The Meadows Blog

The Meadows and The Refuge are hosting a free one-day trauma workshop for clinicians on June 8, 2012, in Delray Beach, Florida from 8:00am to 3:30pm.

This workshop will focus on both attachment and addiction; exploring how the lack of healthy attachment in childhood can lead to a variety of mental, emotional, social, and physical health problems in adulthood, effecting resiliency and a person's ability to function in a healthy manner. The presentation will also explore the neurobiology behind "the perfect storm" of addiction and how trauma replicates and fuels chemical dependence.

Presenters include Judy Crane, Founder and Executive Director of The Refuge; Dr. Jon Caldwell, psychiatrist at The Meadows; and Dr. Douglas Davies, neurobiologist. Titles of presentations include "The Loneliest Heart: "The Many Faces of Trauma,"" "Mindful Awareness of Attachment: "Fostering Emotion Regulation and Resiliency in Trauma Recovery,"" and "Neurobiology of Addictions and Trauma."

For more information and to register for the workshop, contact Shea Beasley at 352.512.8877. This event offers 5.5 Continuing Education Credits sponsored by The Institute for Continuing Education.
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.

Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment. My answer is always the same - "yes". Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic. In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment. These theories of human development have also furthered our understanding of "neural plasticity" the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful. In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences. In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called "schizophrenigenic mothers"). Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the "cognitive-revolution", with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability. For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected. Findings such as these clearly showed that genetics play a role in many forms of mental illness. However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found "the suicide gene").

At the turn of the twenty-first century, genetic theories relying on simple one-to-one relations between a single gene and a psychiatric condition were supplanted by "diathesis-stress" models, which posited that genetic diatheses or "vulnerabilities" could interact with environmental stressors to produce deleterious outcomes. The most prominent study of this genre was published by Caspi et al. in 2002 and showed that the relation between childhood maltreatment and later-occurring antisocial behavior was much stronger for individuals who had the less efficient form of the MAOA gene (a gene that improves the function of nerve transmission in the brain). In other words, genetics alone didn't predict poor outcomes; it was the combination of a genetic predisposition and the stress of childhood maltreatment that led to an increase in antisocial behavior.

Although this particular gene-environment interaction has been replicated a number of times, some researchers have questioned whether the diathesis-stress model tells the whole story. In the last decade, researchers began noticing that when individuals with a genetic "vulnerability" experienced lower levels of environmental stress, they often fared better than those with individuals with the "favorable" form of the gene. For example, in the graph from the Caspi (2002) study (see above), under conditions of no childhood maltreatment, individuals with the "inefficient" form of the gene (red line) actually had lower levels of antisocial behavior than individuals with the "efficient" form of the gene (blue line). In the Caspi study, this difference wasn't statistically significant, but it raised questions about whether it could be a significant finding if studies were designed to see the phenomenon more clearly.

Jay Belsky, a professor of mine at the University of California at Davis, was one of the first to propose that particular genes (like MAOA) may confer risk or benefit, depending on the environment. Instead of thinking of certain genes as merely a liability, he argued that these genes might increase susceptibility to environmental conditions, "for better or for worse". Belsky and colleagues" theory of "Differential Susceptibility" is rooted in an evolutionary argument that, under circumstances where the future is uncertain, it makes sense to have some offspring that are less sensitive, and other offspring that are more sensitive, to environmental conditions. Like a well-diversified financial portfolio with some money in conservative, robust holdings and some money in high-risk stocks that can respond dramatically to market swings (too close to home for some of us), differential susceptibility posits that some people have a more "fixed" genetic makeup that is less vulnerable to environmental conditions, while others have a more plastic or malleable genetic makeup that is more susceptible to the environment, whether it be positive or negative.

