Angst in the Face of Economic Meltdown: How Neurobiology and Attachment
Theory Can Inform Our Response

Daniel Jay Sonkin, Ph.D.
Licensed Marriage and Family Therapist

We live in both frightening and exciting times. The economy is affecting everyone along the economic spectrum. Although the poor and working class in our society are always disproportionately affected by the economic downturns in history, I don’t know anyone personally or professionally that has not been affected in some significant ways. There is a tremendous amount of anxiety out there – both because of what is happening to people, and also because of people’s fears of what may happen in the future. With the new administration, there is a lot of hope out there as well. Granted, the anxiety can sometimes overshadow those positive feelings, especially if you watch too much television news. But there is a buzz of possibility in society that is motivating people to change. Not only do I speak of this with regard to the socio-political realm, but also in the psychological domain as well.

To me, this is an exciting time to be a Marriage and Family Therapist. In the past sixty years attachment theory has grown from a brilliant idea initially postulated by British Psychoanalyst John Bowlby, and operationalize by the American researcher, Mary Ainsworth, to a international field of study of infant, child and adult development. Its roots have spread to such fields as social psychology, psychoanalysis and neurobiology. Similarly, the affect and cognitive neurosciences have also enjoyed an incredible growth in the past twenty years. With the advent of improved scanning techniques we can now literally peak into the brain as it reacts to the world. As we are better able to map the brain and understand this incredibly complex organ, the field of psychology becomes the direct beneficiary of these efforts. We are now able to link what have been historically separate fields of study, into a joint enterprise to understand the human mind and apply that knowledge to the fields of child development and psychotherapy (see Daniel Siegel and Alan Schore for excellent summaries of this research). Attachment theory helps us understand how people experience relationships and events, and regulate affect. Neurobiology helps us understand how to bring about changes in how the brain reacts to the world both emotionally, as well as cognitively. I would like to discuss how I incorporate some of the findings from these two disciplines in my clinical work, and how they may not only help us with clients who are experiencing this current social angst, but also many of the other problems we address on a day to day basis.

Attachment theory in a nutshell!

Most of our clients seek help in the first place because of problems relating to affect regulation – either they are flooded with emotion and having trouble controlling its expression, or they are cut off from emotion altogether, or some combination of the two. In it’s most basic form, attachment theory is a theory of affect regulation. These difficulties modulating emotional processes, that stem for early childhood experiences, can lead an individual to experiencing problems in the physical, psychological, family, social, and occupational arenas. Bowlby’s theory did include a cognitive component, which he referred to as working models. This is an important part of the theory, but for the sake of this article, I will focus primarily on the affect regulation component, but will address it briefly in the section on memory. (For a more thorough understanding of attachment theory see the Handbook of Attachment, by Cassidy and Shaver.)

Attachment researcher, Mary Main, has said that the quote from Tolstoy’s Anna Karenin, captures an important core element of attachment theory. “Happy families are all alike; every unhappy family is unhappy in its own way.” Secure babies are all alike, insecure babies are unhappy in their own ways. Secure babies are alike in that they have developed flexible affect regulation skills because their caregivers had those skills. Insecure babies develop different affect regulation strategies depending on the affect regulation strategies utilized by their caregivers. These problematic strategies fall into three categories – down-regulators, up-regulators, and those who do some combination of the two. I am going to direct my focus on the first two categories, since they are the most common forms of insecure attachment.

It has also be found that attachment status is fairly predictable (approximately 80% of the time you can predict the attachment status of an infant by measuring the attachment status of their caregiver), and persistent (about 80% of infants attachment status measured at 12 months of age will be assessed similarly in adulthood). Attachment status helps us understand how adults (and children) will not only cognitively experience close relationships (what Bowlby called internal working models of self and others), but how they will regulate distress in those relationships as well. Although, the parallels are not perfect, the therapeutic relationship can be conceptualized as an attachment relationship. Therefore, those working models and affect regulation strategies are likely to manifest in the therapeutic setting, which gives us the opportunity to intervene in real time.

The Emotional Fallout of Social Events

The study of traumatic stress has also experienced a tremendous growth in the past thirty years. Our awareness of the short and long term effects of trauma on individuals has led therapists to a greater sensitivity in their approach to trauma victims and a better understanding of how to recognize and treat the effects of traumatic stress. Some traumas are private experiences, others are experienced by a group of individuals, whereas others affect a segment of the population. Societal crises can also have a profound effect on the population at large. In this way, the trauma has far-reaching effects and is a public, shared experience. We all experienced this first hand in the aftermath of the September 11th, 2001 attacks. It taxed the affect regulation strategies of all of us, but it particularly affected people who were already vulnerable to trauma. Individuals with pre-existing psychological problem and/or prior unresolved experiences with trauma were dramatically affected by these events.

