Therapy

This question gets at the remarkable fact under our noses all day long: our ineffable thoughts and feelings are making concrete, physical, lasting changes in the structure and function of our brains. Neurons that fire together, wire together. This is learning, including the emotional, motivational, attitudinal and skills learning that is our focus in therapy. In other words, the making of memory – especially implicit memory, the storehouse of emotional residues of lived experience, knowing “how to,” expectations, assumptions, models of relationship, etc. distinct from explicit memory, the much smaller storehouse of specific recollections and knowing “about” – the gradual change of the structure and function of the brain.

In this context, any kind of mental change is evidence of neural change. Since neuroscience is a baby science, our current, noninvasive, imaging technologies have limited capacities to measure neural change in human beings – especially given how physically fine, fast, and complex these changes are. You could put five of the cell bodies of a typical neuron side by side in the width of just one of your hairs, and five thousand of the synapses, the connections, between neurons in the width of just one hair.

Nonetheless, even though the ethics of animal research trouble and even alarm many, including me, it is the case that more invasive research on animal learning – including emotional, motivational learning, that has some parallels to therapy – has established many fine-grained details of the ways in which experiences of stress, frustration, and trauma, as well as experiences of caring, success, and safety change the nervous system.

So we presume that neural change must be occurring if there is mental change. In this light, there are now many studies with human beings that show structural and functional changes after interventions such as training in mindfulness, compassion, body awareness, and psychotherapy. The cortex – the outer shell or “skin” of the brain – gets measurably thicker due to new synapses and greater infusion by capillaries for blood flow; key regions are more readily activated; there is also greater connectivity between regions, so they are more integrated and work better together; there are even changes in the expression of genes – tiny strips of atoms in the twisted up molecules of DNA in the nuclei of neurons.

And as your mind changes your brain for the better, these changes in your brain feed back to change your mind for the better as well. As these positive structural and functional changes in the brain occur, people become more capable and happy. For instance, training in mindfulness increases activation in the left prefrontal cortex, which supports a more positive mood.

As to new cell growth, I assume this is a reference to neurogenesis, the birth of new baby neurons, primarily in the hippocampus. We can encourage the birth of these neurons through exercise, and encourage their survival and wiring into memory networks through engaging in complexity and stimulation.

Here’s the takeaway: we can be confident in our own lives, and in our work with clients, that our efforts are bearing fruit in actual, physical changes in the nervous system. And since motivation is one of the primary factors shaping outcome in psychotherapy – and in life as a whole – this is heartening, wonderful news.

Regarding brainwave optimization, brainwaves just track what is happening, they are not causally beneficial themselves. This said, personal practices (e.g., taking in the good, meditation, relaxing while walking the dog) can optimize brainwaves. I think you are referring more specifically on neurofeedback and things like Holosync that are essentially biofeedback devices/programs aimed at the brain. Generally, I think they are great IF they work for a person. Sometimes they do and sometimes they don’t.

From a pragmatic standpoint, bottom-line, does something help or hurt, including compared to alternatives. And of course, once a practice of any kind, including with brainwave devices, has induced a beneficial state (thought, feeling, etc.), be sure to internalize it so it has lasting value, woven into your nervous system.

Here are my general thoughts:

• I haven’t used these devices personally.
• There is emerging scholarly and anecdotal evidence that they can be helpful.
• Some people seem to get a lot out of them, some a little, some not at all, and some are bothered by them. You basically don’t know which group you’re in unless you try them.
• I think of these devices pragmatically: are they helpful, but might they also crowd out more self-directed, inside-out training of the mind/brain system.
• I think these can be great if they are helpful, but long-term it’s good to be able to incline the mind/brain towards good states without external help.

The bottom-line is whether they work for a person, and you don’t know if it’ll work until you try it. Maybe check out one of these devices that a friend may have, if possible, before buying one.

