Science Converging on Psychotherapy: Part 2
Nine threads of science relevant to psychotherapy.
Posted Jul 02, 2020
In the previous post, the first of this series of three, problems treatable in psychotherapy were identified as “entrenched maladaptive patterns" (EMPs). These consist of less than ideal responses to circumstances appraised consciously or unconsciously as threats. Below are nine threads of science that, when put together, make sense of the mind’s contribution to human psychological problems and how the relationship and the exchange of words at the heart of psychotherapy can lead to healing and growth.
Evolution: Teaches that even maladaptive patterns are purposeful. The power of the human mind has given us superior powers of adaptation, however, that same sophistication and flexibility also make us susceptible to the establishment and maintenance of dysfunctional patterns. In studying the mind, as in other life sciences, we can legitimately ask what purpose might have been served by the patterns we see before us.
Consciousness: The modern study of consciousness is somewhat humbling, in that an estimated 95% of the mind’s activity goes on outside of consciousness. The dividing line is more like a flimsy curtain that reveals a small, strategic sampling of our mental activity, while behind the curtain the bulk of processing goes on automatically. It is mostly in the unconscious mind that we find the sources of maladaptive patterns relevant to psychotherapy. Even when maladaptive behaviors are consciously chosen, it is usually in response to impulses, feelings, and ideas generated from the other side of the curtain.
Memory: Eric Kandel pioneered the modern understanding that information diffusely distributed in the brain is encoded in synapses that cause neurons to be activated in networks representing explicit and implicit data. Now we know that spoken words and relationship events lead to the activation of groups of neurons unique to the individual. Maladaptive patterns, too, are stored in synapses. So far, just three mechanisms (described below) have been discovered, by which existing maladaptive patterns can be exchanged for healthier or more satisfactory ones. Each of them involves changes in memory.
Learned Fear: Studies by LeDoux, Nadel, and many others have contributed to elucidating the biochemical mechanisms for modification of existing learned patterns. Extinction, utilizes the absence of danger in the therapeutic situation to “teach” the cortex to relay inhibitory signals to subcortical areas so as to block the learned fear response. As Le Doux points out, the original fearful appraisal remains intact and tends to lead to relapse in time.
The other mechanism, Memory Reconsolidation (MR) is permanent and does not require effort to maintain. It requires activation of relevant neurons juxtaposed with the experience of unanticipated corrective information. The resulting prediction error (PE), renders the pattern volatile and subject to updating in accordance with the new cognitive or experiential data. Along with considerable direct evidence, Bruce Ecker argues, by elimination, that, since we know of only one mechanism for permanently and effortlessly updating existing patterns, clinical examples of change having those characteristics can only be interpreted as due to MR. In making this assertion, he is pointing to the likely explanation for Alexander and French’s corrective emotional experience, as well as instances of enduring change in diverse psychotherapies.
Emotion: The work of Jaak Panksepp and of Richard Lane suggests that "core emotion" (subcortically generated affective responses) is a necessary starting point and trigger for maladaptive patterns. These deep affective responses set off visceral reactions, which, when combined with conscious feeling, are recognized by clinicians as “affect.” Regardless of the clinical setting, affect is worthy of the therapist’s attention because it signals activation of exactly those synapses relevant to the problem at hand, a key precondition for modification by both extinction and memory reconsolidation. It is also important to note that subcortically generated affective responses do not necessarily come to full consciousness, but can still lead to the generation of maladaptive responses.
Affect Regulation: Actively advancing science, such as polyvagal theory, has contributed to a focus on affect regulation and the principle that learning can only occur within an optimal window of arousal. Eastern practices, mindfulness, and cognitive tools of proven effectiveness have been added to the traditional use of the therapeutic relationship in helping under- and over-regulated patients achieve a state where they can benefit from therapeutic work.
Motivation: The study of motivation originally focused on addictions but has since been broadened. Panksepp’s concept of the SEEKING system shows how motivation can attach itself to a wide variety of goals, driving their ultimate accomplishment. Motivation is not only a component of adaptive and maladaptive responses, but is also a basic requirement for successful psychotherapy, since the work often demands experiencing uncomfortable behavior change and emotional experiences. Mutative psychotherapy is hard work and supporting motivation is a requirement for all psychotherapies, overtly or not.
Therapeutic Relationship: Relationship is the all-purpose tool of psychotherapy, engaging our extensive mind/brain biology as a social species. Scientific work in the area of attachment and relationships is basic to understanding how the therapeutic alliance supports the above requirements to regulate arousal, motivate for change, and provide corrective experiences.
“Are we there yet?” It is my contention that the answer is “yes.” Basic science has given us the needed infrastructure to understand why and how the human mind, in performing its basic function to adapt, can produce and maintain a wide variety of less than optimal responses. Furthermore, we have now a relatively uncontroversial basis for understanding three fundamental mechanisms by which psychotherapy can support change and the conditions required for this to occur.
The composite picture that emerges when these threads of science are combined does not challenge the collective wisdom our field has gained over the past 120 plus years, but it does provide a coherent foundation to support existing theories. In doing so, it gives us a kind of Rosetta Stone by which we can discern how seemingly incompatible terminologies and theories are, in fact, different ways to describe the same phenomena.
In the next and last post of this series, we will examine how Karl Friston’s free energy principle and the Bayesian brain hypothesis support the notion that individual mental pathology also obeys universal laws of physics, mathematics, and the properties of life.
[For a view of how this list applies to practice, see the SEPI Convergence SIG’s 2020 Poster, The Common Infrastructure of Psychotherapy]
—Jeffery Smith, M.D.
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