Psychotherapy and Neuroscience

Future Direction

Back in 2002 I had a conversation with a neuroscientist, Dr. B.A. Vogt, about the cingulate cortex. He indicated at that time that he believed that an intensive study of the cingulate cortex could potentially generate an understanding of how the brain processes information. Over time I have come to understand and appreciate the wisdom of his words.

We have, since, ceased our association in part due to methodological differences. I believe that the cingulate cortex can not be understood in isolation of its interactions with the medial temporal lobe and other prefrontal structures like the insula and orbitofrontal cortex. I also believe that concentrating studies on the anterior cingulate cortex and its interactions with other areas of prefrontal cortex will be beneficial for understanding the human experience due to its critical role in modulating emotion, facilitating extinction of stress, and in fostering a sense of theory of mind. Finally in addition, I believe that studying the role of the anterior cingulate cortex and the medial temporal lobe during the stress response, psychotherapeutic processes, and ontogenetic development could help to resolve potential areas of confusion as well as help to link together different seemingly diverse concepts.

In addition, in response to my research inquiry, I have learned the following and will expand on some of these concepts in this section. 1. Underlying each mental disturbance is some enduring response to stress that had been deemed as too difficult to manage, rethink, and to process.  2. The maladaptation to a stressful occurrence and/or relationship, gets locked into the central nervous system (CNS) (B. Van Der Kolk) and is implicitly (re)experienced without a person’s awareness through inadvertent reliving of interactive scripts, emotion, and persistent HPA activation and gene expression.  This response persists throughout one’s life and likely underlies future genetic expression of many different adult conditions.  3. Chronic responses to stress can be reflected iteratively in an algorithm as long as all components and thresholds for genetic expression are known. 4. Studying the structures of the cingulate cortex and nature of memory processing into the cortex by the hippocampus and surrounding structures is key for understanding the nature of how the brain works.  The cingulate cortex caudally projects to sensory, receptor areas; dorsally extends to motor/premotor and subcortical regions for pain perception; and rostro-ventrally projects to prefrontal/medial/limbic brain regions for stability and well-being.  The hippocampus is a diverse structure, that can be divided into dorsal and ventral sections, which processes sensory spatial memory into the cortex and emotionally-charged memory into the cortex, respectively.  Long term memory encoding into the cortex takes 15-20 years, when memory storage and retrieval becomes relatively independent of the hippocampus and its surrounding structures.  If memory encoding into the cortex is disrupted, it is likely encoded partially in some caudal sensori-motor cortical regions, is insufficiently processed in other more rostral prefrontal cortical regions, remains in the hippocampal formation and is responsive to sensory environmental triggers.  This disruption likely impacts items 1. and 2. noted above as suggested in Bremner and colleagues’ neuroimaging research demonstrating that a trauma-related stimulus activates caudal regions in the cingulate in individuals with PTSD but seems to activate more rostral areas in those without PTSD.  It is likely that hippocampal-cortical memory processing follows a caudo-rostral trend.   5. Early childhood decisions about avoiding rethinking and reexperiencing painful traumatic memory can have long term term consequences on one’s health and well-being throughout one’s life by not only impacting memory processing due to an immature brain and CNS, the process noted above, and chronic activation of neurohormone secretion (of corticotropin releasing factor, ACTH, and cortisol or the HPA).  These processes likely lay the foundation and groundwork for gene expression of later mental illness and many (or most) physical conditions experienced during adulthood.  6. Therapy needs to focus on gaining access to and processing of memory that had been denied processing due to an immature brain and CNS and its perceived traumatic nature.  Corrective relationships also need to be available at the conclusion of therapy to disprove early childhood conclusions that the child is unloveable, not validated,  is worthless, etc.  6.  Parents need to raise their children with the perspective that they want their babies and children to experience happiness and to love life.  Discipline does not need to be equated with punishment and privilege deprivation.  Parental discipline can be subtle.  Rewarding, praising, and acknowledging behaviors that a parent wants their children to repeat is a form of subtle discipline.  Parental praise for children’s behavior, that a parent wishes to see repeated, serves to shape children’s behavior and makes them feel loved and supported by their parent.  Sometimes children deviate from expected behaviors, especially during the early teen years.  Deprivation of privileges (negative punishment) is typically used to demonstrate consequences for undesirable behaviors that breach parental expectations for desirable behavior.  Depriving a child/teen of positive interactions and rewarding experiences rarely works and instills a sense of childhood frustration, resentment, shame, and, ultimately, negatively impacts the parent-child relationship.  More subtle methods of expressing parental disapproval, such as quiet discussion, requesting empathy for another if another third party was hurt by a transgression, etc. preserves the parent-child relationship and confirms parental acceptance.

This next section is under construction and will be developed at some future time. When complete, it will examine in greater detail neural activity underlying reward and stress-related consolidation processes, the impact of stress on related consolidation processes, and will develop and characterize these processes in an algorithm to help to apply thresholds of stress to genetic research.