The study of the mind has a long history from Darwin to Wundt, Freud to Jung to and Rogers and beyond. As we advance our understanding of the mind, so too do we advance our understanding of its underlying mechanisms. Psychology has birthed a great many schools of thought, including ones to which we now pay little mind, such as functionalism and structuralism (which undoubtedly have contributed significantly to our present wealth of knowledge), and ones we should be paying closer attention to such as the psychodynamic, humanistic, & behaviorist schools. One important concept these divisions have in common is treatment and recovery.

Recovery is a difficult concept for some to grasp, and though the dictionary definition is quite clear, the way it is conceptualized seems to vary greatly from person to person. This is important to keep in mind when giving treatment. Telling someone they need to change does no good, but leading them to the realization that their own behaviours and attitudes are negatively influencing their lives, and having them come to the conclusion that change is imperative for their well being is the key to recovery. It gives a different message than when someone tells you “you have this negative feature about you, and you should change that” because what they end up hearing in that case is: “there is something wrong with you and I love, care, and accept you less because of it.” However, when we lead an individual to this realization on their own, the message is very different. It says “I still accept you for who you are, and I will accept you no matter what.” It demonstrates to the person that their actions do not define who they are as a person, and that they are more than their negative behaviours. This stems from the Rogerian concept of unconditional positive regard, which is integral to the client-centered therapeutic approach. This concept posits that we ought to accept and respect others just as they are, free of judgment or appraisal (Rogers, 1951, 1959).

Although it is important to allow and appreciate another person’s conceptualization of recovery during treatment, the one we will focus on today is the dictionary definition: recovery is a return to a normal state of mind, strength or health (Oxford). This conceptualization indicates that we can fall ill, but return to our original pre-illness state with the help of medication, operations, and (at least as far as mental illness is concerned) therapy. Some, however, hold a very different view; they believe that once you have developed an illness, you will have it for life. We do not refer to those individuals who have cancer, and go through treatment successfully, as having cancer. Once the cancer is gone, the cancer is gone. It may come back, but it is not the same cancer as before, and the cancer does not define who the person is. Why then does the opposite occur with mental illness? Prior to the onset of symptoms of depression, the individual might not experience any feelings of worthlessness, decreased interest in activities or suicidal tendencies (APA, 2013). If they did not experience these symptoms prior to the onset of the illness, why is it so hard to believe that once the cause of the symptoms is eliminated that they return to baseline?

With all the advances in our understanding of neuroplastic change, it shouldn’t be. Neuroplastic change isn’t as temporary as some may think, in fact, there is a restructuring of brain matter in some instances. In a study conducted by May et al., it was found that alterations in gray matter could occur rapidly, and that cortical plasticity may be involved in sustained clinical improvement (May et al., 2007). The study used low frequency repetitive transcranial magnetic stimulation (rTMS). They administered active rTMS to one group and sham rTMS to another for 5 days. They found that depending on the frequency, rTMS can induce similar effects to direct electrical stimulation, which has elicited neuroplasticity in animals, (May et al, 2007). Further, rTMS could be used to target specific symptoms, for instance Hoffman and Cavus (2002) and Poulet et al (2005) found that 1-Hz rTMS that targeted the left tempo-parietal cortex caused a significant and sustained reduction in auditory hallucinations in schizophrenia (May et al, 2007).

There are a number of different interventions that can induce neuroplastic change; we don’t necessarily have to rely on medication or rTMS. Davidson and McEwan (2012) discuss the evidence for plasticity-like change in the brain as a result of regular physical exercise and cognitive therapy. Cognitive therapy is an excellent intervention for neuroplastic change. First introduced by Aaron Beck in the 1960s, cognitive behavioral therapy is used in the treatment of a number of mental illnesses including depression, OCD, anxiety and even psychosis (Beck, 1967, 1975). CBT is based on the idea that our thoughts, feelings and behaviours are all connected, and that the way in which we perceive things influences the way we act. The goal of CBT is to alter negative thoughts and behaviours into more positive ones (Beck, J, 2008).

Cramer et al (2011) defined neuroplasticity as the ability of the nervous system to alter its structure, function and connections, and as a response to the environment, development, learning or therapy. The review article (Harnessing Neuroplasticity for clinical applications, 2011) offered a number of instances offering supportive evidence for neuroplastic change, ranging from stroke, spinal cord injury, developmental disorders and neuropsychiatric disorders[1]. Plasticity promoting interventions produce clinically significant results, for instance, Colcombe et al, (2004) and Kramer and Erikson (2007) found that aerobic exercise programs that benefit cognitive functioning in healthy ageing and early dementia patients, might also be of benefit to those with schizophrenia. They have also been shown to increase brain volume, and enhancements in brain network functioning, (Colcombe et al., 2004, Kramer & Erikson, 2007). Eack et al., (2010) found that two years of social skills group therapy, in conjunction with cognitive remediation for early schizophrenia is accompanied by significant increases in grey matter in the left hippocampus and amygdala, which correlates with the degree of improved cognition (Eack et al., 2010).

As with any intervention, there are varying degrees of success with neuroplasticity. Neuroplastic change is dependent upon a number of factors including the environment, concomitant training, individual motivation, attention, and time (Cramer et al., 2011). Neuroplasticity does not occur overnight, it takes a lot of time and effort, and the client must be open to the idea of change as well.

