Yale Department of Psychiatry Sponsors: Special Recognition of Nancy Suchman, PhD

Name: Yale Department of Psychiatry Sponsors: Special Recognition of Nancy Suchman, PhD
Uploaded: 2020-07-31T17:20:24.163Z
Duration: 1 h 30 min 31 s
Description: " Neurobiology of Addiction and Parenting: Special Recognition of Nancy Suchman, PhD ” Linda Mayes, MD, Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology; Chair, Yale Child Study Center; Deputy Dean for Professionalism and Leadership, Office of the Dean, Yale School of Medicine

July 31, 2020

"Neurobiology of Addiction and Parenting: Special Recognition of Nancy Suchman, PhD”

Linda Mayes, MD, Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology; Chair, Yale Child Study Center; Deputy Dean for Professionalism and Leadership, Office of the Dean, Yale School of Medicine

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00:00So. Uh, for people I have not met
00:03on Tom McMahon, a professor of
00:06psychiatry and child study center.
00:08Here in the School of Medicine I've
00:10worked with Nancy for many years,
00:12and it's my honored to be able to
00:15host this meeting. Before we begin,
00:17I have several announcements.
00:19First, we'd like to ask.
00:20Everyone has always to please mute
00:23your microphone and make sure it stays
00:26muted so that it helps us preserve the.
00:29Quality of the audio presentation.
00:322nd the schedule for today's
00:35presentation should be in the bottom.
00:38Center of your zoom screen in the chat box.
00:42Anybody who would like an opportunity
00:45to say hello to Nancy,
00:47you're welcome to stay in the
00:50meeting for a virtual reception
00:52as soon as. Over. I'd also like to alley.
01:00Kaley Diaz Hello. And Chris Gardner. Or
01:08helped. Land for today's meeting.
01:12And finally, at this point I'd
01:14like to acknowledge that we
01:16have about 110 family friends,
01:18colleagues and other people in the meeting.
01:22To begin our program,
01:23I'd like to present a brief summary
01:26of Nancy's career here in the
01:28School of Medicine. For people who have
01:33not seen her CV, Nancy and her bachelors
01:42degree in psychology at Cornell University.
01:49And then spent her early adult years leading
01:52high adventure trips for outward bound.
01:55The national out outdoor education program.
01:58Many years ago Nancy told me that she
02:00decided to go to Graduate School,
02:03went at the tender age of 20, something.
02:05She realized that despite
02:07her youthful idealism,
02:08it was very difficult to live off the land in
02:11the wilderness with justice seasonal salary.
02:14With that insight,
02:15she went back to school,
02:17earned a Masters degree in the sociology
02:20of education at Syracuse University.
02:23And then began work on a doctoral
02:25degree in counseling psychology at
02:27Colorado State University where
02:28when she missed outward bound,
02:30she was still able to take a brief
02:32walk in the Rocky Mountains to remind
02:34herself how difficult it is to
02:36live off the land in the wilderness
02:38with just a seasonal salary.
02:40Having spent much of her childhood and
02:43adolescence in the New York City area,
02:46Nancy returned to the northeast to
02:49complete her doctoral internship.
02:51At the VA Connecticut Healthcare system
02:54around the corner in West Haven.
02:57When she finished her degree.
02:59She joined a new child and family
03:02research team in our division on
03:04addictions that was led by soon Jalouse
03:07Lutherin, mentored by Bruce Rounsaville.
03:09I was fortunate to be the third early
03:12career psychologist in that group.
03:15Once she had an itch.
03:18Nancy moved from being a post
03:20Doctoral Fellow.
03:21To a ladder track.
03:24Faculty member.
03:25And since 2008,
03:26she's been an associate professor
03:29of psychology and child study.
03:31She's devoted her career to studying.
03:35To the study of parenting as a treatment
03:37issue and the lives of mothers and
03:40father's struggling with addiction.
03:42Oliver work represents an effort to integrate
03:45what we know about gender addiction,
03:48parenting, and child development.
03:50Much of her work has been done in
03:53collaboration with the APT Foundation,
03:55a private,
03:56nonprofit provider of addiction services.
03:57Here in New Haven.
04:00Over more than 25 years.
04:05Nancy's been the principle investigator
04:07or a series of research and research
04:10training grants funded by the
04:12National Institute on drug abuse.
04:15She's had one primary grant that,
04:18through several competitive renewals
04:20and some creative financing,
04:22has been continuously funded
04:25for more than 15 years.
04:28She's also been a Co investigator,
04:30a consultant.
04:31And a mentor on federal grants for Sir,
04:35pursued by many other investigators.
04:38He's been an author on more
04:40than 50 peer reviewed papers.
04:43And she's been invited to speak
04:45about her research regionally,
04:47nationally and internationally.
04:48She's also served as a member of a study
04:52section at the National Institutes of Health.
04:55For people not familiar with
04:57the concept of a study section,
05:00you don't actually go to one to study per,
05:04say,
05:04you go to Bethesda,
05:06MD to critically review applications
05:08for funding from other researchers.
05:11She's also served as a member
05:14of the editorial board for the
05:16Journal family relations,
05:18and she's presently an associate editor.
05:21For the infant mental health Journal.
05:25In addition, Nancy was
05:27the principal editor of parenting
05:29and substance abuse of volume.
05:31That's quickly become the definitive
05:34professional reference on the
05:36impact substance use has on the
05:39parenting of men and women.
05:41Many people present in the meeting
05:44today contributed to this via.
05:46I deny that I included the.
05:49Photograph of the cover with any
05:51intent to sell more books for Nancy.
05:54However. If you do not have a copy,
05:58you should know that the hardcover
06:00edition quickly sold out,
06:01and yesterday Amazon had only four
06:04copies of the softcover version left.
06:06In stock.
06:07After their gone,
06:08either have to wait for it on back
06:10order or settle for the Kindle version.
06:15Working with Nancy for more than 25 years,
06:18I know that the Crown jewel and her
06:21academic career has been the development
06:24of mothering from the inside out.
06:26Her individual psychotherapy,
06:27designed to help others struggling
06:29with addiction, develop healthy
06:31relationships with their children.
06:34Her research on mothering
06:36from the inside out has been
06:39widely acknowledged within
06:41a small research community.
06:44ResearchGate says Nancy has approximately
06:478600 reads and 2000 citations.
06:50Of the 46 publications that are listed there.
06:55For family and friends.
06:57Not familiar with ResearchGate,
06:58it's like Facebook for
07:00the academic community.
07:01Reads in citations on ResearchGate
07:03are the same as likes on Facebook.
07:08Beginning with her first
07:10description of mothering from the inside out,
07:13ten of nancies papers have already
07:16been cited more than 100 times
07:19by people doing similar work.
07:21What papers about the new coronavirus
07:23published in Lancet and the New England
07:26Journal of Medicine are receiving
07:27a little more attention right now?
07:30This pattern of citations represents a
07:32significant impact in a very specific
07:35subject area of research and practice.
07:37I know that Nancy doesn't worry
07:39about her numbers on ResearchGate,
07:41but most people in our field of
07:44knowledge that her work is made a big
07:47splash in a relatively small pond.
07:49It works also complicated for things
07:52things for me on my ResearchGate page.
07:55Whenever I go there,
07:56I repeatedly see these notations
07:58that Nancy Suchman not Thomas J.
08:01McMahon as a first last author
08:03paper that's been cited yet again.
08:06As you can see, this one came in yesterday,
08:09just 12 minutes before I logged
08:12into Nancy's ResearchGate page.
08:13To get some information for
08:16this presentation.
08:17When I go to Google Scholar,
08:19it doesn't get any better on Google Scholar.
08:22I'm repeatedly minded reminded
08:23that three of my most frequently
08:26cited papers where I'm listed as an
08:28author were all written by Nancy E.
08:30Suck man.
08:33The development of this clinical
08:35intervention is also taken Nancy
08:37on an extended tour to speak,
08:39teach and consult not just in this country.
08:43But in Finland.
08:45South Africa Australia, Canada,
08:47France, Italy and the United Kingdom.
08:52Note the bottom row.
08:54It appears that between Graduate
08:57School and returned to Denver in 2009,
09:01Nancy moved from vigorously hiking
09:03through the Rocky Mountains as a
09:07graduate student to hitchhiking.
09:10And riding horses through the Rocky
09:12Mountains as a middle aged faculty member.
09:15Pop center,
09:15she appears as the silly of American
09:18touring Finland wearing a big furry
09:20hat in the middle of the summer.
09:25Moving on, I'd be remiss
09:27if I did not mention the
09:30ansi's contribution to the personal
09:33and professional development of
09:35others is a long list of clients.
09:38And research participants far too
09:40many to count who have benefited
09:44from her clinical acumen.
09:46There's also an equally long list
09:49of students, research assistants,
09:51professional trainees,
09:52addiction counselors,
09:53and researchers who have benefited
09:56from her time and Tillage.
10:01Finally, as Nancy steps away from
10:03our full time faculty position,
10:05becoming the keeper of her flame.
10:08And it will anyone looking for
10:10information about her work and
10:12send a note to this email address.
