalization—and and neural circuitry ofmentalization• Mentalization under Stress• How early and chronic stress impacts parenting• Clinical implications• Substance abuse and parenting• Parenting under economic deprivation• Conclusions

SPECIAL STATE OF MINDTHINKING ABOUT OUR OWNAND MINDS“MENTALIZATION”

WHAT DO YOU SEE?

What is Mentalization• Psychological skills that allow us to make sense of theactions of others as well as our own actions by reference tomental states (e.g., desires, thoughts, memories, feelings)• Spontaneous, Intuitive, Rapid• Qualitative difference between describing mental state andphysical state events (“She(feels vs she fell”)• Physical stance = prediction of the behavior of objectsthrough laws of physics• Mental stance = prediction of the behavior of othersbased on assumptions about their mind

Nature of Mentalization• Mentalization skills develop over childhood,increasingly complex and only gradually achieved fully• Mentalization is a part of social attachment• Sharing internal experiences with others makesthem meaningful• Central to understanding and regulating ownemotions (“why(am I so worried…..)• Also central to regulating emotions in interactionswith others (e.g., empathy…)

Parental PreoccupationWhen I look at my baby, I feel like I am on a different, wondrousplanet—is this really me, is this MY baby. I smile, she smiles, Italk, she coos. She’s s really listening to me and so interested inall that is going on. We’re getting to know one another’s s likesand dislikes. She feels so happy and I don’t t think she has aworry in the world—or I don’t t want her to have any. I’m I m a worrier,I don’t t want her to be—maybe she already knows that since Icheck on her all night but maybe that just helps her know I’m Ithere for her. I wonder what will she think when she sees moreof the world, what kind of person will she be. She’s s probablythinking about me too, does she know how much I love her—somuch going on in that little head, so much for her to feel andlearn about………….A new mother….

Mother's Mentalizing or Reflective Ability PredictsInfant-Mother Strange Situation Classification at 1 year100%80%% SSTs Classified60%40%20%0%2 3 4 5 6 7p

WHAT DO WE KNOW ABOUT NEURAL CIRCUITRYOF MENTALIZATION PROCESSES?

Caution about ReductionismDiffering domains of discourseThoughts, hopes,feelings, dreams,wishes, loves, hates?

? OVERLAP IN “PARENTAL CIRCUITRY”AND “MENTALIZATION CIRCUITRY”• Superior Temporal sulcus,R temporal active acrossdifferent types ofmentalizing events (Spiers,Maguire, Neuropsychologia,2006)• Could response to cry (with similar regions activated) reflectparental reflection on infant’s s state of need—using a specializedcircuit in service of parenting?

“MENTALIZATION CIRCUITRY”• Mentalizing functions of superior temporal sulcus and temporalpole (Frithand Frith, , 2003) especially in response to sensorysignals that provide clues to mental states• These regions connected tomedial prefrontal cortex whichmay be involved in processing themental versus physicalrepresentations of these “mentalstate clues”• “Top Down” component ofmentalization circuit

“Signaldetection” and“top down”mentalizationprocesses

Early Parenting and Mentalizing• Infant cues activate parts of “mentalizingcircuitry” thatgive clues to infants’ mental states (“signal(detection”component)• Early preoccupation = increased activation of “signaldetection” aspects of mentalization circuitry• Initially in highly preoccupied state, “top down” aspectsof mentalization circuitry may be less active but comesinto play with experience with infant and as level ofpreoccupation/worry diminishes

Stress and Mentalizing

WHAT DO YOU SEE?

Stress and Mentalizing• Mentalizing capacity diminished during acute stress• Neurobiological model—take aspects of prefrontalcortex off-line during acute stress to allow for moreautomatic responding (Arnsten, 2004)• “Switch point” for taking prefrontal cortex off-lineindividually variable—reflecting reflecting individual differences instress reactivity• With acute stress or increased stress sensitivity, morereadily take “top down” mentalization circuitcomponents off-lineline—may respond to “mental statessensory cues” but not reflecting on these

