1. How long have we known about neuroplasticity?

Neuroplasticity might be a recent term, but scientists have studied brain change since the 18th century. If clients are worried about “novel” methods, some history could reassure them.

“Here we are, in the late 1700s and early 1800s where we have the perfect experiment … an Italian scientist named Michele Vincenzo Malacarne said, ‘Could nervous tissue be changed by experience?’

He compared rats raised in two environments. One was a small, barren enclosure
and the other a larger space with mazes, toys, and other rats. They found that
in those rats in the richer environments, the cerebral cortex, which is central to
learning, weighed significantly more.

He showed that when animals have ‘education,’ if you will, we find more
neurotransmitters … and brain matter.

Scientific experiments in the 1960s established the fact that experience changes
brain structure – and these were in adult animals. You can trace it not only back
to Plato, but you can trace it back to any of the ancient arts that emphasize
incremental practice to improve things – the martial arts, the meditative arts and
others.

[But] it is only in our time that we have been able to show beyond any doubt
what is happening in the brain.” (p. 4)

2. Why “perfect” can be harmful

We all want to improve ourselves. But the idea of becoming
“perfect” can actually be harmful in a clinical setting.

“[Jean-Jacques] Rousseau realized that this whole notion of perfectibility could
spin radically out of control.

This is very serious clinically, too, if we start thinking of human beings, our
patients, as infinitely adaptable – and we start blaming them, or attempting to
blame them if they don’t get better in the ways we think they ought to get better.

There is an American link to this, though, that I think is very, very important…
which was introduced to the American founders.

Benjamin Franklin introduced Thomas Jefferson to the notion of perfectibility,
and Jefferson said things like, ‘I think people are extremely perfectible’ – I can’t
remember if he used the term ‘infinite’ but the idea was we could all become
perfect.

Today, there’s a strong attitude of perfectibility – the idea that you can always
better yourself and along with that is this feverishness to do so.

For example, ‘What are you doing today to better yourself?’ This very much
defines aspects of the American character in a way that doesn’t define the character
of other nations – or nearly as much.

This is a profound source of plasticity – the discovery of plasticity: We can
understand that human plasticity is a great gift – and now we would say that
plasticity is a gift of evolution – but it also raises problems.” (p. 6-7)

3. How the brain is vulnerable to experience

Experience changes the brain for better or worse. Norman
Doidge explains how bad habits can negatively affect our brain’s
reward structure.

“Plasticity gives rise to a lot of things we don’t like about ourselves. Our bad
habits are a function of the fact that our brains are plastic.

While the human brain is far, far, far more resilient than most people ever
imagined, especially in its response to injury and illness, it’s also far more
vulnerable than we imagined in so far as the brain can be changed by experiences
– for better or for worse.

When we develop bad habits and we use our brain over and over in a bad way,
it’s not just that we are thinking the wrong thoughts but we’re actually changing
the structure of our brains and altering the brain’s reward system to some degree.

We now have this new circuitry, which takes on a demon life of its own, if you
will. That is just one of the examples of the ‘dark side’ of plasticity.

There are other examples of the ‘dark side’ of plasticity. For instance, it is very
common in musicians, where they are practicing all the time and then they lose
control of their fingers – that’s a function of plasticity.

Some Parkinson’s symptoms are a function of plasticity going awry because
they start using their bodies in different ways and that gets reinforced.” (p. 7-8)

4. How acculturation leads to brain change

Our brains don’t exist in a vacuum. Culture can change the
brain. Keep this in mind when working with clients from different
backgrounds.

“We’re not born with a culture – we become acculturated. We become acculturated
by being cultivated, which means that we practice things and we’re trained in certain
skills.

We learn to speak, and we practice speaking over and over again. As we know, anything
that we repeat over and over again changes the structure of our brain. Culture impacts
the brain – you see this in cross-cultural analysis….

For instance, many things that we assumed to be biologically fixed are not when we
look at other cultures.

I like to think of the example of the sea gypsies, which is this nomadic tribe close to
Thailand; they’re a people who live in their boats and do their fishing. They are often
born in a boat, they often die in a boat – and the children go deep diving for food.

Typically, they dive thirty feet underwater. They actually learn to slow their heart rate
– slow down their vital system so that they can stay under the water. It’s now been
shown, interestingly, that they can actually see perfectly clearly underwater without
goggles…

Now, that’s not supposed to be possible because human beings, as you know, when you
go into a pool, everything looks kind of blurry – and that has to do with the refraction
of light passing through water.

When we were fish, we could see clearly in water presumably, but as evolution
occurred, we learned to function on land and see clearly in the air.

It was thought that the pupillary reflex and our control over the lenses of our eyes were
involved here. But the sea gypsies, in fact, learn how to change their focus so that they
can see clearly underwater. This is an example of plasticity – culture changing the
brain.

This is an example of something we thought was built into human beings – that you
can’t see underwater, and this turns out to be teachable.” (p. 8)

5. Working with learning disorders: A clinical example

By training the brain, clients may be able to overcome some of
the limitations posed by learning disorders. Here’s one example
of a woman who developed a program to train her brain.

