Early in life we all learn that there are important differences between thoughts, words, and deeds. As very small children, we quickly realize that our thoughts are our own private business; that our words can get us into trouble (and sometimes get us out of it) but that, in and of themselves, they don’t do anything; and that deeds, such as hitting a little brother, have definite consequences. However, contemporary brain research has found that, at the level of the brain, thoughts, words, and deeds are all neurochemical acts. This extraordinary organ, which has no moving parts, registers electrochemical activity with every thought that we ever have, either awake or in sleep; with every word uttered aloud, even in the softest whisper; and with every movement of even the smallest muscle. And contrary to what we learned as children, it may be that the brain’s activity creates an electromagnetic field that overlaps, and may be perceived by, other people around us: That is, although the content of our thoughts may be private, empathic attunement may allow others to sense our state (Cozolino, 2002; McFadden, 2002).
Brain Change Therapy (BCT) is a therapeutic approach using brain–mind state change as a focus of treatment. Ultimately, all types of psychotherapy—from psychoanalysis to behavioral intervention—are successful to the extent to which they enhance change in relevant neural circuits (Cozolino, 2002). BCT starts with that working assumption: Effective therapeutic change must inevitably include a repatterning of neural pathways. It utilizes cognitive, affective, behavioral, and interpersonal techniques as they are informed by neuroscience.
Short of direct pharmacological intervention, there are three broad therapeutic modalities through which the clinician can assist the client in changing the brain’s neural patterning and shifting attention from negative to positive states. BCT makes directed use of all three. The first is through the conscious refocusing of attention using techniques of mindfulness. The second is by circumventing the conscious mind. To change states and access resources, we access preconscious levels of awareness through the use of hypnotherapy, empathic responses, curiosity, surprise, and humor, which we intentionally employ to inhibit chronic negative states and activate positive ones. The third method, and the one we have found to be the most powerful, is to address the brain specifically. This can be done through the state change therapies of biofeedback, neurofeedback, and deep hypnosis in conjunction with software and equipment that condition brain change, such as Cygnet neurofeedback software and the DAVID PAL device.
We emphasize the value of changing states of consciousness and conditioning the changed state through repetition to access or build internal resources. This process allows clients to experience their own “self-directed neuroplasticity” through the active practice of focusing attention (Rock & Schwartz, 2007b). As an adjunct to those methods, BCT helps clients create new, empowering life experiences that can serve as the basis for new neural patterns. And because the brain generates an electromagnetic field, BCT also requires the clinician to consciously direct his or her brain–mind state within the therapeutic interaction.
Due to the breadth of the BCT approach, it is not only effective in treating clients’ problem states but in working with individuals who are interested in shifting and conditioning peak performance states of consciousness.
Neuroplasticity
The brain, a major organ of the body, and the mind, having no material existence, are intimately connected. Some researchers are of the opinion that the mind and consciousness are simply concepts that we use to describe what are essentially artifacts of the brain (e.g., Baars & Gage, 2010). In other words, the mind is “smaller” than the brain. Other contemporary research (e.g., McTaggart, 2002), particularly supported by studying phenomena such as quantum memory and “out-of-body” experiences, strongly suggests that the mind is nonlocal (i.e., not confined to any particular physical location). The concept of nonlocality implies that the mind is “bigger” than the brain. In either case, for most people, most of the time, the mind and brain are not only co-located but inextricably connected.
Daniel Siegel’s idea that the “mind is using the brain to create itself” (2007, p. 32) may be remarkably accurate. Studies have now demonstrated that the brain exhibits a lifelong property of neuroplasticity: New neurons can be grown, neural networks can be formed, and old networks can be changed (Eriksson, 1998). In fact, contrary to earlier views, the brain continues to grow new cells throughout the lifespan (Restak, 2001). While life experience constantly shapes the brain, the brain can also be intentionally changed through attention training (Schwartz & Begley, 2002). In fact, Schwartz, Stapp, and Beauregard (2004) note that “an accelerating number of studies in the neuroimaging literature significantly support the thesis that … with appropriate training and effort, people can systematically alter neural circuitry associated with a variety of mental and physical states that are frankly pathological” (p. 2). Far beyond the repair of dysfunction, it is also possible to develop the “exceptional” mind, wherein deep states of concentration lead to profound experiences of stillness, calm, and equanimity. In short: The brain can be changed through the mind; reciprocally, the mind can be changed through the brain.