“Threats” to Intact “Parental(Mentalization)) Circuitry”• Impact of parental depression,substance abuse, and otherpsychopathology when reward circuitry dampened or co-opted (e.g., addiction)• Less active response of “signal detection” components ofmentalization circuit that is sensitive to “mental state” cues• Impact of early deprivation/neglect with heightened stressreactivity and less effective downregulation of stress byreward• Less effective “top down” processing of mental state cues

EARLY and CHRONIC STRESS ANDIMPACT ON PARENTING

Genetic FactorsEnvironmentalInfluencesNeurobiologicalCircuitsParentalBehavior &Mental States

Parenting and Emotional RegulatorySystems• Naturally occurring variations in maternal care inthe amounts of licking and grooming a motherprovides pups (“low(low” versus “high” care)• Long-term changes in both reward sensitivityand stress reactivity can be produced by thesenatural variations in maternal care and earlyseparation/disruptions in parental care(Meaney,, Francis, Plotsky)

Experience and IntergenerationalTransfer of Parenting Behaviors• Offspring of, or thosecross-fostered to “low care”mothers show, as adults,increased response toacute stress, decreasedexploration in novelenvironments, enhancedstartle, decreasedhippocampal glucocorticoidreceptor mRNA expression• ? Decreased reward withincreased stresssensitivityAmong cross-fosteredoffspring, individual differencesin maternal behavior related torearing, rather than biological,mother.403020100H/C H/w H-H H-L L/C L/w L-L L-HExploration(secs)Francis et al., ‘99

Intergenerational Transfer ofParenting BehaviorsOffspring from high levels of maternal care crossfosteredto “low care” mothers and vice-versa (lowto high)15105L&G (%)0H/C H/w H-C H-L L/C L/w L-L L-HFrancis et al., 1999

Low Maternal Care in Humans Associated withGreater Striatal Dopamine Response * to Stressor asAdult**reduction in[11C]raclopride bindingpotentialPruessner,et al, 2004

Women with early history ofabuse/neglect show altered stressresponsivity in mid-adulthoodHeim, et. al., 2000

Early neglect in humans associated withreduced neuropeptide (Oxytocin)response to interaction with parentsFries, Ziegler, Kurian, Jacoris, and Pollack, 2006

Impact of neglect on diurnalcortisol/HPA axis in institutionalizedRussian infants and toddlersKroupina, Gunnar, Johnson, 1997

Maternal Depression and ChildCortisol—Impact of PovertyFamily incomecorrelated negativelywith both mother’sdepressive score (r= -.25, p = .001)and child’s cortisollevels (r = -.31, p =.001),Lupien, et al. Biological Psychiatry, 48: 976-980, 2000

Stress summary• Early, chronic stress has enduring impact on• Stress regulatory abilities (increased sensivitity tostress)• Learning and flexibility to new experiences• Reward sensitivity (decreased sensitivity to reward)• Parenting behavior

Early Stress and Parenting• One mechanism shared across a range of early“exposures” (e.g., depression, poverty, abuse, neglect)is altered parental environment through both geneticand experiential impact on stress-reward systemfunction (increased stress reactivity and decreasedreward sensitivity).• Impact endures into adulthood. Expressed in braincircuitry, oxytocin fx, cortisol, and behavior.• This may alter parental ability to enter criticalpreoccupied mental state, to focus on infant’s needs,and respond to infant’s cues early on. Infant cues areless “rewarding”, more “stressful”

Coming Back to Mentalization• If early “preoccupied” or “invested” state diminished,may impact capacity to perceive own and other’smind—or the “sensory detection” component ofmentalization circuitry• Infant negative cues (cries, negative facialexpressions) are more stressful as not seen as signalabout other person but processed more automatically,out of awareness as stress/danger• With heightened stress reactivity, “top down”mentalization facility impacted, “off line”

REWARD, STRESS, MENTALIZINGIncreasedDecreasedstressrewardSensitivitySensitivitySignal detection for “fear”,, not needs of otherwhich increases stress and impairs top downprocessing as well

CLINICAL APPLICATION• SUBSTANCE ABUSE AND PARENTING• ECONOMIC DEPRIVATION

Early Life Stress and Substance Abuse• Higher rates of early abuse and neglect in drug-using parents• Higher rates of attachment related violence(parent-child abuse and domestic violence)among substance using adults• Altered stress response in drug-using using adults----?Both reflective of chronic drug use and of own historyof early care• ? Substance Use also as an attachment disorder

