Prime Time Replay:

Dr. Susan Vaughan
on How Psychotherapy Changes the Brain


MsgId: *brain_storm(4)
Date: Fri May 9 20:32:03 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

Welcome, everyone, to another edition of Brainstorms. I'm your host, Rob Killheffer, senior editor and producer at Omni, and with me this evening is Dr. Susan Vaughan, author of THE TALKING CURE: THE SCIENCE BEHIND PSYCHOTHERAPY. Welcome, Susan!
MsgId: *brain_storm(5)
Date: Fri May 9 20:32:35 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

Thanks, Rob!
MsgId: *brain_storm(6)
Date: Fri May 9 20:33:52 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

The central thesis of your book is that psychotherapy "works" -- that is, helps cure emotional and behavioral problems -- by altering the physical structure of the brain itself, yes?
MsgId: *brain_storm(7)
Date: Fri May 9 20:34:54 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

Yes, the central idea in the book is that psychotherapy works by changing the interconnection between the nerve cells in the cerebral cortex. In so doing, it changes how your brain processes information, which changes the contents of the ideas in your mind.
MsgId: *brain_storm(8)
Date: Fri May 9 20:36:41 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

As you recognize in the text, this is a concept that might be hard for many people to believe, at first glance. What sort of research do you base your conclusions on?
MsgId: *brain_storm(9)
Date: Fri May 9 20:39:41 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

My book contains research from many different fields of science, those include neurobiology, including animal models, neural network modeling and artificial intelligence, and infant development. Although the pieces of science in the book are well researched and generally accepted in the field they come from, what's really new in the book is putting them together and applying them to the therapeutic process. I would say that the piece of science in the book that people find most compelling is the work done on sea slugs. This work was done by Eric Kandel and he was able to show actual structural changes in individual nerve cells in these marine snails as they learned new tasks. This piece of research suggested to him, as early as the 1980's, that psychotherapy might work in a similar method with synaptic changes.
MsgId: *brain_storm(11)
Date: Fri May 9 20:43:05 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

One of the ideas you bring up in your book is that of a "story synthesizer," a kind of narrative template which helps make "sense" of events in our lives -- and the patterns in which often underlie the emotional troubles that bring patients into therapy. Could you explain the concept a little?
MsgId: *brain_storm(12)
Date: Fri May 9 20:47:07 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I believe the story synthesizer is formed through development in early life and that it is the connection between nerve cells and the cortex that serve as a model of what to expect in our relationships. Most models of relationships contain the components, the building blocks, of our stories. Such as, in relationships, I usually do "this," and the other person responds in a particular way, so the story synthesizer is a kind of model that we're walking around with and applying to new situations that helps organize the stories of our relationships in a coherent way.

In the book, I talk about the fact that the bare bones of the story synthesizer are often uncovered through the exploration of dreams. I think that since dreams probably involve random actions of the cortex by the lower parts of the brain, they give us a lot of chaotic information to try and organize. Therefore, you can see what someone's story synthesizer will do with what probably amounts to random firing. It's almost the equivalent of giving the cortex itself a kind of electrical Rohrshack test.

MsgId: *brain_storm(14)
Date: Fri May 9 20:49:58 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

Your examination of dreams as a kind of window into a patient's psyche brings to mind the classic images of Freudian analysis -- a connection you explore in your book. In what ways do you see your ideas as a confirmation of Freud's theories and techniques, and in what ways do your concepts depart from Freud?
MsgId: *brain_storm(15)
Date: Fri May 9 20:52:21 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I think Freud and I are mostly alike in our ideas in acknowledging that dreams are extremely important and by recognizing that by taking an image in a dream and asking a patient to tell you more about it, you find out more about what's in their mind. THE INTERPRETATION OF DREAMS was one of Freud's early works and one of his first explorations of the unconscious. I think I'm using dreams rather differently, less because I think that they'll reveal an unconscious of which the patient is unaware, and more because I think that working with them will reveal connections between ideas that the patient was previously unaware of.
MsgId: *brain_storm(16)
Date: Fri May 9 20:55:35 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