Negativity Bias
Gordon et al. (Gordon, Barnet, Cooper, Tran, & Williams, 2008) and Williams et al. (2008) described the brain’s organizing principle as moving toward reward and away from danger or threat. The brain is constantly scanning the environment and, on the basis of incoming data, making decisions about what to move toward or away from. However, the “negativity bias theory” (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001) states that the brain–mind has a negative bias; that is, it is easier for it to give attention to negative feelings (the “FUD” factor—fear, uncertainty, doubt) than positive ones. Clearly this attunement to potential threat would have survival value and therefore, evolution has presumably favored it. But the result is that, left to itself, the mind’s innate tendency is to wander to something distressing.
Consistent with the brain’s propensity to focus on threats, psychophysiological arousal occasioned by the perception of threat tends to arise more quickly, be more intense, and last longer than arousal levels associated with potential reward. When calm levels of arousal prevail, we experience empowering states such as joy, pleasure, love, concentration, determination, courage, and clarity. However, the positive feeling states are more fragile; they tend to last for shorter periods and can easily degrade (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001). In essence, the negativity bias, which selects in favor of survival, selects against optimal functioning. However, due to the plasticity of both the brain and the mind, it is possible to moderate the brain’s negative bias.
State Change
The term state change refers to the capacity to shift the mind from one emotional state to another and to shift the brain from one neural pattern to another—for example, from anxiety/high psychophysiological arousal to calm/low psychophysiological arousal (Panksepp, 1998; Fisher, 2009). Being able to control one’s brain–mind state is central to living successfully. When people cannot shift from reactive states to calm ones or activate themselves to accomplish a goal, problematic patterns in living emerge.
As Albert Einstein observed, “We can’t solve problems by using the same kind of thinking we used when we created them” (Calaprice & Lipscomb, 2005, p. 292). He was speaking about our problems at a societal level, but the same holds true for individuals. However, with a shift in state, a person can access a different set of emotions and abilities. Often such a shift results in the ability to find solutions where previously none appeared to exist. At other times, the external circumstances simply cannot be changed. Nonetheless, with practice, we can always change internal states. That shift can transform the inner landscape as it is experienced at that moment; it can even transform the inner life.
Focusing on the brain specifically, Siegel defined states as “the total pattern of activations in the brain at a particular moment in time” (1999, p. 208). Brain states permit the organization of mental processes. Grigs-by and Stevens (2000) remarked that a state is “an emergent property of the self-organizing activity of the brain, acting as an organizer of experience, and influenced by experience itself in a variety of ways” (p. 164). All mental processes involve neural activation tendencies (NATs), which are located in different memory systems (Grawe, 2007). These NATs are engaged to reduce stress or incongruity in life situations. In turn, the reduction of tension strengthens the neural activation pattern. Grawe (2007) added: “If this process is repeated, the newly formed pattern occurs more and more quickly and easily and is facilitated better with each new activation until finally it becomes part of the individual’s repertoire” (p. 222). As these patterns become old and familiar, they also become increasingly difficult to change.
States maintain certain levels of emotional regulation, memories, mental models, and patterns of behavior (Siegel, 1999). The physical indications of a mental state shift include changes in breathing patterns, focus of eyes, posture, skin color, rate of speech, tone of voice, choice of language, and nonverbal behavior. A facial expression or fragment of speech can reflect a person’s inner experiential world. For example, someone who feels intimidated by another might have a tight smile while saying “Hello.” Each state determines the behaviors in which a person will typically engage.
Numerous factors determine brain states, including “arousal level, point in the sleep–wake cycle, level of activity, mood, sympathetic nervous system activity, current emotional status, body temperature, blood glucose level, current status at that moment in a significant personal relationship, and short-term behavioral goals” (Grigsby & Stevens, 2000, p. 166). Biological cycles are another significant factor. Research has identified three major biological cycles for humans. The infradian rhythm is governed by biological factors and exogenous cues such as pheromones and extends over periods of more than 24 hours (e.g., the menstrual cycle); the circadian cycle, which recurs every 24 hours (Brown, Graeber, & Curtis, 1982; Rossi, 1986); and the ultradian cycle, which recurs every 90–120 minutes (Rossi, 1986). In addition, states are influenced by mood—mood is defined as the “manifestation of relatively persistent neurophysiological activity” (Grigsby & Stevens, 2000, p. 169)— temperament, immediate physical factors such as feeling hungry or tired, and emotional reactions.
