New Brain Science Quick Start Guide #4

by Ruth Buczynski, PhD

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N a t i o n al I n s t i t u t e f o r the Clinical Application of Behavioral Medicine

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The New Brain Science Quick Start Guide 3

by Ruth Buczynski, PhD with Norman Doidge, MD, Ron Siegel, PsyD, Joan Borysenko, PhD, Bill OHanlon, LMFT, and Elisha Goldstein, PhD 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)

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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 dont get better in the ways we think they ought to get better.

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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 cant remember if he used the term infinite but the idea was we could all become perfect. Today, theres 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 doesnt 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 brains reward structure.
Plasticity gives rise to a lot of things we dont 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, its 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, its not just that we are thinking the wrong thoughts but were actually changing the structure of our brains and altering the brains 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 thats a function of plasticity.

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

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4. How acculturation leads to brain change

Our brains dont exist in a vacuum. Culture can change the brain. Keep this in mind when working with clients from different backgrounds.
Were not born with a culture we become acculturated. We become acculturated by being cultivated, which means that we practice things and were 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; theyre 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. Its now been shown, interestingly, that they can actually see perfectly clearly underwater without goggles Now, thats 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 cant see underwater, and this turns out to be teachable. (p. 8)

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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. Heres one example of a woman who developed a program to train her brain.
Barbaras story was remarkable. She was roughly my age and she was born with a devastating array of learning disorders. She didnt know where her limbs were in space; she had trouble pronouncing words, she couldnt 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 didnt 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 couldnt 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; shed 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 didnt just work on the symptoms, but the function and exercised it. (p. 12-14)

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6. How the brain organizes change

Neuroplastic change isnt random. Norman Doidge explains how the brain develops some functions at the expense of others.
What Ive 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 didnt 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 couldnt go to her easily; she couldnt 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. Its easy for Michelle to get lost. Visual spatial skills are normally in the right hemisphere at least normally, mostly in the right hemisphere. What weve been able to construct from thinking through Michelles case is that plasticity is a competitive process we know that from all sorts of studies.

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 its 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 wasnt 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. Its a learning process, according to Norman Doidge.
[Chronic pain] is a pattern of brain-firing which is learned over time. Lets 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 dont move a part that shouldnt be moved because it is injured. Its probably for other reasons, too, but pain can protect us: Dont touch me Im burned! or I dont want to move thatit really hurts.
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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 its 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 bad habits become self-reinforcing

One of the most insidious things about bad habits is that they reinforce themselves. When one bad practice starts, your brain starts to get used to it, says Ron Siegel.
Theres an image that is used in Buddhist psychology to describe what are called formations, which are habits of mind, including dark habits of mind that we can get caught in.

What they say is this: the way a formation gets started is to imagine a chariot driver driving his chariot across a dusty plain. The first time he picks a route, the route will be somewhat arbitrary. But the second time he goes, if he encounters the tracks that he had the first time, hes likely to fall into and follow those tracks. If you do that several times, youre likely to have deep ruts and then, as you head off, youre very likely to follow the same pathway. This is really what happens in terms of the idea that neurons that fire together wire together. They create these pathways that predispose us to go in a certain direction. That is why in so many spiritual traditions you have people deliberately trying to practice what they consider wholesome habits of mind rather than the unwholesome ones its knowing that just practicing a habit is going to get you going in that direction. Many things are self-reinforcing if I practice a habit of generosity, lets say, or I practice a habit of letting go, it actually feels good to be generous and it feels good to let go. Theres a kind of positive reinforcement that comes from that. Then again, if I practice drinking (alcohol) when Im anxious or I practice hitting somebody when Im angry, that also feels good and has a tendency to be self-reinforcing.

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So, its interesting to see that not only is this neurons that wire together fire together going on, but also these practices are self-reinforcing. We dont have to seek particular reinforcements for our practices often all we have to do is steer our chariot in a given direction, do that repeatedly, and the chariot will tend to go that way. (p. 28-29)

9. One example of helping the shy brain

Socially awkward children can actually improve their social skills through brain training. Joan Borysenko tells her personal story of developing her social neural circuits as a teenager.
I am an example of a person who, until I was in my late teens or early twenties, I was so socially awkward that I couldnt even eat in the company of other people. I was pathologically shy. I didnt know what to say. I was unable to even do things like smile at the right time because my awkwardness got in the way. I had a mother who had a very interesting theory that I think would work not only for me but for many other people she sent me to acting classes!

I joined the drama club in school and talking about those chariots going into new territory and leaving tracks again and again and again there I was learning my lines, standing up in front of people even when I felt awkward, saying the lines, and getting the positive reinforcement of an audience standing up and clapping. I might not have been perfect, but I made an effort, and I gradually improved. I obviously built totally new neural circuits. I will say, too, that the act of reading plays, reading fiction, and understanding character when perhaps you have been protected in your youth and you havent had the exposure to so much character development is very, very helpful, too, in terms of social awkwardness. (p. 29)

10. How the brain deceives itself about pain

According to Ron Siegel, practitioners can play a key role in building good brain habits. Heres one way that a practitioner can help the brain navigate chronic pain.
Chronic pain has to do with the brains habit of focusing with anxious vigilant attention on certain kinds of brain signals, and in doing that, the brain amplifies those signals. So, in looking for a way out of that, what people have found most effective is to first of all shift the whole emphasis from, How do I get the pain to be less? which
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had been the emphasis in most chronic pain treatment for a very long period of time, to How do I get function back? In other words: How do I get to live my life? Instead of directing my focus with vigilant anxiety on pain sensations, how do I direct my focus on the sensations of walking, sitting, or engaging in normal life activities? That does two things: it mitigates the fear and fear plays a huge role. Heres a quick aside: when they test the role of fear in pain, they use a cold pressor test where you put your subjects hands in ice water, and you frighten your subject by saying, Youre going to have to keep your hand there for ten minutes. If you ask them to rate their pain after twenty seconds, theyll say, Its excruciating Im not doing this for ten minutes. But if you reassure them and say, Youll only have to keep your hands there for thirty seconds, and you ask them (the same question) after twenty seconds, theyll say, Oh, its a little cold its not a problem. Just the thought that this is going to be a big problem amplifies it tremendously.

If you can get people back into their life activities, then they get the reassurance that, Im not going to be disabled by this. Im going to be able to live a life, even though it hurts. This mitigates the fear, which also retrains the brain to not focus vigilantly on the pain. There are a number of different factors that all come together when we shift peoples emphasis from, How do I get the symptom to go away? to How do I get my full life back and focus instead on engagement and normal activity?

11. How to rewire the reward system

The brains reward system is a key part of bad mental habits. Heres Elisha Goldsteins 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
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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. 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)

12. When clients think change is impossible . . .

Neuroplasticity means expanding the realm of the possible. Bill OHanlon 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, Youll 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, Theyll never talk again that part of their brain was damaged Erickson wouldnt 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, Youd 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 dont 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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