The Neuroscience of Psychological Therapies available in Paperback
The Neuroscience of Psychological Therapies
- ISBN-10:
- 052168188X
- ISBN-13:
- 9780521681889
- Pub. Date:
- 05/03/2007
- Publisher:
- Cambridge University Press
- ISBN-10:
- 052168188X
- ISBN-13:
- 9780521681889
- Pub. Date:
- 05/03/2007
- Publisher:
- Cambridge University Press
The Neuroscience of Psychological Therapies
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Overview
Product Details
| ISBN-13: | 9780521681889 |
|---|---|
| Publisher: | Cambridge University Press |
| Publication date: | 05/03/2007 |
| Edition description: | New Edition |
| Pages: | 234 |
| Product dimensions: | 5.98(w) x 8.90(h) x 0.59(d) |
About the Author
Read an Excerpt
Cambridge University Press
978-0-521-86317-9 - The Neuroscience of Psychological Therapies - by Rowland W. Folensbee
Excerpt
1
Introduction
Knowledge of brain structure and function has developed rapidly in recent decades; accompanying this increase in knowledge has been the rapid development of our understanding of how brain function relates to human behavior. The roles of specific areas of the brain in specific types of cognitive and emotional processes have been delineated and the complex patterns of interaction between specific areas of the nervous system required for thought and behavior have been increasingly well identified. Processes at the molecular and cellular levels and their relationships to memory, cognition, and affect have been described with increasing clarity. The biological underpinnings of specific psychiatric and neurological disorders have been outlined, and these findings have directly led to improvements in medical, psychological, and behavioral interventions for the various disorders.
The host of advances in the understanding of connections between the brain and behavior can support psychotherapeutic conceptualization and intervention (e.g. Cozolino, 2002; Pliszka, 2003). However, it is the author's experience that the vastness of the relevant literature combined with the complexity of the relationships between brain function and behavior, affect, and cognition serve to preclude the use of such understanding by many practicing clinicians.The terms alone are frightening: dorsolateral prefrontal cortex, superior temporal gyrus, ventricular epithelium. The steps and interactions in the brain comprising so basic a task as focusing attention (Posner & Raichle, 1994) can leave a clinician feeling hopeless in regard to ever understanding enough about the brain to apply such information to clinical intervention. During discussions with fellow clinicians, a moment of early interest seen in a colleague's eye quickly glazes over, turning into blank dullness reflecting a brain that has escaped from a task that seems impossible and therefore irrelevant.
This book has emerged from the author's experiences as a clinician struggling to grasp the implications of “the brain” for psychotherapy intervention. Early in the struggle, jumping from a morning of reading anatomy and physiology into an afternoon of psychotherapy sessions was like leaping from one planet to another. The two worlds seemed to have no connection at all, and the endeavor was fueled primarily by the author's sense of intrigue with the assumption that all of those therapy events must eventually rest on the activity of a collection of bundles and strands in a person's head. As time passed, concepts related to brain function began to intrude here and there into the author's therapy at points where sessions had previously been guided by an eclectic integration of traditional theories including psychodynamic psychotherapy and cognitive behavioral therapy. Discussing the brain helped to explain free association in terms of connections between neural networks. “Thought substitution” seemed to make more sense and to be more easily applied when described in relation to switching from one neural network to another. These brain “intrusions” into the author's psychotherapy have finally increased to the point that concepts of neuroscience are woven into clinical reflections and interventions at practically every turn, informing insights and intuitions as well as offering avenues for communication not previously available. Neuroscience has become one of the primary tools in the author's clinical armamentarium.
When this author first began reflecting on the possibility of viewing psychotherapy through the lenses of neuroscience, there was a fear that increasing consideration of brain function would lead to coldness and estrangement in the psychotherapy process. It has been surprising that the opposite has been the case. For example, empathy with a client being overwhelmed by flashbacks of previous trauma has seemed stronger when this author has reflected on the implications of research indicating that visual cortex used to encode current information is also required for recall of memories of previously established visual images; while being used during visual memory of a traumatic event, visual cortex is unlikely to be available for processing of current experience. How frightening it must be not to be able to see the therapist even though the client can hear the therapist's voice “in the distance” during a flashback. Clients have seemed remarkably reassured when their inability to see the therapist is explained in terms of possible brain mechanisms for such an experience; the apparently “crazy” experience of not being able to see someone sitting in front of them now makes sense. Considering neuroscience has led not to estrangement but to warm connection, a deeper sense of understanding, and improved ability to offer support during difficult times.
The purpose of this book is to provide a useful set of neuroscience concepts with a minimum of technical labels and without the detail that would be needed in order to make explanations anatomically or physiologically correct. The state of neuroscience research offers empirical support only for limited and specific aspects of intervention in psychotherapy; the concepts to be presented are not “evidence-based psychotherapy”. There is no chapter on “brain-based psychotherapy” in the most recent Bergin and Garfield 's Handbook of Psychotherapy and Behavior Change (Lambert, 2004), and the current monograph does not provide information based on controlled clinical trials of therapy intervention. However, even in their present nascent state, current brain–behavior concepts can offer psychotherapists practical guidance that can be combined with previous training in traditional models of psychotherapy to yield new insights that have the potential to result in improved intervention.
