Brain Scans: Five Healing Insights That Advance Psychotherapy and Self Help

Galileo pointed his telescope toward the cosmos, and modern astronomy was born. Louis Pasteur peered into a microscope, identified germs, and dramatic improvements in the treatments for the most devastating of diseases soon followed. It’s an old story: a tool is invented that allows scientists to observe something never seen before, and a wave of new insights invigorate a field of research.

No one is yet predicting that brain scans will usher in anything as dramatic as Pasteur’s Germ Theory or Galileo’s confirmation of the Copernican Revolution, but it may not be an exaggeration to say that recent developments in brain scan technology are poised to direct us toward greatly improved psychological health.

The particular type of scan that is piquing the interest of behavioral scientists is known as functional MRIs or fMRIs. Whereas previous technologies have recorded a map of neuronal roadways in the brain, fMRIs are special: they show what is occurring on those neuronal highways and byways in real time – we are able to watch the activity of the brain as it is occurring. This is especially intriguing for those interested in promoting positive psychological change. With a fMri scientists have been able to watch what is happening in the brains of people who are stuck in a bout of depression or anxiety, and to later, after they have had a successful round of psychotherapy, to see how their brain activity is different.

Not surprisingly, these types of fMRI studies have uncovered things never known before. And, these new insights promise to streamline and enhance many of the old tools that have been shown to promote psychological wellbeing. The convergence of this new neuroscience and established clinical research is the basis for what we refer to as Amygdala Script Theory.

For example, it is in the subcortical regions of the brain – especially the amygdala – where poorly regulated and misdirected emotions originate. The amygdala activates the release of hormones, and these hormones can not only cause problematic emotional experiences, they also tend to inhibit the actions of the prefrontal cortex. This is important because the brain has a balance-of-power design – some areas guard against the excesses of others. One of the jobs of the prefrontal cortex is to play just such a role: to soothe and reality test errant emotional and cognitive distortions. Usually the prefrontal cortex does its job – promoting realistic appraisals and good judgment – but this process tends to break down when we are confronted with unconscious painful emotion memories. Such memories can then become the basis for a wide variety of psychological difficulties, including most forms of anxiety and depression.

If we want to blame something for the havoc that these poorly regulated powerful emotional memories cause, we might look to evolution. The type of rogue feelings associated with many of the most common psychological problems appear to be the result of protective mechanisms left over from our evolutionary past. Evolution was concerned with survival. And, it appears that creating brains that tenaciously hang onto painful emotional memories likely served to promote survival. During most of primate history, when circumstances arose that were similar to those that occurred at the time of a previously painful event, survival was more assured if one automatically reacted defensively: as if he or she was in danger of being hurt again. In short, it was not a good survival strategy to forget about, or minimize those things that had previously harmed us. (Click here to read more about the evolutionary basis for Amygdala Scripts)

Although, amygdala scripts, over the last few millions of years, may have helped our forebears adapt and survive, in modern life this survival mechanism has some important drawbacks. PTSD is perhaps the most obvious example of how the emotional memory of a previously very painful situation can can be unconsciously activated and cause inappropriate emotional and conceptual responses. More broadly, psychological research has repeatedly demonstrated that early experiences become the basis for most common psychological problems, suggesting that the activation of those early memories play a role similar to that found in PTSD, in the creation of a variety of other psychological problems. (Click here for more explanation and an example.)

There are, however, ways to change the neuronal patterning caused by emotion memories. Research into those factors that enhance prefrontal cortex functioning in our brain, is paving the way toward streamlined versions of many psychotherapy and self-help tools that have been shown to bring about positive psychological change.

It turns out that much of this innovation can be distilled into five simple principles. An easy way to understand and remember these principles is to depict them as proverbs about learning to swim. (An allusion to swimming may not be entirely fanciful; both learning to swim, and learning the skills necessary for psychological wellbeing result from training subcortical regions of the brain.)

Principle number one: “Insight and knowledge about swimming will not make you a good swimmer – for that, you will need to practice a lot.”

