Neuroscience & Psychotherapy Gray Matters Neuroscience & Psychotherapy

Mind-Body-Heart State Let’s Begin

Mind-Body-Heart State

OUTLINE Introduction Decade of the Brain Neuroscience and Psychotherapy 7 Principles of Brain-Based Psychotherapy Neuroscience of Psychotherapy: Re-Description Neural Correlates of Depression & Anxiety

The Brain: Overview

In the Beginning… The Decade of the Brain 1990-2000

Basic Psychological Needs A need for ATTACHMENT A need for ORIENTATION & CONTROL A need for SELF-ESTEEM ENHANCEMENT and SELF- ESTEEM PROTECTION A NEED TO Maximize PLEASURE and Minimize DISTRESS The Decade of the Brain 1990-2000

The Decade After the Decade Neuroplasticity Nature AND Nurture The SOCIAL Brain Mental Disorders as CIRCUIT DISORDERS Brain Health

The Decade After the Decade Neuroplasticity Nature AND Nurture The SOCIAL Brain Brain Health Mental Disorders as CIRCUIT DISORDERS

Neuroscience & Psychotherapy “Brain in Mind”

7 Principles of Brain-Based Psychotherapy * Principle No. 1 Genetics and Environment interact with the Brain to shape the individual Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 2 Experience transforms the Brain. Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 3 Memory systems in the Brain are interactive. Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 4 Cognitive and Emotional Processes work in Partnership Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 5 Bonding and Attachment provide the foundation for change Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 6 Imagery activates and stimulates the same brain system as does real perception Cappas, et. al., 2005

7 Principles of Brain-Based Psychotherapy * Principle No. 7 The Brain can process Nonverbal and Unconscious Information Cappas, et. al., 2005

Psychotherapy* is a special kind of enriched environment designed to enhance the growth of neurons and integration of neural networks Cozolino, 2010

Psychotherapy all forms of therapy, regardless of theoretical orientation, will be successful to the degree to which they foster appropriate neuroplasticity, which is enhanced by: Cozolino, 2010

Psychotherapy Establishment of a safe and trusting relationship Mild to moderate levels of stress Activating both emotion and cognition Co-construction of personal narratives Cozolino, 2010

Neuroscience of Psychotherapy HUMAN EXPERIENCE is mediated by Brain Structures: subjected to evolutionary process SHAPING of NEURAL STRUCTURES within the context of RELATIONSHIPS Emotional and Interpersonal learning within the “primitive brain” occurs way before we have the necessary “cortical systems” are developed Thus, social-emotional experiences (positive or negative) are EMBEDDED in/ORGANIZED by this neural architecture Cozolino, 2010

Psychotherapy To say it differently, quality of relationship is encoded within the neural infrastructure of our brains such that translation of EXPERIENCE into NEURO- BIOLOGICAL structures that NATURE & NURTURE become one Cozolino, 2010

Psychotherapy Theory of Psychopathology traumatic and unprocessed relational ruptures and experiences that occurred early on result in neural networks that remain under-developed, under- regulated, and under-integrated Theory of Change: Psychotherapy is a way of reinstating healthy neural functioning Cozolino, 2010

“The Dark Pit” 43 year old woman, mother, wife Battled with depression for many years Prominent symptoms are Cognitive (rumination) and Affective (hopelessness and despair) Treatment: Medication, Psychotherapy, Diet & Exercise

Brain Scan of a Depressed Client

Depression as a Circuit Disorder

Depression as a Circuit Disorder Prefrontal Cortex Mediates goals and values that guide behavior Left PFC is linked to positive goals and positive emotions Right PFC is linked to avoidance and negative emotions Hypoactive Left PFC and Hyperactive Right PFC Reduction in volume of gray matter in PFC due to nonusage

Depression as a Circuit Disorder Anterior Cingulate Cortex Acts as a MONITORING system when inconsistency and conflict appears and recruits other brain regions for resolution AFFECTIVE Sub-region (limbic system) & COGNITIVE Sub- region (PFC) ACC is UNDERACTIVATED (nonresponse, resignation, impairment in executive function and emotional blunting, lacking in coping potential)

Depression as a Circuit Disorder HIPPOCAMPUS Acts as a STORAGE of long- term memory. Downregulate cortisol level when it is high Adjustment of behavior to fit with current context Reduced volume by 8% to 19% due to enduring stress

Depression as a Circuit Disorder AMYGDALA Evaluates incoming stimuli in terms of their importance for one’s motivational goals Activated by surprising or uncertain situations (negative feelings) ENLARGED due to frequent hyper-activation Heightened anxiety and expectations of negative events (rumination)