This book will describe several ways of viewing connections between brain function and behavior, and will then outline how these various ways of viewing connections can contribute to psychotherapy intervention. A broad, neuropsychologically based conceptualization of the way the brain processes information will be outlined. The concept of neural networks related to individual experiences will be delineated. Memory, affect, and anxiety will be described with specific focus on ties between brain function and human experience in each area. Relevant concepts of brain development will be outlined. Once these basic areas have been outlined, connections between these concepts and human experience and behavior will be presented. Finally, implications for psychotherapeutic intervention will be discussed.
It is extremely difficult for people who are unfamiliar with the structure and function of the brain to maintain a clear picture of how the brain and its various processing systems interact. Figure 1.1 presents a simplistic diagram of the brain with labels of function applied to areas related to various types of processing. It identifies areas related to basic cognitive processes, including attention, primary sensory processing, association areas where information is integrated, and motor areas that guide many sorts of behavioral output. Figure 1.1 also identifies processes related to personal and emotional processing, including arousal centers in the brainstem, emotion and anxiety centers in the middle part of the brain, areas of the brain that are related to attachment, and areas in the frontal lobes related to decision making and executive functioning. The purpose of this diagram is not to clearly delineate all of the areas of the brain that contribute to each function. Rather, the figure identifies the basic processes to be developed in this book, and identifies a central area related to each of these functions. If the reader completed a test on brain function using this figure as the guide, failure would be the likely result since most of the processes labeled rely on interactions between multiple areas of the brain in order to carry out the specific function. Readers will not want their personal neurosurgeons to use this figure to guide a laser or a scalpel. The purpose of this visual labeling is to help the reader clearly conceptualize the nature of the division of activity among processes, and to develop a concrete
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conceptualization of how these areas and functions may relate to each other. It will be useful to return frequently to this diagram in order to maintain orientation to the basic structures and functions of the brain.
This book cannot substitute for in-depth training in the various areas that will be touched by the necessarily cursory outline to be offered. Rather, the goal of this book is to offer a framework that psychotherapists can use as they begin to apply concepts of brain function to their clinical intervention. The framework should help the reader organize previously learned information regarding the brain into a more integrated body of knowledge. New information regarding brain functioning will be presented as the framework is outlined, and the reader will be able to conceive of this information within the framework's structure. Finally, the framework will help organize the reader's future acquisition of further information related to brain function in a manner that will optimize the applicability of new information.
Part 1
Basic concepts
2
Neuropsychological concepts
The application of neuroscience to clinical interventions rests on the premise that different parts of the brain carry out different tasks related to elements of cognition, emotion, and behavior. A client's words and actions during therapy provide information regarding which brain systems are active during therapy and the strengths and weaknesses in these different brain systems. An understanding of underlying brain processes can guide conceptualization of the client's functioning, choices of intervention, and communication with the client during interventions.
Neuropsychology is a field that links observed behaviors to the areas of the brain used in carrying out those behaviors (Lezak, Howieson & Loring, 2004). In its early days, a primary application of neuropsychological assessment involved the use of behavioral observations and tests to help determine the location of damage within the brain. These determinations guided surgical as well as rehabilitation interventions. In recent years, imaging techniques (see Appendix) have been developed that allow non-intrusive examination of brain structure and function, minimizing the need to rely on neuropsychological behavior-based tests for locating brain lesions. However, the idea that specific parts of the brain support specific behaviors remains a powerful guide to understanding the nature of clients’ functioning and intervening to help them.
The basic concept underlying neuropsychological assessment is that each behavior relies on activity in a specific set of areas of the brain, and that each area of the brain is involved in only certain types of behavior. If a specific behavior can be carried out successfully, then the areas of the brain needed for the completion of that function can be identified as intact. If a behavior cannot be carried out, then one or more of the areas involved in carrying out that behavior must be impaired. In order to identify brain locations that are the source of specific dysfunction, behavioral tasks can be assigned that use areas of the brain already identified as functioning adequately along with one additional area typically associated with the behavior that can not be completed. Through a process of elimination, the specific area of weakness can be identified.
For example, a particular client's behaviors could be considered with regard to verbal processing, visual–spatial processing, and memory. If a client can easily remember a visual design shown to the client earlier in the day, but has great difficulty remembering a set of words spoken at the same time, it would be suspected that problems with verbal processing are a source of the difficulty. Since the client has shown the ability to remember a visual design, it would be assumed a general memory problem is not the basis of the difficulty remembering the set of words.