Even the most ardent, insightful student of the mechanics and physics of swimming will not learn to swim unless she

gets into the water and practices swimming. The psychological version is that it is practice – not ‘ah ha’ epiphanies into one’s problems –that leads to positive psychological change. This runs contrary to our popular notion that breakthrough insights result in enduring positive change. For example, the turning point in the movie “Good Will Hunting” occurs when, Will ( Matt Damon) tells his therapist (Robin Williams) about childhood beatings and humiliations from his father. The therapist recognizes this as an auspicious moment to offer the insight, “It’s not your fault”. Confronted with this reality, Will realizes that he has been unconsciously influenced by the disastrously mistaken belief that his father’s abuse was his fault. Kindled by this new understanding, Will’s life takes on a new more productive course.

Although there is value in discoveries such as Will’s, neurobiology and a great deal of experience suggests that the usefulness of such “breakthrough insights” will be mostly lost unless they are followed by carefully designed practice sessions where the new revelation is repeatedly employed to moderate targeted emotions and assumptions. Practice is necessary, because in order for psychological change to occur, neuronal pathways need to go through a process called “long term potentiation”; and long term potentiation results when the same neuronal pathways are repeatedly activated; i.e. when one practices new patterns of thoughts and feelings that correct the formerly problematic thoughts and feelings.

By themselves, ‘ah ha’ experiences offer little more than interesting autobiographical footnotes to our lives. We might consider the various forms of insight (e.g. historical insight into the origins of our problems, insight into what we do that hurts our relationships, awareness of emotional states, etc.) to be the seeds for psychological change, but practice is the soil that nurtures sustained change. Even fifteen minutes a day spent training in the application of insights learned through therapy, or through some self-help strategy, can lead to much quicker and more enhanced positive psychological change. Without practice, the seeds of insight tend to dry up, retaining little practical value. Bottom-line: insights and understanding are like a recipe and, in the words of the Zen master Suzuki Roshi, “You can’t eat a recipe.” Even the most accurate insights into what constitutes something good to eat will not be useful until you practice cooking skills. If we are going to change those mental and emotional habits that underlie the most common forms of depression, anxiety and inappropriate behavior, we must be prepared to practice a lot: applying our insights as a means to develop new patterns of feelings and thoughts.

Principle two: “If you want to learn to swim you will need to spend some time in the water.”

We will never learn to be a good swimmer no matter how much we practice on dry land. For that we will need to get wet. This is because in order to learn to swim, our brains must learn to work with the effects that being immersed in water has on our body and muscles, and from this we learn how to use water to our advantage.

This is analagous to the psychological learning that leads to the mastery of those painful emotions and inappropriate thoughts that underlie our psychological difficulties. Taming negative neurological patterns of activity not only requires practice, it also requires a certain kind of practice, practice that occurs when we are actually engaged with the thoughts and feelings that underlie our problems. This is because those areas of the brain – especially the amygdala – that are fundamental to the generation of problematic emotions and thoughts, are moderated by the “long-term potentiation” mentioned above . Psychologists term the necessary type of learning that produces long-term potentiation “classical conditioning”. Before classical conditioning can occur we have to first activate the targeted behavior. So the best practices to tame psychological problems occur after we first identify and then activate the targeted problematic feelings and thoughts that underlie them. (Click here for research citations.)

In short, the tools that Western psychology has developed are much more powerful when we apply them after purposely inviting, even welcoming, a problematic reaction with its attendant bad feelings and distorted assumptions.

So we must get wet! To do this we utilize safe and useful ways to step into the problematic currents of our minds. When we do this skillfully, we can become used to our roiled up feelings. And we usually discover that being in this psychological water isn’t as bad as we imagined. We can begin to tame problematic feelings and thoughts by observing them from a neutral place (the basis for the practice of mindfulness) and also by linking them with more realistic, salutary thoughts and feelings that promote our wellbeing (the basis for cognitive therapy). And we do this repetitively (that practice thing again): evoking the rogue feelings and thoughts, and linking them to healing insights and awareness. It can be surprisingly easy to tame negative and harmful patterns of feelings and thinking (for example, the self-discounting tendencies that underlie depression, and the over-reactions that characterize anxiety) when we persevere in watching them arise and then moderate them with new salutary learning. In What Freud Didn’t Know there are many examples of how to evoke the emotional/cognitive “scripts” that underlie psychological difficulties and how to practice with them.

