The Meadows Blog

It may surprise you to learn that some of the most compelling information we have about human attachment behavior comes from...rodents. That's right - like humans, these little mammalian mothers form attachment-like bonds with their young pups (i.e., rodent infants). As it turns out, the nature of this bond has a profound impact on the pup's development. It has become increasingly clear that the quality of the mother's care induces numerous biological changes in the pup that can be carried forward into adulthood and into the next generation. In fact, thanks to our furry little friends, we now understand some of the mechanisms involved.

Attachment theory, pioneered by John Bowlby and Mary Ainsworth in the early 1900's, put forth the idea that the bond between child and caregiver has been naturally selected for by evolution because it offers survival and reproductive advantages. Through a series of ground-breaking studies, they showed that children who are separated from their caregivers experience predictable stages of protest, despair and detachment. Subsequent attachment researchers, like Alan Sroufe, postulated that early attachment relationships organize the child's inner world, making them more or less able to negotiate future developmental challenges in middle childhood, adolescence and adulthood.

By the end of the twentieth century, attachment theory had risen to prominence in the field of psychology. Yet, little was known about the actual biological mechanisms responsible for most of its basic tenets. That began to change with fascinating research in mice and rats, like that of Marion Hofer and his colleagues. They recognized that, like human infants, rat pups experienced similar stages of protest and despair when separated from their caregiver. More importantly, they found that caregiver separation during specific periods of development (usually in the first two weeks) resulted in a number of physiological deficits in the rat pups.

In fact, Hofer and his colleagues discovered that during critical periods, specific maternal caregiving behaviors were related to the development of specific biophysiological processes in the rat pups.  For example, if pups were not allowed to receive body-to-body warmth and closeness from their caregiver, they developed specific deficits in their ability to regulate their activity level (e.g., they were more lethargic, hypoaroused). On the other hand, if the pups received caregiver warmth but did not receive a continuous infusion of maternal milk, then the pups were not able to regulate their heart-rate (but their activity level was normal). These researchers concluded that the caregiver-infant relationship contained within it "hidden regulators" that shaped the biophysiology of the infant in very fundamental ways.

Around the turn of the twenty-first century, there was incredible excitement about the promise of the human (and rodent) genome project.  Gradually, it became clear that simple one-gene-to-one-disease models were overly simplistic and that most conditions were a product of complex interactions between genes and the environment.

With this in mind, researchers like Michael Meaney extended the work of Hofer and others into a new dimension of research involving epigenetics.  Epigenetics refers to the somewhat radical idea that while our inherited genetic code remains fairly stable throughout the lifespan, the quantity and quality of protein products that are made from the genetic code are highly variable and are heavily influenced by the environment.  That is to say, the expression of the genetic code (i.e., which genes are turned on/off, in which parts of the body, at what times) is influenced by various environmental factors.

Michael Meaney's elegant line of research was kick-started by a simple laboratory observation that rat pups handled by humans tended to develop into less anxious and less fearful adults. Fortunately, they overcame the species-centric urge to attribute the positive results to human contact and discovered that pups that were handled by humans received more grooming from their mother. (Rat mothers were dutifully cleansing their pups of the human contact!) This led to the exciting discovery that it was the maternal rat's licking and grooming behavior that was responsible for their well-adjusted offspring.

Meaney and his colleagues found that high-quality maternal care in rats involves licking and grooming behavior and a style of nursing where the mother's back is highly arched. They also discovered natural variation in the quality of maternal care - some maternal rats were quite good at arched-back nursing and licking/grooming behavior, while others were not. This led to the discovery that pups who received high levels of maternal care (arched-back nursing and licking/grooming) were less anxious as adults, more willing to explore their environment and they became mothers who delivered high levels of maternal care to their own offspring.

Of note, these researchers wanted to be sure that the outcomes associated with high-quality maternal care were not simply due to inherited genes. So, they took pups from low-quality caregiving mothers and gave them to high-quality caregiving mothers (cross-fostering), and vice versa. The results showed that it was the quality of caregiving that determined the positive outcomes, not the pup's genetics.