Sensory input (e.g., suddenly noticing smoke coming out of your toaster) can also trigger certain states, activating neurochemical responses and tendencies toward specific actions. These actions (e.g., quickly unplugging the toaster) help the individual cope with environmental demands. However, the fight–flight–freeze response that mitigates danger is of little use in the therapeutic setting. In fact, it may be highly counterproductive. “The rational, executive brain, the mind, the part that needs to be functional in order to engage in the process of psychotherapy, has very limited capacity to squelch sensations, control emotional arousal, or change fixed action patterns” (van der Kolk, 2006, p. 5). Instead, low levels of neurological and emotional arousal facilitate openness and an ability to make constructive use of the therapeutic interaction.
“As state changes, so does behavior, and thus state is associated with both adaptive and maladaptive behavior” (Grigsby & Stevens, 2000, p. 362). Neuroscientist Jaak Panksepp (1998) recorded seven different neural circuits that turn on mood states. When a particular neural circuit is active, certain patterns of feeling, thinking, and behavior naturally occur. It is impossible to make changes in the perceived experience unless another circuit is turned on. When a person’s emotional circuits have been conditioned to switch on automatically with specific triggers, he or she falls into certain behavioral patterns that are difficult to interrupt.
In a similar vein, Damasio (1999) discovered that each emotion has a specific neural mapping pattern. Sadness, happiness, anger, and fear each has a distinguishable neural pattern that can be activated by the memory of an event that originally evoked the emotion. The parts of the brain that are engaged in the regulation of these feelings, the somatosensory cortices and the upper brainstem nuclei, activate during these experiences. When these emotions switch on and are reinforced over time, their circuit activation seems automatic. Therefore change needs to focus on their inhibition and the activation of alternative states.
Grawe (2007) suggested that the goal of psychotherapy is to bring about neuronal change through incongruence reduction and need satisfaction. He said further, “Neuropsychotherapy strives to shift the brain into a state that enables these basic needs to be fully satisfied” (2007, p. 424), and he concluded that “concepts of traditional therapy schools can no longer be regarded as adequate foundations of psychotherapy” (2007, p. 419).
The Neurochemistry of Well-Being
Davidson and Lutz (2008) researched mental practice and its effects on the brains of monks. Like other research, their study confirmed that the brain can be trained to change its own circuitry. When researchers asked the monks to meditate on unconditional compassion, their brains activated extremely organized and fast-moving gamma waves, which occurred in many different places in the brain. Such complex neural coordination reflects higher mental activity and heightened awareness. Magnetic resonance imaging (MRI) also indicated that, in particular, the left prefrontal cortex was activated by positive thoughts and emotions.
But a monastic lifestyle is not necessary to create enhanced neural patterning; increasingly there is experimental support for the idea that with mental training, anyone can learn to feel happier. General happiness seems to be a constellation of states of well-being. Even if there is trauma in one’s background, an individual can cultivate a happiness mindset. When we shift states to the calm center on a regular basis, the happiness quotient increases and our liveliness, clarity, fulfillment, and ability to enjoy life expands; in addition, our health may improve. By practicing state shifting, it may even be possible to access “pure happiness”—a state of happiness that is pure in the sense that it is not necessarily the result of, or dependent upon, any external circumstance. Instead, it exists internally for each person.
Positive psychologist Jonathan Haidt (2012) discovered one brain circuit that activates what he called a state of elation. Elation tends to wipe out all other emotional states for a period of time. It occurs when people witness virtuous acts or a manifestation of humanity’s higher moral nature, such as a display of generosity, loyalty, or courage. Haidt first developed the idea of elation from reading Thomas Jefferson’s letters, which focused on the practice of virtue. Haidt (in press) said that language can “transport” an audience into a state of elation. Charismatic speakers would easily agree with him. For some people, certain musical compositions may also have the same effect. Haidt found that elation produces oxytocin, the chemical released in the brain during bonding experiences (Silvers & Haidt, 2008). It is not clear exactly how, but the experiences of elation and pure happiness may overlap. One possibility is that pure happiness also involves the release of natural oxytocin.