What is happening in society today, with massive lay-offs, retirement plans disappearing, companies going out of business and no end in sight, it something of a mass social trauma. But unlike other traumas that are short-lived, this trauma is on-going and therefore the potential for it causing cumulative psychological stress in many people is greatly increased. In my practice, people are talking about their fears in ways that has only been matched by the aftermath of September 11th. The current economic crisis is triggering particular clinical issues. For example, a number of people who grew-up post depression, who received many anxiety-ridden messages about money from their parents, are reexperiencing those anxiety-fill memories and they are getting played out with partners around negotiating finances. One person, who grew up in poverty, who is very successful today, is having tremendous fears of losing her job and becoming poor like her family. Another client, who grew up middle-class, but where money was a conduit for transferring family anxiety, is having a particularly difficult time, even though he is fairly secure (or as secure as one can be right now) with his job. Another client, whose family economic status dramatically changed when his parents got divorced, has been feeling particularly powerless in the face of this economic meltdown. Clients who have experienced the powerlessness and hopelessness of childhood abuse are having those experiences resurface and spill over into feelings of powerlessness and hopelessness about the economy. Clients who have personally lost their jobs, savings, home or investments, or have family and friends in this position, are experiencing the greatest levels of anxiety.

We as therapists are in the position to help clients navigate these difficult periods in history in a manner that contributes to greater self-esteem and increased feelings of wellbeing. We do as therapists is one of the most difficult jobs imaginable. To bear witness to a person’s suffering, and slowly guide them to a more balanced state of mind, is not an easy job – both technically (how to get there) and emotionally (the price we pay to our own psyches). During times of great social emotional tumult, it is particularly difficult for the psychotherapist, who is not only having to hold their client’s emotional pain, but struggle with their own as well.

The Problem of Emotion Regulation

What therapist doesn’t work with emotion? We all do, whether it is explicit in our orientation or not. Our clients are emotional beings and as such, they are constantly experiencing varying types and intensities of emotion. Neurologist Dr. Antonio Damasio has found that throughout our days our bodies are continually experiencing emotion, in response to “emotionally competent stimuli.” An emotionally competent stimulus is anything – a thought, event or experience – that triggers an emotional response in our bodies. I say “bodies” because he writes that emotion begins in the body – it is a physical (not mental) experience. We may not have a mental awareness of the emotion, but we are having the emotion just the same. In fact, we are probably not aware of most of the emotions we are experiencing – and this is a good thing. Although emotions can provide us with important information about an event and help us make decisions in daily life, if they are constantly entering consciousness, they can be distracting from other important tasks. So too much or too little emotional awareness can be problematic. If their importance is underestimated, we are missing important information that allows good decision-making and social problem solving. If they are too strong, they can interfere with cognition, which is also necessary to making good decision. Whether we are aware it or not, our emotions are executing behavioral solutions outside of our awareness (not-conscious). Now ordinarily, this is not a problem. But someone grew up in a home, where they learned maladaptive emotion regulation strategies runs the risk of automatically acting out their emotions in destructive ways. So if our automatic behavioral responses, or solutions to emotions, are maladaptive, then a lack of this awareness can result in devastating consequences. Adaptive emotion regulation allows for greater flexibility in responses – tuning up the volume when necessary and turning it when necessary. Adaptive emotion regulation also allows for making choices regarding the expression of emotion, and recognizing when automatic patterns need altering.

Damasio’s research is very applicable to the practice of psychotherapy. In his book, The Feeling of What Happens, he suggests that the terms emotions and feelings refer to two very different biological processes. Emotion can be thought of as the body’s response to an emotionally competent stimulus. These stimuli are frequently handed down by evolution, but can also be learned. An emotionally competent stimulus (can be an external event or even a thought or memory) will cause a change in the physical state of the organism. Behavioral reactions are solutions to emotions and may occur completely out of our awareness. How many times has some asked you, “What are you upset about?” when you didn’t even know that something was bothering you? The emotion occurred and a solution was employed non-verbally without your awareness. It not until the prefrontal cortex of the brain registers the change in the body (either though noticing or someone bringing it to our attention) and mentally represent it (I’m upset), that a feeling occurs. Feelings are mental representations of emotional reactions. So, in psychotherapy, a great deal of our work is helping clients not only recognize that something is happening to them emotionally, but also developing the feeling language to express them, rather than act them out in thoughtless or not-conscious ways.

