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The Next Big Step

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What’s Ahead in Psychotherapy’s Fascination with Brain Science?

By Rick Hanson

The Decade of the Brain officially ended 14 years ago, but certainly not the explosive growth of neuroscience research, nor the popular interest in the three pounds of tofu-textured tissue between our ears. In fact, President Obama has just pledged $3 billion—a billion per brain pound!—toward what amounts to another brain decade, a 10-year project that would, as the Massachusetts Institute of Technology’s Technology Review modestly describes it, “reconstruct the activity of every single neuron as they fire simultaneously in different brain circuits, or perhaps even whole brains.” Only a few years ago, such an undertaking would’ve seemed like sci-fi fantasy; today, it’s just the latest, biggest, and priciest exploratory trip into Brainlandia.

Meanwhile, the tidal wave of popular and professional interest in the brain surges on. There’s hardly a psychotherapy professional conference in which the brain doesn’t figure prominently in a good chunk of the workshops: “the brain and emotion,” “the brain and addiction,” “the adolescent brain,” “the brain and couples,” “your brain on sex”—you get the idea. Plus, there are all of those pop-science books, articles on The Huffington Post site, TV shows, “brain games,” and do-it-yourself neurofeedback.

I fully understand this infatuation with neuroscience, having fallen hard for the little charmer myself. How could I not, given the sheer wonder of the extraordinary complexity of the brain? Just consider the numbers: the brain has 100 billion neurons amid another trillion support cells. A typical neuron connects with 5,000 other neurons, adding up to about 500 trillion synapses. The number of possible combinations of those 100 billion neurons is more than 10 to the millionth power—that’s a one followed by a million zeros. As a comparison, the number of particles in the universe is estimated to be a one followed by a paltry 80 zeros.

Just as exhilarating as these staggering numbers is the new knowledge about neurobiology that’s emerged over the last two decades. Through the remarkable power of brain imaging, we can watch different areas of a person’s brain activate as he or she thinks, perceives, feels, wants, or acts in different ways. Increasingly, new studies are showing how specific neural structures and processes underlie that very intimate experience of being “me.”

Even more thrilling, particularly for psychotherapists, are the implications of breakthrough understandings of the depth and breadth of neuroplasticity, the nervous system’s capacity to be changed by experiences. Of course, neuroplasticity itself isn’t breaking news. For more than a century, scientists have presumed that any sort of learning—a child learning to walk or an adult learning to navigate a tricky conversation with a partner—must involve some kind of change in neural structure and function. The breaking news is in the details of the mechanisms of neuroplasticity and their reach and power. Suppose, for example, someone regularly practices meditation with a focus on her breath. A part of the brain called the insula is routinely activated as she tunes into her body, which leads to a cascade of physical changes: new receptors get built at busy synapses, thus sensitizing them; new synapses grow in a matter of minutes; less used synapses wither away in a process sometimes called neural Darwinism (the survival of the busiest); and tiny strips of atoms, or genes, in the twisted-up molecules of DNA in neuronal nuclei get unpacked (“expressed,” in epigenetics) to do their work. In the insula, the cortex gets measurably thicker. Like repeatedly lifting weights to build a muscle, repeated patterns of mental activity build neural structure. In essence, the mind itself is the greatest sculptor of the brain.

In the famous saying inspired by the work of neuroscientist Donald Hebb, neurons that fire together wire together. Make an impression on somebody’s mind, reinforce it often enough, and bingo!—a new neural network forms. In other words, the mind has altered a little part of the brain. The possibilities radiate hope. Since the nervous system is enormously plastic, with enough effort, skill, and time (not to mention therapy) a person really can do a lot to overcome the effects of trauma, a lousy childhood, or major misfortune. This powerful fact has encouraged psychotherapists—some of us understandably troubled by the growing ascendancy of Big Pharma and psychoactive meds—because it indicates that our work in the consulting room can have a real impact on the concrete, physical brain, as much or more than do meds.

Like a lot of therapists, I was excited about neuroscience early on because I knew that the more we learned about what was going on inside the “black box” of the brain, the more effective we could become at intervening inside it. Much as the periodic table in chemistry provided an organizing structure for the elements, brain science has offered a way to place the great diversity of psychological theories, maladies, and treatments within a single, integrative framework. Neuroscience has given us a common tongue in the Babel-like world of psychotherapy. For instance, whether we describe our work with depression as helping clients grieve the lost part-object, dispute depressogenic thoughts, face existential fears of death, heal disruptions of empathic attunement in early childhood, or access their luminous core of being, it’s reasonable to turn to neuroscience to determine how each of these approaches affects the serotonin system in the brain, since it’s often a major factor in depression. Similarly, brain science offers common metrics for evaluating efficacy, such as the difference a treatment modality makes in serotonin metabolism.

It’s perfectly natural to be enthralled by this wonderful—and scientific!—new framework that’s starting to offer neurological evidence for the effectiveness of different therapeutic methods. Compared with the murky ambiguities of psychotherapy, the sheer visibility of the scanned brain—the ability to watch its neural structures and processes in action—is thrilling indeed. But if we get too infatuated with brain science, we’ll forget how young this field really is and how little we truly know. Neuroscience is a baby science, after all. I think it’s roughly comparable to where biology was a couple hundred years after the invention of the microscope: that is, around 1825.