10:17Now to recognize Nancy's contribution
10:20to the science of addiction,
10:22family process and child development.
10:24Linda mazes graciously agreed to speak
10:27with us about the neurobiological model of
10:31addiction and parenting that served as the
10:35basis for mothering from the inside out.
10:38As noted here, doctor Mays is the Arnold,
10:41his El professor of child, psychiatry,
10:44Pediatrics and psychology.
10:45She's also the chair of the
10:48child study center.
10:49And the deputy Dean for professionalism and
10:53leadership within the School of Medicine.
10:56She's with us today because
10:57she's an early mentor,
10:59an longstanding collie of Nancies.
11:02Linda.
11:05Thank you Tom. Let me just share
11:09my screen. Can everyone see
11:13that? Is that clear, Tom?
11:18Yes, thank you. Thank
11:19you for bringing
11:20us all together and then see is just
11:23such a special time to be with you.
11:26The only thing that would make it better
11:28would be to be with you in person,
11:31but we will be be together virtually.
11:34And I'm very glad to talk about the
11:36neurobiology of addiction in parenting.
11:38But I would say that this is really your
11:41work and you have guided it all the way.
11:44I think there's two innovative scholars
11:46that I'm going to be talking about.
11:48You have mentored Helena.
11:50And much of the neuro biological work
11:52I'll present is really hell in his work.
11:55But you had felt the launch Helen's career as
11:58you've helped launch so many peoples careers.
12:00And your ideas, and your compassion
12:02for families is so infused.
12:04This work on that I could stop right here,
12:08and that would be the primary
12:10message of your caring.
12:11For those that are junior to you,
12:14you're helping launch careers and
12:16your caring for so many families
12:18and such a thoughtful way.
12:20You've changed our field, Nancy,
12:22and I'm just going to offer
12:24just a little bit.
12:26Hawaiian, how?
12:26You've changed our field,
12:28but you have changed our field.
12:30So let me just turn to.
12:33The three key points that I want to be
12:36sure that come across in this talk.
12:39The first is that about excuse me,
12:42let me go back.
12:43The first is about becoming apparent,
12:46so becoming apparent we don't
12:47always talk about it.
12:49Have parenting as a developmental stage,
12:51but it truly involves a
12:54reorganization and key neural systems.
12:56The same neural systems that
12:58are impacted by addiction.
13:00The second key point coming
13:02deeply from your work.
13:03His understanding these overlapping
13:05mechanisms for adaptation to parenting
13:08and for addiction point the way to
13:10very novel interventions for families,
13:12and especially for mothers.
13:14And the third is that thinking
13:17about maternal addiction?
13:19As distinct from addiction among women.
13:20And that's going to be a really key phrase.
13:24Leads us not only to different interventions,
13:26but leads us to a two generation
13:29approach which you have guided
13:32us to think about so often.
13:34So let me just do a little
13:37bit about maternal addiction.
13:39And get the slides to change.
13:42As we know, maternal addiction.
13:45Remains a public health concern that
13:48has tremendous implications for children
13:50and brought her family systems.
13:52And the data shown on these slides
13:54come from 2018, but as you can see,
13:58still a fairly rising increase
13:59on in the use of illicit drugs,
14:02tobacco and alcohol.
14:04Among women who are parents.
14:07And the next slide.
14:09Addiction actually extends beyond pregnancy.
14:11Often times when we talk about
14:14maternal addiction,
14:15we're talking about pregnancy and infancy,
14:17but it truly extends beyond and
14:20in these data on, you see that.
14:23The number of children living
14:25in households with one parent,
14:27one parent's mother, one parent,
14:29his father, or of two parents.
14:32So tremendous number of children
14:34aged 17 or younger are impacted by
14:37substance use and another reason
14:39it is so
14:40key to talk about maternal
14:42addiction rather than addiction
14:44among women who are parents.
14:48Get the slides to move here.
14:51Maternal addiction definitely needs
14:53us to think as you have guided us.
14:56Nancy, a two generation approach.
14:59On the one side,
15:00many of us in the trial study center
15:02have a child focus point of view.
15:04We think about the impact
15:06of drugs on children.
15:08On the other side,
15:09many people working with adults
15:11they might be parent focused,
15:12but they don't always think about how you
15:15bring the parent and the child together.
15:18So what your work has done,
15:20and I'll keep coming back to this theme.
15:23His oriented us to two generations.
15:25When you think about maternal addiction,
15:27you are inherently thinking about
15:30not just the mother of the child
15:33and the subsequent generations.
15:35To that point, maternal substance use.
15:40Is associated with a number of
15:42concerns I increase in child neglect.
15:45Our involved in 80% of child welfare
15:48cases 60% of out of home placements.
15:52And I think the other point that
15:54you guided us to think about Nancy
15:57that will continue to come back to
15:59as I talk is that their addiction
16:02is a developmental disorder.
16:03And it's based on early childhood
16:06experiences that actually sent the
16:08path developmental path for this.
16:11For addiction and substance use.
16:15And we often think about two kinds of models.
16:18The first is the simplest one and that is
16:21drug exposure effect on infant and child,
16:23and that child grows up to be an adult
16:26and we look over time at the effects.
16:29With the model that you've really asked
16:32us to look at is this to generation
16:35one that there's drug exposure.
16:37This drug use in the context of
16:39environmental stress and adversity,
16:41both prenatal Ian postnatally
16:43that impacts the child.
16:44And that then that parents substance
16:47use then becomes just a marker.
16:50Or extreme increases in perinatal and
16:53postnatal stressors and adversity.
16:55And indeed, one can actually draw
16:57an arrow going from this box back
17:01in a two generation approach.
17:03So I want to 1st focus now on the
17:06first box that we talked about this
17:09transition to Parenthood and the neural
17:13adaptation that's essential for it.
17:15There have been just decades of work on
17:18the impact of individual differences and
17:20parent care on child health and development.
17:23Starting with John Bowlby's work
17:24on attachment even before that,
17:26but particularly that's similar
17:27work that Nancy,
17:28you've included and taken to a
17:31whole other level in your work.
17:33But we actually know very little
17:36about this question.
17:37And we know more.
17:38Since Nancy, you've been working
17:40and you been mentoring Helena,
17:41but we really don't know a lot
17:43about how does becoming apparent.
17:46Impact adult psychological neuro
17:48psychological development.
17:50Can you actually change neural
17:52systems as an adult?
17:54The answer to that is yes,
17:56but how does this particular
17:58transition change our biology
18:00as well as our psychology?
18:02And I'm going to spend just
18:04a little bit of time on that.
18:06There's a much greater volume of work
18:08on that reflects a lot of Helena
18:10rather than for its work and others.
18:12I'm just going to give you just a
18:14snippet in order to set the stage for
18:17talking about addiction and parenting.
18:19The first is though,
18:20that there actually are in this review.
18:23Here is actually now as you can see,
18:26nine years old,
18:27there's actually a considerable amount
18:29of work from preclinical from animal
18:31models on that looks at the circuitry.
18:34Long neural circuitry.
18:36Brain circuitry of underlying parenting,
18:38and it's in particular that rewards
18:41reward systems and stress systems
18:44are especially involved on anarchy
18:46to this transition to Parenthood.
18:51In particular, let me just
18:54give you 2 bits of data.
18:56One is about that parents and nonparents
19:00seemed to show actual differences and
19:03how they process Ki Ki Infant cues.
19:06In this particular example
19:08this shows you EG data.
19:11And we're looking at this.
19:13Let me use my mouse.
19:15We're looking at this component of
19:17the brain wave right here and here,
19:19which is where emotional data seemed that
19:22in the later part of this evoked potential.
19:26And you see the difference
19:28between non parents and parents.
19:29So here's 2 images that they
19:31are asked to look at.
19:33Both of unhappy babies,
19:34but one in a spirit in a state of some
19:38discomfort in other considerable distress.
19:40Non parents do not register that difference
19:43at the brain level where his parents do.
19:46And this work has been replicated.
19:50The second snippet actually
19:51looks at from work done at Yale.
19:55Actually looks at changes in Gray
19:57matter with experience with infants.
20:00I'm in the Gray matter increase from two
20:02to four weeks to three to four months
20:05postpartum with parents first pregnancy.
20:07These are data from others.
20:10Most also strikingly is
20:11that that this go back.
20:13Sorry that this Gray matter
20:15increase from two to four weeks to
20:17three to four months is predicted
20:19by the mothers perception,
20:21an engagement of her baby at
20:23two to four weeks postpartum.
20:26Can argue that this is a learning effect.
20:28What kind of effect it is,
20:30but nonetheless it seems to be
20:32driven by the particular contact
20:34and care of the baby.
20:37And let me just focus a little
20:40bit more then on the specifics
20:42of reward and stress systems.
20:44An adaptation to Parenthood.
20:47The first is to look at reward
20:50parenting and addiction.
20:52And you have an image.
20:54They have a baby,
20:55but let me talk a little bit more
20:57about the evolutionary significance.
20:59An attractiveness of infant faces.
