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For The Professionals... Continued

For The Professionals... Continued

Within this developmental framework, Yellowbrick’s treatment enhances brain neuroplasticity, removing interferences to neural growth, and otherwise facilitating the normative developmental maturation of the brain, mind, and spirit during the window of emerging adulthood (late teens to early ’30s). In recognition of the vitally necessary foundation of nurturing relationships for neural and personal growth, all of Yellowbrick’s clinical services occur in the context of an Open Setting Therapeutic Community. This means that relationships are mutual, collaborative, and transparent rather than based on power, control, or responsibility for others’ choices. It is only under those conditions of interpersonal safety that authority can be located within the emerging adult and troubled parts of self will be willing to come forward.

Yellowbrick clinically operationalizes the power of research-based neurobiological principles. Hope, which itself promotes neuroplasticity, is offered through an explanation of the concepts of epigenesis and how adolescence through the third decade of life is a window of maturational opportunity due to enhanced neuroplasticity. Hippocrates understood something crucial about neuroplasticity over two millennia ago; “That which is used – develops; that which is not – wastes away”. Yellowbrick embraces this principle by offering repetitive experiences for learning and practicing new skills and adaptive patterns in situ while living in the community. ReCognition is Yellowbrick’s brain gym utilizing neuropsychologists developed video games for enhancing neural growth in the network centers responsible for attention, concentration, working memory, and processing speed. Most importantly, peers & staff as a Community encourage persistence and the taking of supported risks, both of which promote new neural networking. Donald Hebb in 1948 introduced the principle of “what fires together wires together”; “any two cells or systems of cells that are repeatedly active at the same time will tend to become ‘associated’ so that activity in one facilitates activity in the other”. This principle creates challenges as the patients often have developed associative pathways which maladaptively link networks. Sexual arousal links with aggression from repeated viewing of pornography. Joy can only be experienced with substances. Power and connection to others become associated exclusively with videogame prowess. Yellowbrick works to undermine these pathways (ex: sobriety, Exposure Response Prevention) and create new pathways through experiences of connectedness, authentic intimacy, and competence.

A fundamental evidence-based premise of Yellowbrick’s model is that acute and/or complex psychiatric patients live in a state of brain dysregulation which defaults to automatic symptomatic and behavioral systems and thereby negatively reinforces the dysregulation (Solms, Panksepp). The preponderance of treatment programs attempts to intervene with what are essentially learning and coping skill strategies at a time when the brain is too dysregulated to be fully receptive to these approaches. Medication alone is an insufficient neuromodulation effort in complex conditions because the automatic, default behaviors continue to undermine brain regulation and medication impact is often incomplete and often takes weeks to months to have full effect.

Yellowbrick’s model initially prioritizes facilitating brain regulation as a precondition for introducing activating emotional learning. For those whom this approach remains insufficient, not just incomplete, after 12 weeks, a deeper neuro-psychoanalytic psychotherapy approach is required to bring the self-regulating power of the attachment systems further into the process.

Yellowbrick appreciates the level of personal and financial commitment required of families to secure world-class care and personalized customer service. Treatment at Yellowbrick is customized. Individuals whose psychiatric condition has persisted for several years and/or created safety risks and/or a period of incapacity to function within a developmental continuum have better outcomes with a more extended support platform and continued intensive treatment at varying levels of care to sustain an enduring recovery (deMaat 2009, Webart 2012, Shedler 2010, 2018). 

Yellowbrick’s experience is that most individuals require a minimum of 12 weeks to regulate their brain, restrain from defeating behavioral patterns and practice new adaptive actions, establish sustaining collaborative connections with staff, peers and parents, and initiate actions consistent with values, interests, and ambitions. Yellowbrick’s most intensive PHP level of care is therefore organized around a 12-week neuromodulation curriculum. The transition from The Residence to an apartment in Evanston supported by home visits often occurs successfully at the close of the Neuromodulation Phase of care.

Yellowbrick’s developmental, interpersonal neurobiological model is designed to calm the threat response (limbic) system, and thereby open receptivity to techniques for increasing cortical governance resulting in new learning and emotional growth. The model also facilitates the natural maturation of those brain systems which are coming “online” in the developmental window from age 16 into the young ’30s (Siegel 1999, Giedd 2012, Schore 2017). Yellowbrick’s intensive treatment program targets four dimensions of brain functioning necessary for disrupting maladaptive automatic default systems and behavioral patterns. (NOTE: Yellowbrick offers clinical assessments for patients 16+ while our IOP/PHP and residence is appropriate for some clients beginning at age 17) 

Resetting the threat response (limbic) system.
Complex psychiatric conditions, often arising out of cumulative trauma, derail the functioning of the limbic system such that ordinary life creates ongoing anticipation of or actual re-experiencing of threats to physical and emotional safety. Individuals are in continual fight/flight (hyper) mode or have succumbed to a detached, dissociative state (hypo) of being shut down. Yellowbrick employs multiple evidence and research-based technologies to address these states of hyper/hypo arousal. These technologies include:

