The Brain Story: Module 15

Module 15: The Effects of Toxic Stress, Addiction, &
Depression on Parenting

Excerpt from “The Impact of Maternal Depression on the Transition to Parenthood”
Linda Mayes, MD
Yale School of Medicine

• Developing healthy internal working stories.  Attachments are the development of healthy internal working stories.
• The attachment provides security – which attachment activation seeks to become an answer to a perceived threat.
• This leads the child to seek out the attachment figure.
• The feelings of security in healthy attachment positively reinforce the cycle.
• When the figure is unable to attend to the child, heightened stress and fear continue to build – developing a working model of individuals not being useful in helping the individual.
• We should do best to ensure healthy attachment while also understanding how adversity impacts the working model of individuals who eventually become involved in parenting.

Excerpt from “Stress & Parental Care: Intergenerational Transmission of Parenting Abilities”
Linda Mayes, MD
Yale School of Medicine

• How does becoming a parent impact an adults’ psychological, neuropsychological, and neural system development?
  • The presence of a new infant activates specific circuits involved in balancing between reward-seeking and stress modulation.
  • These neural circuits are enhanced as time with the infant increases.
  • There is a lot of change in child and parent neural development of their neural systems.
• Rethinking parenting
  • Changes in capacity for stress regulation and reward responsivity emerge.  This allows the parent to maintain executive control under heightened arousal.
  • Self-control vs impulsivity
  • Emotional regulation or distress tolerance
  • Decision making/Consequence appraisal
  • Individual differences in the capacities of the parents impact the similar function in the capacities of their offspring.
  • Frontal lobe activation increases at this time.
  • Neural or brain circuits related to capacities for attachment or caring for infants also involve the reward and stress regulatory circuits.
  • Affiliative circuits
    • accumbens, and striatum
    • amygdala
    • modulation from oxytocin, estrogen, prolactin, and dopamine
    • Some genes identified – fosB, prolactin & estrogen, and receptors influence parental interaction
  • Seeing the baby, happy activate the rewarding circuits of their parents.  This is evolutionarily relevant.
  • Own baby images activate the orbitofrontal cortex.
  • Seeing/hearing baby signalled distress – signals stress and comforting of the baby.  This is paired with thinking about how to soothe the baby.
  • Both new and veteran mothers, there is an activation of temporal regions of mothers.
  • New mothers – increase in right hippocampal lobe by 3 months. In veteran mothers, it is present at two weeks and does not change by 3 months.
  • There is an increase in hippocampus connectivity and reward/stress regulation.  This increase is not as significant in veteran mothers.  It suggests the significance of experience-based learning.
  • There is an intervention window for first-time mothers for change.

Excerpt from “Stress & Parental Care: Intergenerational Transmission of Parenting Abilities”
Linda Mayes, MD
Yale School of Medicine

• Preoccupation focus with a baby before birth happens for both mother and father and does not return to baseline after birth (although they do decrease)
• This is normative to have intrusive worries about thoughts about the child’s safety and wellbeing.
• From 2 weeks and 3 months, preoccupation and anxious thoughts decrease, while positive thoughts and feelings of personal transformation increase.
• Experienced parents are less preoccupied in the beginning, but more like new parents by 3 months.
• There is a similar pattern between mothers and fathers.
• The higher the intensity of the preoccupation, the more significant the shift of feeling parenting is a transformative experience.
• There is enhanced processing of sound in mothers – change in neural sensitivity.
• Grey matter increased from 2-4 weeks to 3-4 months postpartum.  This is predicted by the mother’s positive perception of their own baby at 2-4 weeks postpartum.
• Maternal sensitivity at 3-4 months postpartum is correlated with activations of the right superior frontal gyrus and right lateral globus pallidus/amygdala at 204 weeks postpartum to their own baby versus other babies’ cries.
• Mothers show greater activation of post-central gyrus – implicated in motoric responses and less activation of regions associated with the stress response.  Mothers are primed to initiate motor responses to the baby.
• Parent’s perception of attachment (with child and their own life history) – security predicts rewarding response in healthy attachment, along with changes with oxytocin changes impact neural changes.
• Attachment profiles influence the interpretation of a baby’s face – attributed thinking of the baby’s perspective.  Better attachment has a better response to the needs of the baby.  Insecure attachment can trigger regions associated with disgust.
• Differences in maternal mood postpartum relate to individual differences and sensitivity as measures in cues after seeing the babies face as measured in EEG.

