Martha G. Welch, MD, DFAPA
As Director of the Nurture Science Program at Columbia University Medical Center, Dr. Welch leads a team of world-class researchers who test her Family Nurture Intervention and explore the scientific explanation for the underlying biological phenomenon she termed emotional co-regulation. Emotional co-regulation is the key component of her Calming Cycle Theory, which posits that symptomatic behavior can be eliminated by re-establishing and maintaining co-regulatory processes within the family, initially between the mother and child.
Dr. Welch attended Columbia University College of Physicians and Surgeons. There, she was mentored by two Columbia University pioneers, surgeon Hugh Auchincloss, MD, and Chairman of Neurosurgery and Director of the Neurological Institute J. Lawrence Pool, MD. Following her residency at Albert Einstein College of Medicine, Dr. Welch was recruited to the college’s child fellowship program. In 1977, after completing a fellowship in Child Psychiatry, she became a Diplomate of the American Board of Psychiatry and Neurology, and was appointed Instructor in Child Psychiatry at Albert Einstein College of Medicine.
While at Albert Einstein College of Medicine, Dr. Welch began to question the current treatment of autism. Drawn to the work of ethologist and Nobel Laureate Nikolaas Tinbergen, PhD, Dr. Welch found parallels between Tinbergen’s descriptions of approach-avoidance conflict in animal behavior and her observations of approach-avoidance conflicts in children with autism. She conceived and began testing her new therapy, which involved calming interactions between mother and child. Through close contact with family, these calming sessions helped to comfort the affected children who previously avoided physical interaction. After this intervention improved symptoms in her first few patients, Dr. Welch contacted Tinbergen with her findings and began a 10-year collaboration with him.
In 1975, Dr. Welch began a private practice. In 1978, she founded the Mothering Center, a non-profit organization dedicated to the treatment of children with emotional, behavioral, and developmental disorders, including autism.
In 1979, Dr. Tinbergen visited the Mothering Centers in New York City and Greenwich, Connecticut, to observe the therapy firsthand. Tinbergen became convinced that Dr. Welch’s new therapy was successful in overcoming the child’s conflict and avoidance behavior. He was especially struck by an autistic child’s ability to play imaginatively, following a therapy session. A close collaboration between Dr. Welch and Dr. Tinbergen followed and resulted in the publication of two books: Tinbergen’s Autistic Children: New Hope for a Cure (Allen & Unwin, 1983) and Dr. Welch’s Holding Time (Simon & Schuster, 1988); both books were published in many languages. Dr. Tinbergen believed that Dr. Welch’s work represented a paradigm shift from the prevailing ideas about behavior and was, accordingly, a major advancement in the treatment of autism and developmental disorders. Until his death in 1988, Dr. Tinbergen engaged with Dr. Welch regarding the biological basis of the intervention and worked to bring attention to this breakthrough.
Following the publication of Holding Time, Dr. Welch’s approach was criticized in the media when it became confused and conflated with therapies by untrained "attachment therapists," using what they termed "holding therapy." Some attachment therapy professionals adapted the techniques described in Holding Time appropriately, and reported the therapy as helpful in treating behavioral disorders in adopted children. However, others used the book to justify unrelated, and in some cases, coercive and abusive therapies. There is absolutely no connection between the method of holding therapy developed by Dr. Welch and therapies associated with the abuse of children. Despite the misinterpretation of her work, Dr. Welch remained committed to the central belief that her insights into the nurturing interactions between families and children would someday lead to new treatments and preventative medical strategies for developmental disorders. In the late 1990s, she began a research career focused on investigating the biological underpinnings of emotional co-regulation and nurture.
During her fellowship at Albert Einstein College of Medicine, Dr. Welch was introduced to the work of other researchers who became important mentors and collaborators: Myron A. Hofer, MD and Michael M. Myers, PhD, and their group in Developmental Psychobiology. Dr. Hofer’s fundamental research and ideas greatly influenced Dr. Welch’s initial thinking about the important interplay between biological and behavioral processes during infant and early childhood development. Dr. Hofer’s group moved to Columbia University Medical Center, where Drs. Myers and Welch eventually initiated clinical studies with premature infants, a population specifically vulnerable to developmental disorders. Today, the paths of Dr. Welch and the Hofer-Myers group have merged, creating a dynamic and essential collaborative team at the Nurture Science Program.
With the support of Dr. Hofer, Dr. Welch was appointed a faculty position in the Department of Psychiatry at Columbia University Medical Center in 1997. In collaboration with renowned neuroanatomist David A. Ruggiero, PhD, Dr. Welch began to test one of her hypotheses — that behavior was mediated by signaling from the gut to the brain, as opposed to the reverse. She posited that the adverse behavior associated with emotional dysregulation may be coming from signals arising from a stressed or inflamed gut, rather than originating in the brain. Thus, she began to test a novel treatment for gut inflammation in an animal model. This novel idea that the gut might control certain behavior was contrary to the prevailing thinking in psychiatry at that time.
During years of treatment sessions in her clinic, Dr. Welch heard mothers describe feeling as though they had just given birth or just nursed their child. As these two events were known to be associated with oxytocin release, she developed the hypothesis that peptidergic signaling was involved in the observed behavioral changes in both the mother and the child following the calming therapy. She was eager to explore this signaling, together with the physiological and systemic manifestations associated with it.