The Role of Conscious Attention
The 19th-century psychologist and philosopher William James said: “Everyone knows what attention is. It is the taking possession by the mind in clear and vivid form, of one out of what seem several simultaneously possible objects or trains of thought… . It implies withdrawal from some things in order to deal effectively with others, and is a condition which has a real opposite in the confused, dazed, scatter-brained state” (1890/1950, p. 403). Forms of attention have since been categorized more specifically as sustained, divided, and selective. Sustained attention involves holding the mind on a single focus or stimulus over time. Divided attention is the ability to attend to multiple stimuli at one time (or in such rapid and recurrent succession as to be nearly simultaneous). Selective attention is the ability to bring a stimulus into the foreground and place others in the background (Raz, 2004).
New discoveries in neuroscience, systems work, biofeedback, consciousness training, and meditation approaches have reinforced the idea that a direct key to change may lie in selecting which type of attention a person uses at any given time and on what that attention is focused. This skill requires learning how to shift brain–mind states in order to activate different neural circuits, different brain-wave frequencies, and, consequently, different abilities (Panksepp, 1998). In short, the ability to shift brain states makes it possible to view the world through a different lens. Schwartz and Begley (2002) state:
Since attention is generally considered an internally generated state, it seems that neuroscience has tiptoed up to a conclusion that would be right at home in the canon of some of the Eastern philosophies: introspection, willed attention, subjective state—pick your favorite description of an internal mental state—can redraw the contours of the mind, and in so doing can rewire the circuits of the brain, for it is attention that makes neuroplasticity possible. (p. 339)
By shifting the focus of attention, a person can make an immediate change in his or her emotions, mood, perceptions, and behavior. By learning new brain–mind habits, long-entrenched personal patterns can also be changed. Once the shift in internal states has occurred, even on a momentary basis, the therapist can use empowering strategies to help the client access commonly overlooked internal resources or build missing developmental experiences.
State Stability
Shifting attention toward some aspect of a situation that can be considered in some sense positive (rather than strictly negative) is important in repatterning habits both at the neurological and the personality levels. Fredrickson (2001) suggested that developing an internal “reset button” to move from negative to positive states could be done by noticing the part of a situation that was benign or “better than bad.” The ability to change states and “look on the bright side” tends to enlarge a person’s perspective and improve coping ability.
For positive state stability, however, attention training may be necessary. Whatever a person focuses on—a fear or an insight, a dear friend or a personal nemesis—tends to maintain the brain–mind state associated with the experience (Rock & Schwartz, 2007a). Learning to hold a focused attention will contribute to stabilizing brain circuits and improving the brain–mind’s ability to maintain a state associated with a particular positive experience. Intentional and practiced state change shifts emotion and “drives appraisal and reflection” (Baumeister, DeWall, Vohs, & Alquist, in press), such that state stability is more likely and more easily activated by the associated brain circuits. Through attention (state) training, one can become able to regulate thoughts, emotions, and behaviors and achieve goals even in the midst of distraction or situations causing high levels of arousal.
Mihaly Csikszentmihalyi, known for his work in positive psychology, observed: “What we pay attention to, and how we pay attention, determines the content and quality of life” (1990, p. 43). Similarly, the Spanish philosopher and humanist José Ortega y Gasset wrote: “Tell me to what you pay attention and I will tell you who you are” (1962, p. 94). As a person focuses awareness and gives attention to the inner and outer matters of life, he or she creates the moment-to-moment experience of living. When a client can witness a powerful feeling, turn down the intensity, learn to change states, and condition more positive circuits, new levels of self-awareness and mental flexibility emerge.
Circumventing the Conscious Mind
Long-entrenched neural pathways, however, are difficult to dispel. Additionally, many clients find that they have difficulty implementing direct therapeutic suggestion and are often subtly resistant to changing their habituated thought patterns. Because of this, a conscious approach to changing problematic patterns can backfire, causing the pattern to become further entrenched, particularly if a client feels that his or her personal choice is being taken away. Therefore, BCT also includes numerous techniques that address the brain while circumventing the conscious mind.
