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Case Study - Page 2

Understanding Brain Function

Since the "neuroscience revolution" beginning in the 1970s (including radical advances in scanning technology that allowed researchers to study living brains at work), we now know that all areas of the brain are "plastic"—capable of reorganizing themselves, growing new cells and neural networks, and making other areas obsolete in response to experience. Neuroplasticity has two sides, which psychiatrist and researcher Norman Doidge, author of The Brain That Changes Itself, calls the "plastic paradox." Experience and environment produce changes in the brain, for better and for worse, promoting stubborn, frustrating patterns of behavior that result in many of the symptoms our clients bring into therapy. Because of Carrie's neuroplasticity as a youngster, her brain had wired itself in ways that had become rigid, fixed, and, despite her best intentions as an adult, resistant to change. She needed to develop new patterns of response, which could become as automatic and comfortable as the patterns she'd developed in childhood.

Despite the growing interest in neuroplasticity generated by leaders in the field like Doidge, Daniel Siegel, and Jeffrey Schwartz, we still have no sure way of knowing which therapeutic interventions may be able to change the brain, but knowledge of the principles of neuroplasticity is a promising avenue for therapists eager to help clients who can't benefit fully from traditional talking cures. Even before the advent of neuroscience research and brainscan technology, Sensorimotor Psychotherapy, a body-centered talk therapy developed by Pat Ogden, had started using techniques that dovetail with what we now know about the qualities of neuroplasticity.

The first principle of neuroplasticity that's helpful in a therapeutic context, articulated by Schwartz and Sharon Begley in their 2002 book, The Mind and the Brain, is that neuroplasticity is "induced by changes [emphasis added] in the amount [and kind] of sensory stimulation reaching the brain." This means, simply and obviously, that repetition of old, habitual thoughts, feelings, body sensations, and movements won't change the brain, but will only reinforce established neural networks and behaviors. To change the brain, something new has to happen: we must interrupt and inhibit rigid patterns, and experiment with new kinds and amounts of sensory stimulation.

The second principle is that neuroplasticity requires focused attention and direction. As the pioneering French psychologist Pierre Janet pointed out a century ago, the sensory information available to us at any given moment far exceeds our capacity for conscious awareness. Much of the information that reaches our sensory organs doesn't register in our minds. What's registered automatically, without conscious intention, is determined by the intensity and repetition of a signal, its novelty or familiarity, our own internal state at the moment, and our histories. Without conscious awareness, we typically engage well-established neural pathways just by our routine focus of attention.

Carrie's procedurally learned focus was to "signs of danger" evidenced in her husband's body language, tone of voice, or level of tension. Watching him through the narrow lens of this childhood telescope deprived her of other information that might have been reassuring: his old friends rolling their eyes in amusement at the outrageousness of his behavior, how hard he tried to control his irritability, the look of discouragement after an outburst. His acts of apology (gifts or a helping hand with some chore) never registered on her radar screen.

When we consciously select the object(s) of our attention, it's believed that we can stimulate neuronal firing in the areas we wish to restructure. We help the brain retain the new learning by heightening awareness of and sustaining attention to the new stimulus. According to Richard Davidson, director of the Laboratory for Affective Neuroscience at the University of Wisconsin, Madison, "In some ways, attentional training can be thought of as the gateway to neuroplasticity." In other words, we can take advantage of attention's role in neuroplasticity by teaching our clients how to focus on new stimuli they normally might not notice, and consciously keep their attention there.

Third and perhaps most important, neuroplastic change requires the conscious inhibition of old responses, coupled with intentional repetition of new, more adaptive responses. Carrie's instinct was to use therapy sessions to tell story after story about her husband's rages and their effect on her. At times, she was angry at him; at times, she was ashamed of herself for being so affected and desperate to find a way to make him stop. These were understandable but "old" responses, which didn't offer her any new options; they reflected her brain's past neuroplasticity, yet failed to capitalize on her brain's present capacities. However, our clients can, with our help, become conscious, intentional participants in changing their own brains.

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