21:02Evolutionarily,
21:02we could argue that the survival
21:04of human infants depends obviously,
21:06on there getting nourishment
21:08and care from their parents,
21:10and there's key features of infants
21:12and their faces in particular
21:13that make them more attractive.
21:16This is work that goes back.
21:18As you can see quite a long what.
21:21But now has been adapted into the
21:25more contemporary techniques.
21:27But just look at this series of images.
21:30My babies.
21:35The features that make these
21:38infants very attractive.
21:39Are there large eyes, their large cheeks,
21:42large foreheads on just the kind of
21:46accentuation into the face since sensually.
21:50Actually, the same vector
21:52of a prize across species,
21:54for example, look at these images.
21:57Large eyes, big heads, large faces.
22:00That engage engage others,
22:02engage adults and caring.
22:05So here's a particular study
22:07on the salience of faces,
22:08and in this particular study
22:10you take the same face.
22:12In this case,
22:13this is the same face here in here.
22:16And their manipulated just suddenly.
22:20To make them even more engaging
22:23by increasing the live forehead.
22:26By making the ice slightly wider,
22:28the cheeks slightly chubbier.
22:30And so you have a schema here that goes
22:33from low attractiveness if you will to high.
22:37And in the Middle Unmanipulated.
22:39And then looking at a parent
22:42response both parents,
22:43an non parent in this case and
22:45reward region in the nucleus
22:47accumbens of the brain all looking
22:50at parent response to these images.
22:53And seeing that the highest response
22:55in the nucleus accumbens in this
22:57reward region is for these manipulated
23:00images that have been manipulated
23:02to be especially attractive by
23:04these evolutionary features.
23:07So infant faces are incredibly
23:10engaging and rewarding.
23:12What do we know about this now in parents,
23:15an infant and maternal addiction?
23:17So first and maybe you didn't,
23:19we didn't need an imaging study
23:21to say that your own baby smiling
23:24is especially rewarding.
23:25But what is salient about this?
23:28And this is work by Lane Strathearn,
23:30one of our collaborators that
23:32infant faces are rewarding compared
23:35to your own baby compared to a
23:37baby that you don't know.
23:39Is far more rewarding and also positive
23:42affect is more rewarding than any
23:45other affect that is sad or neutral.
23:49So that activating these particular
23:51regions reward regions of the brain
23:54and arguing at this becomes a kind of
23:58engagement and a stimulus for engagement.
24:01And the other hand.
24:05An addiction.
24:07Addicted mothers in this case
24:09shall reduced activation in these
24:12regions with not the same images
24:14but similar images of babies.
24:17Hum in this region, so similar big decrease.
24:20Actually Anna in reward activation.
24:24And maternal addiction also
24:26reduces the reward response to
24:28your own infant face compared to
24:30that previous study I showed you
24:33comparing non addicted to addicted.
24:35This case shows you just maternal
24:38addiction and decreased response
24:40and reward regions to your own
24:42baby with positive affect.
24:46There's also differences
24:48using AG comparative.
24:49We use we go back and forth
24:52between Aegean Imaging data.
24:55That in this case compared substance
24:57use and non substance using and
25:00looking at a component of AEG are
25:02they evoked potential the N 170?
25:04That is very cute.
25:07Interfaces are especially especially faces.
25:11And that substance users have a
25:13slower response to in one said slower
25:16response on the N 170 to infant faces.
25:21And this is work actually building
25:23on collaborations with Vegeta,
25:25Sinha and others in psychiatry looking
25:27at and I'll come even more to that.
25:31Looking at the end 170 in smoking versus
25:34non smoking mothers viewing infant bases.
25:37And showing that increase nicotine
25:40dependence is associated with increased
25:43delay in this in 170 component.
25:45Just to say even on zoom.
25:48For all of those images I showed you,
25:50you were all having very
25:52large in 170 components.
25:53Among of all of those baby images,
25:56there's just built into our biology and it
25:59appears to be delayed in substance users.
26:03So an interim summary.
26:05On this part of the reward part.
26:08Is that infant faces are inherently
26:10rewarding even in non parents,
26:12but especially so in parents and
26:15there's emerging evidence that
26:17suggests that infant queues maybe
26:19less salient and substance using
26:21mothers as compared to controls.
26:23Both in delayed response and in
26:26decreased amplitude of the response.
26:29And these findings are replicated
26:31now across different groups.
26:33Different studies may highlight why the
26:36importance of reward as an engagement
26:39mechanism for parenting that you're
26:41engaging with the baby around these very,
26:44very salient cues.
26:47Well, let's turn distress.
26:49And stress,
26:50parenting and addiction.
26:53So this is the work also that I
26:55referred to earlier that Helena has
26:58done using rigidus in has stress,
27:00metaphor or stress paradigm.
27:02And in this case she asked mothers
27:05to talk about a previous stressor in
27:08the last six weeks more generally,
27:11and then I parenting related stressor.
27:14Mom and then brings them back into
27:16the lab and measures a variety of of
27:19indices of stress but also craving.
27:21And this shows the data for smoking
27:23on and that mothers as you can see,
27:26I'm not talking about the child
27:28related stressor which is in red have
27:31a statistically significant difference
27:32increased since craving compared
27:34to a general stressor when they're
27:36talking about child related and that
27:38it is much slower to come back to
27:41recovery to come back to baseline.
27:44So that trial related stressors
27:46are highly highly salient.
27:48For in this case,
27:50mothers who are addicted to nicotine.
27:54When we met, he told me that we met
27:56in April. He told me he had to. I
27:59don't know or other people
28:01here did OK, thank you.
28:02So the other piece that we just
28:04want to ask though, is that.
28:06One is the major source
28:08of stress and parenting.
28:10Crying is one source that you can't
28:12do what you need to do for your baby,
28:15that your baby is upset
28:16that you don't know and why.
28:19And so it's a great challenge for
28:21a new parent, addicted or not,
28:23is how to regulate stress when faced with
28:26a crying baby and not knowing what to do.
28:29But we know that tolerance of stress
28:31or talent or distress tolerance is
28:34highly compromised in addiction.
28:36And can we assess the stress,
28:39tolerance and addiction an in
28:41parenting in an ecologically valid way?
28:43Because let's be Frank,
28:45in the magnet, listening to kreiser,
28:47looking at baby images is not
28:50particularly getting you really
28:52closer to the parenting situation.
28:54So another piece that Helena has
28:57created is the baby simulator.
29:00And this is a baby that's designed to
29:03be a four to six month old by weight
29:07and size computer control to generate cries.
29:10And certain behaviors will Sue the simulator.
29:14But you can actually manipulate
29:16the amount of Crime.
29:18So you can use the simulator as a
29:21way to interrogate if you will.
29:23This stress distress tolerance
29:25system in parenting.
29:27And So what we find and what Helena
29:29has found is that mothers that have
29:32higher mindfulness or reflective skills.
29:35Spend much more time comforting
29:37the simulator.
29:38Even though they know the
29:41simulator is not real.
29:43Even though you can ask them,
29:44is this a real baby?
29:46They spend much more time with the
29:48higher their reflected skills are.
29:50And then that innocence cuts across
29:53group differences of addiction, an addiction.
29:56If you look at reflective nahs.
29:59The time of the simulator.
30:00As you can see here,
30:02is also reliably associated with
30:04increases in heart rate and
30:05blood pressure on,
30:06so it is of reliable stressor.
30:10Comparing directly addicted parents
30:12to non addictive parents,
30:13there is a very interesting finding
30:16that if you ask parents who are
30:18non substance using how much time
30:21did they actually spend,
30:23only comforting the baby.
30:25Non subscribers using parents
30:27always dramatically underestimate
30:28the amount of time they spent.
30:31They were engaged with the baby
30:34with the simulator.
30:36Substance using parents accurately
30:38estimated as if the stress is so
30:41much that that they're very clear
30:43of the passage of time.
30:45More to be said about that.
30:48And then finally one other Ann.
30:50I just want to again emphasize that
30:53I'm presenting various snippets
30:54of these these studies about
30:56parenting stress and reward.
30:58There's much more work to be said.
31:02Cocaine using mothers ashow
31:03diminished increases in Oxytocin,
31:05Amen greater perceived stress
31:07in response to infant cries.
31:10So while it may sound paradoxical,
31:12all all parents and indeed
31:15probably all adults,
31:16but certainly more so in parents,
31:19will show an increase in oxytocin
31:22that small neuropeptide that's been
31:24associated with care and attachment
31:26even in stressful situations.
31:28Oxytocin will go up in
31:31response to infant cries.
31:33But substance using mothers,
31:35in this case cocaine using mothers
31:37show it diminished response,
31:39but nonetheless they still
31:42perceive enormous stress.
31:43And oxytocin has been are
31:45functionally as an anxiolytic,
31:47so it actually helps to manage anxiety.
31:49So for substance using parents,
31:51it seems to not be go up as much.
31:55So now I want to go to building a model
31:59of how addiction then impacts parenting.
32:02Taking these various snippets that I've
32:04showed you and I showed you suggestions
32:07that parenting is a developmental
32:10stage with neural adaptation.
32:12That there are differences between
32:14addicted and non addictive parents in
32:17in various ways of interrogating sorry,
32:20interrogating reward systems and not.
