Neuroplasticity: A New Approach for ACEs

In 1985, Dr. Vincent Felitti observe that more than half people in his obesity clinic dropped out. The clinic was mainly for people who were 100-600 pounds overweight, although people who wanted to shed as little as 30 pounds were are also welcome. The patients were losing weight when they dropped out and not gaining which puzzled Dr. Felitti as it did not make sense to him. He then decided to dig deep into the dropout’s records. He found that the patients were born normal weight and did not gain weight slowly over the years. This knowledge did not help him a lot which is why he decided to have face-to-face conversation with a couple hundred of the dropouts. While interviewing one patient, he found that she had been sexually abused at the age of four. He found even more such patients who were sexually abused in their childhood.

One of the patients was raped at the age 23 and gained 105 pounds in one year after the incident. Her thought was being overweight meant that people would overlook her and thus would be safe from the sexual predators. Likewise, a skinny kid who had been beaten up felt being fat would keep him safe. Eating helped in soothing down anxiety and depression just as smoking or alcohol would do. During this time, Dr. Felitti met Dr. Robert Anda who had started his journey as a physician and later became intrigued with epidemiology. To understand how childhood events might affect adult health, they started asking trauma-oriented questions. Anda did a research about the major eight types of childhood trauma which the patients had mentioned during the interviews. These included three types of abuse: Sexual abuse, Physical abuse and Verbal abuse.

Also, five types of family dysfunction: a parent who’s mentally ill or alcoholic, a mother who’s a domestic violence victim, a family member who’s been incarcerated, a loss of a parent through divorce or abandonment. Emotional and physical neglect were also later added making ten types of Adverse Childhood Experiences (ACEs). When researchers found out there was a direct link between childhood trauma and adult onset of chronic disease, mental illness, doing time in prison, work issues such as absenteeism. Anda and Felitti developed ACE scoring system to see if a person had experienced one or more ACEs. If a person had none of the events in her or his background, the ACE score was zero. If a person had faced verbal abused in his or her childhood, the ACE score would be one. If a person had been verbally abused and lived with alcoholic mother or father, then ACE score would be two. Higher the ACE score, greater the risk of chronic diseases. People with higher ACE scores are likely to be more violent, to have more marriages, more drug prescriptions, more depression, more auto-immune diseases and more work absences.

Neural Networks of the Brain

A group of neuroscientists and pediatricians including neuroscientist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, neuroscientist Bruce McEwen at Rockefeller University, and child psychiatrist Bruce Perry at the Child Trauma Academy found that our instincts like fighting, flighting or freezing works very well when we are chased by a vicious dog with big teeth. But the problem occurs when these instincts are turned on for too long. The brain exerts control over our actions through neural networks. Through this network, the brain cells (neurons) communicate with one another. This communication is performed through electro-chemical signal processing. If you touch something hot, that information goes from your fingertips to the brain, and then the brain sends information to your fingertips to move them away.

The same thing occurs when a bright light shines in your face indicating to close your eyes, etc. The process of sending these signals takes place in two steps: along the cell (action potential) and between cells (neurotransmitters). Axons and Dendrites which are branch like extensions take messages to and from cells. Neurotransmitters are the chemical portion of the electro-chemical signaling process located at the end of outgoing branchlike extensions. These change the electrical signal into a chemical signal that can float across the synapse – gap between outgoing and incoming branchlike extensions. The receptors are located at the end of incoming branchlike extensions. They accept the neurotransmitter and change it back into an electrical signal to carry the message on to the receiving cell.

There are three general structure groups of neural network activity in brain: cerebellum, limbic system and cerebral cortex. Cerebellum is the motor-control part of our brain which means it deals with activities like breathing, heartbeat and motor skills. Limbi System is the reactionary part of the brain which means it involves emotions, fight or flight instincts, etc. Cerebral cortex is the thinking part of the brain which involves logic, reasoning, judgement, perception, memory and learning. This is important in ACE study since people who have dealt with traumatic events in their childhood have stronger limbic system. It means that they “react” rather than “think”. These toxic stress consequences are mapped, and the brain pays more attention to the things mapped in limbic system as they are critical to one’s survival.

