1. Allostatic Load
Laurel Mellin, PhD
Associate Clinical Professor of Family and Community Medicine, UCSF

2. Stress
Dominant Area
1
2
3
4
5
Mitrovic, I., Fish, L., Frassetto, L., Mellin, L. Re wiring the Stress
Health Care Hypothesis 2011.
Response: A New Paradigm in

3. Emotional Brain States
Homeostatic
Behavioral Physiologic
1
Abstract
Joyous
Intimate
Optimal
Regulation
2
Concrete
Balanced
Companionable Healthy
Regulation
3
Rigid
Mixed
Social
Regulation
Allostatic
State Cognitive Emotional Relational
4
Reactive
Unbalanced Needy/Distant
Unhealthy
Dysregulation
5
Irrational
Extreme
Addictive
Dysregulation
Merged/
Moderate
Disengaged
Mitrovic, I., Fish, L., Frassetto, L., Mellin, L. Re wiring the Stress
Hypothesis 2011.
Response: A New Paradigm in Health Care

4. Repeated episodes of allostasis
increase allostatic load
McEwen, B. S. Protective and Damaging Effects of Stress Mediators.
New England Journal of Medicine. 338: 171-179, 1998.

5. Allostatic load represents an insult
(stressor) in its own right.
McEwen, B. S. Protective and Damaging Effects of Stress Mediators.
New England Journal of Medicine. 338: 171-179, 1998.

6. Brain Set Point Declines
Koob, G. Alcoholism: Allostasis and Beyond. Alcoholism: Clinical & Experimental Research.
Vol 27, No 2 (2003): 232-243.

7. Brain adopts an allostatic state:
fixed state of stress.
McEwen, B. S. Protective and Damaging Effects of Stress Mediators.
New England Journal of Medicine. 338: 171-179, 1998.

8. Brain Set Point
• Homeostatic State or Allostatic State?
• Brain State # What is mode?
• Set Point & Intervention Planning Concepts
1 – 3 Vagal brake engaged, PFC on line
Self-study programs/short-term training
Primary reliance on endogenous chemicals
4
Vagal brake disengaged, PFC on line with co-regulation
Group training and support/long-term training
primary reliance on endogenous chemicals
5
Vagal brake disengaged, PFC on line with dyadic
co-regulation and use of exogenous chemicals,
procedures and devices. Individual training until
set point at Brain State 4.