Oxytocin and Mental Health | How it impacts mood, thinking and behavior

I'd like to welcome everybody today's presentation on oxytocin and mental health. I am your host, Dr. Donnelly Snipes. I would like to mention that the next two months of webinars have also been sponsored in part by BetterHelp. Oops. In this presentation, we're going to learn about the functions of oxytocin, identify how oxytocin may impact mood, cognition, behavior, including addictive behaviors and social functioning. I know, I always just didn't. I never gave oxytocin enough credit. We're also going to explore current research involving the use of intranasal oxytocin for the treatment of a variety of different issues. Oxytocin can function as a stress coping molecule with protective effects, especially in the face of adversity or trauma. Now, you're going to learn in a minute that oxytocin can kind of do a Jekyll Hyde on you. So you don't want to assume it's not like getting gaba, which we know is a sedating, calming, neurochemical. Oxytocin can be a little bit more flexible. Oxytocin is also anti inflammatory, antioxidant and an immunomodulator, which is really cool. When our oxytocin levels are low, then it can contribute to increased inflammation, increased aging, and other things that are caused when we have too many free radicals. And it can also cause problems in our immune system. So oxytocin also enhances socialization, including motivation for pair bonding, sexual activity, affiliative preferences, empathy, and emotional IQ and parental behaviors. Now, they've done a lot of studies and they found that under conditions in which it is a safe, cooperative environment, oxytocin encourages bonding and encourages awareness of others emotions. So there's a lot more. And empathy, you know, it encourages all those pro social behaviors and people wanting to be together and help one another. Interestingly though, in situations in which there is perceived to be a threat, oxytocin can serve to enhance protective behaviors in the individual as well as in parents. They found that, for example, when oxytocin levels were increased in new mothers, and they did this in rats as well as humans, that it actually increased their protective aggression under conditions of stress and threat. So oxytocin is designed to help with preservation of the species. If you want to think about it that way, when things are going well, we want to form our resources, we want to unite, we want to do everything. But when there's a threat, oxytocin brings out mama bear or Papa bear. The effects of oxytocin are context dependent, again, based a lot on the current environment, whether it's safe and the person feels like it's an environment of cooperation or an environment where protection is needed. But it's also dependent on early life experiences. People who have insecure attachment or dysfunctional oxytocin syndrome systems may have difficulty with their interpersonal interactions because oxytocin may be secreted differently. If they have insecure attachment from, you know, early childhood insecure attachment, then they may be in a persistent state of stress. So when they see others that theoretically could protect them, it may actually elicit that fear. Fear response and that protective response. Oxytocin impacts dopaminergic activity, which is crucial not only for reward and motivated behavior and the expression of affiliated behaviors. So we need to have or we don't need to, but it helps a lot when oxytocin is secreted. Dopamine is also secreted. And you remember when dopamine is secreted, that encourages us to do whatever it is again, to be more focused, to be more repetitive in whatever it was. It increases the likelihood we'll do it again. It also increases, generally when dopamine is released, it increases endorphins, which provide the pleasure principle. So oxytocin and dopamine are intertwined. Now, this will be important when we get to the slide, when we start talking about addiction as well. In response to extreme stress, though, oxytocin can actually activate vasopressin receptors. And I'm gonna show you a table in just a second. But oxytocin is basically, you know, in its non threatened state. In its affiliative state, oxytocin helps calm things down, reduce inflammation, you know, improve immunity, whereas vasopressin increases blood pressure, increases aggressive behaviors, increases protection. So in response to extreme stress, or when oxytocin is administered in the context of acute significant stress, like after an acute trauma, it actually increases protective and potentially aggressive behaviors in many circumstances. Now, I will continue to say in many circumstances and a lot of the time, because sometimes some of the research has been contradictory on oxytocin. This is a very, very, very new area for clinical exploration. So we don't want to draw any hard and fast conclusions. A lot of what we're learning is wonderful to guide future research. But in terms of, you know, hard and fast rules for therapeutic treatment, like with people with depression, sometimes