Fine attunement to the ebbs and flows of emotion in our own physical being can teach us something about the inner world of our clients. The more analytically trained therapists will recognize that I am speaking about projective identification. It turns out that this analytic concept has a neurobiological correlate – the mirror neuron system. Neuroscientist Marco Iacoboni has described the mirror-neuron system as allowing our mind to read the intention of others through non-verbal cues. During the course of a session, we are constantly picking up the non-verbal emotional cues of our clients. Our mirror neuron system, located in the prefrontal cortex of our brain, simulates our client’s state in ourselves. It has been suggested that this system is the neurological basis of empathy.

Clients that down-regulate are typically unaware of their emotional state of mind at any particular moment in time. They are executing behavior solutions but not aware of it. But other people are aware of them, which can bring about interpersonal conflict. The therapist, who is attuned to their own bodily emotional reactions, can feel what their client is not feeling, but emoting just the same. When the therapist talks about the emotion they are experiencing from the client, it can bring the client’s attention to their own experience, and begin the process of identifying emotions, representing them cognitively with feeling, and having a choice in how they will be expressed. Clients who up-regulate distress, need help with self-soothing. Emotional reactions overrule cognitive strategies, which often result in impulsive decisions and conflict-laden interpersonal relationships. By staying calm in the face of their client’s anxiety, the therapist can help activate the client’s mirror neuron system – which can simulate a state of calm within them. The more they can learn to soothe intense anxiety, the better they can engage cognitive strategies that help to solve the problems with constructive solutions.

Are you a glass is half-full or half-empty therapist?

Richard Davidson of the University of Wisconsin has been interested in the concept of brain asymmetry - different sides of the brain can function in complementary ways. He has found differences in the patterns of activation of the prefrontal cortex with regard to approach and avoidance emotions. His studies have included brain scans of monks who have studied with the Dali Lama. He found that these individuals had particularly positive outlooks on life and this was reflected by differences in the activation of their right and left prefrontal cortex. Individuals who have an overall positive outlook on life, are more likely to have a higher left to right prefrontal activation pattern in response to problem solving, as compared to individuals who have a more negativistic outlook on life (who have a lower left to right ratio of activation). In other words, some people do really see the glass as half-full and others really see it as half-empty. Understanding this reality is particularly critical when working with patients who view current events through a lens of depression, hopelessness and despair.

What is most interesting about his work is that he has found that the pattern of activation can be changed through mindfulness techniques. People who are familiar with attachment theory will recognize that individuals with secure attachment are more likely to have this positive outlook, whereas individuals with insecure attachment are likely to possess a more negative outlook. So, if mindfulness training and meditation can bring about a change in this activation process, should we be referring clients to our local Zen and Buddhist centers for adjunctive therapy? The answer to that questions is, “it depends.” According to Davidson and others, mindfulness training can have a powerful effect on mood and lead to increased states of well-being. If we approach affect regulation from Damasio’s perspective – that emotion is in the body, and feelings are mental representations of those body changes – then an important part of therapy is helping clients develop a more mindful approach to their experiences. Not that this is the same as the specific practice of mindfulness training, but there is a mindfulness aspect to working with emotion in this way. Some clients may actually benefit from adjunctive meditation and mindfulness training. However how you bring that up in therapy is dependent on your orientation and the client’s diagnosis and world-view.

This data also suggests that an important part of emotion regulation process in psychotherapy is teaching clients how to be more mindful of the changes in their bodies so that a full range of emotions can be perceived, and not necessarily the loudest one at any particular moment in time (such as anger or fear). Is easy to focus on, what Davidson describes as, withdrawal emotions (anger, fear, etc.), and we may not give sufficient time to helping clients develop a sensitivity and awareness of approach emotions (happiness, compassion, well-being, etc.). Damasio suggests that the final outcome of processing emotion adaptively is not reaching a state of neutrality, but, what Carol Ryff of the University of Wisconsin refers to as, states of well-being. Unfortunately, many of our clients process emotions in such a way that the end results are not well-being, but more distressing emotions and negative self-attributions. It is through this more balanced state of well-being our clients can interpret events (even distressing ones such as the economy) through a more benign lens.

