PACT, Horses, Babies, and the Madigan Squeeze

Catherine Seidel, LMFT
PACT Level 3 Therapist

I recently attended a daylong symposium at the UC Davis Vet School on the essentials of equine medicine. Among various topics, the most compelling to me as a horse person and a psychotherapist interested in the neurobiology of attachment was a lecture and demonstration of a technique called The Madigan Squeeze. 

Because the heart and soul of PACT is about secure attachment, and we know that adult attachment styles stem first from early attachment relationships, I am interested in all relevant learning about the mechanism of attachment from the behavioral to the biological levels, even looking for clues across species.

In the process of studying foals, UC Davis veterinarian Dr. John Madigan made several surprise discoveries that relate to our work as PACT therapists. In utero, foals are essentially asleep for 11 months as a result of neurosteroids they secrete that activate the GABA receptors in the brain, creating a calming effect: foals are essentially on valium for their 11-month gestation. This way they do not harm the mother’s uterus with their sharp hooves. As Dr. Madigan said, “Foals do not gallop in the womb!” 

Blocked Receptors

During the foal’s birth process, this sleeping chemistry is switched off, the GABA receptors are blocked, and the brain chemistry for wakefulness and attachment behavior — such as following mom and nursing — is switched on. However, in 1-2 percent of foals something goes wrong with this process at birth, and these “dummy foals,” as the equine field labels them, fail to stand or to follow their mother and nurse. This condition was previously called “maladjusted foal syndrome.”

In his talk, Dr. Madigan said these foals sometimes are found upside down in the corner feeder. Something is clearly wrong. The cause of this dummy foal problem has confounded veterinarians for a hundred years.

In their research, Dr. Madigan and UC Davis veterinarians discovered that the dummy foals still had high levels of the sleepy neurosteroids secreted in the womb. For some reason they had not made the necessary chemical transition. Upon closer case-study examination, they found that a high percentage of these foals were either born quickly, often assisted by well-meaning veterinarians, or delivered by C-section. 

Neurosteroid Levels

In order to facilitate one of the researchers in taking brainwave measurements on a dummy foal, a veterinarian on the UC Davis team needed the foal to be kept still for 20 minutes. A rope fashioned into a thoracic harness around the foal’s body was employed to gently induce tonic immobility, allowing the measurements to be taken. After squeezing the dummy foal in its sleeping position for 20 minutes, the rope was released. To the researchers’ great surprise, the foal popped up, looked for mom, and began to nurse and swallow shortly after the rope was released. The foal’s vitals and lab results were completely restored to normal! 

Upon further investigation this procedure was shown to be repeatable, with the same positive results. The team of veterinarians discovered they could lower the neurosteroid levels and flip the on-switch in a majority of dummy foals by squeezing the foals in this manner. They postulated that this procedure mimicked the 20-minute phase of stage 2 labor and served as a repeat performance of the birth canal.

Restored Behaviors

So, what does this have to do with PACT therapy? At its core, PACT therapy reboots the human attachment system, which has adapted to the life experiences of the individual. In PACT therapy we understand these adaptations as an accommodation to a person’s early experience with caregiving quality: the caregiver’s reliability, sensitivity, and attunement or lack thereof. Insecure or disorganized attachment strategies are both predicted and understood as the child’s attempt to manage his or her dysregulation, given the resources or limitations of the caregiver. These insecure attachment strategies often begin in infancy, becoming needed psychological defenses in family systems, sometimes adapting to further traumas or other misattuned relationships. 

Similar to the foals, some human attachment problems may begin before birth or during birthing. In his 2021 article in Frontiers in Psychology titled “The Interpersonal Neurobiology of Intersubjectivity,” Dr. Allan Schore explores how early experiences, including prenatal and birth-related events, impact attachment and emotional regulation. Dr. Schore’s work on the neurobiology of attachment particularly outlines how right-brain processes in infancy are influenced by early experiences, including those that occur before and during birth.

Many people in the US are not securely attached and may not know they are not functioning at full capacity. Our aim as PACT therapists with insecurely attached clients is the same as the UC Davis veterinarians with dummy foals: to restore healthy attachment behaviors. The task is both behavioral and biological. 

In PACT therapy we can work on this from the top down, i.e., by teaching couples the principles of secure attachment, or from the bottom up, i.e., by modeling and inserting secure-functioning skills and behaviors (words, gestures, tone, timing) into a couple in motion. We can access the attachment system by initiating secure-functioning behavior.

As PACT therapists, we serve as surrogates, bringing secure-attachment behaviors into the room with our attention, attunement, and skills. This work ultimately has a neurochemical component: a couple that is securely attached enjoys the ability to both calm and engage each other and achieves a sense of safety and security that aids their cognitive and nervous systems. 