they respond well to SSRIs. And generally that is one of the first line treatments that a doctor will provide for somebody with depression. Well, right now, intranasal oxytocin is not a first line treatment for anything because it's still in that experimental stage, to the best of my knowledge. But it is definitely something that's on the horizon to help, for example, with treatment resistant depression and autism spectrum disorders. Individuals with low concentrations of endogenous oxytocin, which means the oxytocin that their body makes, might be more likely to experience increased vasopressin like reactions when given oxytocin. So what they've seen is people who have, you know, who don't have enough oxytocin, their oxytocin system is dysfunctional in some way. When that is increased through intranasal oxytocin, it actually triggers a stress response. And that may be the body's reacting to a sudden imbalance in neurochemicals. We don't exactly know why, but they do know that in certain people it can prompt more so stress type reactions. Another interesting little thing here, and I didn't know where to stick this tidbit. Bacterial diversity and composition in the gut uniquely influences the release of oxytocin. Now why might that be? Well, we do know that the gut microbiome changes in response to stress and communicates these changes, this stress via the vagus nerve to the brain. So when there's stress, when that HPA axis is activated, the gut microbiome changes and then it sends a message up to the brain which may say, okay, we need to alter our secretion of oxytocin. And I know this is a little blurry, just kind of bear with me. It's in the, one of the articles on your, in your classroom. But basically when we're looking at vasopressin versus oxytocin, vasopressin promotes behaviors that are more primitive and faster and development that is faster and helps people, you know, move along. Interestingly, when they've looked at premature infants, a lot of times, unless the infant was premature because of something like a car accident that was completely unexpected. But for a lot of parents like me, we knew we were probably going to have a premature infant because we started, you know, having problems early on. But when that happens, when there is something going on with the mother that is indicating that there's probably a good chance of prematurity, the rate at which the fetus develops actually increases. They actually do see increases in vasopressin, which is, which is kind of interesting. So theoretically, you know, it's kind of like turning up the. Well, maybe not Maybe it's more like moving the roast from the oven to the microwave, but, you know, I thought that was kind of interesting. Totally unrelated to oxytocin, but vasopressin is an interesting chemical itself. Oxytocin encourages more modern and slower development. It focuses more on the cognitive and the interpersonal things. And there's greater parental investment in a single offspring and fewer offspring in people and animals that have higher levels of oxytocin. Lower levels of oxytocin, not so much. I mean, you think about rabbits, for example. Rabbits usually have a lot of babies at one time and they tend them for a few weeks and then move them on their way. Whereas, you know, you see things like elephants and humans, we tend to have fewer babies and we invest more and we tend to have higher levels of oxytocin than some of those other animals in the, the animal kingdom in terms of responses to challenges and defense strategies. Vasopressin amplifies stress and fear. It mobilizes people for fight or flight, and it reduces cooperation. It's more in competition, it activates competition instead of cooperation. The oxytocin, on the other hand, when it is activating the oxytocin receptors provides stress, coping and resilience, social cooperation. It promotes cooperation and positive social behaviors. So obviously vasopressin and the vasopressin receptors are probably going to be activated when there is a threat, when the HPA axis is activated. And the oxytocin receptors are going to be activated when there is a time to bond together and work together. But there is not a threat present. Vasopressin causes anxiety. Oxytocin reduces anxiety. VASA in the, in the presence of mild stress, there is a release of vasopressin and possibly an inhibition of oxytocin. Kind of like your glutamate GABA balance that we've talked about before. When one goes up, the other probably goes down. Under extreme acute stress, both vasopressin and oxytocin are released. And that's, you know, an interesting little quirk there because, you know, vasopressin, when there's extreme acute stress makes sense that it would be released to trigger that fight or flight response to help us get out of that situation. But then why is oxytocin released? And there is some hypothesis again that the oxytocin is released in order to motivate self preservation and protection of significant others that are around. Under chronic stress, there may or may not be a continuous release of vasopressin. They're