  • Neurofeedback
  • Deep Transcranial Magnetic Stimulation (Brainsway)
  • Direct Transcranial Stimulation (Alpha-Stim)
  • Mindfulness embedded within the Yellowbrick culture
  • CBT & DBT embedded within the Yellowbrick culture
  • Mentalization (Fonagy 2010) embedded within the Yellowbrick culture
  • Somato-sensorimotor psychotherapy (Ogden 2017), mind-body, drama, and movement therapies
  • Prescriptive exercise
  • Support for sobriety & restraint from compulsive behavior patterns
  • Sleep hygiene (CBTI)

Increasing Cortical Governance
Yellowbrick’s assessment procedures using quantitative EEG and cognitive testing (CANTAB) dramatically demonstrate the derailing of cortical governance in complex psychiatric conditions. The latest research puts particular emphasis on the role of impaired cognitive functioning leading to poor response to treatment with subsequent chronicity and disability. Yellowbrick employs multiple evidence and research-based technologies to support the return of cognitive functioning while also not reactivating traumatic experiences early in the treatment. These technologies include:

  • ReCognition; a brain gym using video games that target core cognitive functions such as attention, working memory, and processing speed.
  • Neurofeedback protocols prescribed by national expert
  • Deep Transcranial Magnetic Stimulation (dTMS) (Brainsway)
  •  Sleep hygiene (CBTI)
  •  Nutritional planning
  •  Dialectical and Behavioral Therapy (DBT)
  •  Acceptance and Commitment Therapy (ACT)
  •  Cognitive Behavioral Therapy (CBT)
  •  Education about the brain in health and illness
  •  Reintegration into college, work, or community service while in treatment

Re-networking the reward/motivation system
Trauma, repetitive disappointments and frustrations, persistent suffering, and the insidious impact of the maladaptive automatic default compulsive behavior patterns ultimately either demoralize, thereby shutting down a sense of reward from daily life satisfactions, or it kidnaps the reward system such that only highly overstimulating, novel pursuits such as substance abuse bring any sense of vitality and relief of well-being (Bloom 2013). Having discussed this issue with multiple international clinician-scholars (Schore, Ginot, Ogden, van der Kolk, Solms), this is one of the most difficult challenges in our field; how to transform motivation from dopamine to oxytocin mediation. For this reason, Yellowbrick employs multiple evidence and research-based technologies to restore motivation including:

  • Facilitating experiences of competence (van der Kolk 2017)
  • Eliciting authenticity over compliance
  • Relationally co-created experiences of joy (Ogden, Panksepp, Davidson)
  • Connection to Community
  • Connection to education, career, community service
  • Spirituality; facilitating a vision for a life that matters
  • Interrupting compulsive behaviors with satisfying alternatives
  • Connecting to and savoring one’s physical, sensory experience through mindfulness (Garland 2013)
  • Nutraceutical supplementation (Bloom 2013)
  • Relief from depression, anxiety, and trauma symptoms
  • Psychotherapy restores hope through self-integration (Frank 1973)
  • Expert family therapy to promote connected autonomy (i.e., supportive connections with family that facilitate healthy independence and growth)

Facilitating Secure Attachment

Since the paradigm-changing work of John Bowlby which was dramatically validated by the Harlow monkey and Romanian orphan studies, it has been increasingly evident that all human growth and development requires secure, safe, and nourishing attachments. It has now been replicated by neuroimaging studies demonstrating that effective psychotherapy enhances neuroplasticity. Neuroplasticity is the molecular engine for creating new synapses which are the structural architecture of learning, healing, and growth. In addition to cortical governance, attachments are a fundamental vehicle for effectively addressing emotional distress. For the less troubled among us who seek mental health care, supportive and cognitive psychotherapy approaches activate latent potentials for secure attachment which had been suppressed during times of significant stress. In contrast, complex psychiatric conditions are embedded within persons whose attachment patterns and development have been arrested, derailed, and distorted by trauma, illness, chronicity, the resultant distortion of family and community support systems, and the malignant consequences to one’s personhood from persistently living in terror, helplessness or pain. For these individuals, relationships become threats or at best barely useable for the emotional nutrients of emotional healing and growth. Tragically, relationships often become weapons of re-traumatization.

Yellowbrick’s experience is that for those individuals who have experienced a significant psychiatric occurrence (ex: singular trauma, the onset of psychosis, major depression or mania, suicide attempt, etc.) but whose self-development has achieved some degree of secure attachment, transition to office outpatient care with enduring outcome and functioning can be achieved within the 12-week curriculum of care of Yellowbrick’s Neuromodulation Intensive Treatment Program as described above. For those with complex psychiatric disorders and severe personality disorders who need a more in-depth neuro-psychoanalytic psychotherapy approach (Schore 2012, Ginot 2015, Cozzalino 2017), length of stay in the most intensive levels of care averages 3-4 months and optimally extends at lower levels of care for another 4-8 months.