Principle three: “After you’ve fallen in a river, is not a good time to learn to swim.”

Too often, psychotherapists give carefully designed advice to their clients, and then expect them to practice new patterns of thought and emotion in the heat of the moment – while in the grip of depression, anxiety or another psychological problem. Instead, we need to teach ourselves, and if we are therapists we need to teach our clients, to rehearse how to overcome psychological problems, when a situation is not so compelling: in other words, ‘off-line’, in a quiet setting. Even if we perceive ourselves as ‘always depressed’ or ‘always anxious’, we can utilize tranquil, safe places and find time where for 10 or 15 minutes a day, we can repeatedly evoke those feelings and thoughts that harm us, and connect them with new realizations and salutary feeling states. If we practice in this way, then when the more intense reactions arise the oft-practiced, beneficial antidotes will be much more easily accessed, allowing us to moderate problematic emotional/cognitive patterns. In this way ‘the decks are cleared’ of psychological distortions and we are able to more easily relate directly and realistically to our present situation. We can learn how to tame our ‘baggage ‘ when it is activated.

In neurobiological terms, research shows that if the amygdala and other emotion-producing centers are too active (as they generally are when we are in the throws of a painful psychological habit) our ability to learn a new response is compromised. For optimal learning conditions, neurobiology suggests the ‘Goldilocks maxim’: seek out situations to practice where the feelings aren’t too hot (we’re not feeling overwhelmed), aren’t too cold (because we’ve purposely evoked the emotional/thinking patterns that seed our problems), but just right. In a safe undisturbed setting we approach our practice sessions with calm confidence (not too hot) and we evoke those emotional/thinking patterns that we’ve identified as the source of our psychological malaise (not too cold).

Principle 4 “The most successful swimmer works with, not against the currents.”

One of the functions of the amygdala regions is to help store both the emotions and some of the imagery associated with painful historical events. When these memories are ‘recalled’, they tend to hijack higher order, reality-testing, regions of the brain – including those that we count on for making realistic judgments about our present situation – causing us to feel and act as if in our present circumstances we are again in danger of being subjected to the harm we experienced when we were first learning an amygdala script. For example, when circumstances are somewhat similar to those we found very painful as a child, our neocortex tends to become hijacked by an amygdala script that sometimes reactivates those early, no longer appropriate, feelings and assumptions. Making matters worse, we don’t even know that this has happened, because conscious awareness of what is going on is also inhibited. The result is that when we are being swayed by an amygdala script there is a good chance we will have very little idea that we are under the influence of something conjured from the past. Instead it will seem to us that present circumstances are the cause of our pain or fear. We might say that by storing and activating these memories, the amygdala serves to “script” how, at certain times, we feel and think about our situation. This is the brain’s mechanism that causes a dog to growl at a person who resembles someone who once kicked it. Or, to cite a human example, it is the mechanism that causes a person at a social gathering to re-experience the depression and self-doubt she knew when as a middle-schooler she was repeatedly rejected and criticized.

It’s worth repeating that a person who is being profoundly affected by these memories is generally clueless as to what is happening, and instead of seeing things objectively she tends to assume that present circumstances account for the bad feelings: for example, she may have an exaggerated experience of herself as being rejected and helplessly unable to garner the affection of those around her. We inherited our brains from our animal kingdom forefathers and mothers. Many scientists think that these patterns of brain functioning, now painfully problematic, once provided an edge for survival, allowing our predecessors to react in protective ways to avoid potential danger. We might depict the attitude of evolution as, “So what if you over-react, and misconstrue your present situation; if an amygdala script protects you from situations that could potentially result in harm, then this is a good thing”. From the standpoint of evolution, it made sense for these subcortical “memories”, mediated by the amygdala regions of our brain, to be stubbornly persistent. (Click here for more discussion about the role of evolution in the development of Amygdala Scripts.) (Click here to find out how to access some of the science behind the evolution of the amygdala.)