not sure but they do see that under chronic stress, there is an increased release of oxytocin among females. So what would make that happen? When we think in terms of developmentally, what would be the purpose for that? Well, the release of oxytocin prompts bonding. It prompts caring for one another. Under conditions of chronic stress, what do we see? Think back to blizzards. Think back to, you know, challenging events in our country's history. In your history, what happens under conditions of chronic stress. When my mother was ill with cancer right after the, well, not right after the tornadoes, but in the months after the tornadoes that hit Tennessee last year, we actually bonded together. In the face of chronic stress, oxytocin prompts individuals to unite in order to try to figure out how to deal with the stress, which is really cool when you think about it. The in terms of the autonomic nervous system, the vasopressin is sympathoadrenal, which means when the adrenal system is activated, the adrenaline goes up, the vasopressin goes up. And oxytocin is parasympathetic. The generally it helps with calming. Vasopressin is primarily pro inflammatory and oxytocin is primarily anti inflammatory. They're not sure if vasopressin mediates pain at all, but they have found that oxytocin is helpful in preventing or reducing pain, especially pain as it relates to inflammation. Remember, when we are stressed, that HPA axis kicks off and cortisol is released, which temporarily suppresses, suppresses inflammation, but it also suppresses serotonin. When this goes on for a long time, then the cortisol loses its ability to suppress the inflammation. So inflammation increases. It loses its ability to, you know, keep opioids at bay or to keep opioids coming because the body says, you know, I'm running out of opioids. So the person starts experiencing more pain when the system's working well. Suppressing inflammation and suppressing pain helps you get through that acute fight or flee. When the system's not working well, then, you know, we still need to repair and replace whatever's going on. And so inflammation actually does return. Oxytocin, and this may not be surprising, is stimulated by the olfactory system. In a lot of mammals, think pheromones. You know, when you smell certain smells, it can trigger oxytocin. And it's not just human pheromones. There are other smells that can trigger, trigger that bonding chemical, that awe sense. You know, sometimes when you smell baby powder, certain smells that remind you of when you had your babies. If you've had babies, it can trigger that caregiver reaction in people. And so that, that's an interesting thing to note, but pheromones themselves, we have pheromones that tell what our health is. And if you've had dogs, you probably have noticed that sometimes the animal can sense something is wrong. They can sense you're angry, they can sense you're anxious. And part of that is because of pheromones. Our smell changes when we are experiencing stress. Our smell changes when we're relaxed. So they take their cues in part by what they smell. And believe it or not, as humans, we do too. We just didn't really recognize that the olfactory system can trigger oxytocin or vasopressin release based on whether the smells trigger a stress response and if protected, others are present. So if what you're smelling makes you feel calm, you smell, you know, a smell that reminds you of your grandmother or something that's calming to you, that can trigger oxytocin release. If you smell a smell, even if it's another person, that reminds you of somebody who was adversarial in your past, or you pick up the scent, the pheromones of someone who is extremely stressed, you know how you can, you can sense it when they're stressed, sometimes even if you're not looking at them. That's, interestingly enough, your olfactory system picking up on pheromones. And some people have become acutely attuned to those pheromones because they grew up in an environment in which it wasn't safe to not be aware. There was a lot of chaos, a lot of stress. So it's interesting that certain smells, pheromones and other smells included, can trigger memories that can impact whether you feel safe and secure in the present or not. And that's one of those targets that we can work on in counseling, for example, is helping people desensitize, for example, to certain smells that may trigger unpleasant memories or stressful memories from the past. Or we can counter condition them. You know, whether it's a particular deodorant or, you know, obviously encountered oxytocin can also act on different brain regions. Remote exploration. Now, I mentioned that oxytocin is also involved in immunity. And it's not one of those super biggies in immunity like some of the other things, but it does downregulate the inflammatory response. This is important because stress increases, especially chronic stress, increases inflammation. Increased inflammation and increased stress is associated with mood disorders. And autoimmune issues. So people who have low oxytocin