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The Healing Brain: How Understanding the Neuroscience of Eating Disorders Enhances
Treatment Compliance
Eating Disorder Conference-Omaha, NBSept. 28, 2019- 10:15-11:15
Ralph E Carson RD, CED-RD, PhD
Nutritionist and Exercise Physiologist
Eating Recovery Center
Senior Clinical & Research Advisor
Intelligence ↔ Creativity• “Knowledge is limited;
imagination is unlimited” (Einstein)
• The problem for scientists is when it tries to explain things that can’t be observed
Scientific Method
Complementary and Alternative
Medicine
Here are the facts
Here are the conclusions
What conclusions can we draw from
them?
What facts can we find to support it?
Bringing Neuroscience into the Therapy Session
• It matters for therapist to understand and help their patients
• It matters to the patient to make sense of her experience of difficulty eating, drive to move, and body image.
Neuroscience Accelerates and Improves Recovery(Guisinger ’03; Kardum ‘08)
PsychoeducationKnowing facts better equipped to succeed
Brain imaging brings neuroscience to wider
population
More stay with the program
Interested in researchReality: Genetics;Neuroscience &
Health Consequences
Construct a neuralmap of the cause
Feel more control over their disorder
Places them withincomfort zone
Triggers and perpetuating factors
Uncover biomarkersthat predict occurrence
Knowing facts better equipped to succeed
Non-threatening way to deal with disease
Readiness to changeIdentify indicators for recovery and relapse
warnings
Greater likelihood of permanent recovery
Therapist: Neuroscience
More Effective as a Therapist
Confidence in Efficacy of Therapeutic Knowledge and Technique
Able to Fill in Knowledge Gaps
Rethink Current Approach
Assessment; Feedback; Outcomes
We Judge Science by whether or not it agrees with what we believe
• Placebo: • Believe in the act of being treated
• Believe in effectiveness
• Nacebo• Believe we will get sick
• Allergy (Vlieg-Boerstra ‘07)
• Results is what matters; and not how we got there
The Contribution of Neuroscience to Recovery(Zakzanis ’10; Lauer ’99; Chiu ‘08)
• Construct a Picture
• Instills confidence In the treatment
• Belief increase the likelihood of successful outcomes
• Clients highly value their cognitive functioning, and can find this motivating
Brain Damage?
Damage: Loss of Cell Volume(McCormick ‘06)
Dial up and High Speed InternetDrawing inferences is speculative
Brain complexity & the emergence of neuroscience
• No evidence that people are predominately R or L brain
• Speech processing was thought to occur in the Wernicke's & Broca's area of the left brain (Nielsen ‘13)
• Speech involves the use of both sides of the brain (Cogan ‘14)
• No area works in isolation
• The brain functions in circuits
Phineus Gage (1823-1860)1848, Vermont
• Cutting a railroad bed
• 3 ½ feet x 1 ¼ “ tamping iron
• Tapping explosives into a hole and then detonated
• Left eye and prefrontal lobe
• Profanity; indifference to others; impulsive and poor decision making and planning
DTI SCAN
VBM SCAN
High Definition Fiber
Tractography
Functional
Connectivity MRI
Inherited(Predisposing)
Triggers(Biopsychosocial)
(Precipitating & Perpetuating)
Neuro Alterations
RepairTherapy
Changes the way you think
Nutrition Sleep
Genetics Environment Cell LossNeuro-
regenerationCBT
COHFiber
Sleep Hygiene
Traits DietingAlteration of
PathwaysNeuroplasticity ERP Ω-3 FA