Yellowbrick’s  Open Therapeutic Community model (Muller 2006) is the optimal platform for both supportive and in-depth psychotherapy. In contrast to traditional settings which operate on the basis of authority, power, and subtle iatrogenic coercion, the Open Setting emphasizes transparency and collaborative relationships as the basis for safety and individual responsibility. This allows the deeper parts of the troubled self to come forward rather than hide in the face of others’ power. Yellowbrick has 12 years of outcome data demonstrating the value of this model (L. Viner, 2019).

Yellowbrick’s services are offered to enable customization of the level of care spanning residential to in-home visits. Transitions best derive collaboratively from Family Rounds strategic planning meetings involving emerging adults, parents, Professional Staff, and the Medical Director. Patients are followed by the same care team throughout their treatment regardless of the level of care.

Services include:

  • The Assessment Center: 3-5 day comprehensive or 1-day focused specialty assessment.
  • The Residence: 24-hour care living in a supported apartment building owned and staffed by Yellowbrick while attending a Partial Hospitalization level of care. The Residence also functions as a Community Center for all patients within all programs.
  • Minding the Brain: organized to restore neuro-regulation and associated command of behavioral impulsivity and symptoms. As described above this 12-week Partial Hospitalization program emphasizes Resetting the threat response and reward systems while beginning to establish new areas of emotional and instrumental competence.
  • Life Strategies Program (LSP): organized to address the specific developmental challenges of emerging adulthood. Embedded within LSP are the neuromodulation principles of mindfulness, mentalization, DBT/ACT/CBT self-regulation skills, the sensorimotor embodiment in tandem with direct neuromodulation technologies being offered within the Center for Clinical Neuroscience. LSP can be accessed at either a Partial Hospitalization or IOP level of care. Individual psychotherapy occurs 3x/week.
  • Separate specialty IOP Programs; Trauma Recovery, Reward Alternative Pathways (RAP) for Substance Use Disorders, eating disorders along with conditions presenting a troubled relationship between the body and self-experience (Soma-Self IOP).
  • Center for Clinical Neuroscience (CCN) providing collaborative and genomically informed psychopharmacology, dTMS, neurofeedback, and DTCS. All patients in all programs receive CCN services. CCN technologies are also available as a standalone intervention for patients not in other Yellowbrick programs.
  • Core Competence Skills Development providing cognitive enhancement, occupational therapy, executive function, and life skills training, education & career counseling, nutritional counseling, activity and exercise prescription, wellness education is available for emerging adults receiving Partial Hospitalization or IOP services.

Yellowbrick hopes this description of our model and services can support trust and confidence in consideration of joining Yellowbrick as a partnership extending to the emerging adult, family, and the professional community. For those already working within Yellowbrick, it is our hope this description enhances your understanding and willingness to make full use of our model.

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Yellowbrick collaborates with adolescents and emerging adults, ages 16-30's, their families and participating professionals toward the development and implementation of a strategic “Life Plan.” An integrative, multi-specialty consultation clarifies strengths, limitations, and risks, and defines motivations, goals and choices.

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    Real-Time Treatment for Emerging Adults and their Families

    Bipolar Disorder

    A mental health condition that’s characterized by intense shifts in mood including both manic and depressive episodes.

    Major Depressive Disorder

    People living with Major Depressive Disorder, or MDD, experience episodes of depression and sadness that are debilitating to daily life.

    Anxiety Disorders

    Those living with anxiety disorders experience high levels of anxiety and stress that interfere negatively with daily life.

    Neuroatypical “Spectrum” Individuals and their Families

    These individuals often experience an extended period of anxiety and disruption as the young person ages out of the structured support settings available through the educational and social services systems.

    Thought Disorder

    A mental health issue in which a person’s cognitive function is impaired, resulting in symptoms like experiencing challenges with conducting speech, reading and writing, and behavior.

    Personality Disorders

    Mental health disorders that negatively affect a person’s behaviors, thought patterns, and function. People diagnosed with these disorders experience challenges with managing relationships and understanding various situations.

    PTSD

    Post-Traumatic Stress Disorder is a mental health condition that people can develop as a result of experiencing traumatic situations, characterized by symptoms including flashbacks, avoidance behaviors, and more.

    ADHD

    A mental health condition that is characterized by specific symptoms of forgetfulness and lack of concentration, which makes it challenging to complete necessary tasks.

    Eating Disorders

    Mental health conditions that interfere with a person’s eating habits, thought patterns, and behaviors in negative ways.

    OCD

    A mental health disorder diagnosable with the DSM-5 that is characterized by both obsessions and compulsive behaviors.

    Adopted Individuals and Families

    We are committed to the developing specialized services for adopted emerging adults and their families.