for one reason or another may also experience higher levels, higher levels of stress and inflammation, and increase in risk or severity of their autoimmune issues. So we do want to look at this again as a target for behavioral health treatment. When we're exploring what's going on and what may be contributing to their mood disorders, we can't ignore inflammation. Inflammation is huge. So the immune system secretes oxytocin to downregulate the inflammatory response. It interacts with those immune cytokines. Remember, there are inflammatory and anti inflammatory cytokines and it promotes the interleukin, the cytokines that are designed for anti inflammatory purposes and are neuroprotective in nature. Now, there are other ways that oxytocin works in our body. It doesn't just go around and flip all these switches all by itself. Serotonin is increased by oxytocin. And they found that serotonin and oxytocin are both required to be in balance for social reward processing. Now let's think about our clients who are clinically depressed. Even if they do have enough oxytocin, if they have insufficient serotonin, then they may have, they still have more difficulty with social interactions, with empathy, with motivation to engage with other people. They're just like, no, I can't, I can't, I can't deal. The same thing could be true for those people, however, where they may have enough serotonin, but they don't have enough oxytocin going around in their system. And we're going to talk in a few minutes. I keep jumping ahead about how oxytocin actually is associated with metabolism and feeding behaviors. So I would hypothesize and I did not find an article about this. I would love to do a study. I would hypothesize that those people who have clinical depression or generalized anxiety and tend to also overeat as one of their symptoms. They tend to eat more instead of having lack of appetite. I would hypothesize that potentially they have insufficient levels of oxytocin that may be contributing to their symptoms. Just my thought. Norepinephrine is one of our main focus chemicals. It's one of those main chemicals that's released when you're excited, when you're learning, when you're working, and when you're stressed. Oxytocin expressing neurons in the hypothalamus are stimulated by stress mediated noradrenaline release to counteract the physiological actions of stressors. So basically that is a clinical explanation that says that when that HPA axis is activated, remember it dumps glutamate to prepare us to fight or flee. But too much glutamate and too much norepinephrine can be excitotoxic. So when norepinephrine is sent out, it's almost like the buddy system and the brain also increases oxytocin release in the brain in order to potentially buffer against excitotoxicity. Thought that was kind of cool. Oxytocin generally suppresses cortisol. There are certain situations where it doesn't. It doesn't increase it, but it doesn't actually suppress it. They're not sure what is different between those situations. GABA reactions are reduced by oxytocin in the amygdala, which I thought was really interesting. And it's possible that this is only under acute stress circumstances. You would think, since oxytocin is typically an anti anxiety chemical, that it would enhance GABA reactions, especially in the amygdala, where we do a lot of fear process processing. But that's not the case. So that's an interesting little caveat to throw in there. You know, when is it that oxytocin is going to inhibit gaba? Dopamine, as we talked about earlier, is enhanced by oxytocin and the endocannabinoids. Your cbd, your THC and all the other endocannabinoids. We have those endogenous endocannabinoids in our brain. Those are recruited by oxytocin in the prefrontal cortex to reduce glutamate. So basically in the prefrontal cortex, oxytocin says, okay, we need to kind of calm things down a little bit, so, so this person can think more clearly, which is very appropriate in terms of survival of the species. We want to be able to process what's going on, so we choose make the right choice. But it is interesting that oxytocin interacts with serotonin, norepinephrine, gaba, dopamine and your endocannabinoids. And all of those chemicals are implicated at least in part, in the majority of mood and psychiatric disorders. Exogenous administration of oxytocin, which right now is usually intranasally, reduces drug seeking and self administration, tolerance and reinstatement of drug use or relapse. This is huge. This is super huge if they find it to be effective. Now let's think about why this might happen. Well, the authors of the study hypothesize that excessive dopaminergic activity that results from drug use leads to behaviors directed towards object oriented rewards. I want that rush again, I want to feel good again. So I'm going to do something that promotes that rush. And a lot of times in addiction, that's food, drugs, alcohol, sex, when oxytocin is administered, it actually kind of rewires the circuit somehow. And they hypothesize it may interfere with this biased behavior