1. Neuroscience & Psychotherapy
Gray Matters
Neuroscience & Psychotherapy

2. Mind-Body-Heart State
Let’s Begin

3. Mind-Body-Heart State

4. 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

5. The Brain: Overview

7. In the Beginning…
The Decade of the Brain

8. 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

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

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

11. Neuroscience & Psychotherapy “Brain in Mind”

12. 7 Principles of Brain-Based Psychotherapy *
Principle No. 1 Genetics and Environment interact with the Brain to shape the individual
Cappas, et. al., 2005

13. 7 Principles of Brain-Based Psychotherapy *
Principle No. 2 Experience transforms the Brain.
Cappas, et. al., 2005

14. 7 Principles of Brain-Based Psychotherapy *
Principle No. 3 Memory systems in the Brain are interactive.
Cappas, et. al., 2005

15. 7 Principles of Brain-Based Psychotherapy *
Principle No. 4 Cognitive and Emotional Processes work in Partnership
Cappas, et. al., 2005

16. 7 Principles of Brain-Based Psychotherapy *
Principle No. 5 Bonding and Attachment provide the foundation for change
Cappas, et. al., 2005

17. 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

18. 7 Principles of Brain-Based Psychotherapy *
Principle No. 7 The Brain can process Nonverbal and Unconscious Information
Cappas, et. al., 2005

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. “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

26. Brain Scan of a Depressed Client

27. Depression as a Circuit Disorder

28. 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

29. 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)

30. 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

31. 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)

32. Neurobiology of Depression
SUBCORTICAL WHITE MATTER ABNORMALITIES
Palazidou, 2012

34. 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

35. Brain Scan of an Anxious Client

36. Anxiety as a Circuit Disorder

37. 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

38. Anxiety as a Circuit Disorder

39. 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)

40. 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.

41. 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

42. 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).

43. 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)

44. 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.

45. 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

46. 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)

47. 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.

48. 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.”