There’s a natural rhythm of rise and fall in any profession when a new and exciting perspective comes along. In our own field, we’ve seen this happen with psychoanalysis, behaviorism, humanistic psychology, family systems theory, and positive psychology—and now it’s happening again with neuroscience. At first skepticism prevails, even resistance, as the Old Guard denounces or dismisses the new movement as ineffective, unprofessional, unsubstantiated, faddish, and even dangerous. Next comes the growing consensus that maybe the new thing isn’t so bad after all, that there might even be something worthwhile about it. As interest mounts, so does excitement: there really is gold in them thar hills! Then the rush is on, as everybody heads out to stake a claim and not be left out of the action. This bonanza mentality can be useful, as many thousands of prospectors explore the new paradigm, bringing in fresh ideas and new methods and enlarging our understanding of its overall worth and meaning. But eventually, once the hills are crawling with miners, the natural tendency is to step back and wonder if all that yellow stuff being dug up really is gold and not just cheap pyrite.

I think we’re at that point now in the history of the “brain rush” when we’re recognizing just how limited our knowledge is and how hard it is to make a meaningful correlation between our general ideas about the brain and the specific, real-life needs of our clients in day-to-day therapy. We’re also up against the temptation to go overboard with superficial and half-digested knowledge about what’s arguably the most complex and still barely explored object known to science.

In the throes of psychotherapy’s love affair with the brain, I know firsthand that it’s easy to make three specific kinds of blunders: oversimplifying the complexities of mental life into reassuringly mechanistic neural explanations, claiming the authority and prestige of hard science in a field that’s historically searched for respect, and underestimating the power of the mind itself.

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5 comments

  • Comment Link Sunday, 09 March 2014 18:44 posted by Steve Andreas

    Hanson’s HEAL process is a fine outline; using it well requires a LOT more specific detail. For instance, the first step, “Have a positive experience,” doesn’t give any guidance about what kind of positive experience to have. Assuming that you know something about what troubles someone, a specific counterexample experience will usually be most useful. For instance, if someone is easily upset by criticism from an authority figure, a counterexample would be praise from a respected authority figure. If a client regrets a decision that turned out badly, a counterexample would be a decision that turned out exceptionally well. An appropriate counterexample will be far more impactful than simply remembering lying in a sunny meadow, or feeling good after an exquisite meal.
    The second step, “Enrich” advises, “Let the experience be as rich as possible.” While that is a nice general hypnotic instruction, some specific direction about exactly how to do that can make it far more impactful.
    One of the first things to check is whether the client is experiencing the memory by being inside it, with easy access to all the positive feelings, or experiencing it as an outside observer objectively looking at a still picture or a distant movie. Objectivity is a great resource when remembering a horrible experience, because the feelings are omitted, but it will also prevent the positive feelings that make a good experience such a powerful resource.
    If a client is looking at a still image, you can ask them to turn it into a movie; if they are watching a small movie of themselves, you can ask them to “Close your eyes, and first make the movie life-size, and then step into that movie, pull it around you as if you were putting on an overcoat, and feel it happening again,” so that they have full access to their positive emotions.
    Then you can check to be sure that their experience is in full color, includes sound, and that it moves and changes over time, just as a real event would. Making the experience a bit brighter, and/or adding a judicious amount of sparkle (like early morning sunlight on dew or frost) to highlight elements will also enhance it, and strengthen its impact.
    These are only a few examples of how you can give specific directions in order to rapidly change your own or your client’s experience and felt response in useful ways.
    Steve Andreas SteveAndreas.com

  • Comment Link Monday, 17 February 2014 23:52 posted by Vivian Baruch

    Thanks Rick for stressing the need to incorporate the multisensory "installation" aspect of desired behaviours used in Focusing, EMDR & Coherence Therapy. And for linking these to your "taking in the good" practice which needs frequent(daily)holding in awareness for a minimum of 12 seconds. Your metaphor of the mind being like teflon for positive events has helped me help clients develop a fully embodied experience in session of the changes they desire, using visual, auditory & kinesthetic cues which we hold in awareness for about one minute. The use of this is encouraged outside the room, immediately after they've been triggered, within the window of consolidation period. It's all about "practice, practice, practice" to rewire the neurons.

  • Comment Link Wednesday, 05 February 2014 11:16 posted by Sally Bailey

    Involving the client's body as well as his/her brain makes the HEAL method work even better (as the body is connected to the brain and, in fact, the body is sometimes talked about as being part of the brain because of the connectivity) Creative Arts Therapies, especially Drama Therapy, does this all the time and, as a result, enhances the effect. Clients Have a positive experience, which is Enriched and Absorbed, and after the experience the client(s) talk about it and Link it to their lives.

  • Comment Link Saturday, 25 January 2014 11:04 posted by Robert Hennelly

    While the article makes some helpful points, it raises several problems it does not address. One is that that the adoption of the language of neuroscience by therapists, which the author advocates, will concede paradigmatic status to neuroscience because of the power of language. Neuroscience, still in its infancy, has not earned that status and may never do so. Another problem is the author fails to address the most critical issue: the relationship between consciousness and the brain. It is widely held in neuroscience that consciousness is dependent on the brain, i.e., no brain, no consciousness. This reductionist position, which is implicit in all the articles on neuroscience in the Networker’s current edition, is inimical to the many therapists who integrate the spiritual into their work, as well as to therapists who do not subscribe to the view that mind is an epiphenomenon of the brain. The therapy community deserves a more balanced treatment of the interface between neuroscience and therapy.

  • Comment Link Tuesday, 14 January 2014 14:56 posted by Sue Cirillo

    loved the article