The Brain Science Behind Psychotherapy
Why does psychotherapy succeed in effecting change where will power alone generally does not? To answer this question we need to understand the development and construction of the brain. The human brain evolved with each new layer added to the preceding layer without replacing it. The triune model of the brain offers a relatively simple way of viewing the brain’s complex structure. The brainstem (or so-called reptilian brain, the most ancient part of the brain) regulates the most basic functions of our existence: respiration, sleeping and waking, maintaining a constant internal body temperature. The limbic system (or paleo-mammalian brain, the part that we share with all mammals) has as its principal goal our survival. The amygdala, an important component of the limbic system, controls the basic fight/flight/freeze response to danger. The neocortex (or neo-mammalian brain) governs executive functions such as planning, self-control, reasoning and abstract thought. What we know as intelligence and personality reside in the neocortex. The limbic system and the neocortex both serve as operating systems for the brain. In the ancient savannah and forest for which our brain was designed, conflicts seldom arose between these two systems. Coping with a complex modern world for which our brain was never intended often leads to trouble.
The potential capacity of the neocortex, which makes up 80 percent of the human brain, is difficult to encompass. The adult brain comprises 100 billion neurons, each with 1 to 10,000 synaptic connections. This means a theoretical number of possible connections numbering 40 quadrillion (that’s 4 followed by sixteen zeroes) running along two million miles of neural highways.
By contrast, a baby’s brain at birth is only 30% of the adult size, a constraint imposed in part by limits on the size of the birth canal. In comparison with other mammals, human babies are alarmingly helpless. You have probably seen movies depicting the birth of a horse or deer or giraffe in which the newborn animal struggles to its feet and immediately begins to walk, a basic function that the human baby must wait months to accomplish. Mammals learn survival techniques within the space of a season, while human infants require more than a decade to become self-sufficient.
Where other infant mammalian brains are preprogrammed for instinctual responses, the human infant is hard-wired to receive certain messages from its mother: you are valued; you are accepted; you are loved; you are understood; you are respected. The successful transmission of these essential messages produces secure attachment for the baby. “When we are born, this part of the brain is largely composed of neurons that are not yet connected to each other. However, these neurons are genetically primed to form connections through the relational experiences we have with those closest to us. The patterns of energy and information laid down in these early moments of meeting develop the actual structure of these limbic regions. This means that the very foundation of perception, particularly in regard to relationships, relies on the quality of these earliest interactions with our parents.” (Badenoch, 20008, p.15) At this stage in the development of the infant brain, the limbic system predominates, producing a very black-and-white perception of the world. Something is either good (meaning warm and safe) or bad (meaning anything else).
On the basis of this extremely unsophisticated approach, the infant constructs a model of reality. The infant formulates “core beliefs”: answers to the fundamental questions: What is the world like? What are others like? What must I do to survive? Secure attachment with the mother leads to answers such as: the world is safe and predictable; others can be counted on to care for me; I can trust the world and others for my survival. “Processes in the amygdala develop generalized, nonverbal conclusions about the way life works—the essence of mental models. These conclusions create anticipations of how life will unfold and remain largely below the level of conscious awareness, guiding our ongoing perceptions and actions in ways that tend to reinforce the foregone conclusions.” (Badenoch, 2008, p.25)
So far we have mentioned only secure attachment and positive core beliefs. But psychotherapists mostly see clients in which this ideal picture has, in one respect or another, failed to materialize. Suppose that, for one reason or another, the mother is emotionally unavailable. This leads to a form of insecure attachment that has been called “avoidant.” The child, learning that its emotional needs will not be met, tends to discount the value of emotional connections and may grow into an adult whom others regard as cold or unemotional. “If our parents were emotionally unavailable, we will tend to pull away from needing them, avoid dependence, and develop a narrative that minimizes our reliance upon others.” (Siegel, 2007, p.202) Another possibility is a form of insecure attachment in which the mother is inconsistent, sometimes responsive, sometimes not. This insecure attachment, termed “ambivalent” or “anxious,” may lead in adulthood to a clingy, anxious approach to intimate relationships. A third form of insecure attachment, termed “disorganized,” arises when the parent is abusive or otherwise terrifying, so that the figure to which the child instinctively turns is at the same time a figure to be avoided. Not surprisingly, this form leads to unresolved grief or trauma.
