An innate brainstem self-other system involving orienting, affective responding, and polyvalent relational seeking: Some clinical implications for a "Deep Brain Reorienting" trauma psychotherapy approach.

Underlying any complex relational intersubjectivity there is an inherent urge to connect, to have proximity, to engage in an experience of interpersonal contact. The hypothesis set out here is that this most basic urge to connect is dependent on circuits based in three main components: the midbrain superior colliculi (SC), the midbrain periaqueductal gray (PAG), and the mesolimbic and mesocortical dopamine systems originating in the midbrain ventral tegmental area. Firstly, there is orienting towards or away from interpersonal contact, dependent on approach and/or defensive/withdrawal areas of the SC. Secondly, there is an affective response to the contact, mediated by the PAG. Thirdly, there is an associated, affectively-loaded, seeking drive based in the mesolimbic and mesocortical dopamine systems. The neurochemical milieu of these dopaminergic systems is responsive to environmental factors, creating the possibility of multiple states of functioning with different affective valences, a polyvalent range of subjectively positive and negative experiences. The recognition of subtle tension changes in skeletal muscles when orienting to an affectively significant experience or event has clinical implications for processing of traumatic memories, including those of a relational/interpersonal nature. Sequences established at the brainstem level can underlie patterns of attachment responding that repeat over many years in different contexts. The interaction of the innate system for connection with that for alarm, through circuits based in the locus coeruleus, and that for defence, based in circuits through the PAG, can lay down deep patterns of emotional and energetic responses to relational stimuli. There may be simultaneous sequences for attachment approach and defensive aggression underlying relational styles that are so deep as to be seen as personality characteristics, for example, of borderline type. A clinical approach derived from these hypotheses, Deep Brain Reorienting, is briefly outlined as it provides a way to address the somatic residues of adverse interpersonal interactions underlying relational patterns and also the residual shock and horror of traumatic experiences. We suggest that the innate alarm system involving the SC and the locus coeruleus can generate a pre-affective shock while an affective shock can arise from excessive stimulation of the PAG. Clinically significant residues can be accessed through careful, mindful, attention to orienting-tension-affect-seeking sequences when the therapist and the client collaborate on eliciting and describing them.