Of course, this theory comes with the exciting possibility that reducing environmental stress (e.g., child maltreatment and relational trauma) may be particularly meaningful for individuals with genetic susceptibilities. In a study published in 2008, Bakermans-Kranenburg and her colleagues tested this hypothesis by investigating 157 families with toddlers who showed elevated levels of externalizing problems (e.g., hyperactivity, oppositional behavior, aggression, etc.) They found that their Positive Parenting and Sensitive Discipline intervention program was most effective in reducing externalizing behaviors in those children who had a version of the dopamine gene (DRD4) that has been linked to externalizing behavior and attention-deficit hyperactivity disorder. That is, children who would have traditionally been thought of as carrying a dopamine-related genetic "vulnerability" were in fact most responsive to the positive environmental changes associated with the parenting intervention program.

The results of this study, and many others like it, suggest that improving environmental conditions during childhood can drastically enhance developmental outcomes, especially for those children who are genetically susceptible to environmental influences. However, these findings might also apply to adults - especially considering recent research showing that the brain remains plastic or malleable well into adulthood. For adults with adverse life experiences who are recovering from conditions like depression, addiction, and post-traumatic stress, the genetic susceptibilities that previously contributed to their sensitivity to adverse environmental conditions may also facilitate their responsiveness to the positive changes associated with recovery treatment. In other words, by improving environmental conditions, what was once considered a vulnerability may actually become the very means for plasticity and growth.

As the Serenity Prayer suggests, it takes courage to improve our environmental conditions and there is much of our day-to-day circumstances that remains beyond our control. However, even when we cannot change our external environment, we can always alter our perspective of it. Approaching ourselves, our fellow beings, and the world with a greater measure of acceptance and compassion can literally change the subjective experience of our environment, and in many cases it can also lead to objective changes in the environment. This shift in perspective is bound to feed back into the biology of our being, perhaps most noticeably for those individuals who at one time may have been considered genetically vulnerable, but who might actually be predisposed to resiliency, especially if the right environmental conditions are established.

Dr. Shelley Uram on the Sense of Self and Nature of Children

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from family dysfunction to the benefits of Somatic Experiencing. In the installment titled "The Sense of Self and Nature of Children," the psychologist and Meadows senior fellow discusses the development of the sense of self.

Dr. Uram first describes the authentic nature of a newborn baby: existing moment to moment with no judgments, expectations of self or others, or sense of the past or future. At three months of age, infants begin to develop a sense of self; as the thinking brain matures, this sense of self grows continually more complex. As individuals progress through life, they advance through Maslow's Hierarchy of Human Needs, wherein self-knowledge and transcendence stand as the ultimate goals.


In other videos in the series, Dr. Uram shares her expertise on trauma triggers and the effects of emotional trauma on brain development, among other topics.
Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain's survival wiring - and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.
The Meadows' video series also includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg. To learn more about The Meadows' innovative treatment program for trauma and other disorders, visit www.themeadows.org or call 800-244-4949.

Over the years, I've had several persons who wanted my counseling, whom I found ravished with shame that manifested in an unusual kind of grandiosity. I connected with them because I have it in a different way myself. Over the years, I came to recognize what I call "reverse grandiosity." Sometimes after I had been working the 12 step program (at least five years), I noticed that details of my story had changed. Instead of sneaking out of Catholic seminary (where I was studying for the Catholic priesthood) and walking ten (sometimes 15, once even 20) miles to buy my drug of choice, I was really only walking three blocks! Ten to 15 miles make the story sound more dramatic and made my addiction worse that I really was. I wanted to make it sound worse. In fact I wanted to be the "best worst" in the program. Being the "best worst" was my "reverse grandiosity." I was the Star, Hero child in my dysfunctional family (capitalized because of the family systems need to have its shame diminished).

The clients whom I recognized with "reverse grandiosity" were somewhat different. They were people who claimed that their problems were so complex and unusual that no one had been able to help them. One man expressed it as clearly as possible. He said, "I';m just here to have someone to talk to, my problem is too unique to be alleviated by therapy." In other words, I'm special that I'm beyond what any humanly designed system of therapy can do. I let him rattle on and offered a follow-up visit. When he returned, I told him that after reflecting on his last visit, I found him pretty boring and quite ordinary. He became enraged when I called him ordinary. He started quickly enumerating every possible abuse that he had endured.