32:23And so, how do we bring that
32:25together to build a model?
32:27And I just need to remind or or
32:29go over just a couple of points
32:31that will be familiar to a number
32:33of people in the audience,
32:35but are actually really key to Nancy's work.
32:39The first is the progression of
32:41drug addiction that typically drug
32:44addiction moves from I positive
32:46reinforcement to negative.
32:48And what we mean by negative
32:50reinforcement as you begin to use drugs
32:53later in the dependence to actually
32:55manage stress to escape the craving.
32:58Another negative affect if states.
33:00That in the beginning drug use might be
33:03for positive on the feeling of pleasure,
33:06but as the addiction proceeds,
33:08it's really around managing these
33:10very negative affect if states.
33:12And so in this case,
33:14the reward system, if you will,
33:16is Co opted is taken over to
33:19maintain a habitual behavior.
33:20In this case,
33:21drug use that's associated with
33:23the relief of negative affect.
33:25So it's a really key point that you can,
33:29as addiction progress is that you
33:32use drugs to decrease your stress
33:34and manage your negative affect.
33:37Second point is about stress in addiction.
33:41And that is this is work of
33:43Ajita Sinha in the Department,
33:46psychiatry and others that exposure
33:48to stress just generally stressed.
33:50Increase is subjective.
33:52Reports of craving among addicted adults.
33:55And that doesn't actually have to
33:58be the stress of the of related
34:00to drugs on its exposure.
34:02Distressed generally increases your craving.
34:04And that overlaps with activity
34:06in neural circuits that aren't
34:09also activated during Q Induced
34:11drug craving inductions.
34:13So that stress increases Cravings.
34:18So then how do we bring this together?
34:21How do we actually tie this now
34:24together into a model? The first point.
34:26Is that as I mentioned earlier,
34:29that it seems that there's a cooptation
34:31of reward systems in addiction?
34:34Tord, this more negative reinforcement.
34:37And in this case it may result in other
34:41rewards such as caring for the baby,
34:44such as social affiliation, relationships.
34:46Parenting is not being asked salient.
34:49What's most salient is the
34:51reduction of your stress.
34:53That's what's most rewarding.
34:55And the related point get to
34:58this here is that feelings of
35:01stress in the caregiving role.
35:04Just as we said by the previous slide,
35:07that stressed generally increases
35:08craving an addicted adults.
35:10That feelings of stress in the
35:12caregiving role may also increase
35:14craving and substance use.
35:15Seeking behavior in parents.
35:17So it's these two key points.
35:20That I'm going to tell you a very soon
35:22central to mothering from the inside out,
35:25but are also very central to this
35:27model that I'm about to build for you.
35:30So we think of parenting and addiction
35:33having two arms if you will.
35:35The first is the decrease salience.
35:37Those engaging baby faces are
35:40just not as salient.
35:41And so is reduced engagement in a kind
35:44of passive and disengaged behavior with
35:46the baby that looks on the outside light,
35:49depression or just or neglect.
35:52And on the other side,
35:54stress reactive also increased craving on
35:56when we're around the stresses of parenting,
35:59which leads to increase substance use.
36:03And indeed,
36:04there actually are across a number
36:06of observation.
36:07Ull studies looking at the quality
36:09of parenting and addiction.
36:11There actually are reports of between
36:13mothers being too intrusive and
36:15over controlling versus to engage,
36:17so it looks like that there are
36:20often these behavioral reports.
36:22These two different arms,
36:23but they're related mechanistically.
36:28So one might talk about a reward,
36:31stress, avoid stress dysregulation,
36:33model of addiction and parenting with
36:36this central hypothesis that substance
36:38using parents find caring for an infant
36:41less rewarding and more stressful.
36:43And they do that because of the cooptation of
36:47their neurobiology by the addictive process.
36:51Not because of a willful decision
36:52or or a conscious decision,
36:54but that their biology is taken over.
36:57If you will buy the addictive
36:59process and thus the infant Q is
37:03less salient and more stressful.
37:05And so it might look functioning like
37:07this that you have parental addiction.
37:10That leads to a dysregulated
37:12reward and stress system.
37:14That encounters then a crying baby.
37:17And then because you have an impaired
37:20response to infant cues, there more
37:22stressful and their less rewarding.
37:24Need you to have more
37:26parenting related stress?
37:28Which then leads you to
37:29turn to habitual behaviors,
37:31increases your craving,
37:32you turn to obih tual behaviors
37:34to reduce that stress.
37:35You turn away from the baby,
37:38and it sets the conditions for
37:41parental neglect and abuse.
37:43But there's one other point before
37:45I could finish this model that I
37:47need to bring in that is so central
37:49to mothering from the inside out,
37:51and that gets us back to the
37:54two generation model.
37:55And that gets us back to the earlier point
37:58of addiction as a developmental disorder.
38:00There's good data now that early adverse
38:04experiences abuse neglect a range of early,
38:07averse experiences,
38:08not only shaped neuro cognitive
38:10function across development,
38:12but they also increase vulnerability
38:14to substance use and adolescents and
38:17add and had altered and thus impact
38:20the next generation of parenting.
38:22So the two graphs are from the Asus study
38:26the adverse childhood experiences study.
38:29Looking at the increase in self
38:31report of alcoholism or the increase
38:34of self report of illicit drugs just
38:36based on the number of self reported
38:40adverse childhood experiences.
38:41We also know that there are pretty stand,
38:44pretty commonly higher rates of
38:47abuse and neglect reported as
38:49children among addicted adults.
38:52So it's really becomes back to
38:55that interactive to generation
38:57model that I spoke about earlier.
38:59That as you see here,
39:01that prenatally there may
39:03be substance exposure.
39:05And infancy there's exposure to
39:07parents stress, maltreatment, poverty.
39:09Hum going all through childhood
39:12with continued stressors,
39:13which increases the risk for substance
39:15use or onset of psychiatric disorders.
39:19Bring Parenthood into that.
39:21At this adulthood stage, bring Parenthood.
39:24And then you have a next generation cycle.
39:29And let me show you that just in this figure,
39:32again in this case,
39:34same figure we saw.
39:35But let me add early River City.
39:39Is the conditions or a dysregulated
39:42stress response?
39:43Which then increases your risk for
39:47addiction and related problems.
39:49Expose them that adult to a crying infant.
39:53Same thing,
39:54impaired response to the infant
39:56Q less rewarding more stressful
39:58parent related stress habitual
40:00increased craving habitual behaviors
40:02turned away from the baby.
40:04Conditions for parental neglect and abuse.
40:07But in this case it goes
40:10back cycle cyclically.
40:12You have then early adversity,
40:14which then increases the risk for that trial,
40:17and that child becomes an adolescent
40:19to become an addict or substance
40:21user to transition to addiction,
40:23and then when they become apparent,
40:26you have the conditions for not only
40:28intergenerational transmission of addiction,
40:30but intergenerational transmission
40:31of compromise parenting.
40:33This is the model that's absolutely
40:35central to what Nancy is doing
40:37and mothering from the inside out.
40:39So I want to take just the last few
40:42minutes to then build out just a tiny
40:45bit about these other two key points.
40:491st is that this model could be a possible
40:53mechanism for the clinical observation
40:55of increased drug use and relapse and
40:58adults after the birth of an infant.
41:01We often talk about that is that
41:03there's just a lot in the environment
41:06and challenges in the environment,
41:08but one could argue that this is the
41:12possible mechanism at a neural level
41:14for the relapse after the birth.
41:17It also should change the intervention
41:19focus in addiction services for mother's.
41:21We often think about if we decrease
41:23drug use will improve parenting.
41:26Well, what Nancy has in a very.
41:29And very.
41:31Very gotten us to think about
41:33is if we improve parenting.
41:35We might actually decrease
41:37drug use by altering the reward
41:40stress system dysfunction.
41:42Or as at the lower side
41:44you improve parenting.
41:45You improve distress tolerance.
41:47You enhance parental
41:48engagement with the child.
41:50You decrease child morbidity and that
41:52becomes your two generation effect.
41:56So let's let's talk about mothering
41:58from the inside out, just briefly.
42:00As Tom said, This Is there's so
42:03many jewels Nancy in your Crown,
42:05but this is certainly one of the most
42:08beautiful pieces of work that you
42:10have done and spread across the world.
42:13In this case, you're focusing on
42:15parenting and parent child relationships
42:18among substance using women,
42:20and you're not making the assumption
42:22that if we decrease drug use,
42:25we can improve parenting.
42:27But you're really saying that
42:29parent child work has to be an
42:32essential part of addiction
42:33services. And so for example.
42:36Many, many parents interventions
42:38are simply not sufficient
42:40for mothers who are addicted.
42:42Their design will a child focus,
42:45not on a two generation.
42:48They lack consideration of the
42:50parents nearby, especially their
42:51neurobiological vulnerabilities.
42:52Using this model, we just laid out.
42:55And substance using mothers
42:57tend to exit substance.
42:59Using mothers tend to exit prematurely also.
43:04So this is the case for mothering
43:06from the inside out in a two
43:08generation approach. In the
43:10line that I've highlighted most,
43:12you can read the others.