Now these researchers had an animal model that looked a lot like what we see in humans: high-quality maternal care (i.e., attachment security) organizes developmental processes in a way that supports greater well-being and caregiving advantages for the subsequent generation. These researchers were perfectly poised to answer the next burning question: What are the underlying biological mechanisms?

This is where epigenetics re-enters the story! Meaney and his colleagues discovered that during sensitive periods of development (the first week of life for rats), high-quality maternal care actually stimulates (i.e., turns on) the expression of a gene that codes for a protein called glucocorticoid receptor (GR). In fact, the GR gene becomes more active because the mother’s licking and grooming behavior sets in motion a cascade of chemical messengers in the pup that eventually act on specific epigenetic factors (e.g., histones and methyl groups) that alter the shape of the DNA, making it more accessible for genetic expression.

As is common in epigenetics, the maternal rat's high-quality caregiving behavior stimulates GR gene expression in the pup at specific locations within the body: in this case, a brain region called the hippocampus. This is critically important because the hippocampus is involved in generating the body's fight or flight reaction to stress. When there are more glucocorticoid receptors present in the hippocampus, the fight/flight response is attenuated. Therefore, high-quality maternal care alters the shape of the GR gene, which leads to an increase in GR gene expression and an increase of glucocorticoid receptors in the pup's hippocampus. This results in a rat pup with better nervous system regulation that behaves more calmly and confidently as an adult.

Although epigenetic programming by maternal care occurs during sensitive periods early in life and tends to be stable over the lifespan, there is evidence that these effects can be reversed. Even as adults, these same epigenetic processes remain open to environmental influences and can potentially be harnessed for the purpose of change. There is some evidence that consistent and repetitive activation of certain brain circuits might induce epigenetic modifications, leading to stable changes in gene expression. Ultimately, changes in gene expression modulate complicated neurochemical feedback loops, which then alter the structure and function of neurobiological systems.

Thus, there is the real possibility that future research will help identify ways that specific environmental factors, including the environment of our own mind, can be utilized to gain access to these powerful epigenetic processes. In that wonderfully hopeful time, we will probably still be talking about mice and mothers.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell's clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

Published in Blog

By: Jon G. Caldwell, D.O.

During my first meeting with Rebecca (as I will call her), I asked about her family history of mental and emotional difficulties, which can tell me something about her genetic susceptibilities, and about her early life experience with caregivers. These two elements of the evaluation often provide critical information about the unique way in which nature and nurture contribute to human development (see my previous article on this topic).

When I asked Rebecca these questions, an unforgettable look flashed across her face that was part shame and part longing as she explained to me that she was adopted and had no “valuable information” to offer on these topics. All she knew was that she had been adopted by an American family from a Romanian orphanage at the age of two. In fact, to her surprise, this little bit of information proved to be extremely valuable as we tried to better understand how her challenges in adulthood were related to her early childhood experiences.

In the last several decades, as geographic and political borders began to break down, the deplorable conditions of many orphanages around the world came to light, including those in Romania. In some cases this exposure led to policy changes, gradual improvements in orphanage conditions and a wave of adoptions by people from other countries. It also offered scientists a rare opportunity to study children who had experienced early deprivation and adversity and to follow these children as their environmental conditions changed after adoption.

Research of this kind has confirmed that early social experience plays a critically important role in human development. Indeed, we come into the world with a brain that has evolved to capitalize on the social environment, which under favorable conditions is full of rich opportunities for learning and completely embedded in a milieu of meaningful social relationships. Unfortunately, this doesn’t describe many orphanages around the world, where children are kept in cribs or cots for long periods with little access to toys or books and caregiver-to-child ratios can be as high as one caregiver for twenty children. This issue is terribly important because, for better or for worse, the early social environment appears to lay the foundation for cognitive, emotional and social development.

In fact, there appears to be sensitive periods early in life, during which time the brain has an overabundance of neurons that are just waiting to capture information from the outside world. During these sensitive periods, certain brain circuits are more easily shaped by environmental input and may also be more susceptible to environmental insult. After the sensitive period has ended, the brain actually “prunes” or cuts back those neural connections that aren’t necessary for success in the environment of upbringing.