When he ran out of steam, I told him "you take pride in your abuse; you've made it sacred and in so doing make yourself superior to everyone else." These truths stung and my client kept coming back. I relentlessly called him ordinary, and one day he broke down crying. He told me how scared and small he felt. He said he realized that his idealization and attachment to his abuse made him feel like he was somebody superior. I took him to a 12 step meeting where he was introduced to the concept of anonymity. He soon realized that there were people of every sort in the group - men, women, rich, poor, middle class, lawyers, university professors, artists, laborers, mothers raising children, even a priest and two ministers. All had the same addiction and while their stories differed in details and they had different IQs, their common problem was the same - they had to stop using the drug they were addicted to that had caused their lives to become unmanageable. We were all simply ordinary human beings ravaged by drug addiction.

Anonymity is the great spiritual gift of the 12 step program. A Tibetan monk, Tara Tulku Rinpoche once said "the intensity of our sorrow will vary in direct proportion to the intensity of our feeling that "I am important.""

The practice of anonymity is the practice of being nobody special and that is the essence of humility. After 46 years of being free from my addiction, I can testify to the fact that those who know they are nobody special are busy doing the work that all ordinary humans are called to do in order to flourish. Gandhi constantly attested to being an average, ordinary person. When Erik Erikson wrote Gandhi's Truth (an autobiographical account) he found that Gandhi's wife and children attested to his flaws and his demanding profections of perfection on them.

Anonymity asks us to give up the idea and energy of trying to be special and different (so that we can be set apart from our fellow humans). Accepting being nobody special freed me from having to live up to demanding images. It freed me to do something I didn't have to work at, just being myself. Think of what you could let go of and the energy you would have if you stop trying to be somebody special, separate from the rest of us. Take on the amazing spiritual gift of anonymity and allow yourself to relish in the freedom of being ordinary.

Mr. Bradshaw has enjoyed a long association with The Meadows as a Senior Fellow, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. His New York Times best-selling books include Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

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.

The Meadows Alumni Association is pleased to host monthly alumni workshops in Houston, Texas, for alumni, family and friends. Meadows' trained professionals will lead the meetings May 22 through July 24, 2012, from 7:00 to 8:30pm. It will be held at The Council on Alcohol and Drugs in Houston and no registration is required to attend.

The following is the schedule for the upcoming workshops:

May 22

Doug Sorensen, LCSW, LCDC, CSAT

"Needs and Wants"

June 26

Joni Ogle, LCSW, CSAT and Taruno Steffensen, ICADAC, SEP

"Perfectly Imperfect"

July 24

Cara Weed, LCSW

"Boundaries"

Additional alumni workshop dates will be announced in the future. For more information, contact Betty Ewing Dicken, LCDC, at 972.612.7443 or bdicken@themeadows.com or visit www.themeadows.com/alumni.

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.

The Meadows is now teaching Emotional Freedom Techniques (EFT), a gentle and effective tool for trauma, addiction, anxiety, depression and physical discomfort. EFT involves tapping certain acupressure points along the face and body while using an affirmation. Tapping on these points produces a relaxation response and helps release energy associated with trauma. The result is that memories remain intact, but disturbing emotional energy associated with these memories is lowered.

EFT is being taught to patients at The Meadows in combination with expressive arts therapy. Patients create a visual map of the body, then label and rate areas of discomfort. EFT tapping is then used while patients focus on these areas. After several rounds of tapping most patients report that the discomfort levels have significantly decreased. Patients are being given this tool for self-regulation and managing triggers in the future.

Sandra Lehmann, MC, LAC, evening and weekend counselor at The Meadows, is teaching EFT. Sandra first came to The Meadows as an intern while attending Arizona State University where she was working on her Master's degree in counseling. Since interning, she has taught at the college level and worked as a clinician with adults and adolescents experiencing mental health disorders, substance abuse issues and co-occurring disorders. Sandra also has a Bachelor of Fine Arts degree and is currently working on her Certificate of Advanced Graduate Study in Expressive Arts Therapy.

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.

