Robust Psychotherapy
How neuroscience informs our care
Neuroplasticity
Neuroplasticity is a term that means the brain can change. This is true both structurally and chemically. As we develop from an embryo to geriatrics, our brains naturally go through developmental changes. Our brains also experience change brought on by environmental impact, such as the air we breathe, food we eat, and experiences we have. Factors that seem to occur completely outside of our bodies (such as what we witness and how we are treated) cause changes to our brain. The brain prefers to be in a regulated, homeostatic state. In therapy, we can harness neuroplasticity to make changes to a dysregulated, imbalanced state.
Polyvagal theory
The vagus nerve (or 12th Cranial Nerve for the bio geeks out there) carries messages back and forth between the brain and the major organ systems. When applied to mental health, polyvagal theory shows us that many mental health conditions stem from the autonomic nervous system. While not a precise depiction of the complexity of the vagus nerve, many neuroscientists and mental health treatment professionals agree that polyvagal theory is a decent start.With over 4 quadrillion possible synaptic connections in the brain, scientists are probably unlikely to comprehend them all. As treatment providers, we know we cannot wait centuries, decades, years, months, weeks, days, or even moments for the final ruling on how the vagus impacts mental health and what can be done about it. People are suffering now. We can only start with what we know and commit to following research. Polyvagal provides decent metaphors to help clients understand how their autonomic nervous system influences mood, mind, and physical expression. Furthermore, when applied therapeutically, it provides exercises for understanding and making changes to their ANS responses.
Bottom-Up and Top-Down approaches
Until the last few decades, going to a counselor or therapist meant talking with the professional about the reason(s) that brought you there and either receiving advice, insight, or exploration about those reasons. This is what is known as a top-down approach and here is why: talking, thinking, rationalizing, and computing are all functions of the neocortex in the frontal lobe. Messages contrived through talk therapy are then carried from the "top" of the brain "downward" lower parts of the brain and subsequently the rest of the body. Now that you've read about "top-down", you may be able to imagine what "bottom-up" could mean. This is the practice of sending messages from the body and/or lower regions of the brain, "upward" to the neocortex. There are several pathways that communicate information upward but only one that communicates south-ward. Does that mean we should eliminate top-down and utilize only bottom-up? Of course not. We can do more with both.
Coregulation
Just as the field of neuroscience is ever-evolving, so is the field of parenting. A currently held belief in this field is that children gain their sense of security through caregivers' ability to help them regulate the strong feelings they hold. In infancy, this is the caregiver responding to their distress by holding then snugly, making sounds that remind them of safety, and providing for their physical needs. As the child grows, a caregiver may respond to their signs of distress by providing comfort, modeling their own feeling of non-distress. This teaches the child's nervous system how to settle after being distressed. The practice is called "co-regulation" because parents are not instructing babies how to settle, nor are they withholding their intervention in order for babies to somehow learn how to provide for themselves. Rather, parents are using their own autonomic nervous system to train the child's autonomic nervous system how to respond to stress and how to settle when the stress is mitigated. At Sojourn Well, we actively use co-regulation to help clients' nervous systems learn what they may not have learned in childhood about responding to stress and settling after distress.
Eye Position
The use of eye movement to address underlying trauma began in the 1980s with EMDR (Eye Movement Desensitization and Reprocessing). Since then, its nuanced roles have been further studied and evolved into a variety of techniques including Brainspotting, Accelerated Resolution Therapy, and Eye Movement Integration Therapy to name a few. We use Brainspotting at Sojourn Well, which is theorized to (a) bypass the 'thinking' parts of the brain, going straight for the functions involved in calming dysregulation; (b) utilize the retinal-collicular pathway (direct connection from eye to brain stem) to clear unsettled autonomic nervous system response to distress such as visual, auditory, emotional, and visceral flashbacks; , and (c) which knowingly engages the oculocardiac reflex to stimulate the parasympathetic nervous system, pumping the brakes on high-speed trauma response.
Ego-state/Parts work
These terms are synonymous and their multiple theories teach that, people, over the course of their lives, develop ways of both interpreting and engaging with the world around them. At Sojourn Well, we fuse these theoretical approaches with our understanding of neuroscience, believing that ego-states or Parts of Self serve as evidence that the brain preferences neurostructural pathways forged during previous lived experiences and apply those pathways to new lived experiences. When therapists use therapeutic modalities developed for ego-states and parts of self, they are effectively changing those pathways from a talk-therapy model utilizing the neocortex. As we discussed above in 'bottom-up and top-down approaches', the brain works faster and more efficiently when the mid-brain is engaged, which we can accomplish by by incorporating eye positioning and bottom-up mindfulness.