Neuropsychotherapy and the treatment of anxiety and depression – Susanne Gilmour

The 1990’s have been called the ‘decade of the brain’. Fascinating new research in neuroscience during those years have begun to change neuroscientists’ concept of the human brain as an electrochemical system to a system of complex interconnected neural networks. These networks are exquisitely responsive to an individual’s social environment, so that repeated or intense experiences constantly reinforce patterns of learned behaviour, thoughts and feelings. This sensitivity also allows for the potential to change those patterns when new, intense or repeated experiences create and strengthen new neural pathways that facilitate alternate patterns of behaviours, thoughts and feelings.

Dr Pieter Roussouw has been using this new research to train practitioners around Australia in the field of mental health in how to apply this new knowledge to the treatment of anxiety and depression. He is based at the University of Queensland and is Director of the Master of Counselling Program, the Director of the Unit for Neuropsychotherapy and the Director of Mediros Clinical Solutions.

His work is showing how the expanding knowledge of the workings of the mind supports the ‘talking therapies’ or counseling, as more often the preferable first line of treatment before medication is prescribed. When successful, the ‘talking therapies’ are more likely to maintain mental wellness over time.

Vulnerability to mood disorders, can have a genetic component but it is our experience of life, the people and situations we encounter that ‘wire’ our brains to respond to perceived threats either with uncontrollable emotions such as fear and avoidance or anger and aggression, or with a more reasoned, calmer and resilient response. If negative life experiences have taught a person that safety , social support and optimism are unrealizable states for her, then her brain is ‘wired’ to see threat all around her and she will respond emotionally with alarm and despair. Brains where experiences of safety, positive support and generally, success in dealing with manageable challenges, have been wired more strongly to use the higher levels of the brain, the cortex or ‘grey matter’ to ‘down-regulate’ emotional responses to stressful situations.

The differing responses can be compared to the default setting on the computer. For those whose experiences and learning may have reinforced genetic vulnerabilities that their world is not a safe or emotionally nourishing place, the brain’s wiring takes them automatically to the ‘default’ position of perceiving threat or hopelessness in even mildly stressful situations. For individuals who have experienced mostly positive events and people in their lives from an early age and suffered no prolonged trauma, their ‘default’ position is usually resilience, as neural pathways in their brain have developed stronger ‘wiring’ away from the emotional and instinctive centres of the brain to the ‘higher’ levels of the brain that have the capacity to control emotions. The therapist’s task is to help his client strengthen neural connectivity to the cortex where rationality, and the ability to reflect more realistically, through language and logical thought processes on one’s experience, helps to ‘downregulate’ the threat response and consequently assist the client to learn new ways of thinking that will prevent him from being overwhelmed by negative emotional responses.

Can the brain’s default setting really be changed by talking therapy? Absolutely, according to Dr. Roussouw and research findings in neuroanatomy. Because the brain exists in relation to its environment, the talking interaction between a skilled and empathic practitioner who fosters a sense of safety in the therapeutic setting, can teach the individual new ways of responding to life experiences. Emphasizing verbal communication and encouraging recording in writing or on voice memos, thoughts and experiences ,over time repeatedly engages the rational , reflective, language centers of the brain ,strengthening connections between the cortex and the limbic systems (the brain’s emotional centre) while diminishing the neural wiring that keeps activating and strengthening negative emotional responses to environmental triggers large and small.

The other very important factor in changing neural structures that reinforce negative emotional responses and continual distress, is practice. Traditionally, psychologists have given worksheets and readings to practice new skills between sessions. Learning new habits takes time and repetition to establish and maintain new neural pathways to override the old ones. I have also found internet sites like ‘Mood Gymn’ (run by the Australian National University) and apps and androids such as Cognitus DBT very useful in encouraging younger people particularly, to practice at home the skills learned in therapy. However, Dr Roussouw points out that such internet based therapies have been shown to be ineffective without client-counsellor face to face sessions to maintain motivation and to model and provide the sense of safety, emotional control and social connectivity, which the study of neuroanatomy is proving to be vital to developing neurostructures that promote mental health.

The University of Queensland in conjunction with the Queensland Brain Institute and neuroscientists around the world are working to develop internet- based activities that will facilitate positive neural changes with regular interventions from the therapist. They promise that therapists across Australia will be introduced to these models soon which promise to greatly enhance treatment programs for a range of mood disorders.

The simple message for clients to take from this, is that a positive relationship with a counselor, well-informed by the latest research in applied neuroscience, and a client committed to practicing the skills learned in their sessions with the therapist, is the key to success in managing well-being for the long term.

Susanne Gilmour, Psychologist

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