How Psychotherapy Changes the Brain

And why talking affects us so much

Nothing much seems to happen during psychotherapy: a person simply complains about their problems.

Many people do not consider such conversations to be treatment. Even some psychiatrists divide mental disorders into "biologically" and "psychologically conditioned" and recommend treating the former with medication and the latter with psychotherapy. Nevertheless, simple conversations can make a big difference.

How new experiences affect the brain

Imagine a production in a theater: there are actors, a script and scenery, the psychiatrist Robert Berezin suggests. But the main character is unaware that he is an actor. It seems to him that he is free to live as he wishes. In fact, he plays out the same script over and over again.

The script in question is the human brain. The way it is structured affects the ability to concentrate, the response to stress, the tendency to form addictions, the choice of a romantic partner, and more. In other words, decisions are governed by the brain - but the person usually doesn't notice it.

This is clearly demonstrated by an experiment conducted in 1983 by neuroscientist Benjamin Libet. The scientist gathered a group of volunteers and asked them to bend their wrist. But before bending the arm, each participant had to use a watch to time the moment when he wanted to do it - to the nearest second. Libet himself monitored the human brain with the help of EEG and noticed that the motor cortex is excited even before the person decides to make a movement.

Later other scientists repeated the experiment and obtained the same result: the brain knows what the person will do at least seven seconds before the person consciously decides to do something.

The brain is shaped by the interaction of genes and the environment. The genes lay its foundation. Everything a person experiences complements it. The latter is due to neuroplasticity - the brain's ability to change under the influence of new experiences. Neurons that are excited together in response to a stimulus form a neural connection. When the same experience is repeated, this connection is activated, reinforced, and eventually becomes a habit, the brain's default setting - or, to follow Robert Berezin's metaphor, part of the script.

A child's brain is especially plastic - it has an incredible number of neural connections. For example, a two-year-old has about twice as many as the average adult. As a child grows up, the neural connections that he does not use disappear. The brain becomes less and less receptive to new experiences, but the habits it has already learned become difficult to change. The script is written, and the mature person reacts to situations the way he or she was used to doing as a child.

Let's say that parents punish a child when he expresses his opinion. In order to avoid punishment, he has to give up his thoughts and obey his parents. When this child grows up, he still unconsciously expects that any expression of his opinion will elicit criticism-not just from his parents, but from everyone around him. Most likely, this person will, as in childhood, constantly feel anxious, hide his thoughts from others, or even seek to think like everyone else in order to avoid "punishment."

The adult brain, though it may become less malleable, does not lose the ability to change. In order to change his habits and stop repeating the same scenario, the person needs to have a new experience - one that will contradict what the brain has learned before. This is the kind of experience that psychotherapy provides.

The effect of psychotherapy has been described by some researchers as "brain repair": talking to a therapist reverses some of the negative changes that have occurred because of the experience.

This is what happens, for example, with social anxiety disorder - a very strong fear of interactions with others: for example, public speaking and meeting new people. In this case, the frontal areas and subcortical structures of the brain, which are involved in the processing and regulation of emotions, do not work properly. And talking to a therapist, as found by a group of Swiss neuroscientists, restores the normal functioning of these areas of the brain.

Which is more effective: psychotherapy or antidepressants

Psychotherapy and antidepressants treat the same disorders: depression, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, eating disorders. Studies show that their effectiveness is comparable. However, they affect the brain in slightly different ways.

Antidepressants inhibit the activity of the amygdala, an area of the brain that determines if there is a threat to survival and triggers the "fight or flight" response if it detects danger. Psychotherapy increases the activity of the medial prefrontal cortex - it checks to see if the amygdala is sounding the alarm for good reason.

Both have the same effect: the brain begins to better regulate emotions. It turns out that pills and talking act on different parts of the same system. And this explains why pills and talking work better together than separately: they don't duplicate each other, but complement each other.

How talking or describing problems affects the brain

The basis of psychotherapy is the transformation of experiences into words: a person learns not just to talk about his problems by listing facts, but to accurately name the feelings he is experiencing. This can be useful in and of itself, even outside the office with a psychotherapist.

For example, one method of therapeutic writing, expressive writing, involves a person describing in detail and emotionally in a diary what is troubling them. Studies show that this helps to significantly alleviate the symptoms of depression.

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The psychologist James Pennebaker invented expressive writing. He explains the effect of his method as follows: without the ability to express pain, we experience stress over and over again. But to understand the neurobiological mechanism behind this effect, we first need to understand what happens to the brain because of psychological trauma.

Imagine you're a scientist and you put a person with post-traumatic stress disorder in an fMRI machine, and then you remind them of the event that caused the trauma. You will see decreased activity in the speech center of the brain, Broca's area. This state of mute horror, the inability to express in words what happened, may not go away even decades after the tragedy.

Broca's area is part of the left hemisphere of the brain. When a person remembers a trauma, activity drops off in this entire part of the brain. The right hemisphere, on the other hand, is active.