by shifting focus from object oriented rewards to social oriented rewards. Oxytocin has been shown in another study to attenuate and even inhibit the development of opioid use disorders in individuals as well. Ultimately, they hypothesize that this comes down to the fact that oxytocin increases dopamine. And when the person is not under extreme stress, when they're not feeling threatened, it can enhance the desire for pro social behavior, including bonding to those pro social peers that are available in recovery. A lot more research needs to be done, but it is certainly an interesting development as another way to stimulate that dopaminergic system. Oxytocin has also been implicated significantly in the development of autism spectrum disorders. One hypothesis is that an aberrant oxytocin system in infancy may lead to the marked deficit in language and social communication, as well as sensory, autonomic, motor, behavioral and cognitive abnormalities seen in people with autism spectrum disorders. People with ASDs typically have not only low levels of oxytocin, but they also have low levels of serotonin and vitamin D. Now why are these things important? Well, vitamin D has been associated with potentiating serotonin. Vitamin D is also associated with, or vitamin D deficiency is associated with depression. But since we need to have oxytocin and serotonin to, to create that social reward, if either one of those is absent or deficient, then it may inhibit the formation of or inhibit the rewards from interpersonal interaction. If this happens, especially in early childhood, you know, if the person never has the ability to develop a sense of reward from relationships, then it may inhibit their future reactions in social situations. Remember, the actions of oxytocin are context dependent. So if the person found initial relationships to be unpleasant, then when they are faced with other people, when they are put in the position of having to interact with others, that may be a threatening, stressful situation. So then what happens to oxytocin? It starts triggering those vasopressin receptors instead of the oxytocin receptors. That's a theory. Again, they're not 100% sure how all this works together, but it does make sense that oxytocin is in some way involved in some of the symptoms of autism spectrum disorders. Oxytocin and vitamin D are expected to be a potential therapeutic resource for the core social symptoms of autism spectrum disorders, hopefully in the near future. They didn't give any date on when that might actually happen. These articles were all written in the past three years though, so that tells me that, you know, it's still on the horizon somewhere. Decreased oxytocin levels have been linked with depression. Not just postpartum depression, but depression in general. Think about depressive symptoms, apathy, changes in eating behaviors, changes in sleeping behaviors, guilt, suicidality, lack of desire to engage with others. Now that can be explained by a lot of things, but it's impossible in some people. It could also be explained by, in part at least by low levels of oxytocin. People with decreased levels of oxytocin may have experienced insecure attachment in childhood. They may not have developed those relationships. Relationships may not be rewarding to them. So that could contribute to lower levels of oxytocin and less anxiolytic behavior from the oxytocin in adulthood. Additionally, if they go on to procreate, then they may have more difficulty bonding with their future children because of their inherent levels of low endogenous oxytocin. Oxytocin, as we said, is neuroprotective against excitotoxicity and hippocampal shrinkage, both of which are very common in PTSD and chronic stress. So we do want to note that in terms of anxiety, when the body tends to be running hot and there tends to be a lot of glutamate, either in acute situations where it's just flooded with glutamate, or in chronic situations where it's just this ongoing mild to moderate level of glutamate. Oxytocin can help protect against that hippocampal shrinkage. Exogenous oxytocin, that's little E, big ot provides restorative, neuroanatomic and psychological effects, including a reduction in PTSD symptoms, decreased limbic activation and restored responsiveness in dopaminergic reward regions. Again, this is only in people with PTSD that they are not in the acute phase. They are separated. There's distance between them chronologically since the stressor Adverse effects of intranasal oxytocin on mood include increased fear processing and reduced top down control over amygdala activation, especially after acute trauma. So again, you know, I Know, I've said it like six times, but I do think it's, you know, one of those really big take home messages that we don't want to artificially elevate oxytocin levels when a person is still in a fear state because it actually works kind of against the process. And in that fear state, the oxytocin actually tends to activate the vasopressin receptors instead. Administration of oxytocin attenuates food