Yes, I know, you were expecting part VI of my multi-part review of the 2014 edited volume entitled Addictions from an Attachment Perspective—Do Broken Bonds and Early Trauma Lead to Addictive Behaviours? I’ve decided to pause my review of Addictions from an Attachment Perspective and talk about a favorite topic of mine Executive Function. Why? Well, last week I attended an all day workshop on Executive Function (EF). What surprised me was how much the information presented during the EF workshop dovetailed nicely with the information I have presented thus far in my review of Addictions from an Attachment Perspective. Ergo, I thought I’d insert this information on EF so that we would have it as a background as we continue to look at Addictions from an Attachment Perspective. Here we go.
The EF workshop was entitled Executive Functions in Mental Health: Are Your Clients Seeing the Whole Picture? The workshop was put on by Dr. Jay Carter, author of such books as Nasty People, Nasty Bosses, and The Complete Idiot’s Guide to Bipolar Disorder (co-written with Bobbi Dempsey). Turns out that Carter is an expert in the area of Bipolar Disorder (BPD). This was a real boon. As Carter told us, BPD is a condition where one can observe Executive Function waxing and waning. BPD is characterized by a manic phase followed by a depressive phase. Manic phases include such things as: heightened sense of self-importance, exaggerated positive outlook, significantly decreased need for sleep, poor appetite and weight loss, racing speech, flight of ideas, and impulsiveness. The depressive phase includes such things as: feelings of sadness or hopelessness, loss of interest in pleasurable or usual activities, difficulty sleeping, and loss of energy and constant lethargy (thank you Wikipedia). Carter told us that during both depressive and manic phases EF effectively goes “offline” (to use a computer metaphor). It is only when the person is swinging between phases that EF comes back online. I found the discussion of EF in the light of Bipolar Disorder to be most enlightening. Let’s look at Dr. Carter’s workshop. Because this was an all day workshop, I’ll be cherry picking the bullet points I focus in on. For the full picture, please attend one of Dr. Carter’s workshops or read one of his books. He also has DVDs available at his web site: http://www.jaycarter.net/
Dr. Carter started out by giving us the following definition of Executive Function:
Executive functioning is a theoretical construct representing a domain of cognitive processes that regulate, control, and manage other cognitive processes.
When you think of EF think of a captain running a ship, or a CEO running a firm, or a general running the military. In their book Switch: How to Change Things When Change Is Hard, Chip and Dan Heath talk about a rider atop an elephant (where an elephant represents the mammalian brain, looked at below) as a way of talking about EF. In all cases—captain, CEO, or rider—having EF is about having the big picture, a point that Carter made over and over during his workshop. What the above definition tells us is that EF is cognition about other cognitions. The technical term for these higher level cognitions is metacognition. The Adult Attachment Interview (AAI) effectively assesses for the presence (or absence) of EF. If the person being assessed is coded as having the ability to think about their thinking, this goes a long way toward ultimately coding the person as securely attached. An interesting study would be to see if there are correlations between the AAI and measures of EF. If you know of such research, let us know. [1] The interesting thing about the AAI is that it can assess for special circumstances that cause EF to go offline, say, the emotions surrounding a particularly traumatic event from the past like a car accident or possibly the loss of an infant.
Dr. Carter gave us one overarching fact about EF that is well worth keeping in mind (and I paraphrase): “One does not need EF to get through life.” I immediately thought of Kohlberg’s stages of moral development. Kohlberg put forth the idea that some people can operate at a conventional or “law and order” level of moral development. These individuals get rules and regulations and are able to obey them without much reflection. Others achieve a higher post-conventional level of moral development that is characterized by such things as “principled conscience” and “ethical principles” (again pulling from Wikipedia). In my mind, to get to post-conventional moral development you need Executive Function. But you can stay at the conventional, non-EF level of moral development and be just fine.
