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.

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By: Bill Blundell

As a therapist who works with children, it is common to work with children who are experiencing the loss of a parent or caregiver because they have moved to a treatment center for addictions. Living in Central Illinois, the options are limited when it comes to inpatient treatment, so many times the loved one attends treatment out of the area, such as The Meadows. This can become even more troublesome for the youth who is going through this experience.

The children of a parent/caregiver in treatment often times children experience varying levels of anxiety. Much of the anxiety is attached to the unknown. Not knowing what the outcome of treatment is going to be, will their parent/caregiver be a different person after coming home or will they ever get to see their parent/caregiver. For children who have a loved one near them in treatment, they can possibly visit on a regular basis for a couple hours. This does help alleviate some anxiety but it adds new anxiety of the simple fact they are seeing their loved one for a short time but know they will not be coming home with them.

At times it is imperative for the child(ren) of a loved one to receive therapy services while treatment is happening for the adult in the situation. It gives the child an opportunity to speak how they are truly feeling through this experience. Many times children do not want to be a burden on the parent/caregiver who is not at the treatment center, because they are aware of how stress the process can be for everyone. This becomes problematic for the child because they suppress their feelings. The result of suppressing to many feelings often results in a negative action. Many times with kids, this action presents itself in the form of anger.

It is important for children to learn the appropriate ways to deal with their emotions and in turn the appropriate ways for them to express said emotions. Sometimes the children in the matter feel as if they do not have a voice. With that said, they tend to keep things to themselves in fear of upsetting someone, especially the parent/caregiver who was in treatment and has since returned home. Children need to be encouraged to speak their minds when they are going through an experience such as having a loved one taking part in an inpatient treatment program.

One of the best ways to help any child in this situation is to find a professional counselor who will be a listening ear and provide feedback to the child. Learning ways to handle the stress and anxiety of having a loved one in treatment is something that can be provided by a professional counselor as well. Simple mindfulness techniques can be introduced in ongoing counseling to help keep the child calm in an otherwise chaotic situation. Also, utilizing groups such as Al Anon or Alateen is beneficial for children and adolescents to help them understand what is happening with their loved one and get a better understanding of how it affects the family as a whole.

Bill Blundell is a Licensed Clinical Professional Counselor and also a Certified Forensic Consultant working in Peoria, IL, at the Antioch Group, a private practice.  Bill specializes in working with anxiety disorders in both children and adults.

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Life seems to offer plenty of opportunities to practice boundaries! Whether it is in our relationships with family and friends or at the grocery store check-out line, we have many chances to decide if, when and in what ways information and people can be part of our lives. Maintaining healthy boundaries is widely considered a fundamental aspect of the recovery process and an important practice for general well-being. However, without a measure of thoughtful awareness, boundaries can inadvertently create walls around our heart, keeping us from connecting wholeheartedly with ourselves and others.

At The Meadows we often talk about two kinds of personal boundaries: external and internal. An external boundary has to do with monitoring and regulating the quantity and quality of other people's interactions with us. An external boundary is sometimes considered a physical boundary because it deals with how much closeness we allow between ourselves and others. This degree of space between us and others can be related to actual physical proximity and contact or it can be related to emotional closeness and intimacy.

An example of an external boundary might be that an individual decides to engage in a face-to-face visit with his or her family once a month and will otherwise make contact by phone. Depending on the situation, this individual may or may not choose to share the boundary and/or the reason for the boundary with his or her family. Another example of an external boundary might be that an individual sets limits with his or her new dating partner regarding physical contact and intimacy. Discussing this sort of boundary openly with a dating partner can help establish healthy interpersonal patterns early in the relationship. External boundaries like these lay the foundation for other types of personal and interpersonal boundaries.

The other type of personal boundary involves learning to establish an internal boundary that can act as a filter for incoming information. Practicing an internal boundary helps us to recognize that incoming information is not necessarily truth with a capitol "T" but is the subjective perspective of another person or group of people (i.e., religious group, political party, society, culture, etc.). Establishing an internal boundary, while also regulating our own reactivity, allows us to respond more wisely by checking the incoming information against what we know about our own truth. If the incoming information has merit, we can choose to let some or all of it in, otherwise we can exercise an internal boundary and let it slip off our backs. (Easier said than done, right?)

An example of an internal boundary might involve a situation where an individual is being blamed for a poor work outcome by a colleague. (The individual may first choose to exercise an external boundary by deciding whether or not to stay and hear what the colleague has to say.)  If the individual decides to listen, then he or she can exercise an internal boundary by choosing to see the incoming data as the colleague's subjective opinion and can then decide what to do with the presented information. After a personal reality-check, the individual may be able to see how well the colleague's point of view fits with his or her own personal truth. Alternatively, the individual may find it useful to acknowledge that the colleague's information was heard, but that more time will be needed to process what it means for him or her. (Again, easier said than done.)