I started out in the human potential movement, then got a near Master’s in Developmental Psychology, then a Master’s in Clinical Psychology with an emphasis on family systems plus Jung, then a Ph.D. in Clinical Psychology from the Wright Institute which was heavily psychodynamic. Plus along the way, I got a lot of training and education in Buddhist psychology, especially its Theravada roots. In a weird way, all these diverse influences were helpful. I suspect that like a lot of therapists, I think developmentally and psychodynamically, and act in a cognitive-behavioral way in a field of attention to the relationship between the client and me – while hoping for a measure of luck and grace!

Finding a therapist is a very personal and intuitive process. It can take time, persistence and mindfulness to find the right match for you. There are a few online resources that might help with your research:

The Institute for Meditation and Psychotherapy offers a therapist directory. Consider reaching out to a few of these therapists that appeal to you and find out whether they do sessions via phone or skype.

Tara Brach also offers some guidelines and resources for finding mindfulness-based psychotherapists.

The Mindfulness-Based Practitioners website offers a registry of therapists who work with meditation, mindfulness, and Buddhist principles, and they have an “available by phone or skype” criteria in their search function.

It’s obviously normal to be depressed and upset when things are collapsing around a person.

I suggest you talk with your counselor about options that could have more impact for you, from exercise to maybe considering medication. In terms of psychological interventions, I don’t know your situation and I can’t make specific recommendations, but Acceptance and Commitment Therapy comes to mind as something you could look into, just Google it.

It’s more or less the Serenity Prayer in action: find your way to peace about what you can’t influence, and do your best each day to influence what you can. You might also find the calming and centering practices in Buddha’s Brain to be helpful.

First, a couple cautions:

• If someone is severely depressed, by definition they are fairly incapable of activating or sustaining an enjoyable experience. As I write in Hardwiring Happiness, with this population I think taking in the good is contraindicated. The one possible exception to this view I offer diffidently: basic experiences of sensual pleasure (e.g., drinking water when thirsty, putting on a sweater when cold, eating a sweet) might be an opportunity to draw attention to a positive experience and – building one second at a time – help the person stay with this experience. This can possibly be a path toward slowly increasing the capacity for enjoyable experiences.
• The “be with it” phase of practice is really important to honor before shifting into the second (reducing, releasing the negative) and third (growing positive qualities – inner strengths – like self-compassion, gratitude, feeling cared about, emotional regulation) phases of practice. Anything I say here about taking in the good with depressed, suicidal, traumatized, grief-stricken, etc. people is in this context.

With this in mind:

• Taking in the good – my shorthand term for activating and installing positive experiences – is implicitly used in many treatments for depression and suicidality, so yes, I do think that doing this more explicitly is appropriate for your population . . . with of course good clinical judgment, and an alert eye to the blocks that routinely arise.
• See if my model of the Avoiding Harms, Approaching Rewards, and Attaching to Others systems is helpful as a way of identifying the key inner strengths that would be good to activate and install in different clients. For example, much suicidality indicates poor inner resources that are loving and encouraging (Attaching system), so developing self-compassion and really looking for opportunities to feel cared about (often in mild yet still real ways) would be relevant “key resource experiences.” Also look for chances to really marinate in reward experiences such as eating a cookie or petting a dog or showering when it’s humid (Approaching system) to build up the sense of life containing enjoyable experiences and reasons to keep on living.

A lot of modern people have been traumatized and there are now a lot of good treatments and therapists who work in this area. Here are a few criteria and suggestions for finding help with trauma issues:

• Google searches often turn up good people. Contact a few who meet your criteria and get a call back with one or more therapists.
• I’d want someone experienced that was smart, nurturing, aware of mindfulness, and focused on results.
• The work of Peter Levine and Pat Ogden on healing trauma is excellent; they have trained many therapists in their methodologies.
• Eye Movement Desensitization and Reprocessing (EMDR) is a treatment used to alleviate the distress associated with trauma. There are many therapists and psychologists trained in this method.
• Contact the referral lines of the associations of psychologists or other kinds of licensed therapists in your county or state.
• Also check for any underlying physiology to make sure there is not an imbalance dragging down mood and flattening the results of psychological interventions. People trained in functional medicine can offer a fine-grained assessment and evidence-based interventions.