Words Change the Brain
Marti Kranzberg, PhD, CGP

In his Plenary session at AGPA’s Annual Meeting in Los Angeles, Jerald Kay, MD, stated that “words change the brain.” He detailed recent advances in neurobiological research that demonstrate how psychotherapy alters brain structure and function. The search for links between behavior and brain echoes neurologist Sigmund Freud’s quest, nearly 100 years ago, to explain behavior in terms of brain function. Without means to test his theories, Freud abandoned his Project for a Scientific Psychology. The creation of such instruments as the positron emission tomography (PET scan), however, has allowed late 20th century scientists to begin to understand the intricacies of the brain, break down such dichotomies as mind/brain and mind/body, and provide evidence for and against various psychological assumptions, theories, and practices.

While still very much in its infancy, it is clear that the field of neurobiology has much to offer clinicians as we move into the new millennium. The intent of this article is to identify several findings relevant to the practice of psychotherapy; findings that Freud, if he were alive, might find interesting, indeed. 

Experience Affects Brain Structure and Function
The brain is an open system that is influenced by, and interacts with, the environment. The relationship is reciprocal: brain development affects a child’s response to experiences, and a child’s experiences influence brain development. Furthermore, interpersonal relations appear to be necessary for normal brain development; in fact, experiences and interpersonal interactions not only influence brain activity but are crucial for brain development. 

One study demonstrated that the development of the orbitofrontal cortex and its neural connections, which are important for certain types of memory, are dependent on face-to-face interactions and eye contact with an attachment figure during infancy. Without this experience, individuals develop deficits in non-verbal communication, attunement to others, and the ability to assess vocal intonation and facial expressions. 

Other research has shown that infants and toddlers regulate their inner world by attachment to caregivers. At this stage of development, the amygdala, which utilizes a primitive form of appraisal and arousal, is activated through emotional communications, especially through eye contact. One study of infants’ responses to a potentially hazardous situation demonstrated that the infants looked to their mothers’ faces to decide a course of action. In this study, the infants had to decide whether or not to venture into an apparent drop off or “visual cliff” to get an attractive toy. While there was no actual danger, it looked risky to a one year old. When their mother smiled, infants would cross the “visual cliff;” when the mother showed fear on her face, the infant turned back. 

Research has also demonstrated that attunement to a caregiver actually increases blood flow to the prefrontal regions of the infant’s brain, resulting in the growth of neural tissue in emotional and attentional centers of the brain. When toddlers get older and begin to separate from their caregivers, they are more likely to experience looks of disapproval as they begin to broaden their range of activity. Without positive affect from the mother, the child’s excitement and prefrontal arousal centers are dampened, and growth in areas of the brain that encourage inhibition is accelerated. Thus, the evidence shows that different types of interpersonal interactions actually stimulate growth in different parts of the brain.

The reverse is also true. The absence of stimulation at different stages of brain development can inhibit neural growth. In addition, stress can have significant impact on the developing brain through the mechanism of neurochemical activity. While neurochemical stress may challenge the mature brain, it may adversely affect the development of the immature brain. A study of neglected children revealed that their brains showed anatomical changes in parts involving affect and interpersonal relationships. In these cases, “nurture” not only affects “nature,“ it determines “nature.”

Implicit and Explicit Memory
Clinicians have long been aware that memory is a complex process colored by perceptions and shades of meaning for an individual; recent research supports this clinical observation. Two different types of memory—implicit and explicit—have been identified which function in different parts of the brain.

Implicit memory is the simplest form and is not dependent on the hippocampus for its formation. It is present at birth and is associated with the amygdala. It does not require awareness of a sense of self or time. It does not require conscious processing during encoding or retrieval. Implicit memory is often identified as emotional memory and may be somatic, emotional, or behavioral. These memories often result in a sensation of vagueness or dissociation from time, place, or person. This is the only form of memory available until the child is about two years old when the brain has developed sufficiently to encode explicit memory. Implicit memory may support the concept of an unconscious in which memories have an unreal, disembodied feel and are not accessible through logical or rational processes. The presence of implicit memory also challenges the notion of repression. Rather than repressing memories of early experience, people do not remember experiences before the age of two because they do not have brain structures in place to do so. 

Explicit memory, on the other hand, requires higher order functioning. It is encoded through conscious and directed attention. This memory is dependent on the hippocampus, the major center for explicit memory processing, and the prefrontal cortex which is responsible for the assignment of meaning. These parts of the brain provide a sense of place and time, regulate sequencing of perceptual experiences, and link mental representations with feelings. The two types of explicit memory, factual and autobiographical, provide a context for what has happened and an awareness of self at specific times and over time. Unlike implicit memory, explicit memory is context-dependent, and the circumstances surrounding the memory are encoded within this type of memory. 

The Importance of Neural Network Integration
These different components of memory are processed in different neural networks so that coherent memory requires the binding together of various and complex neuronal processes. For a coherent sense of experience and self, several neurological systems must be integrated. The left hemisphere of the brain weaves a story but, without access to the right hemisphere, the story is incoherent and disembodied. Dissociative process, then, may be the absence of integration between these two types of memory: implicit memory is present but explicit is not. A goal of therapy then would be to help the client to bridge these types of memory and to access parts of the brain that facilitate integration. The importance of integration provides support for therapeutic interventions that use verbal and experiential techniques, such as Gestalt two-chair work or psychodrama, to help clients to make sense of their experiences.

Furthermore, it appears that these processes must be linked to the language function of the left brain hemisphere if the individual is to articulate a narrative about her experience. Language, then, is an important link in creating cogent memories. The effectiveness of the “talking cure” may lie in its ability to integrate various parts of the brain. 

Emotion and Neuroplasticity
In the past, it was believed that humans did not produce new brain cells. Recent research, however, has found that brain cells do continue to grow and that neural circuitry for integrating the various parts of the brain is active throughout the life cycle. This neuroplasticity means, in part, that early deficits in brain functioning can be changed with new experiences, new learning, and changing old memories with new information. Research has demonstrated that “emotionally meaningful experience” enables the creation of new neuronal linkages, suggesting that new learning may not be possible without emotion. This finding supports the primacy of emotion in health and well-being. Emotion may be significant in ways that clinicians could never even imagine.

The Impact of Later Significant Relationships 
Research suggests that a significant close relationship later in life with a spouse, therapist, close friend, etc. can ameliorate impaired development and psychological deficiencies and seems to confirm the therapeutic axiom that relationships can heal psychological wounds. Moreover, these findings suggest that such relationships in fact alter the structure and function of the brain. 

The organization of the brain as a hierarchical, increasingly complex system of subsystems is structured so that small changes in a subsystem can lead to large alterations in the system as a whole and to significant changes in behavior. Thus, there is a neurobiological basis for the often substantial changes that clients make after therapeutic interventions such as interpretation, reframing, redecision, confrontation, etc. 

Summary
The explosion of advances in neurobiology has only begun to challenge and elucidate some of our most cherished and entrenched psychological and clinical assumptions about the nature of human beings. It will be fascinating to see what emerges as the field of neurobiology continues to expand with findings that Freud, at best, could only begin to imagine. 

References
Allen, J. R. (2000). Biology and Transactional Analysis II: Neurophysiology 1999. Manuscript submitted for publication.
Allen, J. (1999) Biology and transactional analysis: Integration of a neglected area. Transactional Analysis Journal, 29 (4), 250-259.
Rolfe, W. (2000). Rethinking Feelings: Integrating the Biology of Emotion with Redecision Therapy. Journal of Redecision Therapy 2 (1), 13-31.

This article was published in the December 2000/January 2001 issue of The Group Circle.