The examples of patients that you provide certainly makes it clear how the recurring dream imagery -- breaking glass or water, for instance -- can reveal the patterns of thought they've developed. Do you, like Freud, think that certain imagery reaches across individuals, so that breaking glass often or always represents a similar thing in different people? Or does this imagery -- and the patterns of the story synthesizer -- remain pretty unique to each individual?
MsgId: *brain_storm(18)
Date: Fri May 9 20:58:11 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I don't think I could do the work that I do if there weren't common themes, even to some extent, common imagery, so when my patient talks about shattering glass, I have a vision of is and a potential connotation of it, but on the other hand, what makes my work so interesting is the way those symbols are intertwined with people's past life experience and their prior emotional states and the fact that each image has such individual features about it. Carl Jung was much more interested in the idea of symbolism being the same across people, but probably Freud's unique contribution was to realize that you could only tell what someone's dream symbol means by exploring their thoughts associated with it.
MsgId: *brain_storm(19)
Date: Fri May 9 20:59:47 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

Let me get back to the idea of therapy "rewiring" the brain. Given the research that shows that it's possible, what's the mechanism? How does talking lead to changes in the deeply embedded structures of the brain?
MsgId: *brain_storm(20)
Date: Fri May 9 21:02:33 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I think that it's probably not just talking, it's probably talking repeatedly and confronting the ideas that the network contains. For example, having a conversation with a friend is probably a little bit like walking down the street. You use your brain or your body and you change it some, but not all that much. I think that good talk therapy, even when it involves usually essentially Freudian techniques, like free association, differs from plain talk because it's very focused on conflict or a series of patterns. And it's probably repeating and examining those patterns a hundred or a thousand times that probably gets the pattern to change. That idea is supported by looking at how computer models change, how neural networks change, where one or two repetitions don't change the structure of the network very much, but repeated experiences do.
MsgId: *brain_storm(21)
Date: Fri May 9 21:05:55 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

I've read about research that shows how learning to play piano, for instance, produces identifiable changes in the structures of the brain such as the sensory regions devoted to the fingertips. Is it a similar process that you're talking about -- a kind of focused repetitive practice?
MsgId: *brain_storm(22)
Date: Fri May 9 21:11:06 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

It's exactly the same process. The difference is that because we know exactly where the map of the hand is in the brain, researchers have literally been able to watch the size of the area devoted to individual fingers change as people use them in different ways. For example, in one study, where monkeys could only use their second and third fingers, those areas of the brain grew and took over part of the maps for those fingers that weren't used. The problem is, our representations of how to have relationships are probably much more distributed within the cortex and we don't know where the maps of them are. My guess is that's because maps of how to have relationships are evolutionarily newer than maps of the hands.
MsgId: *brain_storm(23)
Date: Fri May 9 21:14:39 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

Your ideas draw on research into neural networks and seem (to me, at least) to adhere pretty closely to the "connectionist" view of the mind -- that it's essentially a product of the connections between neurons. What do you make of the various objections to the neural network view -- the ideas of Roger Penrose, for instance, who thinks the essence of consciousness lies in a smaller, subtler property of quantum gravity or some such?
MsgId: *brain_storm(24)
Date: Fri May 9 21:20:03 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I think for the purposes of thinking about psychotherapy, the connectionist view is a very useful one because of how it fits with certain principles, like our ideas of free association, which lend itself very naturally to a neural network model. In thinking about Roger Penrose's idea of neural consciousness, I think he's speaking on a scale that we don't yet understand how to integrate with the daily practice of psychotherapy.

Still, it's something I believe is essential for clinicians to follow, because you never know how the newer ideas coming out of computer modeling and neurobiology might fit with, or get us to change, our theories. That's something I don't think psychotherapists have been open enough to in the past, and partly I wanted to write this book to get them as well as their patients thinking in brain terms about the work of psychotherapy.