The Meadows is a sponsor of the 23rd Annual International Trauma Conference on June 6-9, 2012, at the Seaport World Trade Center in Boston, Massachusetts. The conference director, Bessel A. van der Kolk, M.D., is a Senior Fellow at The Meadows and the Founder and Medical Director of the Trauma Center at Justice Resource Institute.
The focus of the conference is "Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions." The objective of the conference is to present current research findings on how people's brains, minds, and bodies respond to traumatic experiences. Post-traumatic responses at different developmental levels, as well as the treatment implications of these findings, will also be explored.

Keynote conference presenters include, Vincent Felliti, James Pennebaker, Peter Levine, Stephen Porges, Britta Hozel, Richard Schwartz, Diana Fosha, Pat Ogden and Jessica Stern

"The 23rd Annual International Trauma Conference will once again feature the leading edge neuroscientists and treatment developers to bring you the latest research on how trauma affects mental and brain functioning, as well as how effective treatment can reverse the profound affects of trauma on mind, brain, body and soul," said Bessel A. van der Kolk.

For information regarding the conference, please contact The Meadows at 800.240.5522 or info@themeadows.com.  For fast registration, register online at www.themeadows.com. Attendees can earn up to 27 Continuing Education Credits.

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.

Thursday, 10 May 2012 20:00

Dr. Shelley Uram on Different Trauma

Dr. Shelley Uram on Different Trauma

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from family dysfunction to the benefits of Somatic Experiencing. In the installment titled "Different Trauma," the psychologist and Meadows senior fellow discusses the different types of trauma individuals can experience.

Dr. Uram first distinguishes overt trauma (which she refers to as "the big T") from covert trauma ("the little T"). While overt trauma results from large, perceivable events such as combat or natural disasters, the most extreme cases of trauma generally stem from subtler, or covert, situations that don't appear dangerous to the casual observer. To illustrate covert trauma, Dr. Uram speaks of a toddler whose mother becomes mildly depressed for a month or two. The child's survival instinct interprets his caretaker's depressed state as a significant threat to his well-being, and his developing brain locks this trauma into place. Because covert trauma forms an unconscious framework in the brain, trauma symptoms can emerge without the sufferer knowing why. Dr. Uram notes that this phenomenon makes treatment particularly challenging.


In other videos in the series, Dr. Uram shares her expertise on trauma triggers and the effects of emotional trauma on brain development, among other topics.
Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain's survival wiring - and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.

The Meadows' video series also includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg.  To learn more about The Meadows' innovative treatment program for trauma and other disorders, visit wwww.themeadows.org or call 800-244-4949.

The Meadows is sponsoring a free lecture in Dallas, Texas on Tuesday, May 15 given by Rev. Daniel Gowan, M.Div., M.A., LCDC, LPC-S, on the topic of "Pathways to Victimhood: Enmeshment and Triangulation." It will be held at the Unity Church of Dallas Sanctuary from 7:00 to 8:30pm and no registration is required.

Lecture topics include: How much scorekeeping goes on in your relationships? Are you keenly aware of the rules with your partner and how fair things are? Do double standards frustrate you to the point of conflict? Do you find yourself managing what others think/say/do? Attendees will learn the three roles in a relationship triangle and how to gracefully step out of them to move participation in relationships to a healthier level.

"Most of us confuse love with the craving to be loved," said Gowan. "If we rely (even unknowingly) on enmeshment to get our needs met we set ourselves - and our relationships - up for failure. Move your relationships to a model of love not enmeshment."

The Meadows sponsors free lectures in various cities throughout the country. Speakers include local therapists familiar with The Meadows' model. Lectures are free and open to the public. Attendees can earn 1.5 Continuing Education Credits. For more information, contact Betty Ewing Dicken at 972.612.7443 or bdicken@themeadows.com.

The Meadows, located in Wickenburg, Arizona, 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 http://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.