Norman Doidge outlines a number of salient cases that offer powerful examples of neuroplasticity at work in his books “The Brain that Changes Itself (2007) and “The Brain’s Way of Healing” (2015). These both illustrate a number of ways that neuroplastic change can be initiated ranging from physical activity (chp 2, pp 33-100) to neromodulator devices (chp 7, pp. 226-279), to light (chp 4, pp 114-159). Doidge outlines the stages of neuroplastic healing in chapter 3 of “The Brain’s Way of Healing”(2015), these are: the correction of general cellular functions of neurons and glia (eliminating sources that may be affecting the health of neurons and glial cells), neuro-stimulation (preparing the brain to build new circuits and overcoming non-use in existing circuits; an example of internal neuro-stimulation using thought would be CBT), neuro-modulation (restores the balance between excitation and inhibition in neural networks) neuro-relaxation (sympathetic nervous system is “turned off” and the individual relaxes/sleeps) and neuro-differentiation (the ability to pay attention and learn, making fine distinctions in the brain, or differentiating). According to Doidge, all five stages are essential for neuroplastic change, (2015).

Doidge identifies these five stages specifically because most instances of neuroplastic change and healing; these stages are not necessarily he has observed them in applicable in every circumstance. That said, these do typically occur in most cases (for instance, the building of new circuits is evidenced in the case discussed above, cited by Eack et al). The only difference is that they may not be referred to with the same names as those suggested by Doidge.

Neuroplasticity, or neuroplastic change, is a scientific discovery that can help many overcome mental and physical illnesses. Sometimes, we hear people say that “keeping a positive attitude” or “thinking positive thoughts” will cause good things to happen. Although these statements are most often made with the concept of karma in mind, they are somewhat applicable to the concept of neuroplastic change. It is a key component of cognitive behavioural therapy, which is closely related to the concept of neuroplastic change. Since the evolution of Psychology as a science, we have discovered more and more mental illnesses, their symptoms, and have been able to theorize the best methods to treat them. Many have been convinced that once you have been diagnosed with a mental illness you have it for life. This is not necessarily true. As we have seen over the years, there are a number of therapies that interact with the cognitive structures of the brain (CBT, DBT, light therapy, exercise therapy, etc.), that act as a way to re-frame the mind, and with it, the brain.

The brain and mind are one in the same, while paradoxically also being separate entities. We are unable to identify or locate the mind within the brain; Freud attempted this with his identification of the Id, Ego, Superego, but we have yet to find the location of these structures in the physical brain. The brain is to the mind as the body is to the soul. The two interact with each other motivating our behaviours and actions. We cannot understand the mind without first understanding the brain, and we now understand that our mind (thoughts, emotions, schemas, etc) influence our brain (the actual structure; hippocampus, gyri, amygdala, sulci etc.). This is exactly why neuroplasticity works; our thoughts first interact with our mind, causing negative attributions, altering our brain structure in a way that debilitates us and causes illness. This also means that our brains can change us for the better.

There are still a great number of skeptics who do not believe that neuroplasticity is effective. Neuroplasticity is not a religion; it is not something to believe in or not. It simply is an aspect of science that has proven once again how incredible the human species is, and just how malleable the human brain is. From an evolutionary psychology perspective, we can understand neuroplasticity as a way for the species to adapt, which is just what our brains are doing when we experience neuroplasticity.

 

 

 

 

References:

 

A May, G. Hajak, S. Ga¨ nßbauer, T. Steffens, B. Langguth, T. Kleinjung and P. Eichhammer. (2007). Structural Brain Alterations following 5 Days of Intervention: Dynamic Aspects of Neuroplasticity. Cerebral Cortex. 17: 205-210. doi:10.1093/cercor/bhj138

Beck, A.T. (1967). The diagnosis and management of depression. Philadelphia, PA: University of Pennsylvania Press. ISBN 0-8122-7674-4

 

Beck, A.T. (1975). Cognitive therapy and the emotional disorders. Madison, CT: International Universities Press, Inc. ISBN 0-8236-0990-1

 

Beck, J. “Questions and Answers about Cognitive Therapy”. About Cognitive Therapy. Beck Institute for Cognitive Therapy and Research.

 

Clark D, Beck AT. Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Trends in cognitive sciences. 2010;14:418–424.

Colcombe SJ, Kramer AF, Erickson KI, Scalf P, McAuley E, Cohen NJ, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci USA 2004; 101: 3316–21.

Cramer, S, C., Sur, M., Dobkin, B, H., O’Brien, C., Sanger, T, D., Trojanowski, T, D., Rumsey, J, M., Hicks, R., Cameron, J., Chen, D., Chen, W, G, et al. (2011). Harnessing Neuroplasticity for Clinical Applications. Brain. 134; 1591-1609. doi:10.1093/brain/awr039

 

Disner SG, Beevers CG, Haigh EP, Beck AT. Neural mechanisms of the cognitive model of depression.Nature reviews. Neuroscience. 2011;12

Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, et al. Neuroprotective effects of cognitive enhancement ther- apy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. Arch Gen Psychiatry 2010; 67: 674–682.

Erickson KI, et al. Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences of the United States of America. 2011;108:3017–3022.

 

 

Hoffman RE, and Cavus I. (2002). Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders. Am J Psychiatry159:1093-1102.

 

Kramer AF, Erickson KI. Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends Cogn Sci 2007; 11: 342–8.

 

Poulet E, Brunelin J, Bediou B, Bation R, Forgeard L, Dalery J, d’Amato T and Saoud M. (2005). Slow transcranial magnetic stimulation can rapidly reduce resistant auditory hallucinations in schizophrenia. Biol Psychiatry 57:188-191.

 

 

Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable. ISBN 1-84119-840-4.

 

Rogers, Carl. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In (ed.) S. Koch,Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill.

 

 

[1]
[1]                  Please refer to the full article “Harnessing Neuroplasticity for Clinical Applications” for full examples.

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