Insecure attachment has been described as a core trauma of childhood. As adults we tend to recreate the universe of our infancy. We repeat our core traumas in hope of finding a solution. “We compulsively subconsciously recreate in adult life a core trauma we experienced in childhood. We crave returning to the place of our most intense core emotional traumas over and over again, replaying them in current settings as we try to find solutions.” (Pert, 2006, p.48) Thus, for example, abused children frequently connect with abusive partners, and this unhappy pattern may be repeated many times. This is generally the point at which someone calls on a psychotherapist for assistance.
Our contemporary model of the brain leads to optimism for psychotherapy. In contrast to earlier beliefs that the brain was hard-wired at birth, we now view the brain as plastic, with its plasticity extending even to old age. Neural networks continually alter their structure. Patterns of thought, leading to the firing of neurons, become ingrained, as in the popular expression “neurons that fire together wire together.” “The more the path is refired, the more permanent the message—the new learning—becomes. Eventually an entire network develops that remembers the skill, the word, the episode, or the color.” (Ratey,2001, p.191) But these same neural pathways may become unwired and rewired as we learn new ways of thinking. “In neuroscience this finding is now summarized as Neurons that fire apart wire apart—or Neurons out of sync fail to link.” (Doidge, 2007, p.64)
It has been said that “It’s never too late to have a happy childhood.” The ill effects of insecure attachment can be overcome. The way to have a happy childhood is to supply for yourself those essential messages that, for one reason or another, your parents could not furnish. Often this process requires the intervention of a psychotherapist whose empathic response to the client’s story produces the same kind of attunement which ideally exists between mother and infant.
The injured brain can be healed through integrating unprocessed trauma. In some forms of therapy, such as EMDR (Eye Movement Desensitization and Reprocessing), this involves bringing unprocessed memories in touch with the part of the brain that does the processing. Other forms of therapy rely on making unconscious, or implicit, memories conscious, or explicit.
Memory, the key to resolving core trauma, exists not only in the brain but throughout the body. “Recall is stored throughout the body. …Memories are stored not only in the brain, but in the body as well, where a psychosomatic network extends throughout all systems of the organism.” (Pert, 2006, pp. 47-48) Some forms of therapy, such as Rolfing or bio-energetics, attempt to address memories stored in the body directly and physically instead of verbally. “Part of the process of therapy is bringing implicit memories/mental models to consciousness, where they can receive understanding and comfort for the painful or fearful feelings they carry. This step paves the way for integrating them into explicit memory. … Implicit memories are lodged in the body as well as the feelings, and beginning to work with either body or feelings can lead to changes not only in the emotional tone of our perceptions, but in our behavior as well.” (Badenoch, 2008, p.26)
The optimism of psychotherapy relies on the brain’s natural tendency toward integration. “There is an intrinsic push toward integration, or the subjective experience of wholeness, in our neural circuitry.” (Badenoch, 2008, p.4) The brain and body collaborate in promoting mental health. Physical exercise, a basic prescription for treating depression, anxiety or grief, affects the brain directly. [Physical exercise] increases the amount of blood that gets to the brain. …The three major neurotransmitters—norepinephrine, dopamine, and serotonin … are all increased by exercise and are strongly implicated in its mood-elevating effects.” [Ratey, 2001, pp. 359-360]
The interconnectedness of the body and the multiple operating systems of the brain helps to explain why relying on will power alone to produce change often leads to frustration. Remember that the amygdala has as its primary function our physical survival. Core beliefs, formed in infancy, stand as sentinels against change. Perhaps with the assistance of a self-help book we may set out to make some important alteration in our life, and persist for several days, only to find ourselves, after a week or so, back where we started. Our neo-cortex announces an intention but our limbic system vetoes the proposal so subtly that the neo-cortex “rationalizes” the demurral.
So powerful are the lingering effects of insecure attachment, the trauma of infancy, that a desire for change that does not include healing fundamental wounds has little hope of success. Psychotherapy intervenes to help modify core beliefs, thereby making a profound alteration in the brain’s operating system and permitting the desired changes to take place.
Badenoch, Bonnie (2008). Being a Brain-Wise Therapist. New York: W. W. Norton.
Doidge, Norman (2007). The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York: Penguin Books.
Pert, Candace B. (2006). Everything You Need to Know to Feel Go(o)d. Carlsbad, California: Hay House, Inc.
Ratey, John J. (2001). A User’s Guide to the Brain. New York: Random House.
Siegel, Daniel J. (2007). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. New York: W. W. Norton.
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