Interpersonal Neurobiology & COVID- 19

Katherine Gotis

January 2021  

Abstract

The novel corona virus (CV19) has changed the way humans connect with one another. Activities which are vital to a person’s mental, physical, psychological, and emotional health, have been sanctioned to online formats, and some have just disappeared altogether. This paper will explore the importance of community, connection, attachment, etc., and what happens/might happen  to human development and attachment and attunement in the context of a pandemic. Peering through the lens of neuroscience and its many affiliate disciplines, this paper will weave  material learned from the interpersonal neurobiology (IPNB) course with current scientific and anecdotal findings in an attempt to articulate a clear and present need for authentic meaningful connections perhaps more now than ever before. Finally, throughout this paper the author will share personal reflections on interpersonal neurobiology and how this study has impacted her thinking and how it might benefit her work with clients in clinical practice.

Keywords:  COVID-19, Social isolation, interpersonal neurobiology, professional counseling

“When we try to pick out anything by itself, we find it hitched to everything else in the Universe.”

John Muir

Everything is connected. One of the most important ingredients in the recipe for well-being  are strong social connections in the form of community, family, and friends. The novel corona virus (COVID-19)  pandemic that’s sweeping across the globe in 2020 has proven this in ways that may seem frustrating and inconvenient at one end of the spectrum and devastating and tragic on the other. COVID-19 has not only highlighted how deeply humans impact one another in ways that can be harmful and sometimes even deadly, it has also left many people lonely, depressed, and even suicidal due to the lack of the social support systems that so many relied upon for their well-being (Wasserman, Iosue, & Wuestefeld., & Carli, 2020).

Orders for statewide lockdowns, physical distancing, self-quarantines, the donning of face masks, and school closures are helping to slow and in some cases stop the spread of COVID-19, but the cost of social isolation and the loss of the vital connections needed for social brain development in children and positive mental health in all have yet to be fully realized. This paper will discuss the importance of  human relationships for the development and sustainability of mental health, what is currently known about the impact of COVID-19 on a person’s interpersonal neurobiological processes given the current environment of online therapy, school, and most everything that used to be experienced in-person, is now done in the virtual environment.

This paper also explores attachment, attunement, mirror neurons, and neuroplasticity in the context of the COVID-19 pandemic. Additionally, the implications of IPNB on clinical practice, the therapeutic process, as well as the author’s own personal reflections on these topics at the end of each section.

Interpersonal Neurobiology

Interpersonal Neurobiology (IPNB) is an interdisciplinary field of relational neuroscience which combines various fields of science and studies the universal and common principles within them to explore the way relationships interact with the body, the mind, and the brain (Siegel, 2012). IPNB is a holistic discipline which seeks to leave nothing out, and wonders about the mysteries of the mind, asks what is the mind, how does it relate to the brain, physical and emotional well-being, relationships and why does it matter? What roles do caregivers, trauma, and environment play in the formation of a brain? In answering some of these questions, other questions follow which have yet to be answered.  

The Social Brain

            There is no such thing as a solitary brain or neuron (Cozolino, 2014). Neurons exist organically only in relation to other neurons and brains in relation to other brains (Cozolino, 2014). Throughout its history, the human brain has grown within the context of connecting to other human brains and its adaptation is the result of genetics, environment, and experience within the context of relationships (Cozolino, 2014). The brain changes and adapts in response to healthy and supportive relationships as well as unhealthy and harmful relationships

  The brain has not always been thought of as a social organ, and in fact the idea that the brain and the mind have anything to do with one another didn’t come about until the 1970s after in an effort to stop infections, orphans were kept isolated from eachother and from the staff who might offer them physical and emotional comfort (Cozolino, 2014). It was then thought by doctors that this act alone would keep so many children from dying, but the death rate didn’t improve until the children were allowed to interact with one another and to be physically soothed, that their survival rate improved (Cozolino, 2014). There is safety in numbers, or so says an old adage which points to the importance of tribe, family, and community for an individual’s survival. Throughout a person’s life, the need to belong to a social network of friends, family, or community persists even as the groups that once represented safety and survival, now in the context of the COVID 19 pandemic, represent, at least for a great many, the very opposite.

