I attended a talk by Alison Adcock, M.D. P.h.D., for the Brain Awareness Week lecture series. The point of the series was to spread awareness of neuroscience research to the non-scientific community. The talk, titled If I could take good advice, I wouldnt need therapy detailed how Dr. Adcocks fMRI research for the Duke Center for Cognitive Neuroscience informs her psychotherapy at the Duke Hospital.
The talk began with a description of Dr. Adcocks theory of psychotherapy. She argues that psychotherapy for a number of disorders is designed to help patients out of fixed situation-response patterns and to broaden their view of the world. One example of this is a patient thinking No one wants to talk to me at a party, so I will just sit alone. The psychotherapists job is to convince the patient that so I will just sit alone is not the only option, and perhaps other people are just as shy as they are, and would appreciate the conversation. Rather than focusing on each and every maladaptive behavior, and specifically prescribing a better response, Dr. Adcock thinks it is necessary to change the individuals map of the world, so that they can come to see a variety of possible responses and behaviors in diverse situations that previously elicited maladaptive behavior. This is a traumatic process because it entails a dramatic change in worldview and, as Dr. Adcock points out, people often prefer to be right than to be happy (the person sitting alone at the party is at some level satisfied that their prediction was correct.) The question for Dr. Adcock is how do you prime the patient to be receptive to this type of dramatic learning? It does not happen often or predictably, but when it does, it leads to a sort of Aha! moment or breakthrough. She pointed out that a major goal of psychotherapy is to reach this critical moment, and the main use of psychiatric drugs is to prime the brain to be able to learn how to see the world differently. Drugs, however, may not be the only way to get the brain into the right state.
Dopamine, a neuromodulator produced in the ventral tegmental area and the substantia nigra of the midbrain, projects to a variety of brain structures involved in movement, planning, emotion, learning and memory. Research in the Adcock lab, as well as other labs, has shown that more dopamine is released when the brain is anticipating the arrival of an important event. For example, upcoming rewards, as well as risk of upcoming losses, activate the dopamine system. One thing the brain must do in response to the arrival of an important event is prepare to encode the event in memory. Indeed, research by Dr. Adcock has shown that dopamine release predicts memory performance in a task where participants are given money for successful memorization of pictures.
Furthermore, there appears two be two independent systems for memory. One involves the amygdala, striatum, and entorhinal cortex, and encodes fixed and stable memories that dont need to be changed (dark storm clouds indicate rain, for example). The other system, which involves the hippocampus, is geared towards remembering complex relational maps of how the world works, and these maps are fluid and can be updated based on experience. There is evidence that an optimum window of dopamine engages this latter learning and memory system, and Dr. Adcock proposes that this is the neurobiological mechanism for insight. In Dr. Adcocks lab, she is trying to train subjects to generate this optimum dopamine level (without the use of drugs) by providing people real-time feedback in the fMRI scanner about the level of activity in the ventral tegemental area. Ultimately, if she can train psychiatric patients to generate this internal state, it will allow patients to more easily learn how to update their conception of the world in an adaptive way. She also notes that this research will be profitable for education if children could be taught to generate this state (adderall and ritalin both act by increasing dopamine).
Here is yet another example of how our modern technology is changing the way we view ourselves and how we learn. In this experiment we see a breakdown in the traditional mind body dualism: people see that their brain is them, and by learning to control aspects of their brain, people can learn how to change. Technology is allowing us to think about ourselves in a fundamentally new way, and the implications of this are far reaching. Who knows if this will work (though a similar experiment succeeded in teaching chronic pain patients to control their pain), but if it does, I expect the landscape of psychotherapy and education will change dramatically.