As put beautifully by Donald Hebb, a Canadian neuropsychologist “Neurons that wire together, fire together”. The neural networks work together to form brain maps for the things we do repeatedly such as driving a car, reading, walking, talking, etc. During adolescence, wiring of the prefrontal cortex occurs. This is the time when brain becomes more efficient. The neural networks which are used frequently get wrapped in a fatty tissue called myelin, which makes the functioning of a neural network more efficient. Whereas other neural networks which are not being used frequently don’t get myelinated thus making them inefficient. Strengthened neural networks then get mapped such as coping skills, life skills, and behaviors. Anyone at any age can always re-wire or add new brain maps for new or changed thoughts, feelings, and behaviors.

The Fight or Flight Stress Response is an instinctually wired system built into the human species. It is intended to kick into gear whenever there was a physical danger. Nowadays, instead of normal stress due to physical danger, we have stress triggered by thoughts, and memories of negative experiences. For example, this could be due to sexual abuse faced during childhood, or abusive parents. These triggers can occur frequently throughout the day thus activating the Fight or Flight Stress Response. Chronic activation of this response leads to increased glucose level, increased heart rate, shutting down of digestive system, migraines, hair loss, sleep problems, changes in eating habits which causes obesity or weight loss, depression, anxiety, fear and anger, etc. Thus, whenever a child/teen/adult faces stressful situations which might not be related to original ACEs, their embedded maps of reactionary coping skills and behaviors which are mapped in limbic system get activated.

We can observe some behavior in children when they yell, cry or physically lash out, shutting down emotionally, etc., are some signs that their limbic system is active. The Limbic system overrides the Cerebral Cortex which does not allow them to think. These embedded maps carry on in the adulthood thereby changing that adult’s physical and emotional health. We always thought that brain development stops once a person reaches adulthood. But recent studies have found that this is not the case. It is never too late to re-wire new brain maps. It is our brain’s ability to reorganize and form new neural networks throughout our life. This process of re-wiring is called neuroplasticity. This can help children who may have suffered by ACEs by educating their parents, schools, health care providers, communities about how they could help the child protect and re-wire their brain from the consequences of ACE related toxic stress during brain development.

Neuroplasticity

Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury. As mentioned earlier, the brain can be altered even through adulthood. However, the developing brain offers more plasticity than the adult brain. Neuroplasticity can be observed at multiple scales, from minute changes in individual neurons to larger-scale changes such as cortical remapping in response to injury. Behavior, environmental stimuli, thought, and emotions may also cause neuroplastic change through activity-dependent plasticity, which has significant implications for healthy development, learning, memory, and recovery from brain damage.

Neuroplasticity happens continually as you learn and memorize new data. It can also be spurred by a physical trauma. Neuroplasticity serves as a versatile component that permits someone to compensate for function loss after enduring a physical damage. For example, if someone suffers a brain injury, neuroplasticity allows the brain to rewire itself to restore or maximize brain functioning by rebuilding neural circuits and allowing an uninjured part of the brain to take over the damaged part.

Applications of Neuroplasticity

Neuroplasticity is popularly used in the treatment of brain damage. It explains improvements in functional outcomes with physical therapy after stroke. Due to constraint-induced movement therapy, functional electrical stimulation, virtual reality therapy etc. helps in cortical reorganization. It also has successful improvements in people with amblyopia, convergence insufficiency or other stereo vision anomalies. In the phenomenon of phantom limb, a person continues to feel the pain and existence of the limb which is amputated. In the documentary “The Brain that changes itself”, V.S. Ramachandran, a neuroscientist demonstrated how a person continues to feel pain where his phantom limb is. He demonstrates that by hitting his own hand in front of the patient and he feels the pain in his phantom limb.

When Ramachandran stroked the patient’s face near his ear, the patient felt strokes on his phantom limb. He theorized that phantom limbs were the result of cortical remapping. However, it was later demonstrated by that cortical remapping occurs only in patients who have phantom pain. In 2009, Lorimer Moseley and Peter Brugger found that when used visual imagery, the subjects modify the neural representation of their phantom limbs and generate the motor commands needed to execute impossible movements in the absence of feedback from the body. The applications of neuroplasticity are numerous. But let us see how we can use this concept in treating ACE patients who are obese or over weight.

Emotional Brain Training

Laurel Mellin is a health psychologist and an Associate Clinical Professor of Family and Community Medicine and Pediatrics at the University of California, San Francisco’s School of Medicine. She directs the national research coordinating center for emotional brain training (EBT) in UCSF’s Center for Health and Community. She is the founder of Emotional Brain Training which says that when the emotional brain is out of balance, a person naturally develops problems with behavior, health, mood, and relationships which is most common in patients who suffered from ACEs. Emotional brain training (EBT) emerged from neurobiological discoveries that emotional circuits in the brain were plastic and could be rewired by experiences.