Circadian Rhythm
Shift
HPF; Inactivity
Depletion Neurotransmitters
Collateral DBTFruits and
VegCPAP
StigmaDownregulation
receptorsResilience ACT Protein
Stress(Cortisol)
EpigeneticsExtinction or
RefilingEMDR
VitaminsMinerals
Biology is not destiny
NEUROGENESIS
Left Prefrontal Cortex Right Prefrontal Cortex
Prefrontal Cortex
Happiness Anger Fear
Disgust
Neuroplasticity
• Axonal guidance
• Dendritic arborization
• Synaptogenesis
• Receptors
• Neurotransmitters
• Growth Factors
Rubber Hand Illusion(Botvinick ’98; Ehrsson ’05b)
• Brushed spontaneously while looking at rubber hand
• Gain ownershipRubber → Real
• Perception can be rewired
Collateral Repair(Reicht ’11; Cohen ‘04)
Resilience: Adapting in the face of Adversity(Southwick ’12; Graham ’13; Davidson ’13; Botvinick ‘01; Amodio ’07; Husseini ‘01)
• Flexibility to change when the old ways no longer work
• Practice increases the number and strength of connections in the resilience circuit
• Amygdala• mPfC; vmPfC; lPfC; dlPfC• NAc; ventral striatum• ACC
• Elevation of dopamine and BDNF
Evolutionary Instinct: Advantage for coping with famine(Guisinger ’03; Kersting ’04; Sheurink ’10; Illius ‘2002; Casper ’06)
• Food Scarce: Hungry, weak and fatigued
• Triggers an archaic adaptation
• Starvation Induced hyperactivity (SIH)• Decrease food
• Increase activity
• Overachiever: Difficult foraging journey
• Food Plentiful: Restored to reproductive capabilities by clan
Starvation activated genes(Geisinger ’03; Ammar ‘00; Baird ‘06; Bartness ‘11; Beaumont ‘96; Cabanac ’89; Leklin ‘02, ‘03; Keen-Rhinehart
‘07, ‘08; Negardh ’07; Rutten ‘13; Stewart-Knox ’12; Presnell ‘07; Franklin ‘06) )
• NPY1: Stimulates feeding
• SIH unmasks NPY2: Foraging and hoarding
• Facilitates activity
• AgRP: Feeding → Foraging (Dietrich ‘15)
• Repetitive and ritualistic behavior
Dutch Starvation Winter 1944 (Ammar ‘00; Baird ‘06; Bartness ‘11; Beaumont ‘96; Cabanac ’89; Leklin ‘02, ‘03; Keen-Rhinehart ‘07, ‘08; Negardh ’07;
Rutten ‘13; Stewart-Knox ’12; Presnell ‘07; Franklin ‘06)
• Considerable distances & great physical expense foraging for food
• NPY2 facilitated activity needed for foraging
• NPY2 inhibits consumption and directs attention to food acquisition
Temperament Anorexia References
Novelty Seeking Low Cassin ’05; Fassino ’02; Karwautz ’02
Harm Avoidance High Cassin ’05; Fassino ‘02, ’04; Klump ’04; Atiye ‘15
Reward Dependence Low Klump ’04; *Atiye ‘15
Persistence HighCassin ’05; Diaz Marsa ’00; Fassino ’02b; ’04; Atiye
’15; Bulik ’99; Karwautz ‘02
Self-Directedness LowCassin ’05; Diaz Marsa ’00; Fassino ’04; Klump ’04;
Bulik ’99; Karwautz ’02; Fassino ‘02; ‘04
Cooperativeness Low Cassin ’05; Klump ’04; Karwautz ’02;**Bennett ‘04
Self-transcendence HighCloninger ’94; Pham-Scottez ’12; Bulik ’99;
Karwautz ‘02
Temperament: Relevance(Ely ’15; Clonigner‘86; ’93, Fassino ‘02; Liu ’79; ’07; Klump ’04; Roberts ’04; Tchanturia ‘07; Lopez ‘04; Lask ‘05)
Thalamus: D2 Receptor Deficiency
• Relay station: Filters what gets through; Sensory - Thalamo -Cortical
• ↓Thalamic D2BP (D2 binding potential)
• ↓ Filtering• ↑ Cortical excitement• ↑ Creativity
• Reduced in (Santosa ‘07)
• Addiction• BED; LOC• ADHD
Creativity: How does it come about?
• Ideas come in a disorganized way
• Link up ideas in novel ways
Persistence: The Tale of Two Frogs“It is not that I am so smart; it is that I stay with problems
longer” Einstein
Are Introverts smarter?