BRAIN REWARD CIRCUITRYMechanism for addiction in dopaminergicallyregulated reward systemsRelationships

ATTACHMENT BASED VIEW OFADDICTION• Dysregulated balance between stress reactivity and rewardsensitivity is one mechanism of addiction—enhanced stressreactivity and reduced reward sensitivity• Addiction and social attachment share a common neurobiology• Addiction “co-opts” dopaminergically regulated reward circuitrykey to initiation and maintenance of parent-child attachments• In addicted adults, infant cues increase stress response andserve as potential cue for increased craving and drug use• Because reward system co-opted opted by drug, cannot useattachment based reward to mediate stress

Preclinical models of parenting & drug abuse• Suckling increases activation in mesolimbic dopaminergic rewardsystem and cocaine diminshes this activation (Ferris, et al., 2005;Febo and Ferris, 2007)

OWN BABY VISUAL CUES ACTIVATEDOPAMINE REGULATED REWARD CIRCUITSSTRATHEARN, et al., 2007Preliminary findings in cocaineabusingmothers: Relative decreasein activation in ventral striatum inresponse to infant positive affect

Substance Abuse and ParentingPilot Data—? ? Decrease in “SignalDetection” Attachment CircuitryDecreased activation ofright hippocampus (arrow),modest activation of rightsuperior temporal gyrus(STG) in contrast toincreased hippocampaland greater STG activationin non-drug using.

Oxytocin & Parent-Infant RelationshipAmong Cocaine-Using Mothers(Light, et al., 2008; preliminary data)• Cocaine using mothers had lower overall baseline plasma OT levelsthan control mothers (means = 1.1 + 0.2 vs. 2.0 + 0.2 pg/ml, p< .01).• Cocaine-using mothers show decrease in OT during speech tasksand higher BP and urinary NECocaine, No BabyCocaine, BabyNo DrugCocaine85No Drug, No Baby801.50No Drug, Baby1.0080700.50750.0060-0.5070-1.0065BasePrepSpSp Recov50SleepPost-FeedAwake-1.50BabyNo Baby

Cocaine-Using Mothers Show DiminishedOxytocin Response to Salient Infant Cues(Light, et. al, 2007)No DrugCocaineOxytocin during SPEECH REPLAY1520Plasma Oxytocin (pg/ml)12963Plasma Oxytocin (pg/ml)161284.0Interaction Separation Post Threat Post CryAdjusted for Feeding Group, Between Subjects Effect of Cocaine: F=6.98, p=.0298No DrugCocaine0CocaineNo Drug8.00Perceived StressStressed Rating6.404.803.201.600.00Interaction Separation Replay Recov

Parental Behavior Among Substance Abusing• In human mothers:Adults• Withdraw in face of infant distress• Less attentive to infant bids for attention• Less contingent responding or increased non-contingentbehaviors• Higher rates of negative affect in interactions and heightenedphysical provocation and intrusiveness• ? Each as markers of heightened stress in responseto infant

Do Salient Infant Cues Increase Stress andCraving in Addicted Adults?• Mechanism for clinical observation of increased druguse/relapse in adults after birth of infant• Changes or amplifies intervention focus• Decrease drug use----------improve parenting or…..• Improve parenting--------decrease drug use• Focus intervention on how infant signals may bestressful, difficult to interpret, increase parental stresswith withdrawal from infant

Mothers and Toddlers Drug Treatment Program(Nancy Suchman, Yale)• Intervention for drug-using using mothers focusing on relationship withchild in addition to standard drug treatment focused ondecreasing or quitting drug use• Treatment focuses on specific maternal behaviors andresponses to specific child cues• Early treatment effects show both positive impact of interventionon maternal attention and sensitivity to infant cues• Treatment also increases reward aspects of parenting anddecreases stressful impact of infant signals• Does this also impact drug use by increasing salience of infantattachment?• Mothers in enhanced treatment group show greater change indrug (opiate and methadone use) compared to those in standarddrug treatment