Security, Safety, Trust Rebooted 

Through the PACT approach, we assist couples to wake up and reset their relationships and move toward security, safety, trust, and aliveness. Unlike the veterinary procedure that takes 20 minutes and a piece of rope, building a secure-functioning relationship between adult humans is a long process. As therapists, we work to create the safety and skills that couples need to move in that direction. 

Likening the Madigan Squeeze to a maternal embrace in humans, the UC Davis veterinary team was curious to see if human babies exhibited similar neurosteroid patterns as our equine counterparts. They did further work with the Lucille Packard Children’s Hospital at Stanford in 2015-16 and found similarities between horse babies and human babies in terms of their neurosteroid processes. 

Similar to foals, they found that human babies benefit from the snug swaddling practices as well as skin-to-skin contact termed “kangaroo care,” now widely practiced with human newborns. In their paper, “Skin-to-skin contact after birth and the natural course of neurosteroid levels in healthy term newborns,” researchers KR McCallie, NW Gaikwad, ME Castillo Cuadrado, M Aleman, JE Madigan, DK Stevenson, and VK Bhutani state, 

“In particular, in preterm, very low birth weight infants, skin to skin appears to improve neurodevelopment outcomes, including accelerated neurophysiologal brain maturation and improved emotional and cognitive regulatory capacity in infancy. However, there is a paucity of data on the biological mechanism of skin to skin on neurodevelopment outcome.” 

In addition, these researchers found 

“…there was a significant decline in steroid level from birth to 2 days for all nine of the neurosteroids assayed. The change in steroid level over the first 2 days was affected by delivery mode for the neurosteroids progesterone, epipregnanolone, and pregnanalone-sulfate, in which the decline was significantly more in vaginal deliveries than in C-section deliveries. A trend was also seen toward a larger decline in neurosteroid level in vaginal deliveries for DHEAS and pregnenolone-sulfate. Duration of skin to skin had a significant effect on the change in pregnanolone for all deliveries and in progesterone for vaginal deliveries, with a trend toward a larger decline in neurosteroid levels with more exposure to skin to skin.” 

In other words, the babies who had been squeezed by the birth canal were in better shape in terms of their neurosteroid levels than the C-section babies. And skin-to-skin contact was good for all babies.

Given their findings in foals, the UC Davis team expected that exposure to skin to skin would have even more impact on babies born by C-section than those born vaginally, given that they “did not receive as much ‘squeeze’ or ‘conditioning’ during the birthing process.” They assumed that studying healthy newborns might not be “the correct analog to the neurologically abnormal foals who respond to the squeeze technique.” 

Co-Regulation Skills

While not proven, they hypothesized that skin to skin may have a more impactful effect on newborns with impairment or illness. Further, Dr. Madigan stated that they were not sure how much the effect of the lowered neurosteroid processes were a result of the duration of labor itself or by the actual compression of the birth canal or both. 

Early support for mother and baby attachment translates to greater security over time and could mean less need for PACT therapy later on. In PACT work, we intervene much later, with the same goal of supporting secure attachment between adult partners. While we do not employ squeeze techniques in PACT, we do have ways to initiate a certain kind of kangaroo care with our couples. Specifically, PACT strategies teach couples co-regulation skills, thus lowering stress arousal and increasing oxytocin, the body’s bonding chemical. 

We put people in close contact, in face-to-face and eye-to-eye positions, and they learn to use supportive contact and touch to nurture and regulate each other. The intervention we call Lover’s Pose could be seen as an adult version of kangaroo care, with its trancelike induction of care, sensitivity, and bonding. We have many methods to help couples to bond, often by working with face to face, disengaging the fight/flight response, and increasing connection through the social engagement system.

There remains much to learn about how these interventions work to stimulate both neurochemical change and behavioral change in attachment systems across species. With PACT practices, we put couples in psychological and physical positions that allow them a corrective experience. We work to overcome the imprint of the suboptimal early experiences that live in the procedural memory; to flip the switches that initiate a psychobiological experience of security. By repeating or reinforcing positive early bonding processes that were possibly skipped or insufficient, both humans and horses appear to benefit from a second chance. 

References

McCallie, K. R., Gaikwad, N.W., Castillo Cuadrado, M.E., et al. (2017). Skin-to-skin contact after birth and the natural course of neurosteroid levels in healthy term newborns. Journal of Perinatology, 37(5), 591–595. https://doi.org/10.1038/jp.2016.268

Schore, Allan. (2021). The interpersonal neurobiology of intersubjectivity. Frontiers in Psychology Vol 12. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.648616/full

Trevarthen, C., and Aitken, K. J. (2001). Infant intersubjectivity: research, theory, and practice. J. Child Psychol. Psychiatry 42, 3–48. PubMed Abstract