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The Future of Psychotherapy

Publication date: 20 March 2012

As long as I've been a therapist I've held that psychotherapy interventions should be rooted in an understanding of the biological systems that underlie mental and emotional well-being.

Professor Richard Davidson's recent book, 'The Emotional Life of Your Brain' (co-authored with Sharon Begley), offers us a glimpse of a future in which mental health issues such as anxiety and depression are defined not in terms of their symptoms but rather which specific brain systems are out of balance or need to be strengthened. Such an understanding would naturally inform our choice of therapies.

Professor Davidson is a leading figure in the field of “affective neuroscience”, or the study of the brain mechanisms behind emotions. The book explores his theory of “emotional style”, a way of describing our emotional propensities based on a set of six dimensions, each representing a relatively independent trait and embodied in distinct brain circuits that can be measured objectively using the tools of neuroscience. Examples are resilience, or how quickly you recover from adverse events, and self-awareness in the sense of how well you perceive bodily sensations that reflect emotions.

Each person's emotional style is defined by where they fall on each of the six dimensions. In other words they are not like distinct personality types, rather each of us is a particular permutation of all six, just as a computer can represent colours digitally as a mix of three dimensions: red, green and blue.

The book describes all six dimensions, and the research which identified their neural underpinnings.

There is no one ideal emotional style, but on the other hand there are points on the spectrum you'd rather not be, because they leave you more vulnerable to mental and emotional health problems.

Knowing a person's emotional style will suggest methods for helping them overcome such problems, especially if we know how particular therapies tend to affect the brain systems underlying emotional style. This applies to both psychological therapies such as CBT and mindfulness based therapy, and neurotherapy, for example neurofeedback or transcranial direct current stimulation.

An understanding of mental illnesses based on emotional style has two main advantages over the current system of psychiatric diagnosis. Firstly, diagnoses such as depression, anxiety and ADHD are not seen as distinct diseases in the way that hepatitis is, but rather in terms of a continuous spectrum ranging from health to ill-health. They may share considerable overlap in terms of both symptoms and underlying neurology. Secondly not all people with depression (for example) are the same. There are probably several sub-types, with distinct neurophysiological underpinnings.

It's interesting to note that Prof. Davidson doesn't refer to neurotransmitters such as serotonin in his account of the neural systems underlying emotion – presumably he doesn't think they're all that relevant.

One of the best things about the book is that it includes a questionnaire which can help readers identify their own emotional style. I can imagine this could become a really useful assessment tool for psychotherapists and neurotherapists – albeit only a starting point. Professor Davidson's research is based on objective measures of the brain systems underlying the six dimensions, and ideally the psychotherapy of the future will use similar measures as well.

In the final chapter of the book Professor Davidson discusses ways of changing your position on each of the six dimensions. Mindfulness and meditation figure prominently – they are not specific to any one dimension. It strikes me that biofeedback, neurofeedback and neurotherapy techniques are very pertinent here – though Dr Davidson doesn't mention them. I'd like to devote a future blog post to how specific biofeedback and neurotherapy methods relate to the six dimensions of emotional style.

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