Here’s the example Dr. Carter gave us to drive home the distinction between experiencing life with EF, and without EF. Imagine a worker who is disruptive at work. Every time this worker is disruptive, his or her boss delivers a reprimand. A worker without EF may eventually think to him or herself, “Hmmm … every time I disrupt things here at work, I get chewed out by my boss. I don’t like getting chewed out, so I’m going to be less disruptive.” As Carter told us, this individual is operating at the mammalian level of rewards and punishments or stimulus and response. “Our mammalian brain doesn’t really understand anything,” paraphrasing Carter from the workshop, “outside of about 5,000 simple commands.” The mammalian brain is millions of years old whereas the upper prefrontal lobe (home to EF) is relatively young at about a million years old. The mammalian brain knows that pleasurable experiences are good for survival; painful experiences are bad for survival.
Now let’s imagine another worker, one who has achieved a certain level of EF. This worker is disruptive but decides to stop his or her behavior in a different way. Rather than depending solely on a system of reward and punishment, this person imagines the mind of the boss and may say something like the following to him or herself: “When I am disruptive, my boss chews me out. I can only imagine that my behavior is troubling to my boss who has to make sure that our whole department runs smoothly. Man, if I were in his shoes, I’d be upset if I had to deal with a disruptive employee like me. I can get a sense for what my boss feels and it’s not pleasant. I don’t want him to feel bad, so I’ll stop my behavior.” Both employees stop their disruptive behavior but for different reasons: the former for narcissistic “lack of insight” reasons; the latter for empathetic “insightful” reasons. Simply, we are looking at behavioral inhibition versus empathetic inhibition. [2]
The above points out a big difference between behavioral interventions and so-called reflective interventions in mental health: Behaviorism (i.e., cognitive behavioral therapy) is about changing behavior using the mammalian level of rewards and punishments without necessarily accessing insight. In contrast, reflective interventions (i.e., mindfulness practices) try to change behavior by accessing reflective, empathetic, or EF levels of cognition. Behaviorists will argue, “It’s not our job to build insight or empathy; our job is to change behavior using the simplest means necessary, like appealing to our societal systems of reward and punishment.” Again, as Dr. Carter pointed out, you do not need EF to get through life. And behaviorism underscores this point. It would appear that insight and EF are toppings on a cake made primarily from rules and regulations. And Carter did tell us, “The prefrontal lobe and EF can be elusive.” When people say “I’m about to lose it,” what they are saying is that they sense their EF skills are about to go offline. How do we know this? As Carter stated: “We begin to take things personally. We begin to think that what others say IS directly about us.”
Dr. Carter pointed out during his workshop that such things as empathy, reflective capacity, and a well developed conscience reside in the prefrontal lobe of the upper brain. When researchers scan the brains of criminals or persons who otherwise take an “antisocial” stance toward society, typically there’s little activity in the prefrontal lobe. Either these areas never developed properly (maybe because of an early traumatic history characterized by insecure or even disorganized attachment), or maybe there was some type of traumatic brain injury (TBI). Carter spent time working in the prisons and mentioned research that showed that a high percentage of prison inmates (way above population norms) suffered from TBI.
“Acquiring EF is like sitting in the captain’s chair on a ship at sea,” paraphrasing Carter. Apparently this captain’s chair has a 180 degree “temporal” view: hindsight, insight, and foresight. As I have said many times before, one of the chief EF skills is mental time travel. “EF allows one to envision possible consequences,” reveals Carter. This agrees with neurologist Antonio Damasio when he tells us that the upper brain engages in what he calls “what if” scenarios. In other words, what if I were to do this or that, what would be the consequences? According to Carter, the prefrontal lobe allows one to weigh pluses and minuses. “Our experience of the prefrontal lobe,” Carter told us, “is one of ‘being aware of being aware.’ ” As mentioned above, the prefrontal lobe is home to metacognition or thinking about thinking. In order to think about someone else’s thinking, you have to be able to think about your own thinking first. Makes sense once you think about it. The ability to take in the big picture comes from the prefrontal lobe. “Even higher level animals like dogs and horses are not aware of being aware,” paraphrasing Dr. Carter from the workshop. According to Carter, when a child is able to form complete sentences and begins to refer to him or herself as “I,” the prefrontal lobes are starting to come online. In essence “you” gives way to “I.”