You may notice that I have repeatedly used the words "practice" and "exercise" when referring to boundaries. This is not easy work and it doesn't always come naturally! This may be especially true for people who grew up in family systems where boundaries were unhealthy or non-existent. (Anyone who was exposed to a family environment containing elements of addiction or maltreatment probably experienced serious boundary violations.) However, there is hope! Over the years, I have worked with many people with very challenging backgrounds who have learned how to incorporate healthy boundaries in their everyday lives. Like training our bodies to perform a new physical skill, boundaries are strengthened by regular practice and exercise.

Once we learn about boundaries and recognize their utility in our lives, what keeps us from practicing them more consistently? There are probably many reasons, but I will mention two: 1) fear of disconnection from others and 2) disconnection from our true self.

First, I think we fear that setting external boundaries will lead to disconnection from other people. For example, we might be afraid that our efforts to explicitly identify the quantity and quality of contact we desire to have with other people will result in hurt feelings and emotional distance. We may worry that by exercising boundaries and making our needs known to others we will be seen as demanding, selfish, unreasonable and difficult. At a deeper level, we might be afraid to clearly make our needs known because the pain will be that much greater if the other person then chooses to disregard them. That is, to have our innermost wishes fall on deaf ears may be an especially undesirable outcome.

It is certainly true that practicing boundaries does involve some risk. But it is important to recognize that without clear external boundaries we can miss out on critical opportunities to let other people know what is important to us and how we want to be treated. People in our lives who are dominated by fear and are prone to using control or aggression in relationships may not appreciate our efforts to practice boundaries, at least initially. The relationship may even get worse before it gets better... if it does get better. However, by courageously implementing external boundaries, we honor our fundamental human right to be treated with respect and we have a greater chance of cultivating loving relationships.

The second reason why a regular practice of boundaries, in this case internal boundaries, can be challenging has to do with our tendency to experience disconnection from our true self. Establishing an internal boundary in the face of incoming information, some of which can be extremely uncomfortable, requires that we have some sense of ourselves as a unique person with inherent worth. If our sense of self is mostly derived from external sources, like what other people think of us, then we might find it very difficult to exercise an internal boundary. If our sense of worth is primarily dependent on whether or not we are pleasing to other people (codependence), then any semblance of an internal boundary will easily be whipped about like a flag in the wind. In order to filter incoming data according to how well it resonates with a deeper sense of ourselves, we must first have some notion of our deeper self - we must have an inkling of our own truth!

Paradoxically, exercising boundaries helps us to better understand the nature of our true self - we become more intimate with ourselves through the self-loving act of setting boundaries. So, it's a catch-22, isn't it? Finding our center allows us to establish healthy boundaries and by exercising healthy boundaries we cultivate greater awareness and acceptance of our true self. What are we to do with this chicken-or-the-egg paradox? Well, we can start where we are at...with the awareness of true self that we do have. Right now, in this moment, we can begin to truly care for ourselves by letting go of any information that is incongruent with what we know of our inherent value and worth. Gradually, we can develop a regular practice of internal boundary work by meeting incoming information with greater awareness of, and care for, our maturing true self.

As our practice of healthy boundaries continues to develop and grow, it is very useful to pay attention to our tendency to inadvertently make boundaries into walls. For example, we can easily trick ourselves into thinking that an external boundary is necessary with a particular person, in order to feel safe and secure. However, when we get real honest with ourselves, we might find that our external boundary was more about a subconscious wish to avoid an undesirable aspect of ourselves that comes up with this particular person. In this scenario, the external boundary isn't necessarily based on an intention to honor our fundamental human right to respect and security, but is actually driven by a fear of facing our vulnerabilities.

Another example of replacing boundaries with walls is when we react to incoming information by putting walls up between us and the person offering the information. For example, when outside information is offered, instead of saying to ourselves, "How well does this incoming information match or enhance what I know of my true self?" we can find ourselves in a state of reactivity saying something like, "I could care less what you say, I don't need you in my life anyway!" In this case, the boundary turns into a wall when we outright discard the information and the person or people offering the information. In other words, we sometimes close our hearts and minds to others in the name of creating an internal boundary. The driving motivation behind creating a wall of this kind isn't necessarily rooted in a desire to honor our inner truth, but may actually be another form of avoiding uncomfortable bits of truth about ourselves by vilifying and shutting out other people and outside information.

You might be thinking, "Wall versus boundary, what's the big difference...if I need to protect myself from unhealthy information and people, either one will do the job, right?" While it is true that both a wall and a boundary can establish a safe distance from others and temporarily protect us from potentially harmful information, the wall does so at considerable cost to ourselves. Walls are forged in the fire of reactivity and are tempered under a dangerous duality of mind that argues, "It's me against you; I'm right and you're wrong." In this sort of battle for safe ground, walls can be fashioned into a formidable fortress that restricts other people's access to vulnerable areas of the self. These fortress walls may keep stuff out, but they also keep parts of us walled in; we can end up feeling cut off from ourselves and others.

So, how do we practice boundaries without armoring our hearts?

Listed below are several suggestions on how to exercise external and internal boundaries with an open mind and heart.

1)Pay attention to our intention: Our efforts will be greatly enhanced if we can identify and repeatedly revisit our deepest intentions underlying our commitment to practice boundaries.  Again, boundary work is tough and others may not always appreciate our efforts to speak and live our truth. Reminding ourselves of our innermost intentions will cut through the confusion and help sustain us during difficult times.