Often, during the first week of treatment at The Meadows, people will skeptically inquire, "Do experiences in childhood really continue to affect my life as an adult?" While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and well-being. However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD's, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts. Of course, this resonates completely with our clinical experience and treatment model at The Meadows. However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood. In fact, results such as these have led some people to elevate childhood maltreatment to the level of a "public health threat". Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment). Over fifty years ago, John Bowlby (the "father" of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

One way that attachment security may contribute to positive health outcomes is by fostering an open, flexible, and optimistic approach to life's diverse and often unpredictable challenges. The development of such a resilient approach to life may come about as repeated experiences in secure attachment relationships organize and optimize emotion-regulation strategies and cognitive representations of self and others (i.e., internal working models). Consistent with this view, attachment insecurity has been associated with rigid, maladaptive responses to environmental demands and difficulties in appropriately understanding, expressing, and regulating emotions.

As a central feature of attachment theory and resiliency, the regulation of emotion may be an important variable linking childhood adversity to the various mental, emotional, physical, and social problems described in the ACE study. To address this clinically relevant question, my mentor and esteemed colleague, Phil Shaver, and I conducted a research study2 that has been accepted for publication in the journal of Individual Differences Research. In this study, 388 young adults completed questionnaires regarding adult attachment style (e.g., secure, avoidant, anxious), emotion regulation tendencies (e.g., emotional suppression, cognitive rumination, negative affect, emotional clarity, mood repair), and resiliency (i.e., an open, flexible, and adaptive approach to life).

Consistent with our hypotheses, the results indicated that, compared to attachment security, the two dimensions of attachment insecurity (i.e., anxiety and avoidance) were associated with lower levels of emotion regulation and resiliency. Interestingly, attachment-related anxiety and avoidance were connected to these outcomes through distinct cognitive-emotional pathways. For example, people scoring high in attachment-related anxiety reported a greater tendency to ruminate on negative thoughts and experience negative emotions, while people scoring high in attachment-related avoidance frequently relied on suppression of emotion and reported problems in clearly understanding their emotional states.

These results are very congruent with general theories on attachment and with my clinical experience at The Meadows. Attachment-related anxiety (similar to Love Addiction in The Meadows model) is characterized by hyperactivation of the attachment system, involving energetic and insistent attempts to attain proximity, support, and love. Generally, these individuals are hypervigilant to possible relationship threats (i.e., rejection or separation) and respond to such threats with intense mental rumination and high levels of negative emotion (e.g., anxiety, fear, shame, or anger). On the other hand, attachment-related avoidance (similar to Love Avoidance) involves deactivation of the attachment system, inhibition of the quest for support, and a commitment to deal with threats alone. These individuals divert attention away from possible relationship threats and tend to suppress their emotions, which contributes to a lack of understanding about the nature of their emotional states.

In contrast, repeated experiences with sensitive and responsive attachment figures increase a person's general sense of safety and security and foster optimistic beliefs about others' trustworthiness and one's own ability to effectively manage distress. Security-based strategies integrate cognitive and affective processes so that emotions can be openly acknowledged and clearly understood, while at the same time, metabolized and expressed without one's becoming excessively distressed or disorganized. In summary, the results of our study suggest that secure attachment relationships optimally organize emotion regulation capacities in a manner that enhances flexible adaptation to life's demands. This relationally acquired resiliency may be underdeveloped in people who have experienced childhood adversity and may contribute to diminished health and wellness.

Fortunately, recent evidence suggests there is considerable plasticity in the neurobiological systems underpinning social-emotional processes, which means there can be meaningful changes in emotion regulation and intimate relationships. Therefore, people who have experienced childhood adversity and relational trauma are not destined to experience the negative outcomes described in the ACE study. In fact, many professionals think of the alliance between therapist and patient as a type of attachment relationship where the capacity for emotion regulation, intimacy, and resiliency can be cultivated in an environment of safety and security. Treatment is available and there is hope for recovery.

1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks, JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 1998;14:245-258.

2. Caldwell JG, Shaver PR. Exploring the Cognitive-Emotional Pathways Between Adult Attachment and Ego-Resiliency. Individual Differences Research, 2012 (Manuscript accepted for publication; available upon request).

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