In March of 2020, the author left her job as a registered nurse at The Mayo Clinic in Arizona where she had worked for almost 13 years alongside a group of people who became a kind of family and lent her a sense of belonging and safety. She left her role to begin a full time internship which eventually fell through related to issues around the pandemic. In July of 2020, the author moved her life from Phoenix to Santa Fe, New Mexico to begin an internship at The Sky Center, a non-profit family counseling center which offers free family counseling to suicidal teens and their families. The Sky Center started offering online therapy sessions during the author’s internship and eventually, all interns and staff were asked to work from home and this continues as this paper is being written in January of 2021.

The impact of losing the relational connections at The Mayo Clinic with not only colleagues, but patients as well, is hard to measure. The stress of moving to another state, changing careers in the middle of a pandemic, political and social upheaval, and natural disasters, while not having the support system of family or friends nearby and not being able to connect in person with my new colleagues has taken a toll as evidenced by the lateness of this paper as well as a loss of vitality and inspiration for the things that once made all of this work feel like it was worth it. The community in-person dances, yoga classes, dinner parties, etc., have all vanished and the online substitutes feel flat in comparison.

Suicidality & COVID 19

            Social isolation, fear of contagion, chronic stress, anxiety, financial worries, and uncertainty about the future, can all lead to exacerbation or development of stress-related disorders (Sher, 2020). Cases of COVID 19 related suicides have been reported all over the world, including here in the United States of America (U.S.A.) where calls to suicide hotlines have increased considerably since the pandemic began (Sher, 2020).

            Healthy social connections are correlated to positive physical and mental health (Cozolino, 2014). Being in the presence of supportive people reduces the risk of illness by decreasing stress hormones, blood pressure, autonomic nervous system reactivity, and decreases the overall negative impact of stress on the human organism (Cozolino, 2014). A sense of belonging, feeling loved, and having obligations to others support growth, well-being, and longevity, and are expressions of the design and function of the social brain (Cozolino, 2014). These things also promote resilience, which is a protective agent against suicidal ideation (Sher, 2020). It is not surprising that the social isolation that is required to slow the spread of COVID 19 also greatly contributes to the increase in suicidal ideation during the pandemic (Sher, 2020).

            The author currently works with at risk and suicidal teens in the context of family therapy in Santa Fe, New Mexico. In 2020, it was reported that New Mexico has the highest rate of suicide in the nation (New Mexico’s Suicide Rate, 2020). In New Mexico, kids have been asked to do seven hours of school online, with only five minutes between classes, and over 50% of these students have stopped attending school during the fall semester. Anecdotally, kids and parents who come to The Sky Center for counseling sessions report increased stress and decreased financial, social, and emotional resources which has led to an increase in depression, anxiety, and suicidal ideation in these families.

            The author’s family member attempted suicide in July of 2020 and is currently in trauma therapy working through unresolved childhood issues that surfaced during the period of social isolation where they were forced to be alone and to slow down. No one noticed that she was in crisis, because she wasn’t seeing anyone and didn’t know how to talk about what was happening until it was too late. While the outcome in this case is positive, it does seem like the current landscape of life during a pandemic as well as the accompanying social and political situations, does set the stage for some people who might not experience suicidal ideation under normal circumstances, to become vulnerable and to even attempt to take their own life.

                   

“Every man can, if he so desires, become the sculptor of his own brain.”

            Santiago Ramon Y Cajal

Neuroplasticity & Mirror Neurons

Anytime new learning or experience happens, the structure of the brain changes (Eagleman, 2020). The ability of the brain to change in response to new stimuli is called neuroplasticity (Siegel, 2012). The ways in which human brains are changing in light of the current state of the world remains to be seen, but fear is likely playing a large role in driving neuroplastic changes.