So, what does all of this have to do with addictions you may ask? Well, as Carter told us over and over, substances such as alcohol and cocaine take EF offline. As a matter of fact, drugs and alcohol have wreaked havoc on the logic of the mammalian brain: these addictive substances “taste good” but are in fact bad for us, bad for our survival. Insecure attachment can have a similar affect but in the opposite direction: being close to others may “taste bad” but is in fact good for us, good for our survival. Carter told us that the experience of a manic phase, or use of meth, or amphetamines, or cocaine share much in common. In all cases EF goes offline. Here are the shared characteristics that Dr. Carter talked about (pulling from our study guide):
- high euphoria or
- anxiety
- thinking faster
- feels hyper-logical or engages in cold (e.g., non-empathetic) logic
- Executive Functions suppressed
- goal-oriented (but with specifics)
- decreased “need” for sleep
Cater told us that persons suffering from BPD will self medicate depending on where they are within their cycle:
- cocaine use during the manic phase
- marijuana use while swinging through phases as mood stabilizer
- alcohol during the depressive phase
As I have talked about in my review of Addictions from an Attachment Perspective, persons suffering from BPD take drugs as a way of self medicating not to feel good, but to feel better. Carter told us that kids who suffer from BPD report that they smoke marijuana to feel better, not good.
As I have blogged about before (and Dr. Carter confirmed), you need EF for such things as obtaining an education, maintaining a marriage, guiding a family, and planning for retirement. According to Carter, the metacognition that holds all of this together is “purpose” or “passion.” “Once you arrive at a purpose or passion,” paraphrasing Carter, “you’ll put up with a lot of discomfort—like a professor who grates on your nerves—to get to your goal.” The tagline for ads for the movie about Dr. Martin Luther King—Selma—sums it up: “Keep your eyes on the prize.” EF serves purpose well because it is EF that allows you to set a position in the future and then navigate toward that position. Put another way, EF allows you to “map out your future.” Education requires the ability to engage in delayed gratification (which I have blogged about before). Sadly, according to Dr. Carter, adults suffering from ADHD have on average lower levels of educational attainment because in large part they are not able to delay gratification. [3] Dr. Carter told us that it costs about $500,000 in social services to provide support to a person who does not finish high school. Cater gave us this “take home” thought (and I paraphrase): “People with purpose or passion often do not have the luxury to get depressed because they have so much to do, or have so many depending on them.” My guess is that Sir Winston Churchill may have succumbed to his Black Dog (which is what he called his bouts of depression) if he was not so consumed with his passion: saving the country he so loved. [4]
According to Carter, EF is how one establishes a strategy. Strategy is different from goals. Seeing yourself in the future as a psychologist (or as a human rights leader freeing his people) is a strategy. From that strategy comes goals: I’ll start taking some psychology classes or I’ll start leading some marches. Putting my spin on Dr. Carter’s insights, there is a dynamic feedback loop between the upper EF brain and its strategies and the mid brain and its ability to set and achieve goals. As Bowlby would put it, goal-corrected feedback loops are set up between strategies and goals. In truth, the upper brain and the mammalian brain must learn to work together (which is the main point delivered in Switched mentioned above). As Carter puts it, “The closer the consequences, the bigger the motivation.” Using attachment theory as a background, I’d reframe Carter’s statement thus: “Secure attachment is the experience of being close to your motivation.” In other words, being close to your purpose or passion will feel similar to the early experience of being securely attached to your primary attachment figure. In my mind, the pain of being insecurely attached as talked about in Addictions from an Attachment Perspective stems in large part from an unconscious knowing that one is far from their purpose or passion. As Carter reminded us: “Some people never get their prefrontal lobe to kick in.” Here’s a diagram that Dr. Carter gave us that I think has attachment implications:
Substance Abuse:
- Possibly blocks EF because the bigger picture is painful
- High association with PTSD and used to self-medicate and distance
- Poisons the body
- Tends to fixate like trauma
- Stops development in certain areas of the brain
- Tends to take EF offline
So, what helps with EF development? Yes, according to Carter, EF can be learned. Here are Carter’s recommendations:
- Mindfulness & Meditation (as mentioned above)
- Tae-Kwon-Do
- Aerobic exercise
- Montessori school
- Neurofeedback
- Journaling
Dr. Cater also mentioned a point concerning EF that I have mentioned before: a strategy one can use to develop EF is to seek out connections with others who have well functioning EF and prefrontal lobes. In a perfect world, parents act as surrogate prefrontal lobes for their developing kids. Teachers act as surrogate prefrontal lobes for their students. Mentors act as surrogate prefrontal lobes for their mentees. The clergy act as prefrontal lobes for their parishioners. And, yes, insight oriented therapists act as prefrontal lobes for their clients. But not all surrogate prefrontal lobes are created equal as cult leaders and charlatans show us.
Allow me to end on a sobering topic: Major Depressive Disorder, especially in the elderly. Dr. Carter told us that before becoming a psychologist he worked at IBM. The following wisdom circulated IBM widely when Carter worked there: never retire because the average lifespan of a person who retires from IBM is about two years. Apparently people gain so much purpose and passion working at IBM that it is hard to find either upon leaving. “People going through empty nest syndrome or retirement,” paraphrasing Carter from his workshop, “often lose their purpose or passion.” Interestingly, behavioral techniques are less effective in older adults. I guess getting old is cause to reflect on one’s life, which naturally will put you into the reflective upper brain. It may well be that reflecting on a life lived is not very uplifting for some. As a result, things like retirement and empty nest syndrome can trigger depression in older adults. As an elder adult, when the “I” reflects on the “you,” the result may not be a glowing big picture. As Cater told us, “The prefrontal lobe is the last to develop, and the first to go.”
Ooops … one last EF factoid: EF development can be partial. Dr. Carter told us that brain scans of person’s with Asperger’s Syndrome—a form of autism—reveal reduced activity only in the right prefrontal lobe. Because of this partial development of the prefrontal lobe, person’s with Asperger’s Syndrome are able to create and use a big picture view but are otherwise socially inept. This may explain why a visionary like Steve Jobs can change the world while at the same time be a difficult person to work for by all accounts.
I promise that in the next post we’ll look at chapter seven of Addictions from an Attachment Perspective—Struggling With Abstinence by Richard Gill. See you then.
Notes:
[1] A few researchers have started looking at the connection between attachment and EF. As an example, see the 2010 article entitled From External Regulation to Self-Regulation: Early Parenting Precursors of Young Children’s Executive Functioning by A. Bernier, S. Carlson, and N. Whipple (Child Development, volume 81, number 1, p. 326–339). And I just discovered (by reading Humans Are Underrated by Geoff Colvin—see note 4) research that draws a comparison between the skills needed for face-to-face social interactions (like those needed to maintain an attachment relationship) and EF skills. The work was done by researchers at the University of Michigan, the University of California, San Diego, and the Warsaw School of Social Sciences and Humanities. Sorry no researcher names were given. “The researchers noticed that the brainpower required by supposedly simple in-person social interactions seemed to be just like the other highest-level [EF] abilities,” reports Colvin.
