Three Skills From Psychotherapy That Can Change Your Brain

From a Washington Post column by Christopher W.T. Miller headlined “3 skills from psychotherapy that can change your brain”:

When I suggested talk therapy to one of my psychiatry patients, he asked, “How can talking help?”

Diagnosed with an anxiety disorder as a child, he told me he had a “chemical imbalance” that required psychiatric medications for the rest of his life. He had heard this message over and over from doctors, parents and teachers.

He was not too sure, though, since medications had not seemed to help much with his endless worrying, low self-esteem and fears about being criticized by others. He sounded defeated as he told me that nobody wanted to hear about what else was going through his mind, at least not beyond the usual drill of issues with sleep, appetite and mood.

After I completed my assessment, I asked if he had considered talk therapy, which came as a surprise to him — he had not been open to it because he had been repeatedly discouraged by others. People had made claims such as “No one does that anymore,” “Psychobabble doesn’t change anything” and “You have friends you can talk to — how can a stranger have anything useful to say?”

He challenged me, asking, “Is there evidence that therapy actually changes the brain?”

Many people get relief from psychiatric treatments. Research has shown that antidepressants can change brain pathways and stress responses linked to depression, anxiety and impulsive behaviors, among other symptoms.

Others, however, do not wish to take psychiatric medications, or do not benefit from them. And so, alternative ways of relieving distress are crucial. The benefits of psychotherapy, exercise, mindfulness, yoga and meditation for mental health have been backed by encouraging scientific data.

Different forms of talk therapy can lead to improvements in several subjective areas, including self-esteem, optimism, understanding who one is as a unique person and strengthening interpersonal relationships in matters such as intimacy and reciprocity — the healthy give-and-take we need to have when relating to others. Psychotherapy has also been shown to decrease biological markers of stress and inflammation.

Negative talk, psychotherapy and the brain

After agreeing to give therapy a try, my patient came to the first session visibly nervous, eyes downcast, wringing his hands and giving curt, barely audible answers. He told me: “This is pointless,” “You’re just going to tell me I can’t be helped,” and “We’ll talk and talk, and you’ll just prescribe me something anyway.”

He was echoing the messages drilled into his head over time. What he imagined I was thinking came from his inner templates — his relationship models that made him assume he was weak and helpless and I was a cynical and uncaring authority who would refuse to see him as a real human.

If we were to look at my patient’s brain activity during this negative, harsh self-talk, there would probably be an overfiring of areas responsible for strong emotions, including an almond-shaped region called the amygdala. An overactive amygdala can lead to anxiety and unrest.

When we’re worked up, it can be hard to think, and often the same messages keep running through our heads like a broken record. Talking to anyone, let alone someone unknown like a new therapist, is a tough ask when we are feeling crummy (especially if we expect more of the same upsetting messages).

To help patients deal with these repetitive negative messages, brain areas that help people think more flexibly, such as the ventromedial prefrontal cortex (VMPFC), need to be activated.

The VMPFC is a key area of the brain involved in how people communicate. It is located on the inner surface of the brain, behind the forehead. This area is involved in empathy toward others and in thinking through problems together.

The VMPFC also keeps the amygdala from firing too much. In several psychiatric conditions such as depression, anxiety and post-traumatic stress disorder, the VMPFC is not used enough — emotions remain high, and it is harder to change the tape that keeps negative thoughts going.

How talk therapy affects certain brain areas

One effect of talk therapy is that the VMPFC and other brain areas involved with reasoning and problem solving become increasingly active, keeping emotions in check and giving us room to reflect on situations, as opposed to reacting to them.

Therapists help patients develop flexibility in thinking by offering space.

As therapists, we do not validate patients’ worst views of themselves, nor do we propose to have life advice that is meant to solve all their problems.

The world pushes and demands action. We invite reflection. I do not impose my point of view on patients. All the fancy theories I have need to be set aside as I discover the person in front of me, someone no theory has described. I let them show me how they view the world.

This can help patients feel less trapped, broadening how they think of themselves and the world around them.

Sometimes, when we expect something from the world and we find something different, the VMPFC is kick-started. This is called a prediction error, and the VMPFC gets called upon to make sense of this.

My patient found himself in this situation. I did not shrink him down to a chemical imbalance to be medicated away. Instead, I wanted to make the space about him and join his rhythm. As his harsh templates were challenged and we learned how to think together, he became less tense.

He started making eye contact, expanded upon what was on his mind and even told a joke or two. He was discovering who he was beyond the unchanging ways others viewed him.

How to use therapy skills in everyday life

Many people struggling with mental health issues may not be able to access therapy because of the costs and the shortage in therapists and culturally competent care. But there are ways to incorporate some of the lessons from psychotherapy in our everyday lives.

In many ways, it comes down to how we treat our own thinking. Some tips include:

Choose reflection over reflex: We get caught up in tough thinking patterns because we do not take a step back to consider other points of view. When we find ourselves stepping into a thought loop, it helps to catch ourselves and try to consider other ways of looking at the situation.

Bring softness, not hostility: We often assume the worst about other people when they say something we don’t agree with. Even if people are behaving or speaking in a way we disapprove of, it is useful to remember that they have a story behind their perspectives. The stronger the negative feelings we have about people, the more it might help to get to know them better. This helps us develop empathy and connectedness.

Be curious, not judgmental: The mind is complex and can go anywhere, if given the chance. Although it is tempting to think our understanding of life is all there is to know, being open and inquisitive to things that are confusing and unsettling helps us stay flexible. If our mind goes to unpleasant and defeating places, instead of beating ourselves up over it, we should welcome the thought and reflect on what we can learn about ourselves by holding onto it, instead of throwing it away.

Christopher W.T. Miller, M.D., is a psychiatrist and psychoanalyst practicing at the University of Maryland Medical Center and an associate professor at the University of Maryland School of Medicine.

Speak Your Mind