The fear occurring for most during the COVID 19 pandemic, has bodily, interpersonal, cognitive, and behavioral features (Schimmenti, et al., 2020).  

Bodily fear shows up as fear of the body as a potential source of harm to others and fear for the body due to being infected (Schimmenti, et al., 2020). Interpersonally, fear of being separated from attachment figures and also fear of being close to them arises, whereas behavioral fear shows up as anxiety around taking action, or not taking an action, an example which is relevant in this moment is getting the COVID 19 vaccine or not getting the vaccine, and there are many others (Schimmenti, et al., 2020).

Finally, the domain of cognitive fear shows up as the fear of knowing versus the fear of not knowing (Schimmenti, et al., 2020). Ingesting the constant stream of news, which is often confusing and fear laden is perhaps training the brain into a chronic state of stress via neuroplasticity, but not knowing the latest news might for some have the same impact.

Since March of 2020, the author has witnessed many friends and family members change in ways she never would have imagined, some have exhibited harmful behaviors which seemed to be related to overwhelm coupled with lack of inner and outer resources, while others have showed the capacity to bend and stretch in ways which reveal strength and resiliency that wasn’t obvious before. Are these changes permanent or is this collective trauma creating only temporary shifts in their brain’s crinoline creases?

The pandemic has robbed so many of the connections that made life worth living and also provided a kind of resistance and surrender training that no one ever wanted. The author has no way of measuring the breadth of her own neuroplastic change as she is still in it, but there does seem to be evidence of positive growth in both her professional and interpersonal relationships. It has been incredibly difficult to learn how to do family counseling after moving to another town and leaving a career and home, while still having the responsibilities of school and paying the bills, all while in a prolonged sympathetic response without the protective agents of family and community close by.

INPB & Therapy

The brain is changed not only by fear and stress, but also by experiences, relationships, and environments which foster parasympathetic activation, or relaxation of the nervous system (Cozolino, 2014). Feeling powerless can lead to anxiety and the antidote to powerlessness is agency. Mindful awareness can change the neuronal structure of a person’s brain and help them to experience agency over reactive emotional and psychological states of being (Siegel, 2012). Practicing mindfulness over time can cause neuroplastic changes which lead to an increased sense of well-being, positive relationships with self and other, and the healing of harmful addictive and attachment patterns (Siegel, 2012). According to neuroplasticity, many mental health issues and illnesses are not fixed, as measured by the corresponding neuronal structures in the brain mirroring every thought and behavior (Siegel, 2011).  

It’s hard to grasp the complexity of how quickly life has changed and what the future will look and feel like when this particular storm has passed. The author has been teaching a mindfulness group to teenage girls and it seems as though they are stuck in a chronic state of stress activation, and unable to focus on anything for more than a few moments. They also don’t like to have their video cameras on, and I find this takes away from the very real attunement that seems to happen even in the online setting.

Positive change in therapy is the result of guiding the client to purposefully direct their attention, which then leads to structural changes in the brain (Siegel, 2011).  Mirror neurons are located in various parts of the brain and have both motor and perceptual functions (Siegel, 2012). Mirror neurons fire when an individual visualizes or feels the actions and emotions of another, which then create similar activations in the observer’s nervous system (Siegel, 2012). Emotional expressions, behaviors, as well as bodily movements of the witness may mimic those of the person being watched (Siegel, 2012).

A prolonged stress response, like what is being experienced now with COVID-19, can have negative health consequences (Abramsom, 2020). Recruiting the ventral portion of the vagus nerve, part of the parasympathetic portion of the autonomic nervous system can help to calm an individual’s system, and facilitates feelings of safety and well-being, which also leads to better decision making during a difficult time (Abramsom, 2020).

