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Supplement to: The Happiness Blog: Making sense of David Wallin's (2007) book - Attachment in Psychotherapy. Prefrontal cortex, mirror neurons and clinical implications of recent findings Copyright (c) Jim Byrne, 30th July, 2010 Introduction
Chapter 5 then outlines the structure of the brain, and describes each of the major components. The prefrontal cortex Wallin describes the frontal cortex as the ‘executive brain', after Cozolino, 2002. It is the seat of consciousness, reasoning, memory, planning, intentional action, and other higher cognitive functions. He then describes the prefrontal cortex and its division into two important areas: the dorsolateral and the middle prefrontal cortices. The dorsolateral prefrontal cortex seems to be the seat of working memory and the rational mind. It deals with conscious thinking about our experience. It is implicated in thinking, planning, scheming and problem solving. The middle prefrontal cortex, on the other hand, seems to integrate the physical/emotional self to the conscious thinking self, by linking the limbic systems to the thinking areas of the cortex. This is the area of the brain where thinking and feeling interact and overlap, as illustrated in my model which follows:
Figure 1: Schematic illustration of the "significantly overlapping" cognitive and emotive processes, both of which exist within point B of the A>B>C model. This model ties the physiology of the brain/body to the elements of the Freudian structural model of mind, and suggests that the neuronal seat of the self is in the middle prefrontal cortex, but tied closely to its emotional history, which is rooted in the limbic system (but stored in the cortex), and to its working memory capacity in the dorsolateral region. The middle prefrontal cortex contains an area, directly behind the eyes, called the orbitofrontal cortex, (or Ofc), which seems to give us our ability to read non-verbal emotional cues from the faces, tones of voice and body movements of the people with whom we relate. The Ofc is thus implicated in emotional intelligence, and is described by Daniel Goleman (1995) as the ‘thinking part of the emotional brain'. This is the part of the brain which manages affect regulation, which are implicated in self regulation and social relatedness. It integrates information from the body, the emotions and from (conscious and non-conscious) cognitive (or thinking) processes. The anterior cingulate, which is located above and behind the Ofc, is also implicated in attachment behaviour, especially in maternal behaviour and the conscious experience of emotions. There is much more to Wallin's description of the brain structures relevant to attachment and psychotherapy, including the role of the insula - which deals with conscious awareness of visceral states, and thus of ‘how we feel' - but there is not sufficient space in this blog post to cover it all. (I would recommend that you read this chapter!) Cortical functioning On pages 75-76, Wallin describes the work of Hawkins (2005) on cortical functioning. In Hawkins model, the cortex, or outer layer of the human brain, is shown to have a column of six neurons (or nerve cells) at any given point. It seems the top three of those neurons are linked back to stored experiences, and the bottom three manage the arrival of new experiences. The top three neurons "registers repeated experiential patterns (and stores them) as memories that shape predictions about what we can expect in the immediate and distal future. Stored as patterns of synaptic connections between neurons, these cortical memories have three defining characteristics: They are autoassociative, involve invariant representations, and have a hierarchical structure". (Page 75). Auto-association means an incoming stimulus is automatically matched to a pattern in memory to which it is ‘a good match'. Invariant representation means the brain-mind abstracts from the hundreds of images you have of your mothers face and creates a single image of mother which is fixed. (This does not rule out a fixed image of good mother; a fixed image of bad mother; a fixed image of happy mother; a fixed image of unhappy mother; and so on. But each ‘template' is fixed, static, not animated). The hierarchical structure is the column of six neurons at every point in the cortex, with stored experiences at the top of the hierarchy, and incoming experiences at the base. This model produces a system in which new experiences flow into the base of the hierarchy and are confronted by stored experiences. This is what is called ‘top down processing' in post-Gibsonian psychology (e.g. Gregory). In Neisser's (1967) model, the information flows in both direction, from the top down, and from the bottom up. However, the top down process is more often dominant, and this is described by me as ‘frozen schema' syndrome. When there is no flexibility in the stored schemas and templates of the individual, every new experience is judged to be an example of an already stored experience. Piaget called this process 'assimilation', where new data is assimilated to pre-existing schemas. 