2. Presentation Overview
Introduction to Interpersonal Neurobiology (IPNB)
Understanding Shame from an IPNB Perspective
Neurological Structures Active in Shame
Neurological Pathways of Shame
Relational/Attachment Impact of Shame
Clinical Presentations of Shame
Clinical Practices Effective with Shame Informed by
IPNB
3. Interpersonal
Neurobiology?!
“Human connections shape the
mental connections from which the
mind emerges” (Siegel, 1999, p.2)
Construction of reality is influenced
by interpersonal experiences. (Siegle, 1999)
Interactions between child and
primary caregiver directly shape how
representational processes develop.
(Siegle, 1999)
4. Understanding Shame from
an Interpersonal
Neurobiological Perspective
Shame is characterized by a sense or belief that one is defective,
deficient, or worthless as a human being- the mind set is that
something is wrong with one’s personhood. (VanVonderen, 1989)
Shame is rooted in insecure attachment schemas and is particularly
prevalent in chemically dependent families and where abuse has
occurred. (Fossum & Mason, 1986)
Affect regulation and attachment circuitry networks are negatively
affected by regular and prolonged shame states. (Cozolino, 2006)
5. Understanding Shame from
an Interpersonal
Neurobiological Perspective
“Fear is the limbic experience underlying engrained
shame...” (Badenoch, 2008, p. 108)
Shaming interactions, in combination with a lack of relational repair
leads to humiliation. Such a state is proposed to be toxic to the
developing brain. (Siegel, 1999)
“[s]hame is neurobiologically toxic...” (Cozolino, 2006, p.235).
6. Neurological Structures Active
in Shame
Neurological Structures: (Badenoch, 2008; Siegel, 1999; & Cozolino,
2006)
Limbic Region- Central for processing social
information
Amygdala- seat of implicit memory, meaning
making, evaluates for fight or flight
Hypothalamus- controls the release of
neurotransmitters to maintain homeostasis,
“master control for the Autonomic Nervous
System” (ANS) (Goldberg, 2007, p.63)
Hippocampus- assembles information into explicit
memory, retrieves from past, “storage of short
term memory” (Goldberg, 2007, p.63) It plays a role in
converting the perception of danger into a
physiological response. (Cozolino, 2006)
7. Neurological Structures Active
in Shame
Structures con’t:
Middle Prefrontal Region- specialized for integration
Orbital Medial Prefrontal Cortex (OMPFC)- link to
consciousness; control affect expression and relational,
calming, and flexibility functions
Emphasis given to the Right-Mode Processing (RMP)-
avoidance/withdrawal modes, sensory processing
Neuro-Physiological Integration: (Siegel, 1999 & Badenoch, 2008)
Parasympathetic (PNS) and, in a lesser role, the sympathetic
(SNS) branches of the ANS
“When integration is not going well, the mind moves toward rigidity
(a state that may result from too much differentiation of neural
circuits without the balance of integration)...” (Siegel, 1999, p.50).
8. Neurological Pathways of
Shame
“When the shaming experience is early,
frequent, and without repair, this person also
develops a cortical invariant representation...
the circle is complete as limbic circuits and
cortex converge, triggering the body to
paint the portrait of shame and humiliation
all over again” (Badenoch, 2008, p. 105).
9. Neurological Pathways of
Shame
Neurological Pathway
Shame begins in the right-hemisphere limbic
processes, especially the meaning making
amygdala. The amygdala houses implicit memory-
the only memory available in the first 2 years of
life. These memories contain behavioral impulses,
affective experience, perceptions, etc. that, with
repeated experience, cluster into mental models.
(Cozolino, 2006 & Siegel, 1999) Thus, “the amygdala develops a
generalized, nonverbal conclusions about the way
the world works” (Badenoch, 2008, p. 24)
10. Neurological Pathways of
Shame
Shunning, rejecting, and/or neglectful
signals send a “neuroception” (Badenoch, 2008, p. 60)-
genetic wiring for the neurobiological
detection of safety, danger, or threat to
life- that there is danger. The amygdala
understands relationships to be unsafe and
send a message to the hypothalamus.