Another peptide, secretin, received attention after a gastroenterologist published findings showing that three children with autism, who had been given this gut hormone as a probe of abnormal pancreatic function, spoke and made eye contact for the first time. Dr. Welch observed that many of the gut problems experienced by her patients with autism resolved after the nurture intervention. She postulated that mother-child calming interactions might be releasing two peptides, oxytocin and secretin, and that these and possibly other hormones led to improved social behavior and improved gut status in the child.
Dr. Welch’s work in this area became the basis for a series of six publications. One of these showed that a combined secretin-oxytocin treatment for experimentally-induced colitis in rats overcame inflammation in the gut. With the help of Columbia University’s Science and Technology Ventures, she applied for a patent, which was issued in 2011 for the treatment of inflammatory bowel disease. During this time, Dr. Welch also spearheaded a research program aimed at understanding brain-gut signaling, and how it is involved in the mutual regulation of gut function and behavior. She was first to demonstrate secretinergic neurons in the forebrain and that secretin activates visceral brain regions involved in both autism and inflammatory bowel disease.
In 2004, Dr. Welch co-founded the Brain-Gut Initiative along with Chairman of Anatomy and Cell Biology at Columbia Michael D. Gershon, MD. For the first time, their labs demonstrated that oxytocin receptors were present and developmentally regulated in the enteric nervous system and in the epithelium of the gut. Their pioneering work shows that mice lacking oxytocin receptors have abnormal barrier function of their gut epithelium, lower villus height, and decreased crypt depth, and are more prone to inflammation.
Dr. Welch has collaborated with numerous other faculty members at Columbia University. With Harry Shair, PhD, she tested her hypothesis that ultrasonic vocalizations in rat pups are mediated by gut signaling. Initial studies show that cutting the vagus nerve between the gut and brain abolishes potentiation of ultrasonic vocalizations in rat pups twice separated from their dams. Collaborations with Susan Brunelli, Frances Champagne, and James Curley focus on exploring differential central oxytocin receptor expression in selectively bred, high-anxiety versus low-anxiety rat dams.
Together with Hadassah Tamir, PhD and Benjamin Klein, MD, PhD, Dr. Welch has elucidated gut oxytocin and oxytocin receptor signaling. In a series of biochemical and molecular biology studies, they found that oxytocin has a modulatory role in the stress signaling pathway in a gut cell line, as well as a modulatory role in protein translation during a critical postnatal developmental period. They also discovered that oxytocin in colostrum has a protective effect on postnatal gut villi. Colostrum OT was shown to attenuate the impact of inflammation, as well as protect against amino acid insufficiency-induced stress. Ongoing research surrounds stress and inflammation signaling in hypothalamic and other brain areas in response to the colostrum impact on gut villi.
Dr. Welch’s innovative research has been supported by private philanthropy to date. In 2008, the Einhorn Family Charitable Trust urged Dr. Welch to translate the promising results of her basic research into practicable clinical interventions that can be used to help infants, children, and families. With Michael M. Myers, PhD, she initiated a randomized controlled trial of Family Nurture Intervention. This trial examined early development in premature infants treated with either Family Nurture Intervention or standard care in the neonatal intensive care unit (NICU). Multiple papers have been published by Dr. Welch and her collaborators, including a paper in Clinical Neurophysiology, that describes robust increases in electroencephalographic power in the Family Nurture Intervention babies at near-to-term age. According to the research findings, there was a 36 percent increase in power in the frontal polar region of infants who received Family Nurture Intervention.
This finding is considered highly significant, because an electroencephalographic power increase in the frontal polar region predicts better cognition, language, attention, and emotion regulation. Preterm infants often have deficits in these areas. The Family Nurture Intervention results also showed positive effects on mothers’ levels of anxiety, depressive symptoms, and sensitivity to their infants during feeding. Together with Manon Ranger, PhD, Dr. Welch aims to uncover new biomarkers of risk for suboptimal neurodevelopmental outcomes in preterm infants using a rodent model. The goal is to examine the adverse effects of repeated maternal separation on electrical brain activity and cardiac response in rat pups, using wireless EEG/ECG implants. With a better understanding of the underlying mechanisms explaining these adverse effects, Dr. Welch aims to test high nurturing intervention methods to mitigate the impact of these undesirable events.
Combining observations in her clinical work with the results of her basic science and clinical studies, Dr. Welch developed the Calming Cycle Theory to explain the profound effects of the Family Nurture Intervention. She theorizes that emotional co-regulation, the key component of the Family Nurture Intervention, is primarily a visceral/autonomic phenomenon, as opposed to a cognitive/central one. Further, she believes emotional behavior is the product of Pavlovian conditioning, as opposed to operant conditioning; this may help to explain why physical contact and communication between family members is so important.
The next steps in research are multi-site replication studies. These will be followed by an effectiveness trial to determine if this intervention can be effectively applied to all babies in a NICU. The hope is that in the next few years the Nurture Science Program will be ready to promote Family Nurture Intervention in NICUs around the country and help even more children and families.
Martha Welch Awards and Honors
- 2014 Gold Medal for Meritorious Service to Columbia University, College of Physicians and Surgeons
- 2013 Physicians and Surgeons Alumni Lifetime Learning Award
- 2011 Columbia University Alumni Medal for Meritorious Service
- 2011 Autism Research Institute Award
- 1995 Middlebury College Distinguished Alumni Award
- 1985 Gold Medal Award in Community Psychiatry, American Psychiatric Association, Nominee