However, as you might expect, children raised in deprived circumstances may not receive adequate brain stimulation during sensitive periods of development, and this is bound to negatively affect the neural pruning process as well. Fortunately, the brain’s mechanisms of neural pruning are balanced with its incredible capacity for “neural plasticity” – which is the brain’s ability to continually change in response to environmental demands. Thus, even when environmental conditions are suboptimal during a particular sensitive period, it doesn't mean that development can't or won't take place, but it can mean that development might proceed along a somewhat atypical trajectory, bringing with it some challenges for the child and the child's caregivers.

Early social experiences with caregivers and family members are important for the development of adaptive emotional and behavioral regulation (i.e., self-regulation). Children everywhere encounter stressful situations on a daily basis and typically they must rely on caregivers to help them resolve these situations and to aide them in regulating their nervous system so that the toxic effects of stress are ameliorated in a timely fashion. In typical rearing environments, children experience repeated cycles of nervous system activation and caregiver-facilitated deactivation and these cycles get written into the child’s neurobiology until it becomes a natural, self-regulatory response pattern for the developing child.

Individuals like Rebecca who were raised in adverse environments often do not receive the short- and long-term benefits that come with this kind of nervous system regulation and organization. Often, these children are forced into a sort of social hibernation where they must shut-down their natural impulses to seek closeness and security from caregivers. Some of these children will learn to sooth themselves, but these make-shift measures are by no means optimal and it is likely that many of these children do not experience the much-needed social-emotional brain development that comes through interacting with sensitive and responsive caregivers.

Despite these concerns, the research on Romanian orphans illustrates the power of neural plasticity and provides some degree of hope because many of these orphans show significant developmental gains in certain areas after they are adopted. The first area of development to show progress after adoption is often physical health; these children can rather quickly experience improvements in weight, height and fine and gross motor skills. In fact, many these children may not be physically different from their peers by the time they start school.

Somewhat surprisingly, these children often make gains in the cognitive domain too – they seem to catch up in terms of reading and writing, and general intelligence is often similar to their school-aged peers. Yet, a proportion of children who were in an orphanage have some lasting problems with attention, concentration, focus, distractibility, impulsivity, and poor organizational skills. It seems as though the neural circuits involved in “executive function” (i.e., attention, cognitive flexibility, planning, goal-directed behavior, etc.) are very sensitive to suboptimal rearing environments.

Of interest, the areas that seem to be most affected by early deprivation are the social and emotional domains. Children raised in orphanages frequently have challenges in terms of regulating their emotions, calming themselves, coping with difficulties, initiating and maintaining friendships, and negotiating close relationships. Because these children often make noticeable physical and cognitive gains after adoption, the lingering social-emotional issues can be confusing to the child and caregivers. Of course, these social-emotional issues can be compounded if the adoptive home environment is less-than-nurturing or if the child encounters any form of trauma later in childhood.

Even after leaving the orphanage, some of these children have difficulty learning to trust caregivers and to make their attachment needs known in adaptive ways. There can be a tendency on the part of these children to avoid showing vulnerable emotions and outward displays of affection and they may seem indifferent to, or afraid of, intimacy and closeness. On the other hand, some of these children may show signs of heightened separation anxiety, clingy and anxious behavior, and they might have strong fears of abandonment. Some children display signs of both of these extremes in their relationships with caregivers – the so-called “push-pull” pattern where they desperately want companionship but at the same time seem to fear closeness or fear that it won’t last. This sort of picture is sometimes referred to as “reactive attachment”.

That being said, it is important to stress that a warm and nurturing home environment will go a long way to buffering many of the social-emotional difficulties associated with early adversity. Over time, sensitive and responsive parenting practices, coupled with consistent and caring limit-setting, can gradually establish a sense of trust and security. Within the safety and security of the caregiver-child attachment relationship, the child’s nervous system can be re-organized in a way that supports greater self-regulation. This socially enriched environment can stimulate new brain pathways in the adopted child that will eventually underpin a greater capacity to regulate emotions and maintain close relationships.