11. Neurological Pathways of
Shame
The hypothalamus, with the pituitary, sends
neurotransmitters throughout the body-brain
translating social interaction into bodily
processes. The fear/danger response triggers the
autonomic nervous system. The SNS is activated
stimulating the physical fight or flight response.
Without the relational repair, the PNS over
functions to create a withdrawn response-
Schore (2003a) states, “the word used for the
latter experience is shame” (as cited in Badenoch, 2008, p. 21).
12. Neurological Pathways of
Shame
The Orbital Medial Prefrontal Cortex is active in the
role of affect regulation, serving as a center for
appraisal and influences arousal. As such, it is
primary in the creation of attachment styles. It
facilitates the regulation of bodily arousal by pushing
down the SNS and activating the PNS. (Siegel, 1999) An
unmodulated PNS pulls the child into painful and
isolating stillness...” (Badenoch, 2008, 107).
It is hypothesized that in insecure attachments,
“[i]ntegration of the right limbic system with the
middle prefrontal regions (vertical integration) is
patchy” (Badenoch,2008, p.69).
13. Neurological Pathways of
Shame
Part of the ANS, the adrenal glands releases
glucocorticoids (GCs), stress hormones, to respond to
the distress. However, prolonged, high levels of GCs
cause inhibited hippocampal functioning (dendritic
degeneration)- cells basically get tired, collapse, and
die. The hippocampus is vital in the role of explicit
memory and conceptualization of new episodic
learning- so in a distressing circumstance one may not
know why he or she is reacting in a shamed/ing
manner. (Cozolino, 2006)
16. Relational/Attachment
Impact of Shame
Bowlby’s Attachment Theory
“the infant and young child should
experience a warm, intimate, and
continuous relationship with his mother (or
permanent mother substitute) in which
both find satisfaction and enjoyment” (as cited
in, Bretherton, 1992, p. 7).
“ and that not to do so may have
significant and irreversible mental health
consequences” (Bowlby, 2010).
17. Relational/Attachment
Impact of Shame
Bowlby’s Attachment Theory
Premises:
Securely Attached- Basic need for
successful human existence
Insecurely Attached- Separation results
i n a n x i e t y, a n g e r, d e p r e s s i o n ,
dependency, and disengagement
Attachment Theory postulates that early
interactional patterns between an infant and
the primary caregiver constructs a framework
or filter through which subsequent relationships
will be evaluated. Due to the nature in which
the brain develops during this time the
attachment style has life long effects.
19. Relational/Attachment
Impact of Shame
“An ‘internal working model of attachment’ is
a form of mental model or schema... mental
models [are] a fundamental way in which
implicit memory allows the mind to create
generalizations and summaries of past
experiences...then used to bias present
cognition for more rapid analysis of an
ongoing perception and help the mind
anticipate what events are likely to happen
next” (Siegel, 1999, p.71).
20. Relational/Attachment
Impact of Shame
Body, limbic region, and cortex are involved
in the physiological, emotional, and
intentional states as one person resonates
within another who is paying attention to
the other’s facial expressions. (Siegel, 1999)
As an attentive primary caregiver tunes into
the needs of an infant, gazes into the infants
eyes, and meets it’s needs for affection,
safety, and sustenance; the infants brain is
developing neural pathways for relational
survival. (Badenoch, 2008; Siegel, 1999)
21. Relational/Attachment
Impact of Shame
The inner state of a parent is what creates a
child’s mental model. (Badenoch, 2008) The creation of
this model is the process by which a child’s
response to a parent’s patterns internalizes
the parent. (Siegel, 1999). Such internalizations
offer a map, of sorts, to inform the
individual how to navigate relationships.
Attachment schemas illustrate the
metamorphosis of interpersonal experience
into biological structure. (Cozolino, 2006)
22. Relational/Attachment
Impact of Shame
Secure Attachment Style
Attachment thrives on predictable, sensitive,
attuned communication - a parent shows interest
in aligning with the child’s state of mind. Shared
states amplify positive and reduce negative
emotional states. (Siegel, 1999)
Secure attachments optimize network integration,
autonomic arousal, and positive coping response.
