Welcome to the last in a series of four articles where I have been looking at ways the biology of the brain can potentially be altered by the experience of psychotherapy. I began by looking at how the environment can impact our genes, acting like a molecular “volume control” over gene expression, in the fascinating field of epigenetics which I reviewed in Volume 1 Issue 1 of the IJNPT. I then turned to neurogenesis, the equally fascinating process by which newly generated neurons integrate into our existing neural network, creating new connections for new learning or for holding old learning in a new way. This process too is profoundly influenced by our environment, facilitated by exercise and inhibited by trauma. Synaptic plasticity is a very obvious way that the brain is shaped by the environment, and underlies our capacity for learning and memory. The synaptic connections between neurons are highly dynamic, allowing us both to remember and to forget. In the last issue I built on the idea of plasticity to include white matter plasticity, the capacity of our brains to dynamically change the amount of insulating myelin that increases the speed and efficiency of transmission of action potentials, and therefore information, within and between regions of the brain. White matter plasticity is associated with practice and repetition in the environment, so, for example, the effect of practice can be readily seen in the brains of musicians, as the degree of myelination in particular brain regions correlates with the number of hours of practice on an instrument. Even the practice of meditation can lead to changes in white matter in the brain! In this issue, I introduce the idea that the connectivity between brain regions can also be influenced by experience in the environment, from the styles of relationships we have with our parents to the new experience of relationship we may have in psychotherapy. At all levels of the brain, from our DNA up to the whole brain with its interconnected regions, adaptation to our environment occurs so that we may become better at anticipating and thus surviving the unique environmental challenges we all face.
Different regions of the brain are specialised for different tasks; the amygdala as part of the limbic system is the seat of emotional processing, the hippocampus is important for memory formation and spatial navigation, and the pre-frontal cortex is considered vital for executive function and for driving socially acceptable behaviours. These regions are specialised within themselves but also connect with each other, and these “between region” connections can now be visualised using various imaging techniques. It is frequently, although not universally the case, that synchronously activated brain regions, considered to be functionally connected, are also structurally connected through bundles of myelinated axons called white matter tracts. Both structural and functional connections can be imaged using distinct magnetic resonance imaging methods. Imaging studies have demonstrated that the functional connectivity between various brain regions changes throughout development, with age, and differs between males and females. Connections between the amygdala and the pre-frontal cortex of the brain are important in how we process our emotions, and thus it is unsurprising that early life stressors such as abuse impact the connectivity between these brain regions, and that people who suffer depression, PTSD or any of a number of other mental health problems also have altered connectivity between their amygdala and pre-frontal cortex. Allan Schore suggests that increased integration and connectivity between higher and lower right brain regions is the hallmark of a secure attachment and is also a predictor of infant mental health. This fortuitous state of an integrated right brain is achieved through a myriad of rewarding interactions between a mother and her “securely attached” infant where their right brains are in harmony or “affective synchrony”. As adults, attachment patterns (described by Ainsworth and Bowlby) are modifiable through new experiences of relationship, including within the psychotherapeutic relationship. Fortunately, the orbitofrontal cortex which underlies many of our attachment-related interpersonal skills, including our capacity to empathise and to reflect upon ours or other’s emotional states, remains plastic and is thus modifiable by new relationship experiences even in adulthood. Greater activity in the orbitofrontal cortex and increased connectivity to subcortical regions has already been linked to successful psychological treatments, so the prospect of visualising a psychotherapeutically mediated change in attachment pattern through a correlating change in functional connectivity between brain regions is almost within reach.
The brain is the organ of adaptatiion. At every level in our brains, from the molecular and epigenetic through to neurogenesis and neuroplasticity, to the connections between regions of our brain, adaptive changes occur. In the broadest sense, the brain perceives our environment to anticipate it and adapts so that we may thrive, or at least survive, and reproduce. An important aspect of our environment is our relationships, which at the very beginning of our lives are crucial for our survival when we are babies depending entirely on the caring relationship we have with our mother or caregiver. Our brains are profoundly shaped by, and adapt to, our relationship with our primary carer, creating representations of relationship and attachment patterns that will probably be maintained throughout our lives. If our relational experiences are positive and our brains are changed by that relationship in all and more of the ways described above, we may achieve right brain integration and benefit from having a secure attachment with our caregiver, but if our experiences are not so positive, neglectful, or even abusive, our brains will adapt to reflect and anticipate these experiences. For better or worse, we all carry the ways our brains have adapted and the experiences of our primary relationships out into the world where they linger as anticipations and expectations, and become the creators of the relationships we forge with our partners and our own children, often despite our conscious determination to break free of our past. Clearly, as babies, we cannot choose the relationship we will have with our primary caregiver, nor can we prevent our brains from adapting to the relational experiences we have had; however, armed with the information that experiences can change brains, we can as adults make choices about what kinds of relational experiences we would like to have and actively seek out those experiences. Psychotherapy offers our brains a positive relational world to experience and thus may ameliorate some of the effects of previous negative relational experiences. Through a multitude of new and repeated experiences of empathy, attunement and repair after ruptures in the psychotherapeutic relationship, our brains adapt to this new paradigm of relationship, which may then be taken out into the world as a healthier anticipation and therefore creator of healthier future relationships. Although it is unlikely that psychotherapists will be able to scientifically validate their efforts with a visual representation of the changes in a client’s brain through the process of the psychotherapeutic relationship, it is positively heartening to understand that the experience of relationship has the power to change the brain at every level, from the expression of genes through to the connectivity between brain regions. The profound changes experienced by the client and witnessed by the psychotherapist are real even if they are still not easily measurable by neuroscience.