43:14The emotional quality,
43:16decreasing emotional dysregulation or
43:17district or improving distress tolerance.
43:20Most important line is that you're treating
43:23addiction in parenting at the same time.
43:25And that goes back to the earlier key point.
43:29That maternal addiction is the phrase,
43:31not women, who are addictive,
43:33who happened to be addicted.
43:36So you're shifting intervention focus and
43:38this is what you've called our attention to.
43:41Nancy refocus on the adult is apparent.
43:44You focus on the change
43:46from what the baby is.
43:49Which is what traditional
43:50parent education is.
43:51This is what your baby needs to
43:54actually focusing on the adult.
43:56How do the demands of caring
43:58for the baby impact you?
44:00What kind of parent do you want to be?
44:04How do you understand your
44:05babies needs an your needs and
44:08you focus on increasing adults,
44:10pleasure and caregiving improving their
44:12digest distress tolerance and becoming
44:14mindful then of their own emotional states.
44:16In other words,
44:18trying to decrease that.
44:19That Trigger if you will,
44:22that increase his craving and drives adults
44:25than to not be caring for their baby
44:28but trying to reduce their own stress.
44:31And the overall results across three
44:33trials and mother from the inside out is.
44:36It says you can see pretty impressively
44:38decreases in maternal negative emotionality
44:40in the face of caring for their infants.
44:43Improved or decrease in relapse risk.
44:48Or maternal depression improvement.
44:50Child withdrawal emphasizes again
44:52this two generation model that
44:54you're really looking at.
44:56Mother and child family together.
44:59And improvements in maternal,
45:01reflective functioning and
45:03child attachment security.
45:04This is really impressive work.
45:07In a very,
45:08very complicated,
45:09challenging families who have so
45:11much going on to be able to hold
45:14families in this kind of treatment
45:16and to be able to have these kinds
45:19of effects is really impressive and
45:22reflects such thoughtful creativity
45:24from the person Nancy who designed it.
45:27So I just want to end with this.
45:29This is a summary of what I've said.
45:32But the transition to Parenthood
45:34is a key adult developmental face.
45:37But there's overlapping neural
45:39circuits underlying this transition
45:41and those for addiction.
45:43That maternal addiction is associated
45:45with a decreased salience of infant cues,
45:47an increased parenting stress.
45:50A critical to approach maternal
45:52addiction with the two generation
45:55perspective and then finally.
45:56Then interventions focusing on
45:59parenting among addicted women.
46:01Improve parenting and drug use behaviors,
46:03and they had this two generation effect
46:07of positively impacting the trial.
46:10But I really want to conclude
46:12with thinking Nancy as a colleague
46:14and friend Nancy it is.
46:16It is.
46:17It's been a great journey,
46:18working with you and I have learned so much.
46:22I have learned so much from
46:24your ability to think so deeply
46:26about the families you care for,
46:28your willingness to take this
46:30work all around the world.
46:31Amen, habit adapted all around the world,
46:34and your willingness to always.
46:36Our convey a sense of Hope
46:38in situations were so
46:39many people don't have that where
46:41they frame addiction is hopeless
46:43that your willingness to really
46:45think that families can can not
46:47only recover from their addiction,
46:49but they can do well by their children
46:51and to think about the next generation
46:54that is so characteristic of you to always
46:57be thinking about the next generation.
46:59and I am just so grateful to have
47:01then and were and continue to be
47:04your colleague in your friend.
47:06And to have learned so much from you.
47:08So thank you Nancy,
47:09and thank you everyone for listening.
47:14Time, should I stop sharing
47:18my screen at this point?
47:26Yes, if you can. Figure that out. Thank you
47:33very much. Uhm, well figure this out.
47:39So. Nancy If you
47:44want, this is the point in the
47:46program where we set aside some
47:48time for you to say a few words.
47:51If you'd like to. Stop. Got it. Can't see
47:59you in this sub, checkerboard.
48:01If There you are.
48:04Do you have anything you'd like to
48:06say? Yes. First I want to.
48:13Thanks for all of the people who are
48:17involved in organizing this grand rounds,
48:21including Tom Linda.
48:22Crystal Stephanie O'Malley Um,
48:26Chris Gardner and that I was deeply moved.
48:34Up by the news at this grand rounds uhm.
48:38And as. Um? I also want to thank
48:46my senior colleagues like Linda
48:49who was a major mentor in my life.
48:53For many years I learned so much from Linda.
48:58Um? Who helps me design studies?
49:03From a developmental perspective,
49:05an attachment Christmas.
49:08Active. Um?
49:30Nancy, I think you have to
49:35unmute your muted. You need.
49:40No, she wasn't muted.
49:44And so I was just
49:47wanted to acknowledge the group of people
49:52who organized this grand rounds and I'm
49:56just deeply honored. To be part of it.
50:02I also wanted to acknowledge the
50:05Department of psychiatry for the support,
50:09particularly of the leaders in the Department
50:12who have given me some really good advice,
50:16and especially I'm thinking of Doctor Bunny.
50:21Who I had a meeting with and
50:25his parting words were. Um?
50:29Don't forget to have fun.
50:34And I was just blown away.
50:37It was such a good advice because I love.
50:43I have loved my job.
50:46And the work that I've done.
50:49And. The UM?
50:55And there is fun and creativity that has
50:58meant so much to me. Um? And then, uh.
51:10I got similar
51:11advice from John Crystal was also.
51:15You know the chair of this Department and.
51:20Encourage me to enjoy the process.
51:24I also wanted to thank.
51:27My mentors over the years,
51:30my first mentor here in the
51:33Department was soon ya Luther.
51:36Um from home.
51:38I learned about having strong compassion
51:42for the population that we serve.
51:47The research population and
51:48sooner had this in in spades,
51:51and she was such a good role model for me.
51:57Um? And also Tom.
52:03Who showed me the ropes
52:05of research design and
52:07statistical analysis since we both
52:10came to the Department in the early
52:1390s and we're working together,
52:16he's at very generous teacher and.
52:19I've learned a lot from him over the years
52:24about statistical design and methods.
52:28And and have enjoyed it tremendously so.
52:35And then I also wanted to Adknowledge
52:38Arrieta Slade, who was very important,
52:40has been a very important mentor to me.
52:44Um, learning?
52:45Um about attachment research an about
52:50doing attachment research and also she
52:53allowed me to use the measure that she
52:57developed as our primary research outcome.
53:01The parent development interview. Um?
53:05Which is a measure of maternal or
53:10parental reflected functioning and.
53:12Um? Eventually I became a teacher
53:17of that method with Arrieta.
53:20But just enjoyed it enormously and then
53:23finally Bruce round to bill um in the
53:27Department of psychiatry and Carol,
53:30Kathy, Carol.
53:31Um both taught me a tremendous
53:35amount about grant writing. Um?
53:38Aunt about making your writing,
53:42including your grant writing accessible,
53:45especially if you're.
53:47Doing a developmental study for
53:50a developmental grant or an
53:54attachment based grant,
53:55it's important to make it accessible
53:59an knowable to your audience. Um?
54:05And I learned how to do that.
54:09And then the importance of doing that.
54:14And then. I wanted to thank my research team.
54:18Who did a phenomenal job of seeing this
54:22project through in my absence during very
54:25difficult period in my time in my life?
54:28Um? And they were able to see the
54:35project through on their own.
54:38And it's just a phenomenally dedicated.
54:42Group. Um? And especially I want to thanks
54:49Cindy to coast my project director during
54:52the time who lead this effort. And Uhm.
54:59And taught my team how to. How to
55:08do this work and just did a
55:11phenomenal job of carrying it out?
55:13So I want to thank her. People.
55:20And finally I want also knowledge.
55:25Amanda Lowe, who's on our team whose offense?
55:29I really talented teacher
55:33who has taught clinicians.
55:36No deliver demaio and I learned a
55:40whole lot from Amanda about teaching.
55:45And I and I loved watching her
55:48teaching teaching with her.
55:51Um, and that was a phenomenal experience.
55:56Nothing.
55:57So I just want to thank you all for your
56:04support for what I've learned from you.
56:08It's nice to. It's nice to see you
56:13on the screen and I look forward to.
56:17Having a backyard.
56:20Barbecue or something?
56:23And and to see you in person.
56:25And just want to acknowledge
56:28your support to thank you.
56:32So.
56:36This cat.
56:41So Tom. So that concludes
56:47our formal program. We have
56:49agreed that if people want
56:51to stay on the call for a few
56:55minutes and say hello to Nancy,
56:57people are more than willing to do that.
57:00I mean, more than welcome to
57:03do that, I'm sorry.
57:04Chris and I will try to moderate it.
57:08But people can just.
57:10If they want to stay open their
57:13Mike and say a few words.
57:15Believe Nancies Michael Friend.
57:17People who one of these are
57:19also free to go at this point.
57:22And again,
57:23I'd like to thank everybody for
57:25chipping in making this possible.
57:35Hi, this is Stephanie Nancy. Um I just
57:39want to say it's been such a pleasure
57:42to work with you over the years and
57:45I hope that you see all the great
57:48comments and congratulations and
57:50words of appreciation that are
57:53in the chat function today.
