In Klaus Grawe’s book Neuropsychotherapy he explores the relation of brain anatomy and physiology in relation to psychotherapy approach. There are a number of structures within the brain that give clues as to why people may experience disorders like depression, anxiety, PTSD, OCD, eating disorders, personality disorders. Some of his research is summarised below.

To begin let’s look at some of the brain structures and what they actually do and why they are related to psychotherapy approach.

The amygdala and hippocampus are related to the memory and emotions:

AMYGDALA – functions to evaluate stimuli in terms of importance for motivational goals. It can increase cortisol and monitors environment. Anxiety is the central alarm system and is activated to threat. The amygdala is central to this function and will trigger the flight, fight, freeze and fawn trauma responses. It will release adrenaline, increase blood pressure. If the amygdala is functioning optimally it can also send messages to the prefrontal cortex (PFC) when the threat is only minimal or non-existent. The PFC will then formulate conscious action planning and the amygdala will stand-down. The amygdala is also sensitive to facial expressions, prejudice, judgement, criticism. Projection is connected to amygdala response. In a damaged amygdala people may find it difficult to read emotions, trust and get false alerts to threats that are not threats. Reactions like avoidance, catastrophisation, rumination, worrying, irrational thinking, amplification of emotions may increase with hyper-aroused amygdalas. Psychotherapy can assist with recallibrating reactions. Where depression is present the amygdala is larger due to arousal and increased metabolic rates. Hyperactivation can lead to suicidality and overreaction. Anti-depressants can reduce the amygdala activity. Clients with anxiety disorders can go onto develop depression. Hyperactivity of amygdala increases anxiety readiness and expectations of negative events – catastrophisation, worry and rumination. Negative content is stored in the memory and is recalled in the form of SDBs, coping/defence mechanisms, negative thinking.

HIPPOCAMPUS – is responsible for memory, behaviour, spacial cognition, processing and storage of contextual information. The volume of hippocampus is 8-19% smaller in depressed, bipolar, PTSD, BPD clients. Impaired function is caused by enduring stress, sensitivity to cortisol. When cortisol increases so too does blood sugar levels, immune system is suppressed, fat, protein and carbohydrates are metabolised and bone formation is reduced. Low neurone density can be reversed (neuroplasticity) by anti-depressants, positive environmental stimulation. It is possible the hippocampus was always smaller genetically to begin with.

The orbito frontal-medial frontal cortex and dorso medial prefrontal/posterior parietal cortex relates to executive functioning and are often hypo-activated in depression, schizophrenia and OCD:

ORBITO FRONTAL-MEDIAL FRONTAL CORTEX –

DORSO-MEDIAL PREFRONTAL/POSTERIOR PARIETAL CORTEX –

Other Regions:

THALAMUS – registers everything that may have happened but doesn’t necessarily relay it all to other brain areas simply because of the immensity of the information. That is why we can only remember certain things and not others in our life experience.

PREFRONTAL CORTEX (PFC) – critically involved in action phases, conscious faculty, working memory, assesses and processes action and response to situations, rational, logical. Left side contains positive emotion processing  and right side negative emotion processing. Depressed clients have hypo-activated left side and hyper-activated right side explaining why they are more negative in their thinking patterns with higher levels of cortisol. Therapy requires systematic activation of positive thinking directed towards motivational approach goals, instincts and needs. People with lesions in the PFC are easily distracted, controlled, confused, poor concentration, more thoughtless, unplanned. Their behaviours and intentions are more incongruent and memory impaired. When the PFC works optimally it has conscious action, right perception, thinking. It uses imagery, positive sentiments, feelings, memories. It is continuous and consistent and can shut out inputs that may lead to cognitive dissonance. Damage and dysfunction to the ventromedial PFC ay impair a client’s valued goals. Personality values and goals are determined in the PFC. Motivational approach goals and positive emotions are associated with the left PFC and motivational avoidance goals and negative emotions in the right. The left medial PFC responds to rewards and the right to punishment. In depressed clients they respond mainly to the right – punishment. Therefore positive goals don’t influence depressed clients easily. However, anti-depressants increase activity in the left dorsolateral PFC. Depressed and anxious clients respond poorly to SSRIs. Overall there is a decrease in conscious action planning, control of planned behaviour, active thinking and problem solving. There is also a decrease in grey matter/density of well-developed neurones and increased density of poorly developed neurones. In bipolar he PFC density was reduced. Depressed clients feel joy and motivation with more difficulty with reduced deliberate, rational, active behaviour and problem-solving. However, therapeutic interventions will lead to neural repair and growth.

ANTERIOR CINGULATE CORTEX (ACC) – activated in uncertain conflicting situations, cognitive/motivational conflicts, risk-taking, monitoring of conflicts. In depressed clients the ACC is less active and find it difficult to cope in challenging environments. The ACC is activated with anti-depressant medication.

Psychotherapy can increase neural activity in these regions and inhibit activity in other regions by directive and planned process approaches. Hence goals are essential to increase brain effectiveness. Exploration must therefore focus on facilitating change in the client by altering the problem, facilitating new thoughts, behaviour patterns, emotions in real-life situations.

Neural structures, patterns, hypo- or hyper- activity in the brain can mirror culture, society and social groups in the client’s life. Brain changes can be induced by focusing on client goals, needs and motivations.

The brain can inhibit anxiety based on non-threatening events and experiences and because it is assessing threat accurately. Where the client has insecure attachment, trauma or violating relationships then the brain cannot assess accurately and will overreact to certain situations. Where it may think it is protecting the individual it is actually creating greater problems and so therapy is required to recallibrate response. This over-reactive processing can lead to concentration problems, mania and attention deficit disorders.

© Martin Handy 2022