“Barbara’s story was remarkable. She was roughly my age and she was born with
a devastating array of learning disorders. She didn’t know where her limbs were
in space; she had trouble pronouncing words, she couldn’t see more than two or
three letters when she looked at text on a page.

She was often extremely depressed because she might have to read a paper twenty/
thirty times, just to get through it.

All the conventional treatments didn’t work for her, and all the conventional
treatments at that time involved trying to work around her learning disability.
Why? Because we believed that the brain was hardwired – if you were born with
a learning disorder, you had to live with it.

Around this time, Mark Rosenzweig started showing that if you trained rats and
mice with various cognitive activities, they could grow new connections in their
brains .

So Barbara said, ‘Maybe I can train my brain.’ and since she couldn’t read a
wristwatch, she and Joshua Cohen basically wrote out clock faces on cue cards,
showing different times. But to make it simpler – they just put the hour-hand on,
and on the back they wrote the time.

She also devised the idea of adding something for the week and the month and the
year, and by the end of it, she had these really complicated clocks. She got tenhanded
clocks; she’d be flipping these cards over and now she could, of course,
tell the time and do it very fast.

One day, when she was at her home, she walked past the television and 60 Minutes
was on, and she listened to the program and she realized that she had, for the first
time in her life, understood what the announcer said, in real time…

Her problems with logic and grammar and relating symbols and prepositions…
basically disappeared because she found the function that had gone awry – she
didn’t just work on the symptoms, but the function – and exercised it.” (p. 12-14)

6. How the brain organizes change

Neuroplastic change isn’t random. Norman Doidge explains how
the brain develops some functions at the expense of others.

“What I’ve learned from spending time with Michelle is that when she was born,
there were a number of challenges that she had. She had a lot of trouble crawling
– she didn’t have half her brain so she had compromised motor movement. She
also had visual problems early on.

If she wanted to reach out to her mother, she couldn’t go to her easily; she
couldn’t see her easily – but she was able to speak. We learned from her that the
right hemisphere was able to take over and do the functions that were necessary
for her survival.

Now, there was a cost to that: to this day her visual spatial skills are compromised.
It’s easy for Michelle to get lost. Visual spatial skills are normally in the right
hemisphere – at least normally, mostly in the right hemisphere.

What we’ve been able to construct from thinking through Michelle’s case is that
plasticity is a competitive process – we know that from all sorts of studies.
brains .

The cortical ‘real estate’ you have will be devoted to the activities that you
do, and the activities that you do will be the ones that are most necessary for
survival.

Imagine a small child, who can barely see for the first year of her life and barely
move around, and can only speak – it’s going to be speech that she has to do.

So the right hemisphere took over speech. But because she probably has
compromised visual input and because she wasn’t moving around in space as
much as a child with two hemispheres would, her visual spatial processing was
compromised.” (p. 18-19)

7. How our brains “learn” chronic pain

Chronic pain, especially pain caused by trauma, can change the
brain. It’s a “learning” process, according to Norman Doidge.

“[Chronic pain] is a pattern of brain-firing which is learned over time.

Let’s go back to someone being in a car accident and the nerve around T4 is
stimulated.

Pain exists for an evolutionary, biological purpose – to protect us, basically, so
that we don’t move a part that shouldn’t be moved because it is injured.

It’s probably for other reasons, too, but pain can protect us: ‘Don’t touch me –
I’m burned!’ or ‘I don’t want to move that…it really hurts.’
brains .

It seems that part of the function is to just put the limb or the area in a state
where it might be better healed, but it’s not a perfect system that has evolved.

If that T4 keeps getting triggered, then the brain ‘learns’ that there is a
problem, and it just gets better and better at receiving a pain reaction. This,
again, increases its catchment area over time in chronic neuropathic pain and
increases how long it lasts.

So ‘learning’ is going on because we are seeing this increase – this change –
and the question is: Can we help a person unlearn?” (p. 24-25)

8. How attachment influences ability to read social cues

Ron Siegel discusses various roots that could lead to inability to pick up on social cues, and he offers his strategy for addressing this in a non-judgmental way.

A huge part of that involves helping people to see where, within themselves, it came from.

I mean, for some people, it is kind of like me with art or drawing – it just doesn’t come naturally – they’re not wired that way.

They might be, as we talk about people these days, on the autism spectrum, but that spectrum is very, very broad – everything from somebody who is just kind of intellectual
rather than emotionally attuned, all the way to people who really have profound difficulties. So, seeing those roots is important.

And the other roots that Norman talked about were those in attachment relationships that didn’t go so well.
brains .

I find it very helpful to look at the attachment literature on this, and Dan Siegel talked a bunch about this – the way in which we develop strategies to deal with what we didn’t get.

So, for one kid, it’s to become avoidant, and Stan Tatkin talks about them as island personalities – I won’t be dependent on anybody – I’ll be kind of distant. And that can lead to not really picking up on social cues – not seeing the need of the others.