57:55And I've asked Chris to see if
57:57he can't capture that for you,
57:59so you could have it in
58:01case you haven't read them.
58:02Also, thank you so much.
58:04I really enjoyed the
58:05time I've spent with you
58:06and following your important
58:07work. Thank you Stephanie.
58:10Hello Nancy, wonderful to see
58:14you here today and wonderful
58:19to hear Linda's great auk tums
58:23telling us about your history and,
58:27um, I'm so pleased to have known
58:33you through this whole time.
58:37Doing your research and hearing
58:38about it over the years and it's
58:40wonderful to have this celebration
58:42of your so I'm so glad to be able to
58:44be here and see your friends from
58:46around the world here with us too.
58:48I'm finally glad to meet you.
58:50All of you. Yes, I'm from me.
58:55Nancy high acid speaking.
58:58Hi I just want to let you know that
59:02you work continues here we are.
59:05As you know going forward with it,
59:08expanding it and thank you for for
59:11opening our eyes to this way of
59:14working an for your very very special.
59:17Human. Humanity. You're mentally cut.
59:24Thank
59:24you and we will continue absolutely. I'm
59:29looking forward to that.
59:31But for people who don't know her ass
59:33trick logged in from South Africa.
59:38I
59:46still.
59:55Nephew This whole meeting has
59:59been about nances professional
01:00:01accomplishments,
01:00:01but I just saved my person perspective.
01:00:04Well, I guess one going way back
01:00:08just growing up with an Ant.
01:00:10Tuned in and Smart and interesting.
01:00:13His name was. Amazing,
01:00:15but now that I have known,
01:00:18I benefited much from emissions.
01:00:21Nancy about child development
01:00:23and all of their milestones I've
01:00:26learned so much understood,
01:00:28so much from her expertise on that.
01:00:32Now, just as anything,
01:00:34I have also seen my kids rapper up in
01:00:37blankets and pretentious rito. Experience.
01:00:44Well, I guess first but also just to
01:00:48understand more of her academic work
01:00:51and how these theories relate to my life
01:00:54and my children and our family is a.
01:00:57It is a wonderful thing to
01:00:59have. And she must
01:01:02have had such a. Her strong
01:01:06sense of understanding, um,
01:01:09reward and behaviour an and with
01:01:11you for children at any age
01:01:14must have strongly played in their
01:01:16decision to take two adolescents for a
01:01:20three day backpacking trip up
01:01:22Mount Washington.
01:01:23When we were what,
01:01:2513 or 16 and 14 at a certain,
01:01:28that was just as brave,
01:01:30and in fact will is all
01:01:32the research we've done.
01:01:34We love you, Nancy.
01:01:37No, you might be fine if you wanna
01:01:42say something. We've had some great
01:01:45conversations to Leanne and Alex.
01:01:49Who are my nephew and niece about?
01:01:55Reading Children's behavior.
01:01:59Their own and. It's
01:02:02it's just been such a delight.
01:02:07Just an underlying. You wanna
01:02:10say hi, nan said Cheryl.
01:02:14Hey Hun, um I'm I'm friend and
01:02:17Anna work colleague. We've known
01:02:19each other since
01:02:20music came to New Haven
01:02:23and 1st I want to thank Tom and
01:02:26Linda and Christopher
01:02:28Planning this today. It's
01:02:29such a great opportunity for
01:02:32everyone to know your great work
01:02:34and I see and it's been really.
01:02:37This is just been a
01:02:40wonderful presentation and.
01:02:41Just wanted to say hi
01:02:43and I'll see
01:02:45you soon. Yeah, take Care Alright. Good to
01:02:49see you, yeah. Are you ready
01:02:56conversations? Support. Nancy
01:03:02I don't know if.
01:03:08Nancy Can you hear me? It's soo yes,
01:03:13OK good, I just wanted to
01:03:15say it's great to see you.
01:03:17Um I haven't seen you in too long
01:03:19since I was in London and you came
01:03:21and we went to the art Gallery so.
01:03:24I'm thrilled to see you online now.
01:03:26I don't know
01:03:26if you Remember Me,
01:03:27but I was at your wedding.
01:03:29Nancy did not each other a long
01:03:32long time, and I'm really. I didn't
01:03:35introduce Lionel to the group if
01:03:38my husband. I have taken care
01:03:41of me phenomenally. I can see
01:03:43I can see Tony in the background.
01:03:46It's good to see you too Tony.
01:03:49And I'm Yep. I'm really,
01:03:52really pleased to see you and I just
01:03:55want to say I love you and I'm really
01:03:57proud of everything you've accomplished.
01:03:59It's great. Good to see you. You
01:04:05can speak. I love you, Nancy.
01:04:08I love you too.
01:04:12Cammalleri I look,
01:04:15I look forward to seeing you.
01:04:18I miss you. I'm so scared.
01:04:25Together, we'll
01:04:26figure it out.
01:04:28Hi Nancy, it's Heather.
01:04:35Hi Heather, Hi, I want to pop in and
01:04:38say hello in this presentation of
01:04:40all your work
01:04:41was amazing to witness.
01:04:42I was aware of some of what
01:04:44you've done, but not nearly
01:04:45all the impact it had.
01:04:47And I wanted to share with you how
01:04:50much your impact has meant on me.
01:04:53I continue to have the circle
01:04:55of security graph. Somewhere
01:04:57in my new
01:04:58setup, working with mothers
01:05:00and children's all times and.
01:05:02Carrying forward your work on
01:05:05mentalizing myself with my own
01:05:08research and exploring it in.
01:05:10Organizational psych and just.
01:05:12You have inspired me immensely,
01:05:14both personally and with my own children
01:05:17and professionally in education as well.
01:05:19So thank you very much for everything.
01:05:21Invent so gracious to share with
01:05:23everyone and love you dearly,
01:05:25and I'm so grateful to see you again.
01:05:28I really missed our supervision.
01:05:32Was I meetings? Yeah.
01:05:38Hi, um Nancy. It's Sue Ann Dumb.
01:05:46I wanna let everybody know
01:05:47I don't know Nancy's Nancy.
01:05:49I know her is Suki because she was my camp
01:05:53counselor when I was 13 and she was 18.
01:05:57And. I have to say that all of the
01:06:03qualities that she's brought to
01:06:06her profession and helping people.
01:06:08She had as an 18 year old counselor Ann.
01:06:13This summer that she was my counselor was.
01:06:17I had come from a very, uh.
01:06:22Difficult family situation in that
01:06:24summer was the best of my growing
01:06:28up an it was because of Tsuki.
01:06:31And her just the beauty of her,
01:06:36um, spirit and her kindness.
01:06:40And her fun.
01:06:41Oh my gosh,
01:06:43we had so much fun and I'm just
01:06:46so honored to be apart of this to
01:06:50see the amazing work you've done.
01:06:52Like wow like it's just.
01:06:55One, it's really interesting and
01:06:58too I just I'm blown away by
01:07:01how many people you have helped.
01:07:04So anyway,
01:07:05just wanted to say I'm just really
01:07:08touched by this whole thing and I'm
01:07:12really grateful to have been part
01:07:14of it and and yes, and thank you,
01:07:17um, you've been, uh.
01:07:19Wonderful presence in my life and
01:07:22I'm so happy to have been part of
01:07:25this honor for you. Thank you Sir.
01:07:29Thank you for coming.
01:07:32I love our
01:07:34conversations. Nancy, it's Arrieta. I just
01:07:41I really miss you so much.
01:07:43It's been such a pleasure to work with you.
01:07:46I loved our Tuesday morning breakfast
01:07:48when we were able to squeeze those in.
01:07:51They were so great.
01:07:52I just made my day. They made my week.
01:07:55And I I just wanted to say
01:07:58that the thing that hasn't,
01:08:00I think been mentioned fully is
01:08:02what a beautiful writer you are.
01:08:04Um, you've made you've made such
01:08:06huge contributions, but I always
01:08:08whenever I'd read anything of yours.
01:08:10At least just so moved by
01:08:12the beauty of your writing.
01:08:14Your ability to communicate
01:08:15complicated things and clear way,
01:08:17and I would look back and say,
01:08:20OK, how did Nancy say this?
01:08:22And you know, like following,
01:08:24you know,
01:08:24just appreciating how great you
01:08:26are at organizing papers and
01:08:28makes your great communicator an.
01:08:30This has been a beautiful moving.
01:08:34Time and I send you lots of love and I'm
01:08:37just really grateful to be part of this.
01:08:39Thank you, Tom.
01:08:41Thank you Linda.
01:08:43Whoops,
01:08:43did I lose anybody somebody's
01:08:46sharing their screen anyway?
01:08:50Once again. OK. Ariana, thank you for
01:08:59coming. To see you.
01:09:02And enter everybody. Wow.
01:09:08Now from Philadelphia,
01:09:09I just wanted to know.
01:09:12Hello where are you? Oh Hawaii.
01:09:15Yeah, we're like your newest
01:09:17PM club for all on today.
01:09:20And, um, really are just so
01:09:23proud and privileged in feel.