The hemispheres of the brain share the same functions, but the left hemisphere is more focused on language and the right hemisphere is more focused on emotions. Normally, they work in concert. When the left hemisphere, especially its speech center, Broca's area, "shuts down", the person experiences intense emotions but is unable to make sense of the experience because language is the main tool for making sense of the experience, explains psychiatrist and post-traumatic stress disorder researcher Bessel van der Kolk.

When a person expresses experiences verbally - whether in a dialogue with a therapist or in a journal - he overcomes the numbness of the left hemisphere and stops losing his mind when feelings overwhelm him. Studies confirm this: if you find the right word for an unpleasant emotion - the right ventrolateral prefrontal cortex, which is responsible for speech and meaning, is activated, while the activity of the amygdala, which triggers the stress response, is reduced.

How Relationships Impact the Brain

Talking about emotions is an inevitable part of psychotherapy. But there is another mechanism that allows it to affect the brain that goes beyond verbal communication. That mechanism is emotional communication. When scientists decided to find out what determines whether psychotherapy is effective, they found out: the main thing is the so-called psychotherapeutic alliance, that is, the relationship between psychotherapist and client.

In terms of neurobiology, the relationship does have great potential to retrain the brain - thanks to cells called mirror neurons. Their existence was discovered in 1992 by scientists from the University of Parma in Italy - almost by accident.

It all started when the researchers wanted to find out which cells are activated in the macaque brain when it makes different movements. To do this, they placed microelectrodes in the premotor cortex of the monkey and gave it different objects, such as an orange or a raisin. The experiment lasted, and the brain activity data continued to be recorded. The experimenter decided to have a snack, reached for his food - and discovered: neurons in the premotor cortex of monkeys were activated as if they were doing the same movement themselves.

These neurons were called mirror neurons - that is, they reflected the actions of someone else like a mirror. It is now known that humans also have such cells, and their main function is learning: thanks to them, one can learn a skill simply by watching others. But mirror cells are located not only in the premotor cortex, but also in the temporal cortex and amygdala, areas that take part in memory and emotion regulation. This means that the brain mirrors not only the actions of others, but also their emotions. This is most likely what makes psychotherapy effective.

During psychotherapy, the client's mirror neurons reflect the therapist's feelings and behavior. The therapist shows calm, no matter how difficult the situation is - and the client learns to cope with anxiety just as he does. The therapist shows kindness and compassion, accepts the client as he or she is, and the client learns to treat him or herself in the same way and expects the same from others.

How to change the way your brain works without a therapist

Consultation with a psychotherapist is not the only way to change the brain for the better. An example of this is the story of neuroscientist Brian Penney.

He had suffered from severe anxiety since childhood, but found no healthy way to deal with it. When he was in his twenties, he started using heroin. In 2013, after fifteen years of addiction, he was detoxing and happened to participate in a study in which he underwent a brain scan.

The topic of brain plasticity fascinated him and took over his life. Penny stopped using drugs and alcohol, got his sleep and wakefulness routines in order, began meditating and using psychotherapy techniques on his own.

In 2018, he took another brain scan - and compared it to the one he had taken five years earlier. It turned out that in five years of following healthy habits, his brain had gotten younger in several ways - in 2018, it was almost 10 years younger than his real age. Penny also learned to manage his anxiety and became more stress-resistant.

The habits that helped Brian Penney change his brain for the better can't completely replace seeing a therapist. The experience that psychotherapy provides is healing through a relationship with another supportive, accepting person who accepts you for who you are. However, these habits are a tool that can help improve brain function if you're not ready to go to a therapist, or supplement the effects of psychotherapy. Here are the most useful ones.

Regular exercise. Just six months of regular exercise can increase brain volume. Movement has such a powerful effect on the brain because it increases the number and quality of mitochondria, the organelles that provide the brain with energy: oxygen and glucose. In addition, exercise increases levels of the brain's neurotrophic factor, a protein needed to keep the brain malleable.

Mastering new things. When a person learns something, such as a foreign language, his brain forms new neurons and neural connections. This creates what is known as cognitive reserve - the brain's resilience to various disorders, including those associated with aging. Penny himself is educated in the neurosciences.

Communication. Older people with a high genetic risk of developing Alzheimer's disease are less likely to experience cognitive decline if they live together with someone. Scientists explain it this way. Communication is a workout for the brain: to talk, you have to quickly analyze large amounts of verbal and nonverbal information and use memory resources.

Hobby. Experience is the best thing a person can give his brain. And the more sensory and motor-rich the experience, the more useful it is. Therefore, hobbies such as knitting and gardening are nothing less than a trainer for the brain.

Meditation. Acute and chronic stress can alter the brain so that neuroplasticity and the amount of gray matter in the prefrontal cortex are reduced. To avoid this and the accompanying problems with emotion regulation and remembering new things, you need to manage stress effectively.

The best way is meditation: by meditating, one learns to breathe slowly and smoothly, and this changes the activity of the central nervous system and puts the body into a state of rest. In addition, a little research shows: meditation can not only protect the brain from stress, but also change its structure.