Or somebody else might become very clingy, constantly needing reassurance, and that person might not pick up on social cues because their own needs are blinding them to the state of the other person.

I find that talking to people about the origins of these things, and what their experience was as a child is actually quite helpful.

I know that’s a little old fashioned these days – it sounds terribly psychoanalytic – but it’s very useful for putting these things in perspective and having people understand it, again, in a non-judgmental way. (p. 31-32)

9. How to work with fear of change

Ruth Lanius describes a concrete strategy she uses with clients to illustrate what the process of change looks like so they can feel safe and comfortable in working through feelings.

We want to look at each person differently and say OK, what is the right pace for
you, for your mind, brain, and body to change?

Then, we want to validate that change is frightening, and we’re going to go just at
the pace that feels safe and comfortable for the individual.

What I always use in therapy is a set of stairs that I draw, and I say, “Right now,
we’re at a certain steady state.”

For example, if we’re trying to get in touch with feelings – if people are detached
from their feelings – I’m going to say, “We’re going to take it step-by-step, each
step needs to feel safe for you to embark on.”

For example, the first step in reconnecting with feelings may be to get in touch
with physical sensations in the body, and this increases their mindfulness.

Then, I say to people, “As we’re moving from the first step to the second step,
you’re going to feel increased instability and increased chaos, and that’s normal.

And that means we need to practice getting in touch with physical sensations
over and over again until we’ve strengthened those neural pathways probably
involving the insula and the dorsal medial prefrontal cortex.

Once we’ve taken the first step and you feel safe, then we’ll move on to the second step.

People find it helpful to understand that change is a step-by-step approach,
they need to be mindful of their own pace, and it needs to be safe.

This can be very effective to achieve neuroplasticity for each individual person. (p.30)

10. How to rewire the reward system

The brain’s reward system is a key part of bad mental habits.
Here’s Elisha Goldstein’s strategy for helping a client rewire their
reward system.

“To understand the reward system, the first thing is to understand that the way that,
when the brain is wired, it works off of cues.

And so there are cues all around us that we build over time that create automatic
reactions and automatic interpretations, like a snap judgment that we are not
usually aware of.

So the first thing is to understand what are the cues to the bad habits – whether it
is eating, drinking, or even just thinking in certain automatic negative directions
– and so identifying those cues as people, places, times, negative emotions or
something like that.

And then understanding and teaching how the habit works. And so maybe there is
that cue that comes in but then a routine gets set into place because of the grooves,
the deep grooves that have been set into the brain over time, and then there is
usually a reward that comes up from that: some sort of relief or something like
that – when you first meet that Big Mac, there is maybe a form of relief that comes
before the shame kind of sets in.

For example, the first step in reconnecting with feelings may be to get in touch
with physical sensations in the body, and this increases their mindfulness.

Then, I say to people, “As we’re moving from the first step to the second step,
you’re going to feel increased instability and increased chaos, and that’s normal.

And that means we need to practice getting in touch with physical sensations
over and over again until we’ve strengthened those neural pathways probably
involving the insula and the dorsal medial prefrontal cortex.

And when we are able to do that – someone is able to recognize that habit loop
– there is a space between their awareness and the experience itself, and in that
space lies choice and possibility, and there is a feeling there that is happening in
the present moment.” (Next Week in Your Practice #4)

11. When clients think change is “impossible” . . .

Neuroplasticity means expanding the realm of the possible. Bill
O’Hanlon talks about his experience with some remarkable brain
change.

“One of my mentors was Milton Erickson, the late psychiatrist who died in
1980, and I studied with him in the seventies and he – I think I was a plastic
therapist for a long time because he believed everybody was changeable: their
emotions, their neurology. And he cured himself, if you will, from paralysis,
which was they gave him a bad diagnosis and said, ‘You’ll never walk again.’
And so he proved them wrong; he learned to walk again in very unusual ways.

And then, when he would tell me stories, he would tell me stories about working
with, again, impossible cases of aphasia after people had had strokes and teaching
them to talk again.

When, again, the doctors had said, ‘They’ll never talk again’ – that part of their
brain was damaged – Erickson wouldn’t buy it. He would have them do nursery
rhymes, play ‘Pat-a-Cake’ to rehab their brains, like people are doing now – now
that the scientific evidence is coming in saying, ‘You’d better work with their
brains and get other parts of the brains to compensate.’

So I saw this early on, both with Erickson and with some of the cases he talked
about – and they seemed impossible. But now we know – the science says –
brains can change all through life, which we thought to be impossible in the
seventies. I remember learning it in neurological psych, you know, all the stuff
that Norman talked about. And things have changed – but he gave me that. I
called my therapy ‘possibility therapy;’ my approach changed because I just
thought, ‘You don’t know what the limits of possibility are.’

I am sure there are some physical limits but I have seen some impossible cases
where people changed.” (Next Week in Your Practice #4)

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