(Cozolino, 2006)
23. Relational/Attachment
Impact of Shame
Insecure Attachment Styles:
Anxious/Avoidant Attachment Style
Parents, neglectful of the child’s attachment needs, can cause a child to
learn that relationships lead to pain. There is a shut-off to the awareness
of a limbic longing for connection. Implicit mental models of despair about
life-giving connection develop as the mind fails to establish integration
between the body and the right middle prefrontal region and the right and
left hemispheres. (Badenoch, 2008)
The level of shared emotion is very low, increasing the likelihood for
underdeveloped levels of interest/excitement and joy. In addition, there is
low attunement and sensitivity resulting in excess parasympathetic
activation. The child learns to minimize attachment-related emotion. (Siegel,
1999)
24. Relational/Attachment
Impact of Shame
Insecure Attachment Styles:
Anxious/Ambivalent Attachment Style
Uncertain about how a parent will respond, it is hypothesized, the child’s
dissociated neural nets within the right limbic region bind him or her to
strong perceptual bias. Horizontal and vertical integration is, therefore, not
solid. (Badenoch, 2008)
Disorganized Attachment Style
When infants are terrified by the parents who should care for them a
neuroception is created holding the infant between a state of life threat
and freeze. (Badenoch, 2008)
There is little capacity to develop organized, adaptive strategy as the
child’s brain is structured around abrupt, chaotic shifts leading to
disorganization. (Badenoch, 2008)
25. Clinical Presentations of
Shame
Bradshaw (1990) claims, “Prolonged shame states early in life can
result in permanently dysregulated autonomic functioning and a
heightened sense of vulnerability to others. Their lives are marked
by a chronic anxiety, exhaustion, depression, and a losing struggle
to achieve perfection” (as cited in Cozolino, 2006).
Shame is an underlying catalyst, it does not have its own diagnostic
criteria or DSM category. However, the neurobiological pathways
resulting from an early and persistent shaming environment creates
a mental model predisposing adults to perceive the world with
despair and anxiety. (Badenoch, 2008; Cozolino, 2006; & Siegel, 1999)
26. Clinical Presentations of
Shame
Axis I Disorders:
Anxiety Disorders
“The OMPFC assesses the reality of the danger and is
capable of inhibiting amygdala activation when a fear
response is deemed unnecessary. Anxiety disorders may
result from an imbalance of this system in favor of the
amygdala, with safety signals from the OMPFC failing to
inhibit the activation and output of the amygdala” (Cozolino,
2006, p. 317).
27. Clinical Presentations of
Shame
Axis I Disorders (con’t):
Depressive Disorders- Shame would play a role in the
biological etiologies of depression via the altering of the
neurotransmitter functions in key areas of the limbic system.
(Preston et al., 2008)
Specific types of depression vary and a thorough evaluation
would be necessary to determine which pharmacological
treatment would best suit which particular disorder. No
particular drug has been shown to be superior to another,
therefore, a treatment is often chosen according to the least
side effects and symptoms coexisting with depression. (Preston et
al., 2008)
28. Clinical Presentations of
Shame
Axis II Traits may include but are not
limited to:
Negative thinking
Social anxiety and avoidance
Perfectionism
Easily hurt by criticisms
Excessive worry
29. Clinical Presentations of
Shame
• Axis II con’t:
Compulsivity
The need for control
Affective instability
Feelings of shame
(Fossum & Mason, 1986; Preston, O’neal, & Talaga, 2008)
30. Clinical Presentations of
Shame
Fosssum & Mason (1986) include:
Anxiety Disorders: Post Traumatic Stress Disorder and
Obsessive Compulsive Disorder
Mood Disorders: Depressive Disorders and Bipolar Disorder
Substance Abuse Related Disorders
Eating and Sleeping Disorders
32. Clinical Practices
Siegel (1999) postulates that even close physical proximity affects the
electrical activity of each individual’s brain.