ECONOMIC DEPRIVATION AND EARLYADVERSITY• Substance abuse not a special case but rather an example ofhow increased stress reactivity and decreased reward sensitivitymay impact parenting• Same principles apply to economic deprivation in which parentsare struggling daily to provide• Also co-morbidity of chronic poverty with other earlyadversities—abuse, abuse, neglect, parental depression, etc.—andimpact on stress reactivity

An Intervention Research “Gap”How do early interventions with an attentionto the relationship between mother and infantwork—what is the mechanism of action?Do changes in parental reflective ormentalizing capacities vis a vis the infantmediate the positive outcomes ofrelational/attachment based therapies?

PROPOSITIONMentalization based interventionprograms may improve both signaldetection and top down processingcomponents of parental reflective ormentalizing function.

Minding the Baby: A Reflective Parenting ProgramLois Sadler, PhD, APRN, PNP,Arietta Slade, PhD, Cheryl deDios-KennKenn, , MSW, Sarah Fitzpatrick,MSW, Denise Webb, MSN PNP, Betsy Houser, MSW, Linda Mayes,MDA Collaboration:Yale Child Study CenterYale University School of NursingFair Haven Community Health Center

How does understanding the biologyof parenting help us?• Focuses our interventions on response to specificresponses infant cues:• On how those cues such as a cry may increase parentalstress, diminish “reward” of effective parenting• On helping parent understand impact of cry, for example, onself and then on response to infant—andand “meaning” of cry forthem• Also focuses on key developmental period—initiationinitiationof parenting and setting up of “parental reward circuits”

TYING THINGS TOGETHER• Neural circuitry of reward, stress regulation, environmentalshaping of gene expression—each each components/”buildingblocks” of capacity to be preoccupied with child• Managing stress gives time to observe, reflect on own—andchild’s—experience• In this reflective time, meanings come into being—meaning of acry, of child’s s expressions and behaviors—and and these meaningsshape moment to moment “mind forming” interactions• Child “comes into being” with experience of a mind that holds hismind in mind

WHAT WE HAVE COVERED----1• Relation between reward and regulation of fear/stress• Balance of sensitivity to fear/worry and to reward/attachment• Early parental preoccupation as a common (and ? essential)early mindset• Neural substrates of early parental behavior with attention tooxytocin (“calm and connect)• Converging preclinical and human literature on basic circuitry of oearly parental affiliation• Neural circuitry of parental response to infant signals—ventralstriatum (reward), superior temporal gyrus and R medialtemporal

WHAT WE HAVE COVERED----2• Mentalization as a human process with neuralcomponents—signal signal detection and top downprocessing• Stress and impact on mentalization• Enduring impact of chronic stress on parenting• Substance abuse in parents as a clinicalexample

Conclusions• Early initiation of parenting is a time of veryrapid change in adult mental states andbehavior (and of changing neural substrates)• Parental ability to shift mental energy/investment toward infant may be a keyreorganizational phase for setting up the parent-child affiliative system and parental reflectivecapacities toward infant• Early stress has an enduring impact on bothreward sensitivity and stress reactivity—andpotentially on compenents of parental andmentalization neural circuity

CONCLUSIONS• Interventions may fruitfully focus on this criticalinitiation phase and the degree of parental“mental” as well as behavioral investment• Interventions have capacity to change parental“mentalizing” function such that alter expressionof key capacities (reward sensitivity, stressreactivity) in child

Collaborative NetworkYaleJames LeckmanJames SwainMarc PotenzaRajita SinhaHilary BlumbergLeslie JacobsenDaryn DavidArietta SladeLois SadlerMichael CrowleyLondon/AFCPeter FonagyMary TargetIsraelRuth FeldmanShmuel Shulman

THANK YOUFor questions, e-mail: eLinda.mayes@yale.eduSLIDES WILL BE AVAILABLE ONCONFERENCE WEBSITE

Early ParentingExperienceRisk forDepression,Substance AbuseGeneticRegulationStress-RewardRegulatory SystemMentalization/ReflectiveAbilitiesParentalPreoccupationParenting SensitivityTo Infant CuesInfant cues