Neurobiology of Depression SUBCORTICAL WHITE MATTER ABNORMALITIES Palazidou, 2012

Neurobiology of Depression Stress & Depression stressful life events as triggers of depression in the presence of existing vulnerability, related to adverse early life experience abnormalities in the hypothalamo-pituitary-adrenal axis (HPA) with raised cortisol concentrations in depressed patients Depressed subjects with a history of childhood abuse have enhanced HPA axis responses to psychosocial stress STRESS MANAGEMENT Palazidou, 2012

Brain Scan of an Anxious Client

Anxiety as a Circuit Disorder

FEAR Response in the Brain Feeling of disquiet that begins rapidly in the presence of danger and dissipates quickly once the threat is removed. It is ADAPTIVE. ANXIETY Uneasiness over the anticipation of less specific and or predictable threats. It lasts longer than fear and can also be adaptive

Anxiety as a Circuit Disorder

Anxiety as a Circuit Disorder Central ALARM and DEFENSE SYSTEM of the organism that is ACTIVATED in RESPONSE to THREATS of any kind. AMYGDALA is the center of this DEFENSE-AGAINST- DANGER system (along with the hippocampus)

Anxiety as a Circuit Disorder AMYGDALA Predisposed to respond particularly strongly to FEARFUL, IRRITATED, and ANGRY FACES. Is not always accompanied by conscious awareness Enduring activation of the Amygdala due to stimuli that are PERCEIVED threatening can lead to a chronic stress reaction.

Neuro-Informed Psychotherapy all forms of therapy, regardless of theoretical orientation, will be successful to the degree to which they foster appropriate neuroplasticity, which is enhanced by: Establishment of a safe and trusting relationship Mild to moderate levels of stress Activating both emotion and cognition Co-construction of personal narratives

Neuropsychotherapy: A Treatment Modality Clinical Application of Neuropsychotherapy Focus: strengthening from the core of their motivational system to facilitate an increasingly robust APPROACH to self and the world. This approach motivation leads to better need satisfaction and subsequent mental well-being. Establishing a “safe” therapeutic alliance to facilitate approach patterns that will satisfy basic needs, down-regulate stress activation, and optimize new, positive neural connections while reinforcing existing ones (Rossouw, 2014).

Neuropsychotherapy: A Treatment Modality Primacy of SAFETY Key to the facilitation of approach and avoidance motivational schemas Activated in terms of meeting basic needs for orientation/control, attachment, maximizing pleasure Provision of external safety is key to neural development and integration (enriched environment (neural proliferation) vs. compromised environment (neural protection)

Neuropsychotherapy: A Treatment Modality Controllable Incongruence as the Lever for Change Induction of manageable stress PLUS effective coping strategies, which raise the arousal level of sympathetic excitation to a minimum so that learning occurs (stabilizes neural connections or facilitate new neural connections) Key here is strengthening new and effecting coping skills and facilitate new ones on a neurological level of resilience.

Neuropsychotherapy: A Treatment Modality Controllable Incongruence as the Lever for Change Prior Requirements 1. Motivational Priming: positive emotional experiences or positive-need satisfying experiences (attachment, orientation and control, minimizing pain, self-esteem enhancement) within the therapy session (therapeutic alliance, empathy) 2. Resource Activation: identifying resources, characteristics, and abilities of the client that can be emphasized in order to enhance client’s feelings of control or self-esteem

Neuropsychotherapy: A Treatment Modality Controllable Incongruence as the Lever for Change Prior Requirements Safety “a safe, enriched environment actually facilitates the development of new neural patterns, which, in turn, leads to enhanced attachment and control, and stress reduction. Psychotherapeutic approaches that provide safe environments will thus enhance the positive social interaction that is an essential element of healthy neural proliferation” (Rossouw 2013)

Neuropsychotherapy: A Treatment Modality Two Person Psychology Emphasis on “right brain-to-right brain, embodied, affective, autonomic change between therapist and client is central to the therapeutic process” Enhancing right-hemispheric capacity for broad affective awareness, empathy, and connectedness Requires therapists to be self-regulated and to have an experientially developed intuition of attunement.

Neuropsychotherapy: A Treatment Modality Neuropsychotherapy Defined “Neuropsychotherapy is a neuro-biologically informed framework for psychotherapy that conceptualizes thought and behavior as emerging from the influences of motivational schemata developed to preserve or enhance basic psycho- logical needs. Therapeutic processes start from the development of a safe and enriched environment to activate positive approach motivational schemata utilizing a bottom-up neurological approach and proceed from a top-down approach to facilitate long-term change in neural architecture.”