01:09:26So grateful to carry on
01:09:28your work in Philadelphia.
01:09:30Amanda has
01:09:31been wonderful, so a shout out
01:09:34to her as well. And really was nice
01:09:37to spend some time with you here
01:09:40today so so thank you and um were
01:09:43carrying on here in your honor and
01:09:46doing the best work we can, awesome.
01:09:50Hey Nancy, it's Ashley.
01:09:52I just wanted to say hi from
01:09:55Florida so I'm just.
01:09:56Hawaii how are you? I'm
01:09:58good thanks yeah. So I just wanted
01:10:01to say thank you.
01:10:02I'm currently pursuing my pH D
01:10:04in clinical psychology at the
01:10:06University of Central Florida
01:10:08and I did not realize how lucky
01:10:10I was to work under you an have
01:10:13you is my first mentor until I
01:10:15got here and I just knew so much
01:10:18so quickly and it has just been
01:10:20such an easy experience for me
01:10:23because you taught me it already.
01:10:25So thank you so much. Ah.
01:10:30Glad to hear that it's going well for you.
01:10:34Thank you, you're lucky to have you.
01:10:37Thank you.
01:10:38I Nancy it's Amanda Zaydi.
01:10:41Uhm, I. I mean I could say so many things.
01:10:45Um, you've been such an incredibly
01:10:48important person in my life,
01:10:50but I'll keep it brief.
01:10:52I wanted to thank you for being
01:10:55such an outstanding mentor,
01:10:57learning from you and working with you.
01:11:00It didn't just change my whole career
01:11:02trajectory. It changed my life.
01:11:04I'm so grateful to you, um, you know.
01:11:07And I'm just sending you so much love.
01:11:09And I'm so thankful to be here today.
01:11:13At your hair.
01:11:19I'm doing OK. Speak.
01:11:23Hi Nancy, it's
01:11:25Jesse I did see I'm so happy to
01:11:28be here to an I I consider myself
01:11:31to be so lucky 'cause I think I'm
01:11:35one of your first meant ease maybe
01:11:38um from your first PDI training.
01:11:41And I think actually what I was
01:11:43thinking when I was looking around the
01:11:45sport is how you can see so many men,
01:11:47teas and all the lives you have touched from.
01:11:50Joanne is here and Nicole's here.
01:11:52So from your earliest trainees,
01:11:53the people who worked with you who
01:11:55now have multiple children and me like
01:11:57where the earliest kind of cohort
01:11:59Darren was here till like the more
01:12:01recent people have worked with you.
01:12:03And there's Amanda,
01:12:04the both of the Amanda's and all
01:12:06of those people.
01:12:07And Lily, I don't know if Lily
01:12:09still here and just like so.
01:12:11It's like this army of people that
01:12:13you've created who have, like,
01:12:15you know, gone all over the world.
01:12:17Now an are going to be your
01:12:19people and the coolest thing.
01:12:21I think the sign of the really great
01:12:23mentors are the people who have
01:12:25influenced all these people who have
01:12:27done that in this way that they just
01:12:30want to go out and spread their work.
01:12:32and I think you really created that.
01:12:34I mean, there's so many of us,
01:12:36Maggie even my students like there are
01:12:39four of my students who have attended today.
01:12:41Because they've been so
01:12:42inspired by your work as well.
01:12:44So thank you for all of that.
01:12:49When I say something. Hi Nancy,
01:12:53it's Ruth. I just wanted to
01:12:56say um quickly that it's wonderful to be here
01:13:00with you today. I miss you.
01:13:03I miss our conversations and
01:13:05I just feel like.
01:13:08The things that people
01:13:10have talked about I share tremendously,
01:13:12but I think another wonderful thing about you
01:13:14and a little bit about what Jesse
01:13:17said is how you bring people together
01:13:19and you've connected me with so many
01:13:22different people and sort of elaborated
01:13:24my relationships with them from people
01:13:26in Finland to people in South Africa.
01:13:28For people you know all over
01:13:30the United States.
01:13:31So I just I adore you and your work
01:13:34and I just wanted to appreciate
01:13:37your friendship as well so.
01:13:38Thank you so much, thank you.
01:13:41It's good to see you.
01:13:44I can. I
01:13:46was just about to Unclick.
01:13:48It was perfect timing.
01:13:49It's so wonderful to get a sense of
01:13:52what a beautiful career you had in here.
01:13:55So many fabulous testimony.
01:13:56It's just glorious.
01:13:58It's also was like, Oh my God,
01:14:00that's Alex and Julian.
01:14:02They're all good.
01:14:03Amazing and I also wanted to
01:14:05just just to say hi to Tony and
01:14:08linen and Sarah Harrison too.
01:14:10And also that I'd have a Lake as the
01:14:13background, 'cause it seems like
01:14:15I know it looks beautiful.
01:14:17Algonquin Park. Ha.
01:14:20It was also
01:14:21cool to hear about your camper.
01:14:23I know you are. I didn't know you
01:14:25were camp counselor were Sookie.
01:14:27Sookie had a summer camp so
01:14:29that was a little a little.
01:14:31Piece of your past I didn't know.
01:14:35The woman who knew you from your camp,
01:14:37whatever camp that what camp was it?
01:14:39Oh I incarnation.
01:14:43The impetus companion
01:14:47camp. It's just down the
01:14:51road. Well, Yeah. Sending with his ear.
01:14:57What a great zoom meeting.
01:15:08Hello. Hi hi
01:15:11Nancy is lovely to see you.
01:15:14Um, I'm Cindy. I've been Nancy's
01:15:17project director for 15 years.
01:15:20I just want to say it's been such
01:15:23a privilege and honor to work with
01:15:27you and work alongside of you.
01:15:30You taught me so much.
01:15:32I'm I'll be forever grateful
01:15:35for all that you've taught me,
01:15:38both, as as a colleague and also.
01:15:41As a parent and I've learned so
01:15:46much personally from you as well.
01:15:50I have such fun
01:15:52memories of our various trips
01:15:54around the world. Places
01:15:57that we've been together,
01:15:59and adventures that we've gone
01:16:01on together and both work adventures an an
01:16:05outside of work adventures, so I hold those
01:16:09memories very close at my
01:16:11heart and I just want to thank
01:16:15you for everything that you've done.
01:16:18Everything that you've taught for
01:16:20me taught me and all the people that
01:16:24I've had the wonderful opportunity to.
01:16:27Learn from end to grow and
01:16:30to get to know and I just.
01:16:33So uhm, touch to see the turn
01:16:37out today and all that and it's
01:16:40just lovely to see people who've
01:16:42worked with us over the years and.
01:16:46I've been smiling through about as I've
01:16:49seen people talk Papa and so just thank you.
01:16:54Hold up.
01:16:55Wonderful wonderful colleagues.
01:16:58And for being the leader for us in that.
01:17:04It's
01:17:05been such a pleasure. Very sad is fine.
01:17:12Hi Nancy, it's Amanda level.
01:17:15Amanda, can you hear me?
01:17:18But yes I can. Looking for you.
01:17:23Hey say thank you too.
01:17:25It's been such an honor.
01:17:27I really came to yell with
01:17:29the intention of working with
01:17:31you and I am so grateful that
01:17:34we were able to connect and
01:17:36I learned so much from you.
01:17:38It's been an honor.
01:17:42Well, Amanda, I have learned. I
01:17:46know I told you this. I've learned
01:17:51so much from you because you're such
01:17:54an exceptional teacher.
01:17:56So I've learned a lot from
01:17:58you about how to teach.
01:18:01And it's been, uh. Just such a.
01:18:06A treat working alongside you.
01:18:10Supervising and training.
01:18:13Um? Yeah. It would seem.
01:18:18The pleasure
01:18:18has been all mine. All right?
01:18:26Well Nancy's just gonna say hello and
01:18:29then um it's a great pleasure that I
01:18:33got today. Your previous life
01:18:35as a Canadian outward bound
01:18:37instructor or outstanding as well.
01:18:39So very grateful to be able
01:18:42to join all of you today so.
01:18:45Congratulations on your
01:18:47incredible work over. Area.
01:18:52Amazing period of time in
01:18:57your professional career,
01:18:59so it just is Sarah. Looking
01:19:04forward to keeping in touch. Yeah.
01:19:07I give up. I can't do it OK. Nancy is.
01:19:15Nothing it's Monica Ordway. Was gonna
01:19:18say thank you for so much for my
01:19:21experience with you. During my postdoc.
01:19:24An your inspiration that you gave me
01:19:26around and implementation science,
01:19:28and I felt so privileged
01:19:30to be part of that time.
01:19:33When you were exploring that
01:19:35an learning that I still apply.
01:19:38Now to my own work and your introduction,
01:19:41yours and Toms to community based
01:19:43work and committee engaged work.
01:19:46That is something I always like so
01:19:49many stories in conversations from
01:19:51those meetings sitting around with the
01:19:55clinicians in the West Haven Clinic and.
01:19:58I think the only way to
01:20:01sort of really for me to
01:20:03make this work applicable is
01:20:05to involve the community and
01:20:07think Thoughtfully about
01:20:09implementation science an and
01:20:10you're so careful in your thoughts.