A particularly effective means of “flying under the radar” of the conscious mind is the use of integrative hypnosis. Milton Erickson viewed trance as a common, naturally occurring, and everyday experience. As an example, a person might be driving on the freeway while listening to the radio and thinking about an upcoming luncheon meeting. Arriving at her destination, she might have no memory of driving from her point of departure to her destination. This was similar to, if not precisely the same as, a formally induced amnesia. One of Erickson’s many contributions to therapy and hypnosis was his recognition that therapy can utilize these everyday trances with or without a formal induction. Instead of suggesting directly that a person would experience something, Erickson often embedded or interspersed suggestions within a prolonged monologue. He altered the tone of his voice in such a manner that the client’s unconscious mind would hear the suggestion, while his or her conscious mind did not pick up on the fact that anything had been suggested (Erickson-Klein, February 15, 2003, personal communication).
Listening attentively to the client and then offering a completely unexpected, positive response is another method of “making an end run” around the conscious attitude of the client. This tack achieves three purposes. The surprise element immediately shifts the client’s state; simultaneously, the fact that the response was unexpected calls into question the client’s sense of the unquestioned “rightness” of his or her perspective; and the “novel” response models the possibility of seeing the situation in a completely different way. As examples of an unexpected response, curiosity on the part of the therapist can counter a client’s fear and anxiety; gentle humor can defuse frustration; and pleasant surprise can offset negativity.
Addressing the Brain Directly
In the 1970s Barbara Brown (1974) demonstrated that subjects could turn on subjective states to make a biofeedback machine light up. Going further, the Greens discovered that people can become aware of very subtle internal sensations that normally go unnoticed until they are hooked up to a biofeedback device. What can then be sensed and controlled is a state of consciousness that contains sensory cues (Green & Green, 1977). During their research, Elmer Green noted that although it is possible to be aware of corresponding physiological conditions such as muscle tension, cold extremities, or a pounding heart, it is impossible to detect one’s own brain-wave patterns. However, by incorporating different types of brain feedback and/or brain stimulations, delivered by an increasing variety of specialized devices, training the brain to produce particular wave frequencies becomes readily possible. Deep hypnosis is another means of accessing states of profound inner quiet, which then allows rich material to come to the surface of the mind in the form of hypnogogic imagery. All of these methods can lead to integrative and long-lasting experiences of psychological well-being—which, in the therapeutic context, can significantly increase the effectiveness of state management.
The State of the Therapist in BCT
Science has yet to determine the full extent of the capacities of the human mind. Nonetheless, with recent research in the field of neurobiology, therapists are now able to understand more about the ways in which clinical interventions function at a neurological level and, with new brain-based technologies, can design interventions that are more effective. However, interventions are far from being the sole agents of therapeutic change. In fact, substantial clinical evidence supports the idea that the relationship between the therapist and client is significantly more influential than the interventions, per se (Cormier, Nurius, & Osborn, 2009). Based on this understanding, it becomes clear that the state of the clinician must be as intentionally managed as the state of the client. As therapists, when we shift our own internal states and focus attention in the right way, we help the client shift his or her internal state and then keep that desired target state stable. As we are able to witness, accept, and keep the intensity of our feelings managed, the client’s functional behavior will follow.
Milton Erickson conceptualized what he termed response readiness as the internal state of the therapist in making him- or herself ready to respond to a client and to utilize whatever the client has to offer. He believed that in therapy, response readiness was crucial not only for client change, but also for therapist efficacy; that is, the therapist must be able shift states deftly in order to be effective. Zeig (1992) noted that “problems represent a ‘state’ of insufficiency in which patients believe they do not have resources to cope or change… . The therapist enters into a state of response readiness and thereby becomes a model for the patient to access a similar state” (p. 300). Holding the appropriate state, the therapist models sufficiency back to the client. Response readiness thus becomes a state that creates a bridge between the client’s problem and more functional and resourceful inner states.