The elements of the client's brain being used to produce specific, clinically important behaviors can be considered in light of the stages of processing events and experiences, as well as in light of the contributions of different levels of the brain to understanding and responding to experiences. Stated more succinctly, it is useful to consider the “input–process–output” nature of brain functioning as well as the “top–middle–bottom” influences.
Input–process–output
At the broadest level the brain can be viewed as an information processing system (see Figure 2.1). Data enters the system, the data is processed, and output is generated: input–process–output (Lezak et al., 2004, pp. 18–37). Applying the concepts of neuropsychological assessment,
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various areas of the brain are used for each stage of information processing, and strengths and weakness in individual areas will shape the manner in which the overall process is carried out.
Input, in this model, includes information gathered through the five senses. It also includes proprioceptive signals initiated by processes active within the body. Sensation is the process whereby stimuli outside the nervous system trigger the firing of receptor neurons in the eyes, ears, nose, skin, or internal tissue that subsequently send neural signals into the brain for processing.
It is useful to imagine a 12-year-old student learning in a classroom. Visual reception systems are activated as he watches what the teacher writes on the chalkboard and observes the pictures and diagrams the teacher displays. Auditory receptors are triggered as he hears his teacher's descriptions of the material. In science class, he may go through the physical steps of carrying out an experiment, thereby activating tactile receptors. As he takes notes, his fingers move and tactile sensory feedback systems associated with writing are stimulated. The olfactory sensory system, evolutionarily the oldest, is less prominent in day-to-day activities such as school, but the student may register the scent of a particular classroom setting, or the pungent smells associated with a science experiment. At the same time that sensory systems deliver information to the brain, neural pathways from internal organs send proprioceptive signals as well, so information regarding the student's physiological state is integrated with other sensory input. In our example of the 12-year-old student, the student's muscles may be tense and his digestive system may be distressed; signals to the brain regarding these states will be encoded along with information from the environment brought in through the various sense organs. At any given moment, reception of current experience consists of an array of stimuli impinging on the student's sensory and proprioceptive systems as information is absorbed.
Processing begins immediately upon reception of input. Multiple areas throughout the brain take part in sorting through incoming information, organizing it, analyzing it, and deciding how to respond (Kandel, Schwartz & Jessell, 2000; Lezak, Howieson & Loring, 2004).
Attention and concentration systems guide other processing systems throughout the brain to become more or less engaged with specific incoming sensory information. Establishing and maintaining attention involves a series of steps including disengaging from the focus of current attention, shifting focus to a new center of attention, amplifying the new focus of attention, and dampening down competing incoming sensory stimuli (Posner & Raichle, 1994). The 12-year-old student in the example will need to attend to the teacher's presentation before he can adequately absorb it and organize it in a way that will be useful in the future. If he is distracted by the girl in the seat next to him he will stop attending to the lesson, and relevant academic material will not be adequately processed.
Perception follows sensation as the brain begins processing incoming information. Signals from individual neurons are combined to yield patterns that are the bases for increasingly complex recognition and understanding. For example, within the visual system the stimulation of individual neurons in the retina of the eye triggers signals that are sent by way of the optic tract to occipital (back of the brain) visual receptive areas (see Figure 2.1). Within the visual cortex the firing of individual neurons progresses from neurons that correspond to specific points on the retina of the eye to neurons in other layers that combine the incoming points of information to yield the perception of specific elements of vision such as points in space, lines, and shapes. These elements are combined to yield a progressively more complete representation of the source of the visual stimulation.
Perception differs from sensation in that the processes occur within the central nervous system rather than at the cells that initially respond to the incoming physical stimulus (Lezak et al., 2004). An implication of the term “perception” is that the integration of information is influenced by the receiver more than is the initial processing at the level of “sensation.” This is a difference in relative strength of influence, and it is important to remember that all processing of information by the brain, from sensation to response output, is shaped by characteristics of the brain doing the processing.
Returning to our student trying to pay attention to his teacher rather than to the girl next to him, the words the teacher writes on the board are initially encoded as a series of individual locations on the retina in the back of the eye that fire in response to incoming light. The individual spots associated with the teacher's writing trigger individual neurons in layer IV of the visual cortex in the back of the brain and, in a rapid cascade of firing, are combined from spots to lines to complex shapes as information is passed from layer IV of the visual cortex to layers that combine visual signals in progressively more complex ways. The words put on the chalkboard in front of the student are taking shape in his brain. The visual shapes the student perceives are then sent to cortical association areas at the intersection of the occipital, parietal, and temporal lobes of the brain. In a progressive way, these shapes are recognized as individual symbols (letters), individual symbols are combined into complex symbols (words), complex symbols are combined with meaning, and individual concepts are combined with other concepts in an integration of content, grammar, punctuation, syntax, and context. As part of the process of integration, information travels in from other sensory receptors, such as ears and fingers, in ways similar to the progressive processing of visual information just described. The information from all sensory channels is incorporated into the integration process in the posterior cortical association areas. The student now recognizes what the teacher is saying and writing, and also begins to understand implications and make connections with previous relevant learning.
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