Practice Makes Perfect

Psychiatry Grand Rounds, 10-10-11:  Brain Based Psychotherapy by Lloyd Linford, PhD

"The more often you do something, the more likely you are to do it again."  If you take on a French tutor to work on learning that language, you are likely to do that again.  If you go on a drinking binge, there is a good chance you will repeat that behavior.  Patterns are created in the brain so, "...not only does biology create the mind, but the mind also creates biology."
 If you want to install a good habit in your lifestyle, do it a few times; each time you do, you reinforce that brain pattern and set yourself up to more readily repeat it.  If you want to change, we now know that psychotherapy changes the brain:  "Psychotherapy works by producing changes in gene expression that alter the strength of synaptic connections."

 Neuroplasticity informs us that the brain can change through early nurturing relationships and experiences, psychotherapy, meditation, and mindfulness.  Neuroplasticity means that our brains can form new dendrites, new synapses, improved synaptic efficiency, and perform neurogenesis.  The brain can turn stem cells into new neurons.

Neuroscience was an important field of study until 1900 when Freud published The Interpretation of Dreams.  At that point, most brain studies stopped.  Now, there is an upsurge of interest in this area of inquiry.  Now we have consilience:  Biological realities and psychotherapy are becoming connected in the thinking about human dilemmas and growth.  Once again we see the holistic approach being validated; the mind and body are connected.  As we look at the brain we see that both hemispheres, feeling and thinking are important.  So, now the field will begin moving away from the recent popularity of Cognitive-Behavioral theory to a more comprehensive view:  We do not only move from cognition to affect.  Feelings are not only caused by thoughts but also arise from body states, are a response to memory, and more.

Some of the knowledge emerging from brain studies is:

• Psychotherapy and anti-depressant medication are about equally effective in depression treatment (info. from effectiveness research).
• Specialized methods of psychotherapy are not as important as the alliance between the patient and the therapist.  In addition, the outcome of therapy is due to what the patient brings to the table, 40%, to the therapist, 20%, to the technique/type of therapy, only 5%
• There are gender differences in the brains of females and males.
• The brain begins with a surplus of neurons; those that are stimulated and used live, the others are subject to apostosis;  "Use it or lose it."
• Brain development is dependent upon both nature (temperament and genetics) as well as nurture (attachment experience).
• Attachment=emotional regulation.  A secure caretaker of a child produces a secure adult; attachment leads to healthy autonomy.  Secure attachment leads to lower cortisol levels.
• 40% of adults are insecure

For more information  on this new current in the theory of therapy, look to the book on evidence based treatment for everyday practice, Brain Based Psychotherapy by Dr. Linford.

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