The BCT Process
The BCT process can be encapsulated in the following steps, which are illustrated in the case that follows:
1. Acknowledge the client’s presenting state and the issues driving it.
2. Define the problem as solvable.
3. Identify the target state.
4. Assist the client in changing states and moving toward the target state.
5. Condition and reinforce the new state.
6. Establish the new state as a means of resolving the underlying issues.
7. Assist the client in creating workable solutions as they emerge from changed states and behaviors.
8. Support the client in taking action.
9. Link the action into the client’s social context.
Case Example: Using State Change to Reach Therapeutic Goals
Arriving for his therapy session, Roger appeared to be depressed and in a state of negativity. Carol asked Roger where he would like to begin. Roger, looking toward the therapist to start the session, replied, “I don’t know. Everything is the same, nothing is better.” Hearing the hidden blame couched in sad language directed toward the therapist, Carol responded empathically: “Life feels really difficult when you are stuck and not going in the direction you want. Tell me what ‘the same’ feels like.” [Step 1: acknowledge the client’s presenting state]. Roger replied that it felt like a huge, heavy weight.
Roger had lost a good job 4 years earlier and had been unable to find work at the same level of pay. Several dating services had rejected him, and collectively, these blows had been devastating; as a result, he felt helpless and could not summon the motivation to make any significant changes in his life. Questions about his family of origin revealed that in his childhood, Roger had felt rejected by his father and continued to feel judged as inadequate in his ability to take care of himself.
A therapist who had not considered Roger from a neurophysiological perspective might have continued to respond empathically and then explored potential cognitive and behavioral strategies to help him. Using BCT, however, the therapist would include some additional inquiries in an initial assessment—among them would be questions to determine if the client had racing thoughts or lived in such negative states so chronically that it would be difficult for him to switch out of them. In that case, underlying damaged neurophysiology might be a contributing factor. Many clients either do not remember if they had a fall or believe it to have been inconsequential. However, the number of people, clients included, living with some type of undiagnosed head injury is significant (Amen, 1999; Proler, personal communication, May 23, 1998).
Usually, after the initial evaluation, we begin with the simplest neuropsychotherapeutic intervention to see what response occurs. This intervention entails the use of therapeutic dialogue to determine the range of states to which the client has access. These various states might include anticipation, determination, humor, excitement, happiness, a sense of pleasure, and/or hopefulness.
Roger had difficulty accessing positive feelings, but he was grimly determined to feel better. We asked when he felt the cheeriest, what truly held his interest, and what he found himself passionate about. He had difficulty formulating any answers, but the questions themselves launched him on an internal search (state shift).
Roger felt inadequate, anxious, and depressed and had little access to a sense of humor—the possession of which is an indicator of ego strength and the ability to change states. We hypothesized that if he could experience his own capacity to change states, perhaps through changing temperature in his hands with trance, he might develop enough self-confidence and motivation to explore other potential capacities [Step 2: define the problem as solvable]. The experience of trance phenomena such as developing heaviness or warmth suggests indirectly to a client that the mind’s hidden abilities can create the backdrop for solution generation. Roger was intrigued by the idea that he could use his own body as a biofeedback device and learn how to control certain physiological responses.
In designing an intervention, the therapist should identify the emotional circuits that are chronically aroused. Roger was persistently anxious, depressed, and angry; overall, he was caught in a loop of emotional upset that he medicated with alcohol. Because of his chronically depressed and angry mood, we assumed that there was an increased level of activation in his right prefrontal cortex, which generally tends to mediate negative feelings (Davidson, 2000). Furthermore, Roger had responded poorly to selective serotonin reuptake inhibitors (SSRIs). This response fit the research on anxious and depressed people with an activated right prefrontal cortex and low activation on the left, who tend to experience little change in their emotional states with SSRI medications (Heller & Nitsche, 1998). The hypoactive state of the left (since the right prefrontal cortex is activated) prefrontal cortex is associated with a reduced ability in the executive areas of conscious planning and problem solving (Grawe, 2007). We also wondered if he was drinking more than he said.
Carol helped Roger to activate the impoverished brain circuits that were factors in his current inability to nurture himself and to experience curiosity and play [Step 3: define the target state]. This was accomplished first by using empathy and nurturance and then through the experience of trance phenomena. Roger became really curious about not only that experience but about what else he might be able to do. The curiosity circuit turned on, as well as his interest in exploring other abilities without alcohol. Carol also encouraged him to stop drinking. She developed as much rapport as Roger would allow, with the intent to stimulate positive feelings. Because it takes some time for the brain to grow new neural pathways through experience, the activation of positive emotions may take several weeks. Therefore, it is important to keep triggering them over time. Educating the client about the process may also be useful.