Thanks for the memories

Another area in the neurosciences (and is related to the attachment literature) is the science of memory. Our understanding of memory has grown over the past two decades. The one discovery that I have found incredibly relevant to our work as therapists is the area of implicit memory. Here I am referring to the work of Eric Kandel and Larry Squires. Kandel won the Nobel Prize in medicine in 2000 for his research of implicit memory. Implicit memory is very different from the type of memory that we are used to discussing – explicit memory. When we are experiencing explicit memory, we know we are having a memory. When I think about what I did last summer, I know I am having a memory and it is not last summer. What is so unusual about implicit memory is that when you are having an implicit memory, you don’t have the experience of remembering – it’s just happening. One of the most common forms of implicit memory is procedural memory – how things are done. When you get into your car, you don’t need to remember how to start it or back out of your driveway, you just do it. The same is when you work on you computer (unless you are technically challenged), most tasks are automatically completed without much thought. Your fingers just know what to do. These are bodily memories that you learned though repeated past experiences until they became pretty much automatic. This type of learning and implicit memory allows for efficient processing of information. If you had to think about these things every time you did them, you couldn’t use your time for other tasks.
Implicit memory can also come in the form of emotion and behaviors that represent beliefs about self and others. As I mentioned earlier, Bowlby called these beliefs internal working models of self and others. Essentially, these are cognitive constructs about self, others and expectations about how those will be experienced in close relationships. Bowlby wrote the following about internal working models.

Each individual builds working models of the world and of himself in it, with the aid of which he perceives events, forecasts the future, and constructs his plans. In the working models of the world that anyone builds a key feature is his notion of who his attachment figures are, where they may be found, and how they may be expected to respond. Similarly, in the working model of the self that anyone builds a key feature is his notion of how acceptable or unacceptable he himself is in the eyes of his attachment figures. (Bowlby, 1973, p, 203)

Obviously, these working models are established through repeated experiences with caregivers in childhood. These working models are carried into relationships and are manifested through emotional and behavioral implicit memory. In other words, is a person perceives the world as essentially a benign place, then those working models will interpret current events through a benign lens. If the person has learned that the world is not a safe place, then others, events and circumstances will be experienced as frightening. Imagine, growing up with repeated experiences that engender feelings of powerlessness and fear. The brain becomes primed to respond to or view the world through that perspective. It’s automatic, like riding a bicycle. Those negative working models are likely to evoke withdraw emotions (right prefrontal cortex activation) such as anger, fear and anxiety. Positive experiences are likely to engender working models are more likely to evoke approach emotions (left prefrontal cortex activation), happiness, interest, curiosity, joy.
The emotion centers of our brain don’t have a sense of time, only that emotionally competent stimuli can trigger the emotional response. When emotions are activated, they have varying degrees of intensity, but there is no sense of whether the emotion has to do with the present or the past or the future. It’s the prefrontal cortex that has the capacity of autonoetic consciousness – knowing self over time. When strong emotions are activated, our first response is to figure out what is causing those emotions. The first place we look is around us – we ask who or what is causing this reaction. Here is where implicit memory is vital to our work. Because emotion doesn’t have a sense of time (the emotional centers of our brains don’t distinguish between, for example, fear from yesterday and fear from today), and unless we are used to deliberating on our reactions, we usually assume it’s something happening right now, rather than a memory. Of course, chances are, the stimulus may have happened in the present (a thought or event), but the intensity of the emotion, can actually be partly attributed to an implicit memory of the past. The most clear example of this would be the Iraq veteran, who is now stateside as serving three or four tours of combat duty. When a car backfires, and they duck to hit cover, they are not having an explicit memory (Oh, that reminds me of when I was hearing gunshots in Iraq). The fear is in the present and they are immediately, for the brief moment of time until the gather their thoughts, are transported to being in combat.

People have grown up in families where money or economic issues were avenues for anxiety, anger, fear or even abuse, are likely to have those emotional memories triggered when thinking about the economy, hearing reports through the media, or directly experiencing financial setbacks. You might ask, why is it so important to make this distinction between current emotional reactions and past emotional memories? Because emotions exist to help the organism solve problems and endorse opportunities. A behavioral solution will be set in motion. The stronger the emotion, the more immediate is the solution. The stronger the emotion, the more likely cognition may be overruled. The stronger the emotion is, the more extreme the solution will be. In other words, by understanding and separating out implicit emotional memories, from current emotional reactions, the more likely the person can engage their cognitive problem solving functions, rather than react with default solutions that are maladapative and may only make the situation worse. When clients understand how the past can intrude on, and negatively influence perceptions about the present, you help them reevaluate the current situation with a sense of perspective, which opens the door to learning that more mindful deliberation can lead to better decision-making and problem solving.