Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression
I was just working on a review of the book Neuropsychotherapy by the late Klaus Grawe for one of my favorite peer-reviewed professional journals, the journal Neuropsychoanalysis. With the development of advanced technology that allows us to investigate and create images of the brain and the processes that happen in the brain, such as PET scans or fMRIs, we are just starting to deepen our understanding of the neural basis of our psychological and emotional experiences, and of the brain mechanisms that underlie mental health and mental illness. This is an area of research that I personally find incredibly fascinating and intriguing, and in many ways also very puzzling.
The main tenant of Klaus Grawe’s book is the idea that all our experiences correspond to processes that happen in our brain. In other words, if I experience stress in my life, this will be reflected in processes in my brain. If I experience fun in my life, this will be reflected in processes in my brain. If I have relationship issues, this will be reflected in processes in my brain. And if I am depressed or anxious or experience trauma, this will be reflected in processes in my brain as well.
What’s more, in his review of the research literature, Grawe concludes the connections between the nerve cells in the brain tend to form pathways based on our internal experience. Put very simply, if I have a certain experience, corresponding cells in my brain will send corresponding chemicals or electrical impulses to other cells in my brain, thus forming neural pathways. These pathways will be firing more readily next time I repeat that experience. If I repeat an experience frequently, this will lead to forming neural pathways that fire very quickly, which you could compare to building a highway. If you’ve ever learned an instrument or learned a new sports or activity, you may relate to this: The more you practice and repeat the behavior, the more easy it becomes for you. The idea is that you are building new pathways that fire more and more quickly and easily the more often you engage in the behavior. If you take a break from practicing, it will initially be just a little harder to get back into it, but you very quickly get back to the level at which you left off.
Along similar lines, the author conceptualizes mental illness – particularly depression and anxiety disorders – as having to do with neural pathways that fire sometimes excessively or in a context where it’s not wanted or helpful. If you live in certain life circumstances and make certain life experiences, then you will form the corresponding pathways in your brain. If your circumstances and experiences change, you can activate different pathways. However, when you return to those circumstances or repeat the old experiences, it is very easy for your brain to return to the old pathways. This could explain, for instance, why symptoms of depression, anxiety, OCD, or eating disorders tend to return during times of heightened emotional distress in one’s life – old neural pathways seem to get reactivated.
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The goal of therapy, then, according to Klaus Grawe is to help a person to modify these neural activation patterns. In other words, if all experiences are linked to processes in the brain, then therapy is about facilitating experiences that change activation patterns in the brain and about facilitating brain processes that activate patterns having to do with psychological well-being and good mental health. Moreover, Grawe points out that when it comes to changing internal experience, for instance, when treating anxiety, the therapy work is not only about building different neural pathways, but also about inhibiting some of the engrained and problematic old pathways.
Certainly, much more research is needed in this really exciting line of thinking about therapy. When it comes to Personality Disorders, there is still a lot about neural functions that is unknown. There’s some indication, however, that the difficulty in regulating intense emotions that is frequently found in Borderline Personality Disorders corresponds to some specific neural circuits. Hence, the research group around Drs. Otto Kernberg and John Clarkin at Weill Cornell Medical College just started a project that looks at the topic of therapy, emotion regulation, and brain changes in people with Borderline Personality. The study is following their earlier project that compared three different types of therapy for people with Borderline Personality Disorders, which I have written about in a previous blog. The new study will look a t people with Borderline Personality Disorder and will administer FMRIs of certain brain areas that are thought to have to do with regulating emotions. The participants will then enter a year of treatment with Transference Focused Psychotherapy. After that year, people will go through another fMRI in order to see whether any changes can be detected in the brain. For more information, check out the Personality Studies Institute website.
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