MsgId: *brain_storm(26)
Date: Fri May 9 21:23:41 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

In several recent editions of Brainstorms, we've had guests on talking a lot about the neurochemical view of emotional distrubances and brain function -- all the research into neurotransmitters and their role in the functioning of the mind. How does that research tie in to your ideas? Clearly there's a link, since some people respond so well to drugs like Prozac and Paxil.
MsgId: *brain_storm(27)
Date: Fri May 9 21:27:41 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I think that drugs have generally a very different action in the brain. Most drugs we use in psychiatry work by adjusting your transmitter levels, often in very widespread parts of the brain, so when you regulate serotonin, you get effects all over the brain as well as in other parts of the body. In contrast, I think psychotherapy at it's best works on a very limited and focused set of connections, so from my perspective, using medications, which I do a lot in my private practice, is sort of like changing the brightness on your TV set.

Psychotherapy is more like looking at the picture and changing it by changing the individual pixels one by one. There are hints of some interesting overlaps. For instance, one recent study showed that Zoloft, an antidepressent that affects serotonin, promoted the sprouting of new neural connections, so it may be in the future that we use medication to help kick the brain into a state where it's particularly plastic and psychotherapy is particularly effective.

MsgId: *brain_storm(29)
Date: Fri May 9 21:33:50 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

We're running short on time, so this may be my last question. You describe yourself as a "microsurgeon of the mind," and with that apt image comes a sense both of the power of your methods and the inherent dangers. As with a physical surgery, when you're talking about making very real alterations in your patient's brains, there must be the possibility of causing damage rather than improvement. When you're trying to help a patient alter their patterns of thought, how do you know what a "healthy" pattern might be? The territory of the mind is not nearly so well mapped as that of other parts of the body, where the "right" shape is clearer, right?
MsgId: *brain_storm(30)
Date: Fri May 9 21:38:41 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

I think that's right, but because the process of change in the brain takes a long time, because of the need for repetition, etc., I tend to get a lot of confirmatory evidence about whether we're moving in the right direction. By this I mean, it's very common, even while we're in the middle of working on problems, for things to begin to change in a positive direction in people's daily lives. But I think you're right in your concern in the sense that one of the points I make in the book is that not only am I do the microsurgery, I, as a person in my relationship with my patient, are literally being taken into their neural network.

I think this means it's very important for patients to have a clear sense that their therapist is someone that they wouldn't mind carrying around with them for the rest of their lives. It also means that when a therapist misuses their power and their relationship to a patient, that they're causing a kind of potential damage to the brain that we know can take years to undo with other treatment. One of the things that impressed me and prevented me from becoming a neurosurgeon was how coarse actual brain surgery is, how large parts of the brain affected by tumors are simply removed and one of the reasons I liked the microsurgeon of the mind idea is that I believe what I can do with my patients is actually something quite pointed and much more sophisticated than most people tend to think.

MsgId: *brain_storm(32)
Date: Fri May 9 21:41:41 PDT 1997
From: Rob_Killheffer At: 38.254.181.13

That's an excellent point to end on, I think -- psychotherapy is a powerful tool, so it's vital to find a skilled and sensitive practitioner before you put your brain into their hands. We've exceeded our time limit a little, so let me thank you, Susan, for being my guest here and for a delightful and informative chat. To the audience, as always, we've only been able to scratch the surface of the topic here tonight; if you're curious, I highly recommend Dr. Vaughan's book, THE TALKING CURE. She offers a revolutionary way of looking at psychotherapy that puts it on a much firmer scientific foundation. Thanks again, Susan! Goodnight for Brainstorms!
MsgId: *brain_storm(33)
Date: Fri May 9 21:42:47 PDT 1997
From: Susan_Vaughan At: 207.172.73.95

Thanks very much for having me on the show; I enjoyed the chat! Goodnight!


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