 

Excerpt from “The Impact of Maternal Depression on the Transition to Parenthood”
Linda Mayes, MD
Yale School of Medicine

• Clinical features of maternal depression:
  • predominantly depressed mood; being despondent and/or anhedonic
  • Sleep disturbance, fatigue, and irritability
  • appetite loss
  • Feelings of inadequacy/self-criticism
  • Concentration difficulties increased distractibility
  • Increased negative attribution – belief the world is dark
  • Increases in difficulties of making decisions
  • Increased emotional liability and sensitivity to stress.
• Attitudes towards the infant
  • This influences the mother’s perception of the child being more bothersome – increasing the harsh judgements made of the infant.
  • Feelings of guilt, resentment, and ambivalence towards the infant increase
  • There is an increased risk for abuse of the infant.
  • Ego dystonic thoughts of harming the infant can emerge – they are guilt provoking.  There is increased self-criticism.
• Changes in interaction when there is maternal depression.
  • Less eye-gaze with the infant
  • Prolonged time is taken to respond to the infants’ utterances
  • They have fewer positive facial expressions
  • Diminished awareness of infant’s cues
  • An alternate between low activity level, flat affect, lack of contingent responding and intrusiveness
• Within the attachment cycle, the comfort-seeking averts the loop of heightening distress and fear by strengthening how attachment provides comfort.
• When caregiver recognizes the child’s distress, they regulate their own distress- Mentalization.
• Mentalization Defined:
  • Reflective functioning – the ability to think about others and oneself in terms of mental states
  • It allows others to perceive behaviours in terms of mental state constructs – making them meaningful, explicable, and predictable.
  • Effective mentalization is acquired in the context of secure attachment relationships.
  • It allows us to explore what others are thinking and feeling.
  • We can attribute intentions and feelings to the self and the baby.
  • This is intrinsic to emotional regulation.
  • The two processes include detecting the child’s signal and interpreting what those signals mean.  Two different parts of the brain are activated by these processes (superior temporal sulcus and temporal lobe process signals).
• Signal detection and parental attention impact the temporal region.
  • Mentalization relates to security as a product of mindfulness skills.
  • Parental depression and substance abuse dampen the reward circuit response form the baby.
  • Early deprivation/neglect heightens stress reactivity.  Infant cries are stressful, and there is less effective top-down processing of the mental state cues.
• Depression is associated with an impairment in depressed female inpatients’ ability to identify/interpret mental states of self and/or others.
• Significantly related to other cognitive deficits assessing cognitive flexibility
• The mentalizing deficits are not specific to depression, however.  It is about the relationship.
• Depressed mood impairs mentalizing – being sucked into a black hole.
• What is thought is felt as real.
• Things become too real.
• Concreteness of thought – rejection hurts.
• No, pretend or play
• Psychological pain is bodily pain.
• Changes to the experience of time
• Mis-understanding can take place – feeling that the baby does not like them.  This is especially the case in traumatized parents.
• Interventions:
  • impairments and distortions in mentalizing are both cause and result of mood disorders and need to be addressed at both levels.
  • Focus on the adult’s needs and allow them, as a parent, to communicate a sense of control over what seems uncontrollable.
  • Focus changes from meeting the needs of the baby to how the demands of caring for an infant are stressful.  Acknowledge the impact of understanding an infant’s needs and how the parent perceives and experiences these cues.  How does the parent interpret and feel the stress?
  • Look at the mother’s interpretations of the baby and the perception of how the baby views the parent.

Excerpt from “The Impact of Early Adversity on Parenting”
Linda Mayes, MD
Yale School of Medicine

• Substance use impacts the suckling activation of the dopaminergic reward system.  Addiction co-opts the reward circuits.
• Substance use may diminish attention to infant (experiments on pup rats and moms in substance use)
• Heightened aggression to intruders, but not to protect the pups in experiments.
• Less attentive to pup vocalizations.
• In human mothers, there is:
  • a withdraw in the face of infant distress
  • decreased attentiveness to an infants bid for attention
  • decreased contingent responding/increased noncontingent (not contextually sensitive to the child’s bid) behaviour
  • Increased rate of negative affect in interactions with heightened physical provocation and intrusiveness.
  • At what point do processes become habituated to a point where it becomes maladaptive.
  • Addictions can impact child development through the process of connecting with the child postnatally, and developmental trajectories in prenatal development.
  • Each of these can become markers of heightened stress in response to the baby.
• Substance using mothers has decreased activity over healthy controls when exposed to happy faces in the right parahippocampal area – associated with memory formation and recall – also implicated are the orbitofrontal gyrus which processes emotion.  There is also a decrease in sensitivity to language processing regions.
• There is also a decrease in oxytocin with more significant perceived stress to a baby’s cries.
• Addiction processes reflect dysfunction in self-regulation.
• Early adversity increases the risk of addiction
• Addictive adults are less responsive to infant cues
• The reward for attending to infant cues is not as rewarding and is secondary to the stress/reward system in addiction and personal adversity.
• Mindfulness – looking towards the future when there is an addiction – which modulates the consequence appraisal is seen as more stressful, and anticipation of actions is diminished.
• The unresolved stress can lead to withdrawal from the infant, which increases the craving for habitual behaviour that downregulates the stress (through things such as process and/or substance addiction), which can lead to neglect.  Essentially the infant needs to be quieted for the parent to decrease their own stress.
• Adversity leads to increased parental stress, which increases craving (in the short term), which can lead to drug-seeking and relapse.
• Parenting programs such as mothering inside out can have an impact on decreasing substance use.
• As an intervention:
  • Focus on adult parent
  • Change focus from what baby needs to how the impacts of infant care are stressful and looking at the understanding of what the infant’s needs are.
  • Increase the distress tolerance and capacity of parents to maintain decision making in the face of stress/remain mindful of their own emotional states.