• Outperform extroverts • Academically in High School and
College• IQ wise they are similar
• Receive a disproportionate number of graduate degrees
• Deep thinkers• Possess Analytical skills that integrate
and process complex concepts• Creative?... Persistent• Better in handling information
overload
Set Shifting: Sensory - Thalamo – Cortical(Santosa ’07; Gilbert ‘00; Kim ’01; Saxena ’08; Rachman ’09; Harsanyi ‘07)
• ↑ Thalamic D2 binding potential
• ↑ Filtering
• ↓ Cortical excitement and new associations
• ↓ Set shifting
Resistance to change
Cognitive Flexibility
Habit Change
Hebb’s Law: Nerves that Wire Together, Fire
Together
Quantum Zeno Effect:Long Term Potentiation
Mindfulness(Kabat-Zinn)
Body Dysmorphia: Integration Exteroceptive & Interoceptive(Guardia ‘12)
Take 2” off Your “Waist”Attractive: Eye Contact an invitation to enter one’s space
LOC: Hedonic Neurocircuits
• Insula: Sensory overload (Wang ‘01; ’09)
• VAT: β-Endorphins &μ – receptors (Gosnell ’09; Bernard
’03; Bello ‘09a)
• NAc: Reward receptor deficiency (Berthoud ‘11; Wang ‘01;
’09; Blum ‘96;’00)
• vmPfC & dlPfC: Free won’t (Carr ‘11; Volkow ’12; Weygandt ‘13)
LOC
Stress: Serotonin(O'Connor ‘08; Singh ‘07; Streigel-Moore ’07; Hagan ‘02; Heatherton ’91; Pike ’06;
Steigel -Moore ’07, Teegarden ‘07)
High Fat Food is Self-Soothing(van Oudenhove ’11)
• Nasogastric tube
• Brain scan
• Melancholy tunes
• Saline: No Change
• Fatty acids• Reduced sad feelings
• Reduced hunger by half
Satisfied? (Janowitz ’50; Wolf ‘47)
Dissociation Capsule(van der Kolk ‘15)
• Traumatic event is encapsulated in the cortex
• Retrieval is challenging
• Overly consolidated memory
• Therapy: Shrink and extinguish dissociation capsule
Cues or Thoughts
Present Moment
Amygdala Kindling(Scaer ‘07)
• Flashbacks, intrusive thoughts, nightmares: Float in time and invade & corrupt present moment
• Amygdala: Smoke detector
• Intrusive thoughts from repressed memories keep the amygdala kindling (idling)(Scaer‘07)
Heightened immune reactivity ↑ likelihood of developing PTSD(Posh ’07; Tal ’13; Hendricksen ’14; Dobbs ’09; Lilienfeld ’12; Glatt ’13; Velasquez-Manoff ’15; Eraly ’13)
• Chronic stress revs up neuronal immune function
• ↑CRP prior to developing PTSD (Glatt ’13; Eraly ’14)
• WBC secrete cytokines cross BBB → inflammation
• Glial cells are sensitive to inflammation
• Alters neuroplasticity and synaptogenesis
Prefrontal Cortex: Executive Function (Watchtower)
• Dimmer switch for Amygdala• Regulates emotions in response
to fear
• Inflammation causes PfC goes off line with amygdala
• Lose access to higher cognitive function
Trauma, Chronic Unresolved Stress, Worry(Rainnie ’09; Scaer ’01, ’05; Van der Kolk ’85; Chen ’10; Muchu ‘11)
• Fear & anxiety: Flood the brain with cortisol
• Cortisol is neurotoxic
• Triggers inflammation
• Stress Damages the Brain and Alters Repair (Kim ‘02)
• Shut down healing & regeneration
• Decreased BDNF• Alters neuroregeneration
380 cc vs. 1500 cc
60% of the Brain’s Dry Weight
Membrane Fluidity
• Lots of unsaturated
bonds
Substituting Omega 6, Trans or Saturated Fats Impairs Docking
Neurobiology of Binge Eating Disorder – A Synopsis
• https://psychscenehub.com/psychinsights/neurobiology-of-binge-eating-disorder/
• www.drcrysstalcollier.com• Crystal@drcrystalcollier.com
• 713-254-9719
• The neuro WhereAbouts Guide
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