intake, increases fat oxidation and improves insulin, Insulin, insulin sensitivity and reduces body weight. Whoa, that's a big thing. Think about the American population. How many people have insulin resistance? How many people have, you know, that tend to carry fat in their, in their belly, tend to have problems, be pre, pre diabetic or diabetic. How many people in the United States tend to eat emotionally? They found that oxytocin actually works with ghrelin and leptin, your hunger and satiation hormones, and to minimize or to reduce appetite as well as reduce food seeking behavior and increase fat oxidation and insulin sensitivity. So that's huge, not only for people with eating disorders or mood disorders, but also for people with, who may be struggling with cardiovascular cardiometabolic disorders associated with insulin resistance and obesity. So that's huge. Oxytocin may only impact specific aspects of higher order social cognition in body dysmorphic disorder. So this was an interesting study because they obviously gave intranasal oxytocin to people who had body dysmorphic disorder and they found that it didn't increase their empathy, it didn't increase their self identification of emotions. The only thing it really did was increase their blame of others for things and reduce self blame, which I thought was a really interesting turn of events. That, and, and it also had some unwanted effects in emotional attributions. So, so that's, that's kind of an interesting study that makes you step back and think why would oxytocin increase other blame and reduce self blame in this particular population? So they didn't have any answers to that. But it is important to recognize that for example, in the future, if intranasal oxytocin were available and you were working with somebody who had depression and anxiety and comorbid body dysmorphic disorder, that oxytocin may be a sticky wicket because it can increase externalization and reduce some internalization. Endogenous oxytocin, that is the oxytocin that's made in our brains does not readily cross the blood brain barrier. Behavioral studies indicate that our circulating oxytocin levels may act on the vagus nerve. You know, the oxytocin throughout our body acts on the vagus nerve, which prompts the brain to release its own oxytocin. There were a few studies that looked at oxytocin and personality disorders. Two of the main personality disorders that were looked at were borderline personality disorder and antisocial. I did not find any on schizoid, schizotypical, schizotypal, histrionic, narcissistic, you know, the other biggies. But borderline personality disorder did come up several times. And they found that early childhood interpersonal trauma that led to ineffective or insecure attachment may contribute to enhanced defense mechanisms and avoidance behavior in the presence of oxytocin. So those people that were supposed to keep you safe, who that didn't end up keeping you safe, it set up this dynamic where when your body says, releases oxytocin and says, hey, this is a caregiver, Vasopressin receptors are actually activated because the brain also knows that, well, they're supposed to be a caregiver, but they're also dangerous at the same time. So it creates this conflict in the person's brain. In antisocial personality disorder, when they administered intranasal oxytocin, they found in some of the respondents, behavior became a little bit more empathetic. There was a little bit of an improved emotional iq. But in other respondents, it actually increased aggression. Again, we probably want to go back and look at which would want to go back and look at which receptors are being triggered and what historical events are similar to the people who, for whom it triggered the vasopressin receptors and the and the aggression versus the people for whom it triggered a calming response. So we do want to understand how the brain has ultimately conditioned itself to respond to the releases of oxytocin. Over 10,000 people come to BetterHelp every day looking for a counselor. BetterHelp makes it easy for you to move your practice online and focus on what you love Most, helping others. BetterHelp's easy to use platform takes care of referrals and billing and provides a secured platform to communicate with your clients. Join more than 18,000 therapists at BetterHelp, helping to improve people's mental health and lives. The exploration of the impact of oxytocin on the mind and body has only just begun. Oxytocin can promote both pro social, affiliative as well as protective and aggressive behaviors depending on the situation. You know, the most common example is that oxytocin promotes cooperation and caretaking and all that kind of stuff. But in the presence of a threat, especially a threat to self or children, it promotes that mama bear, papa bear, you know, really aggressive defensive reaction. Oxytocin release is based on prior learning and current contextual cues, including cues from the olfactory system based on pheromones, but also based on just smells that trigger prior memories schema that