Gregory P. Barclay, M.D., Newsletter Editor
Editor’s note: In this edition, I am pleased to summarize 3 books I have recently read. They all relate to a common theme, which is how our increasing understanding of neuroscience helps us to understand and re-define the process of psychotherapy. As professionals with particular interests in adolescents, it is essential that we have a thorough and updated education in neuroscience, since what we are learning about the adolescent brain has enormous impact on how we conduct treatment and what we should expect from patients at an individual level. Moreover, as a society, our growing understanding of the adolescent brain moves us into the forefront of highly charged societal issues, including the controversies of trying adolescents who commit violent crimes as adults, invocation of the death penalty for adjudicated delinquents, and as Dr. DeCrise explains in his article, the requirement that youthful sexual offenders be placed on public monitoring.
The Behavioral Neuroscience of Adolescence, by Linda Spear, Ph.D. (2009, New York, Norton Professional Books), 368 pgs, hardcover. $40 US.
This book was presumably written for professionals without advanced training in neurosciences as well as those with more formal training and experience in the area. Even though I was in the latter group, I found myself challenged as I attempted to recall the basics of neuroanatomy and neurophysiology I learned 30 years ago as a medical student and later on during my residency in psychiatry. As a professional with that knowledge, I found Dr. Spear’s book to be a refreshing and comprehensive review of our current understanding of the teen brain. However, I would doubt that other professionals without advanced training in neurosciences would be able to grasp or fully comprehend the subjects as presented. For psychiatrists who work with adolescents, though, this book is one definitely to purchase and read, as the information it contains influences our expectations and approaches to adolescents in our daily work with them.
The book is divided into two sections. The first reviews overall brain structure, function, and development as influenced by evolutionary, genetic, hormonal, neural, and sociocultural factors. The interaction of these produce distinctly adolescent behaviors and thought processes that are reviewed in the book’s second section. Those later chapters include detailed reviewed of the neurodevelopmental basis of adolescent risk taking, social behavior, and cognitive capacities, as well as the basis for emergence of psychological and drug abuse disorders during adolescence.
This book is an excellent resource for any professional who works with adolescents. I found the use of bullets and italicized first sentences of paragraphs to be especially helpful for doing a quick read and review.
What Freud Didn’t Know - A Three-Step Practice for Emotional Well-Being through Neuroscience and Psychology, by Timothy B. Stokes, Ph.D. (2009, Rutgers University Press), 210 pgs., hardcover, $24.95 US
Although this book is intended for the lay person who struggles with emotional regulation problems, I found it to be a very useful book from my perspective as a treating provider. As its title suggests, Timothy Stokes reviews how Freud’s fundamental concepts of the Id, Ego, and Superego now are best understood as corresponding to brain regions of varying degrees of connectivity and maturity. He develops the concept of “Amygdala Scripts” and reviews how powerful emotional experiences are stored instantaneously in the amygdale and subsequently “hijack the neocortex”. This process is at the root of what maintains negative and distorted cognitions and compensatory maladaptive behavior, and therefore “mastering” the amygdale scripts is the core of his 3-step practice.
The 3-step practice is essentially a self-help style simplification of what is accomplished in Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behavior Therapy. Dr. Stokes provides guidance on how to first establish an enhanced state of mindfulness so as to allow for access to deeply buried Amygdala scripts. Consequently, it is possible to develop enhanced insight to facilitate the mastering those scripts and attaining the third step, which is belief change. Throughout the book, there are examples and exercises designed for the motivated lay person to accomplish meaningful change. Dr. Stokes makes it clear, however, that many individuals with these problems require a much higher level of treatment delivered by a trained professional.
This book is useful to have on your shelf to share with a highly motivated and intelligent patient with emotional regulation problems, as it may assist them before committing to an extensive course of EMDR or DBT. It is also a good reference for patients already participating in psychotherapy.
Changing Minds in Therapy – Emotion, Attachment, Trauma, & Neurobiology, by Margaret Wilkinson (2010, New York, Norton Professional Books), 248 pgs., hardcover, $32 US.
This book is designed as a resource for therapists who conduct long term therapy with patients with trauma histories and/or disturbed early attachments. Dr. Wilkinson explores the dynamics of brain-mind change in therapy utilizing current research. She describes the neural basis of attachment, attunement, and affect regulation and how their development is influenced by our earliest attachments. Disruption of this process leads to observed changes in the orbitofrontal cortex where those experiences are initially encoded and consequently dictate how we experience emotion and relationships later in life. Dr. Wilkinson skillfully demonstrates with case examples how problems with attachment and attunement lead to clinical problems seen in the therapist’s office and how proper attunement by the therapist is central to the repair process.
Dr. Wilkinson’s book is divided into two sections. The first introduces the reader to the neurobiology of attachment, attunement, and affect regulation. In particular, she emphasizes how the right brain matures earlier than the left, and therefore how disruptions in attachment and attunement occurring at a very early age leave their residua in the right limbic structures, the Amygdala in particular. Since the ability to form memories with a verbal narrative occurs later and generally involves the left hippocampus, patients with early trauma experience right brain-mediated emotions in relationships that they neither understand nor can regulate unless therapeutic work is done to enable the left brain to neutralize the right. Dr. Wilkinson’s approach is a more traditional one in which she utilizes the therapeutic relationship itself over the course of time as the medium through which the repair process occurs. In this respect, she differs from the more contemporary therapies yet the general principles, e.g. harnessing the right limbic system with the left prefrontal cortex remains the same.
I found this to be a fascinating book because I have a particular clinical interest in adoption and attachment-related disturbances. In that respect, this is a good book for clinicians with similar interests who desire a deeper understanding of the neurobiology involved.