Therapy is a process of reactivating the attachment system. In therapy,
clients are helped to mend/rewire early relational fears, adding new energy
and information of compassion, care, safety, stability. “As implicit neural nets
holding these early fears reveal themselves, they become available for
incorporating warmth and goodness” (Badenoch, 2008, p. 54).
“If integration of consciousness is the main support for therapy,
interpersonal integration is the soil in which healing grows” (Badenoch, 2008, p.37).
Brain Regions targeted:
Right Hemisphere OMPFC-
Further, “[t]he ability to consciously process stressful and traumatic
life events creates the possibility for positive change via the growth
and integration of neural networks” (Cozolino, 2006, p. 233).
33. Clinical Practices
Integration begins through therapist/client attunement
“Instead of an isolated bundle of neural nets holding fear, we would see
long integrative fibers of comfort extending from the middle prefrontal
cortex down into the amygdala, bringing soothing neurotransmitter GABA
to provide the ongoing reassurance that supports increasing depth of
connection” (Badenoch, 2008, p. 109).
Integration with the limbic regions communicates to the SNS and the
PNS that everything is OK.
“[E]lements of attachment relationship, within therapy ... facilitate new
orbitofrontal development and enhance the regulation of emotion
throughout a life span” (Siegel, 1999, p. 285).
The OMPFC-amygdala circuit has capacity for highly complex social
interactions, therefore, the positive shaping of this circuitry leads to
development of attachment schema, internal objects, and interpersonal
affect-regulation allowing for social engagement and falling in love.
(Cozolino, 2006, p.319)
34. Clinical Practices
Brain Regions targeted (con’t.):
Hippocampus-
Shame creates an anticipated experience of rejection with a
sense of having no value. A new belief system is necessary
for optimum mental health. The hippocampus is involved with
the OMPFC to conceptualize new autobiographical learning.
(Cozolino, 2006)
Due to its sensitivity to stress hormones, a safe, calm
environment is necessary to engage hippocampus flexibility.
35. Clinical Practices
Badenoch (2008) describes this process: In insecure attachments, needs were
not attuned to, therefore, intentional attunement begins the healing process.
Begin with “receiving our patients’ inner world into our being” (p. 54) -
shared inner states
Be mindful of one’s own body, feelings, and thoughts to assure
intentional attending.
Then give our inner state in regard to them (empathy). (p. 54)
Providing calm instead of rage, attentiveness instead of a shaming face,
and consistency instead of erratic behavior creates a space for
refuge. This must be done at a pace comfortable to the client. The
balance must be achieved through careful listening to one’s own body
and the client’s body for signs of hyperarousal. (p. 108)
36. Clinical Practices
The resulting harmony creates continuity of being that moves a
person toward secure attachment.
Therapists must be careful not to be drawn in the clients
wounds in order to cultivate a balanced and mindful state.
Because shame says a person is defective, often tracing a
problem back to an interpersonal interaction pattern starts a
connection that generates a new narrative of self and a new
perceived truth. (p.108)
37. References
Badenoch, B. (2008) Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York: Norton.
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28, 759-775.
Bowlby, J. (n.d.). In Wikipedia. Retrieved January 14, 2010, from http://en.wikipedia.org/wiki/John_Bowlby
Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing social brain. New York: Norton.
Fossum, M. A. & Mason, M. J. (1986). Facing shame: Families in recovery. New York: Norton.
Goldenberg, S. (2007). Clinical neuroanatomy made ridiculously simple: Interactive edition. (3rd. ed.). Miami, FL: Med Master, Inc.
Ortberg, J, (1998). Love beyond reason: Moving God’s love from your head to your heart. Grand Rapids, MI.: Zondervan.
Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2008). Handbook of clinical pyschopharmacology for therapists. (5th ed.). Oakland, CA: New
Harbinger Publications.
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: The Guilford Press.
VanVonderen, J. (1989). Tired of trying to measure up: getting free from the demands, expectations, and intimidations of well-meaning
people. Minneapolis, MN: Bethany House Publishers.