we have. You know, there's a lot of contextual cues that can let the person know whether they're in a cooperative or competitive situation. In the presence of a threat and a need to protect. Oxytocin can and often does activate those vasopressin receptors which promote the fight or flight response. Oxytocin, however, can promote fear processing and aggression when the person does not feel safe and especially in the aftermath of an acute stressor. So that was a lot of information about oxytocin and the fact that we really just don't understand exactly how this hormone behaves in any individual. We can't look at somebody and take a list of symptoms and go, you're low on high oxytocin. They haven't done any studies that have looked at people who have exceptionally high levels of endogenous oxytocin. I don't know if it's even possible to measure it, but that was one thing I did not find in the, in the research. But it is certainly interesting to start recognizing the interrelationship between our perceived sense of safety, between our context, our hormonal reactions to that context, and how it impacts neurotransmitters and vice versa. In response to your question, Pat, I am really not sure how other drugs would impact oxytocin. I didn't look for, for any research in terms of the impact of. The impact of statins or something on, on oxytocin release. But. It's certainly interesting to think about. Anything that's going to alter serotonin or dopamine levels or norepinephrine levels may impact the levels of oxytocin in terms of getting a level of oxytocin. Just like your other neurotransmitters, they can do a blood test and tell you what your circulating levels are. However, that does not tell you what your brain levels are. You have serotonin receptors, norepinephrine receptors, et cetera, throughout your entire body. And so there's a certain level that's in your blood, that's circulating in your body, but how much of it is actually activating the receptors in your brain and in your nervous system. As of yet, there is no easy way for medical personnel to assess that. Now there are some, there is some technology that they're experimenting with, but it is still way out in the future. And even when it is released, it's going to be kind of on par with an MRI where it's going to be expensive to do. Would I say that cognitive perception is primary to oxytocin release? And that's a hard question because I think my first thought is, I'm thinking back to infants and infants and caregivers have that initial oxytocin release and the infant isn't cognitively processing the way I define it, what's going on. It is a very primitive interaction, which is one of the reasons when children are in the nicu. But even for, you know, term infants being held and for children in the nicu, kangaroo care, skin to skin contact is so incredibly helpful to neurological development because when they are skin to skin it promotes the release of oxytocin. Remember, oxytocin is a buffer against glutamate and excitotoxicity. Being in the NICU stressful, whether you're a parent or you're an infant, all those noises and just being out of the womb before you're supposed to. There's a lot of stressors, physical and sensory, that happen to children in the nicu. So that skin to skin contact may promote oxytocin release which can serve as a buffer against some of those stressors. If you work with parents that have children in the NICU or children period. You know, I'm a, I'm a strong proponent of kangaroo care, which is skin to skin contact between the caregiver and the child. But they have done extensive research on kangaroo care with NICU children pre premature as well as term children that have to be in the neonatal intensive care unit for some other reason. But it is so important that they do get that contact on a regular basis. That's another reason that having cuddlers come into the NICU can also be helpful if for babies whose caregivers don't come to visit them and obviously releases are signed and everything else. Obviously cuddlers are not doing skin to skin contact with the infant because it's, you know, not family. But just having, being touched, being held by a human can be very calming to that infant. They've also found. I know I'm going off on a tangent here, but we got finished a little early, that weighted blankets and weighted vests stimulate the release of oxytocin. Regardless of your age, obviously you're not going to use a weighted blanket on an infant. That's not what I'm saying. But if you have had children, you know that swaddling them, or what we used to call making a little burrito baby, swaddling them so their arms are sort of pinned down because, remember, as infants, they don't have control of their limbs quite yet anyway, that provides a sense of safety and security and actually does promote the release of oxytocin. And then obviously, when they get older, toddlers, adults, those weighted vests and, and weighted blankets, that pressure contributes to the release of oxytocin, which can increase calming and it can also also improve sleep.