'Accommodation' is also possible, but not always easy. Accommodation means that I accommodate my cognitive structures to take account of new information, instead of forcing the new information into 'old bottles' or 'boxes'. Mirror neurons The insula, mentioned briefly above, is implicated in being able to feel the emotions of others, which leads us to a consideration of mirror neurons. Mirror neurons were discovered by a researcher called Rizzolati who was working on brain circuits in macaque monkeys in the mid 1990s. He discovered that these monkeys have a class of neuron in their premotor cortex - which he termed ‘mirror neurons - which fire not only when they initiate a particular action, but also when they observe such an action being taken by another monkey. "Subsequent research has confirmed that human beings, like our primate ancestors, have a ‘mirror neuron' system that duplicates or simulates in our own brains the actions of others". (Walling, 2007: page 77). My understanding of this phenomenon is this: When I witness a fellow human initiating an action which implies a particular intention, I can infer their intention reliably, because ‘mirror copies' of their intention fire in my own brain. In this sense, I can get intuitions about your intentional behaviour which amounts to a form of ‘virtual mind reading', at non-conscious levels. I do not ‘think' what you think: I intuit you intention and can respond to it, without necessarily being able to report what my intuition ‘said' to me. It seems likely that mirror neurons are the neurological substrate for empathy, emotional intelligence, and intersubjective attunement - or understanding of ‘where the other person is coming from' - or ‘mind reading'. Clinical implications of recent findings On pages 80-83, David Wallin summarizes some of his key clinical insights from his review of the neurological evidence; how it relates to attachment theory; and now how it links to applications in psychotherapy. He presents four insights, as follows: First, he cites evidence from Damasio (2003) and Siegel et al (2006) that higher, cortical structures of the brain are built upon, and frequently dominated by, the lower, sub-cortical functions. That is to say, there is evidence that emotion is primary and thinking secondary. (These are Freud's primary and secondary processes). It seems LeDoux (1996) argued that "...neural ‘traffic' is much heavier from the bottom up - from the amygdale (fear response) to the cortex (fear management) - than from the top down". (Wallin, 2007: pages 80-81). David Wallin argues that this makes the case for a bottom up approach in psychotherapy. That is to say, not relying on cognitive feedbackto regulate emotions, but focusing the client's mind of bodily sensations and emotions, plus "a focus on the nonverbal, primarily right-brain-dominated dimension of the therapeutic relationship that is expressed through what is sensed, felt, and done, rather than said (van der Kolk, 2006; Ogden, Pain, Minton and Fisher, 2005; Schore, 2005). Secondly, Wallin admits that there is top down traffic involved in affect regulation, but he points to a weakness in the cognitive approach, because it is not the dorsolateral (rational) prefrontal cortex that performs this role, but rather the middle prefrontal cortex (which is richly connected to the [fear inducing] amygdala and the emotional right brain). However in my view, those areas interact, and influence each other, and so the cognitive approach to psychotherapy must be seen as having some effect, though not as much effect as a cognitive-emotive approach. The emotive component is addressed in much the way described by David Wallin: "We need, in addition, to activate the middle prefrontal cortex by helping these (clients) attend to their internal experience, especially bodily experience including in particular, perhaps, the breath. Bringing the mind's attention to bear on the body may go against the grain for these (clients). Yet such a focus can be a potent resource for strengthening their capacities for affect- and self-regulation (van der Kolk 2006). This interoceptive attention is a form of mindfulness that helps ground the (clients) in the present moment, potentially modulating the distress associated with the traumatic past and feared future. Asking our (clients) to label what they feel in their bodies enlists cortical capacities in the processing of painful subcortical (i.e. somatic/affective) experience. It invites them to observe that experience rather than simply identify with it, and feel overwhelmed". This kind of focus on cognitive processing of felt affects is what we call in CENT "completing your experience of what is so". Bringing up painful past experiences in a context of body