The other, more familiar kinds of memories – historical memories – often decay relatively quickly, leaving you with limited knowledge of most past events. For example, you may not remember much about the circumstances surrounding the first time you felt the pain of a burn, but when your hand strays near a hot surface, your brain generates a surge of alarm, and your body reacts to jerk your hand away – the historical memory has dissipated but the emotion memory remains strong. And, it is only after you have jerked your hand away that the consciousness-producing part of your brain renders the thought “I almost got burned”. The amygdala-mediated memory is there and ready to cause you to react, even before your consciousness knows what is occurring. It is because of its durable design that it doesn’t make sense for us to grapple with an amygdala script in an attempt to overcome it. Struggling against these seemingly rogue feelings and thoughts is minimally effective and puts us at odds with ourselves. Fighting against negative psychological habits as though they are an enemy usually accomplishes little more than to frustrate us and undermine our confidence in ourselves. Analogous to a swimmer, it is much more effective to work with the currents of our mind than to set one’s self in direct opposition to them. Worse yet, struggling with our mind can make us feel alienated from ourselves. Psychology has found ways around this conundrum. For example, mindfulness practices (adapted from Buddhism) pave the way for developing a skillful, non-adversarial engagement with our problematic tendencies.

The goal is to be a good teacher to oneself; to cultivate a friendly but instructive relationship with those habitual patterns that bedevil us.

Principle 5: Good swimming skills (and psychological wellbeing) begins with relating to the body.

Swimming instructors coach their students to tune into how their bodies feel in the water. Similarly, it is our bodies that are perhaps the most powerful tools that we have for improving our psyches. Psychological recovery from something that has been an obstacle for us, or any other kind of psychological advancement toward greater wellbeing, is greatly enhanced if we utilize the insights and wisdom that our body offers. Our emotions arise as subtle feelings in our bodies. With a little practice we can learn to identify the subtle messages from our bodies that distinguish between emotions that are appropriate to our circumstances and those emotions that are old habitual thoughts and feelings from the past.There are many familiar examples of such feelings: a spurt of fear that causes a mild sick feeling in the stomach, or a pang of sad feeling that arises as an ache in our heart, or the heavy feeling of immobility that is sometimes associated with hopelessness. Experiences such as these might originate from emotion memories that aren’t a good fit for our present circumstances. If we ignore these emotion memories, they will tend to distort our understanding of our present situation and lead to psychological problems. The good news is that by tuning into the subtle experiences that arise in our bodies, we can learn to separate scripted emotions, based on things that happened in the past, from those that fit our present circumstances and utilize those motions that are appropriate to our immediate situation to promote greater skillfulness and mastery in engaging whatever arises in our life. And we can learn to compassionately and accurately tune in to the emotions of others. All of this begins with attunement to the subtle experiences that our body is constantly making available to us, but that we usually ignore. Our body and the emotions that it engenders is actually a highly attuned instrument that can inform us in many useful ways. It is this realization that is the basis for the “mindfulness of body” practices found in Buddhism.

It is hoped that the five principles, described above, will be intellectually provocative. Better yet, this article may encourage some who have embarked upon a path of psychological exploration to experiment with applying the principles described above to what they have already learned, and see how this might enhance their progress. Unfortunately, it is beyond the reach of this article to detail more of the many particulars of how these principles can streamline and focus existing psychological tools. The book What Freud Didn’t Know is dedicated to that task. (It is written for a general audience by this author.) The guidelines in that book follow the principles described above, and apply them in the form of an easy-to-learn Three-Step Practice that has been utilized to help hundreds of people attain a greater sense of psychological well-being. It is a great source for learning well-researched psychological tools to master “amygdala scripts”. It has extensive footnotes and citations that can lead the reader to the research referenced above, and many more research citations, conducive to a personal path toward psychological wellbeing. (Those interested in seeking the scientific basis for what has been presented here will be pleased to find that most of the research citations are drawn from peer-reviewed, mainstream scientific journals.) We also offer seminars on these topics.

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