2)Boundaries are a form of self-care: It is tempting to make our boundary work about other people (e.g., "I must practice boundaries to keep others from hurting me"). Yet, at its core, boundary work is about self-care. Plain and simple. Practicing boundaries is a powerful way to cultivate self-compassion. When we keep the focus of our boundary work on self-care, we are less likely to armor our hearts; and that means we get the opportunity to live more wholeheartedly.

3)Watch for judgment and blame: In boundary work, judgment and blame are telltale signs that boundaries are about to become walls. Judgment and blame indicate that our focus has shifted from self-care to a duality of mind that, if left unchecked, will result in separation by making us right and others wrong. Bring the focus back to our deepest intentions and let judgment and blame fall away as we offer gentle loving-kindness to ourselves by making and keeping boundaries.

4)Boundaries show compassion to others: As mentioned above, we often fear that practicing boundaries will disconnect us from others. Yet, in healthy and loving relationships, boundaries are a compassionate means of clearly identifying our needs so that others have the opportunity to meet those needs, if they so choose. Boundaries show compassion to others by offering clear guidelines on how we want to be treated.

5)Let go of the outcome: Practicing external and internal boundaries doesn't guarantee any particular response or behavior from other people. We might exercise boundaries with a subconscious hope that people will recognize our worth and offer greater respect. This would be a nice outcome, but it isn't the reason for our practice of boundaries. Boundaries are a way for us to recognize our own worth and to show ourselves greater respect and compassion. When we do that; others will naturally follow our lead.

It is our inalienable right and our responsibility to practice healthy boundaries. No one else can do it for us; not because other people don't care enough about us, but because we must care enough about ourselves for boundaries to have any meaning. When boundaries are used to avoid and protect against vulnerability and intimacy, they become walls. These walls may provide temporary protection from fear, pain and shame, but they can also become a fortress around our hearts - creating separation within us and between us and others.  On the other hand, the practice of exercising external and internal boundaries is a profound act of self-care and compassion; compassion for ourselves and for others.

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' Senior Fellow, Alexandra Katehakis, MFT, CSAT-S, CST-S, along with Dr. Sonnee Weedn and Jill Vermiere, are the recipients of the 2013 Clark Vincent Award from the California Association of Marriage and Family Therapists (CAMFT) for their role in writing sections of the textbook, Making Advances: A Comprehensive Guide for Treating Female Sex and Love Addicts. The award was presented at CAMFT's 49th Annual Meeting in Sacramento, Calif. on May 16-19, 2013.

Katehakis is the Founder and Clinical Director of the Center for Healthy Sex in Los Angeles, Calif. She is an expert in the treatment of sexual addiction and other sexual disorders and has incorporated interpersonal neurobiology into her Psychobiological Approach to Sex Addiction Treatment (PASAT). Katehakis was the 2012 recipient of the Carnes Award, a distinguished acknowledgment for her significant contributions to the field of sex addiction. She is author of "Erotic Intelligence: Igniting Hot Healthy Sex after Recovery from Sex Addiction" and is currently writing a book for the W.W. Norton Interpersonal Neurobiology Series edited by Allan Schore and Daniel Siegel titled, Sex Addiction as Affect Dysregulation: A Holistic Healing Model (2014).

"The Meadows is thrilled that Alexandra Katehakis was presented with the prestigious Clark Vincent Award honoring a literary or research contribution to the profession of marriage and the family," said Jim Dredge, CEO for The Meadows. "We also applaud and congratulate Dr. Sonnee Weedn and Jill Vermiere."

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

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 Sub-Acute Agency that is accredited by the Joint Commission.

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The Meadows' Senior Fellow, Dr. Shelley Uram, and Meadows' Psychiatrist, Dr. Jon Caldwell's presentation at the International Trauma Conference on Friday, May 31 can be accessed live via a webinar. For more information visit (outside link is no longer active) .

Dr. Uram and Dr. Caldwell's workshop "A Neurobiological Perspective on Trauma and Attachment and the Role of Mindfulness in the Healing Process," will be presented on Friday afternoon, May 31. In a manner that is easy to understand, they will identify ways that psychological trauma affects brain development and attachment relationships across the lifespan. Additionally, a mindfulness-based approach will be introduced for promoting attachment security in individuals with a history of trauma.

Dr. Uram, a Harvard trained, triple board-certified psychiatrist, is a Distinguished Fellow of the American Child and Adolescent Psychiatry. She speaks nationally and internationally and is best known for transforming the complexity of the brain and traumatology into interesting and easily understandable explanations. Dr. Caldwell is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. 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. In November 2012, Dr. Caldwell was the recipient of a research grant from the International Society for Traumatic Stress Studies (ISTSS) for his research proposal entitled "A Wait-List Controlled Study of a Mindfulness-Based Workshop for Promoting Attachment Security."

The focus of this year's conference is "Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions." The conference goal is to present current research findings on how people's brains, minds, and bodies respond to traumatic experiences; how they regulate emotional and behavioral responses; and the role of relationships in protecting and restoring safety and regulation.

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