awareness and present-centredness maximizes the client's capacity to complete their experiences that they have been pushing away, and to cope with the painfulness, and finally get that it is not totally insufferable, but only very painful. (Ogden 2006). Once the pain if fully processed, it will go into the background of their lives, with its sting drawn. Third, previous experiences bias us towards misinterpretations of incoming stimuli in the present moment. This is in keeping with the structure of the brain. The upper three layers of the cortex stores past experiences in fixed, invariant schemas. Those schemas are primed to predict what can happen next. The lower three layers process incoming information, which is then often, or normally, misrepresented by the upper three layers. In other words, as we say in CENT, humans are interpretation machines that resist changes to their programs. As Wallin says: "One clinical implication here is that in order to loosen the grip of such invariant misrepresentations (e.g. outdated internal working models) we need to cultivate our patients' mindful attention to here-and-now experience. In helping them quite literally to ‘come to their senses' (Kabat-Zinn, 2005) we diminish the likelihood that the data of present experience flowing up the cortical hierarchy will be swamped by the memories and predictions flowing down". (Wallin, 2007: page 81). Fourth, Wallin returns to the concept of ‘mentalizing', which is variously defined, including as "the process that allows us to read other minds", and "the recognition that our thoughts/ideas are representations only". The first of these, mind reading, is largely a function of mirror neurons, though Wallin likes Mary Main's idea that people engage in high level ‘metacognition', or thinking about thinking. In my experience, this is not common; and may be restricted to the educated middle classes from which Wallin, Fonagy and Main come. The second definition, that our thoughts and ideas are ‘representations only', is quite an uncommon insight, which came from Zen and social constructionism and est, and is not widely distributed across the social classes. Any capacity that a therapy client has to mentalize (which I am defining as thinking about their feelings and feeling their experiences, including social, relational experiences) must have been learned in some specialized learning context, including having well informed and emotionally intelligent parents, or teachers, or from particular schools of psychotherapy. In any case, the argument here is that in order to reduce their emotional distress, psychotherapy clients need to think and talk about their distressing emotions while they are actually feeling them, which suggests the need for a cognitive-emotive form of psychotherapy - like CENT - and not a purely cognitive or a purely emotive system. The more general point here is this: "When awareness (in the client) is repeatedly focused on such (disturbing) experiences, new synaptic connections are generated, eventually resulting in ‘cortical remodelling'... The clinical implication here is tht by repeatedly focusing on, and linking, different aspects of the (client's) experience - somatic, emotional, representational, and so on - we can establish new connections in the (client's) brain. Such connectivity is the neural equivalent of the psychological integration we hope to facilitate for the (client) though a relationship that is more inclusive and collaborative than those that originally shaped him(her)". Wallin, 2007: pages 82-83. Conclusion That's all for now. I will pick this theme up again next week. Best wishes, Jim Dr Jim Byrne ABC Coaching and Counseling Services ~~~ |
The final two-thirds of Chapter 5 of David Wallin's book on Attachment in Psychotherapyis about the neurobiology
of attachment. Early on (page 69) he describes the work of Allan Schore and Daniel Siegal. These authors conceptualize
both brain development and psychological development as depending upon the availability of an attachment relationship, and
the ‘attuned responsiveness' of attachment figures. In other words, as Gerhardt (2004) has pointed out, when young
babies do not get the right kind of relationship encounters, the parts of their brains that are responsible for social intelligence
actually fail to grow and become wired up. This leaves ‘holes' in the ‘social brain' where relational programmes
should be stored. The lack of a warm, positive relationship between mother and child dooms the child to inhibition of
normal brain development. The baby's brain has a genetic blueprint for brain development, for sure, but this significantly
depends upon environmental stimulation to switch on and stimulate those developments. Positive experiences of maternal
care wire up the brain for feelings of secure attachment, and negative or neglectful maternal care wire up the brain for insecure
attachment with all its attendant disadvantages to the growing child.