Like Rebecca, some individuals who have experienced early social deprivation require additional support and treatment later in life. This may come as a result of ongoing issues from early childhood that were never quite resolved or previously resolved issues that resurface due to subsequent experiences of loss/death, abandonment, betrayal or traumatic experiences. While the resurfaced issues can usually be handled by traditional treatment methods, it can be very helpful if the treatment providers also have an understanding of how early social deprivation and trauma can influence social-emotional functioning late in life.

The Meadows treatment model is designed to specifically address the core developmental issues related to early childhood neglect and abuse. Treatment at The Meadow also helps individuals to understand how these core developmental issues are related to secondary symptoms, like shame, anger, low self-esteem, co-dependency, love addiction/avoidance, anxiety, depression and addictive behaviors of all kinds. Through various forms of expertly delivered treatment, individuals at The Meadows build on these insights by gaining actual experience in learning to esteem themselves from within and regulate their own nervous systems more effectively. Gradually, as individuals at The Meadows feel more comfortable with themselves, they are aided in forming safe and meaningful relationships with family members and significant others.

For many individuals who come to The Meadows, the experience of early social adversity starts to become a vital part of a broader life story that no longer carries with it the pain of the past, but instead offers the promise of a brighter future.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell’s clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

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The Meadows Psychiatrist, Dr. Jon G. Caldwell, was featured on BlogTalkRadio's program "Hope-Strength-Recovery"; with host Carol Juergensen Sheets, LCSW, CSAT, PCC, on Monday, January 7, 2013. The program can be accessed by clicking here. To access the transcript of Dr. Jon Caldwell's interview on BlogTalkRadio, please click here.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell's clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

Carol Juergensen Sheets, LCSW, PCC, CSAT, is currently in private practice in Indianapolis, IN. She speaks nationally on mental health issues and is featured in several local magazines. In addition, she is featured in regular television segments focusing on life skills to improve one’s potential.

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The Meadows Psychiatrist, Dr. Jon G. Caldwell, was featured on VoiceAmerica Health and Wellness Channel with host Rebecca Buillon, LCSW, BRI-1 on the program "Addiction in America" on Tuesday, November 20, 2012.

The discussion focused on attachment theory in children, in addition to Dr. Caldwell's article, "Facing the Truth Behind the Mask" which describes how addiction becomes a mask. This article can be found at: http://www.addictionrecoveryreality.com/?p=2874.

"What is meant by 'behind the mask' is the idea of trying to develop a metaphor of how we move through life. A lot of time we act out of old scripts that we inherited from early attachment relationships that are so powerful and written into our neurobiology," said Dr. Caldwell. "It is how we relate to other people, the world, and how we respond emotionally. We may not even be aware of the script and need to step back and get help with early scripts in order for us to react in a different way."

One of Dr. Caldwell's interests is attachment theory in children, whether it is secure attachment, anxious or preoccupied attachment, or avoidant attachment. "These styles of attachment have far-reaching consequences. They can set the child on a trajectory as far as mental and emotional health, and even physical health later in life," according to Dr. Caldwell.

To listen to the complete interview, visit http://www.voiceamerica.com/episode/65774/addiction-in-america.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell's clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

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The Meadows is pleased to sponsor a lecture by Dr. Peter Levine titled "In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness," on March 30 from 9:30am to 4:00pm (Pacific Time) at the Westin San Francisco Airport.

With doctorates in both medical biophysics and psychology, Dr. Levine, a Senior Fellow at The Meadows, is the developer of Somatic Experiencing®, a naturalistic body-awareness approach to healing trauma. In his lecture, Dr. Levine will discuss that it is possible to live robustly with pleasure and creativity even when dealing with the most devastating experiences - and deceptively trivial ones.

Dr. Levine will address the nature of trauma, how it is a condition that can be healed from, as well as how the body is utilized to make that happen. During the lecture, Dr. Levine will describe how traumatic healing can be strengthened by learning to attend to the "unspoken voice of the body." The roots of addiction in unresolved trauma, insecure attachment and habitual childhood frustration will also be explored.

Event Information:

Friday, March 30 from 9:30am to 4:00pm (Pacific Time)

Cost: $125

Westin San Francisco Airport
1 Old Bayshore Highway
Millbrae, California 94030

Registration available at http://www.regonline.com/builder/site/Default.aspx?EventID=1059970

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