            Teaching clients how to connect with the sensations in their body, and to learn what stress feels like to them, is the first step in interrupting the chronic-stress cycle (Abramsom, 2020). Guiding a client to direct mindful awareness to body sensations and stressful thoughts, and teaching them to use the tools of grounding, deep breathing (extending exhales), and humming, etc., as a way to self-regulate and to reduce the negative impact of the collective and chronic stress, increases agency and can bring peace in the midst of a storm which seems to not have an expiration date (Abramsom, 2020). 

In a time when so much feels to be out of control, professional counselors can support clients in fostering agency over how they respond to the current crisis, which goes well beyond the pandemic. A counselor’s own grounded presence can assist the client to feel into a sense of safety within themselves. Modeling mindful awareness of breath, words, movement, thoughts, etc., while with a client, will support the regulation of their nervous system, while building trust and teaching them empowering tools to facilitate self-regulation.

The need to wear masks in public may also impact the social human brain. Particularly children, whose brains are still developing. The author wonders if young people may lose some of their ability to connect with other humans if they aren’t able to fully experience the subtle sub-conscious cues of another person’s facial movements. The author also wonders about humans of all ages and how and to what degree might they be neurobiologically altered and how does mask wearing in a session with a client impact a client and counselor’s therapeutic alliance and attunement?

The term neuroception describes how the brain processes sensory stimuli and how this unconscious process influences an individual’s experience of situations and people as safe or unsafe (Porges, 2004). The muscles of the human face produce movements which are perceived below the level of awareness by another person as someone to move towards or away from (Porges, 2004). If an individual’s neuroceptive awareness evaluates safety, then the individual may move towards pro-social behaviors, which come from the ventral portion of the vagus nerve (Porges, 2004). On the other hand, if the individual’s neuroceptive evaluations do not perceive safety, the sympathetic or dorsal portions of the vagus nerve are activated, and pro-social behaviors and thus connection is unlikely (Porges, 2004).

                                     Conclusion

The last ten months have been a time of intense physical, emotional, and psychological stress for almost all humans everywhere. The effect of the COVID 19 pandemic as well as the political upheaval in the USA around the 2020 election, racial and social injustice, and the endless natural disasters, will have long term consequences on human brains and thus on human relationships. Resilience is key to negating some of the negative effects of this unprecedented time in history.  The author is aware of the collective trauma still happening as these words are being written and that she has not been spared, though she is resilient and intends to keep connecting with what is most essential so that she may support others in doing the same.

                                 References

Abramsom, A. (2020, April 9). If there was ever a time to activate your vagus nerve, it is now:

Four simple steps to return to a rest and digest state. Elemental.

Cozolino, L. (2014). The neuroscience of human relationships: Attachment and the developing

                        social brain. W.W. Norton & Company.

Eagleman, D. (2020). Livewired: The inside story of the everchanging brain. Pantheon Books.

Porges, S. (2004). Neuroception: A subconscious system for detecting threats and safety. Zero to Three.

Report: New Mexico’s Suicide Rate Is Highest in the Nation. (2020). US News & World Report. https://www.usnews.com/news/best-states/new-mexico/articles/2020-07-05/report-new-mexicos-suicide-rate-is-highest-in-the-nation

Sher, L. (2020). The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine, 113(10), 707–712. https://doi.org/10.1093/qjmed/hcaa202

Schimmenti, Billieux & Starcevic (2020).  The four horsemen of fear: an integrated model of understanding fear experiences during the covid-19 pandemic. Clinical Neuropsychiatry, 41–45. https://www.clinicalneuropsychiatry.org/download/the-four-horsemen-of-fear-an-integrated-model-of-understanding-fear-experiences-during-the-covid-19-pandemic/

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. Bantam Books.

Siegel, D. J. (2012). Pocket guide to interpersonal neurobiology: An integrative handbook of the

mind. W.W. Norton & Company.

 Wasserman, D., Iosue, M., Wuestefeld, A., & Carli, V. (2020). Adaptation of evidence‐. based suicide prevention strategies during and after the COVID ‐19 pandemic. World

             Psychiatry, 19(3), 294–306. https://doi.org/10.1002/wps.20801