01:20:12So careful in your thinking.
01:20:14Sitting on that couch for many years,
01:20:17years of postdoc.
01:20:18Just sort of talking and I
01:20:21could see you sort of being
01:20:23so thoughtful and always had.
01:20:25This way you have this way of thinking and.
01:20:29That I just wanted to kind of get in
01:20:31that head instead of like what was, you
01:20:34know, how are you putting that
01:20:36altogether? Uhm, so just wanted to
01:20:37say thank you for that and you.
01:20:42Ansi, it's Lillie from
01:20:44Springfield, MA and just wanted to echo
01:20:47so much of what's been said already.
01:20:49But um, it's been such a joy to get to
01:20:53know you in your work and to think about
01:20:56how to bring all that you've done to this
01:21:00to the setting up in Massachusetts in
01:21:03our partners have been overjoyed to have
01:21:05the opportunity to collaborate with you,
01:21:08and as Amanda Zaidi said,
01:21:10it has been life changing for sure.
01:21:12and I joke that.
01:21:14I met many of the people.
01:21:16Some of the people on this on this
01:21:18call through through the connections
01:21:19that you help us make and just a
01:21:21joke that every time I meet someone
01:21:23new that was connected to you,
01:21:25we just I just love them instantly.
01:21:27I'm certain that that's,
01:21:28uh, you know,
01:21:29speaks to the wonderful people
01:21:31that you bring together.
01:21:33So thanks for doing that again today.
01:21:36Such a pleasure.
01:21:38I love hearing
01:21:39about how things are going
01:21:41and hearing from you.
01:21:43Congratulations and just sounds.
01:21:45Phenomenal that you and Ann
01:21:47Amanda had been doing so.
01:21:49Without citing to Maine,
01:21:51yes, well will continue to bring you the
01:21:55stories from West Wonderful. But I.
01:22:02Hi Nancy, can can you hear me?
01:22:06Hi, this is Nicole Castiglioni.
01:22:10Great to see you in Spanish.
01:22:13I have no idea somewhere. I am not
01:22:18going to bring my goodness Hawaii, Hawaii.
01:22:21It is so so great to see
01:22:24you Anne everyone else.
01:22:26It's in a lot of years and I could
01:22:30not even begin to put into words how
01:22:33much I value the work we had together.
01:22:37Even past all these years I carry it with me.
01:22:41Anyways, personally with my own children,
01:22:44my work, and besides,
01:22:46you're incredibly brilliant.
01:22:48Mind that we all very much, no, you have.
01:22:52The things that I've always carried
01:22:54the most of me is your love,
01:22:57your compassion and the fun.
01:22:59That was like the first thing I
01:23:01learned how important it was to
01:23:03have fun and to care deeply from our
01:23:06heart and just please know that.
01:23:08I mean, that's not something
01:23:10that just anyone can teach.
01:23:12Just know that our work has just been
01:23:14with me every day and Cindy, Jesse,
01:23:16Joanne, everybody that I'm seeing,
01:23:18Linda Tom.
01:23:18It's when I saw the email about
01:23:20this meeting to say I was honored
01:23:22is an understatement.
01:23:23I'm just so grateful to be here today.
01:23:26So thank you.
01:23:27Thank you from the bottom of
01:23:29my heart. So
01:23:31good to see you, I've thought
01:23:33of you over the years, wondered
01:23:36how you doing. So great to see you.
01:23:42Ah.
01:23:49Incredible
01:24:00see everybody.
01:24:09So what do we do now, Tom? I
01:24:17mean, I could keep talking if we want.
01:24:20Can I just add something since
01:24:22we do have this moment of pause,
01:24:24I think one thing that also stands
01:24:26out with me is also whatever so many
01:24:29other people are saying is just how
01:24:32many peoples lives he's touched.
01:24:33I mean back when we were working
01:24:36together I just remember being in the
01:24:38clinics and just the the amount of
01:24:41mothers and children live that you've.
01:24:43Help to change is just I don't think
01:24:46any of us could even put into numbers
01:24:49and to see the turn out today and
01:24:52just so how far your work has spread
01:24:54since since I was even a part of it.
01:24:58I mean it's it's incredible,
01:24:59you're incredible and the work
01:25:01that you have done is incredible.
01:25:03An you've just changed lives all
01:25:05over the world literally so.
01:25:07This is wonderful to be here to
01:25:09celebrate that with you guys.
01:25:12I want to add to that as somebody
01:25:15who literally knew nothing about
01:25:17Nancy's career until today because
01:25:19I'm an old friend of Nancy Nancy,
01:25:22it is really dazzling to be part of this.
01:25:25I hope you all is how extraordinary is
01:25:28cousin outside or my perspective is wow,
01:25:31what an impact. It's lovely to see.
01:25:34And you can. Yes, I want to speak
01:25:39up as your Big Brother.
01:25:43Say how much I look up to you.
01:25:47You've done such amazing work and to see
01:25:50you and your colleagues and the kind of
01:25:53professional family that you've created.
01:25:55And the and the impact that you
01:25:58fed mean in some ways I knew it,
01:26:00but it's coming home in a much bigger way.
01:26:04It's just just extraordinary to.
01:26:05So thanks to everybody who joined this,
01:26:08and especially thanks to Tom.
01:26:10Beautiful acknowledgement of
01:26:11Nancy's career and funny and
01:26:13Linda for an incredibly clear.
01:26:16Overview of what was going on.
01:26:18That helped us really appreciate.
01:26:20This is Stephanie and the other should help.
01:26:23First, we were just all so grateful. So
01:26:26I'm glad you mentioned that it was funny.
01:26:28It's very difficult to speak when you
01:26:30can't see people and you can't hear
01:26:32anything and it really wasn't clear to me.
01:26:34I had some help with the editing,
01:26:36but it really wasn't clear to me if
01:26:38people were getting some of the I told
01:26:41Nancy we're going to have some fun.
01:26:43But it wasn't clear to me if people got
01:26:45it because you can't see anybody in.
01:26:47You can't hear anything except
01:26:48your own voice in your earphones.
01:26:50I'm so it's refreshing to know
01:26:52that at least some of the comedy
01:26:55made sense to people. There
01:26:56is great. It would be what we
01:26:59were laughing out there. Thank
01:27:01you. All to see to see her all of
01:27:04Nancy's pictures there all the years.
01:27:07Oh my goodness, that was such a tree.
01:27:10And so I had a lot of fun watching that.
01:27:13I thought it was so cool to see
01:27:15Nancy as kind of a brand new
01:27:17professional posing in all of her
01:27:20wonderful things around the world.
01:27:22That was really cool to see, so that was
01:27:25it. What was the story with the hat,
01:27:28though in the middle of the
01:27:31summer in Finland? You
01:27:32had all those, but she won the
01:27:35black phone. Yeah, I haven't.
01:27:37Cindy, I have no memory of that
01:27:40had none except that it might
01:27:43have been when I was in Lapland.
01:27:46I don't know we. We
01:27:50were We were at American Nancy
01:27:52in Helsinki and we were walking around
01:27:55together and you put one of the hats
01:27:59on and I put that smoking and we have
01:28:02both in one. Uh, it
01:28:05was just I think you put yours
01:28:07on 1st and then
01:28:08you said, Cindy, I think you need
01:28:11one too. I love that picture.
01:28:13I remember that picture.
01:28:15I remember that picture an
01:28:17I remember the big matching
01:28:19gloves think I still have sex?
01:28:22Yes, that was a wonderful picture
01:28:25to see. Oh Was it down the
01:28:29street market? Uhm, yeah. Right
01:28:32in Helsinki right along
01:28:34the waterfront. Oh my.
01:28:42I can think of
01:28:44a few more pictures. When we went horseback
01:28:46riding. Anyway. Well, we have a few more
01:28:53minutes if anybody else has
01:28:55anything they'd like to say.
01:29:04Well, I mean
01:29:06extra Mama, former classmate of
01:29:08Nancies from Cornell
01:29:09University. And it's really wonderful
01:29:11to understand, uh, you know.
01:29:13Her entire VK and how her her academic
01:29:16career developed and to understand
01:29:18the significance of the research.
01:29:20I don't think I really had a really
01:29:24strong understanding of that until now.
01:29:26So thank everybody for pulling
01:29:28Mr gathering when preparing that
01:29:30presentation that was so enlightening.
01:29:35Who's speaking? Dean, extra.
01:29:41Oh dear, I got it. Entrican
01:29:49Nice.
01:29:52OK, well we're about out
01:29:53of time I want to thank
01:29:55everybody for joining us.
01:29:57There's been a wonderful
01:29:58celebration of Nancy's career.
01:29:59Ann Nancy. I'll call you next week.
01:30:03Alright, let's say 2:00 o'clock.
01:30:07OK. Thank you again everyone.
01:30:10I think at this point we're going to
01:30:13have to close the meeting, but thank
01:30:16you everyone again for
01:30:18and Amanda were meeting
01:30:19on the 17th
01:30:21so much, alright? Call
01:30:24Bye bye. Hi Nancy. By Nancy. No by everyone.