[2] Here’s another story that Dr. Carter gave us showing the difference between behavioral inhibition versus empathetic inhibition. Imagine a couple racing toward the hospital because the woman is in labor. The husband rolls through a stop sign to save some time. A police officer pulls him over. The husband explains what’s going on. It’s obvious to the officer that the woman is in labor. But he writes them a ticket anyway. That’s the law and the couple broke it. Now imagine the same scenario but with a different officer. This second officer hears the husband’s explanation and can clearly see that the woman is in labor. This second officer closes her ticket book and tells the couple to follow her to the hospital as she turns on her lights and siren. The first officer is operating out of the middle “rules and regulations” mind and cannot see that there may be a more appropriate way to handle the situation. The second officer may have started out using the rules and regulations mind, but then shifted to the upper mind with its ability to engage in EF and think about thinking. The second officer was able to see the bigger picture. In all likelihood, the second officer said something like the following to herself: “This couple has good reason to be in a hurry. If I was in her situation, I’d want my husband to do whatever was necessary to get me safely to the hospital. Rolling through a stop sign could be dangerous for not only this couple but for others. More than likely, the husband will continue rolling through stop signs and running through yellow lights until he gets to the hospital, even if I were to give him a ticket. Having them follow me is probably the safest approach for all concerned.” If you’re rushing your pregnant wife to the hospital, pray that officer number two comes along to provide aid.
[3] Dr. Cater told us that the military has started testing new recruits for adult ADHD. If a recruit is found to be suffering from adult ADHD, the military will then steer that recruit away from military specialties that require significant study.
[4] I just started a 2015 book entitled Humans Are Underrated: What High Achievers Know That Brilliant Machines Never Will by Geoff Colvin. In the introduction, Colvin suggests that in the near future EF skills will be valued. Colvin (along with other futurists) suggests that even though computers will become really really smart (i.e., IBM’s Jeopardy! killer Watson), they will not become “EF smart.” In other words, computers and other artificial intelligences will operate mainly at the level of a human’s middle brain with its focus on such things as cause and effect, rules and regulations, and stimulus and response. Colvin puts forward the idea that the upper brain of humans—with its focus on reflection, empathy, minds knowing minds, and the big picture—will remain largely off limits to computers. If this is true then EF becomes even more important in the near future. Here’s how Colvin puts it:
The skills that will prove most valuable are no longer the technical, classroom-taught, left-brain skills that economic advances have demanded from workers over the last 300 years. … The new high-value skills are instead part of our deepest [and youngest] nature, the abilities that literally define us as human: sensing the thoughts and feelings of others, working productively in groups, building relationships, solving problems together, expressing ourselves with greater power than logic can ever achieve.
Bowlby must be smiling from ear to ear because the above skills that Colvin suggests are going to be valuable—EF skills—are the same ones that rest on a foundation of secure attachment. If Colvin is right, then returning to Bowlby’s insights makes good sense, especially good economic sense.
OK, I just read ahead a bit further. Trust me, I had no idea that Colvin was going to talk about EF, but he did:
Besides our basic cognitive skills like counting, calculating, and remembering we all have another set of skills called executive functions, which are essentially the ability to manage and coordinate the more basic skills, including interpersonal abilities. Executive Functions are important because they enable us to solve hard problems, find and fix mistakes, plan complex activities, make difficult decisions, and override immediate impulses (eat the funnel cake) in order to achieve beneficial, more distant goals (lose weight, be healthier, feel better). For performing well in the real world, strongly developed executive functions are key [my emphasis].
What does Colvin (and others like Nicholas Carr) point to as eroding our EF skills? Yup, extensive social media use, especially Facebook. Colvin sums it up thus: “In economic terms, the supply of certain basic human abilities [like EF skills] appears to be diminishing…. At the same time, the demand for many of those abilities is actually increasing.” If Colvin is right then, by extension, the demand for secure attachment is also increasing. Sure, a college degree will help with success, but a college degree along with robust EF will be the key to success in the near future. Using research conducted in the UK as a backdrop, Colvin concludes: “[E]mpathy and other interpersonal skills are as important as proficiency in English and mathematics in ensuring young people’s employment prospects.” There you go.