The wires in the brain of an ACE patient which have become dominant over the period of time is the main problem EBT addresses. It trains the individual to process daily life stress effectively by rewiring emotional circuits of self-regulation. It focuses on treating the source of the stress itself by rewiring the emotional circuit. Studies so far, have shown positive results during and after treatment. After talking with Frannie Wilson, EBT Member care specialist, I found how helpful this program could be for patients who experienced childhood trauma. She walked me through 4 major concepts of the EBT method which focuses on changing emotional circuits to treat the source of the problem.

These four concepts are:

1. It’s not us, it’s our wiring: we all know that different people react to certain situations differently. Some are able to maintain calm in tough situations, but some can go on in full panic attack mode. This is due to our wiring. The ideal state to be is the homeostatic state. It holds us in a sense of safety in this world which takes us through a stressful situation and brings us back to state of well-being. Whereas the allostatic state does not have internal self-correcting mechanisms which is why we are not being able to back to state of well-being. The program focuses on teaching people to identify the allostatic state and weaken or erase those circuits and strengthening the homeostatic circuits.
2. Wiring triggers brain states: Laurel Mellin mentions that there are 5 brain states. When the stress increases, the wire is triggered, and the lower-order areas react quickly so that the brain defaults to them. As shown in the table below, Brain state 1 occurs when a person is relaxed and stress free. During this state, the craving to eat sugary, fatty foods is not present. But as the stress mounts, the brain state reaches state 5 the limbic system is in charge and goes in the survival mode which is why it is possible that a compulsive eater’s drive for food comes through his/her emotional state. By targeting the source of the problem, effective interventions could be achieved.
3. Brain states become persistent: Once these wires get mapped on the brain, it keeps using these circuits in the moment of any stress. Thus, when a brain is frequently in stress, it misinterprets stress as good as it is familiar. This makes an individual stuck in the allostatic state all the time. This is what happens in the case of people who faced childhood trauma. The problem is not over-eating or smoking, but wrong wiring in the brain.
4. We can change our wiring: Through EBT program, one individual can know his/her brain state and can change the wiring as we know by now that our brain is plastic. Although this is a difficult road to go, it is not impossible. People with brain states in the higher range that is 3-5 would definitely have a harder time in rewiring the circuits. But the EBT program helps through this process using technology. Using EBT app and instructional videos, one can start with the brain training method.

There are several courses one can choose from $39 for 4 weeks to $699 for 30 days. The most popular option till now has been the 30-day intensive program. This program is specifically designed for those people whose brain state could be between 3-5. It provides private coaching sessions with the patient’s healthcare provider to personalize the plan suitable for the patient. One can reach out to certified EBT provider through messaging whenever the need arises. One can also opt for private telephone coaching, relaxation programs, phone-in workshops, video courses and reading, and much more. This method can be more useful to those who do not want to rely upon medications and surgeries as it is cheaper and targets the root cause rather than focusing on the chronic stress symptoms. One can call in into their Joy Intensive group which includes a certified EBT provider with 6-7 other participants wherever they are. Everyday a person is given a set of new activities which they have to explore with the other group members.

The emotional brain is social and changes more rapidly when we connect with others. When we learn a new skill, it becomes easier to erase those old circuits and live a stress-free life. This is why hobbies get our adrenaline high, we feel energized. For me, to release some of the stress I like playing games, learn cooking, trying out a new sport, etc. Each session helps in getting charged and energized and ready to create joy in our life.

One could say this method is similar to cognitive behavioral therapy (CBT) which is also a form of psychotherapy. But the main difference is that the CBT changes the cognitive circuits rather than emotional circuits. It does not address the underlying cause of the response. In the case of CBT, a person facing a stressful situation would go back to square one if his emotional circuit is reactivated.

With the correct set of questions, it is necessary to identify for signs of childhood abuse or neglect. neuroplasticity is a research which is constantly evolving. In this era of Artificial Intelligence and robotics, more advanced interventions could be expected. With proper interventions, it is possible to live a life without the burden of past upon us. In the word of Santiago Ramón y Cajal,, a neuroscience pioneer “Every man can, if he so desires, become the sculptor of his own brain” with the help of neuroplasticity.