This process with Roger was especially difficult in that he consistently blocked Carol’s attempt to stimulate positive feelings. When he later reported that he had stopped drinking, he still could not move from the state he was in to a more positive state. Because alcohol can have an inhibiting effect on the neurotransmitter serotonin, Carol surmised that part of his depression may have been due to brain injury sustained from alcohol abuse. In therapy, Carol focused on his ability to raise his hand temperature in hypnosis. This small success allowed him to begin to move into the “access state,” that state of mind where there is an openness to new learning. He became curious about what he could accomplish [Step 4: assist the client in changing states and moving toward the target state].
Roger began to be able to shift into more positive states during his therapy sessions but found that he was still unable to sustain those states outside the office. Carol suggested that he try alpha–theta training, using a neurofeedback device to assist him in reaccessing his innate capacity for relaxation and to encourage a more open, optimal learning. This training helped him move into the state just above sleep, which lowered his emotional reactivity. It also improved his access specifically of the alpha frequency, which his alcohol use had diminished. This increased access translated into an increased ability to self-comfort [Step 5: condition and reinforce the new state].
In one of the alpha–theta sessions, Carol suggested the following: “As you relax your mind and drift down to the edge of sleep, try viewing this predicament [his joblessness] on your mental screen. This may come as a symbol or question to be answered. Ask your unconscious mind for an answer to the mystery or for a new path to take.”
After 20 minutes, Roger said: “What comes to mind is an image of the most modern computer I have ever seen. I think my mind is telling me I can upgrade my skills and become an expert in a niche.” After several sessions of alpha–theta training, Roger began to respond more positively in psychotherapy sessions. Brain training was allowing him to experience a state change that he could practice at home with meditation [Step 6: Establish the new state as a means of resolving the underlying issues].
An important therapeutic goal was to help Roger begin to experience life events that would stimulate positive emotions. Because he had few friends, Carol inquired about the possibility of adopting a pet. She hoped a pet might interrupt the long periods he spent at home ruminating on negative emotions. In addition, learning how to nurture and receive unconditional love from an animal might ultimately be generalized to a human relationship. With an animal, Roger would be able to practice being in a positive state, un-self-consciously, attaching to a responsive creature and feeling the simple pleasure of connection. At Carol’s suggestion of acquiring a pet, he immediately smiled and reported that he had been thinking of doing the same. After he purchased a puppy, dialogue about the new puppy took up some of each psychotherapy session and served to stimulate positive feelings [Step 7: assist the client in creating workable solutions as they emerge from changed states and behavior].
The next phase of therapy dealt with Roger’s avoidance of his previously stated goals of quitting smoking, starting to exercise regularly, and improving his nutrition. Although he himself had identified these goals, Roger found that he could not stay motivated enough to accomplish them. Therapy was able to help him shift states and be open to experiences that would help him achieve his goals [Step 8: support the client in taking action]. As he began to feel better, he also initiated the process of acquiring several certifications that would qualify him for a higher-paying job.
Without an active focus on continuing to inhibit negative responses and activate positive ones, the BCT therapist would not be surprised to find a client’s problems generally recurring. For this reason, homework assignments that activate positive states are important. As an assignment, Carol asked Roger to engage in social conversation at work several times a week. Over time, he began to feel more positive and achieved several interpersonal goals [Step 9: link the action into the client’s social context].
Although not appropriate in Roger’s case because he lived alone, the BCT therapist may ask family members or other parts of the client’s support system to come in. We suggest that these caring members can help the client by paying attention to where they focus their conversations with him. While we are careful not to identify one person in a family system as the source of dysfunctional behavioral patterns, we want to be sensitive to how the client’s personal family system operates. For example, the interpersonal dynamics within which the client lives may contribute to a propensity to stimulate negative circuits of fear and panic. Making an intervention in the family dynamics often affects the entire family system for the better.
We also encouraged Roger to practice brain–mind training at home with a brain technology device called the DAVID PAL (see Chapter 6). It was in following this suggestion that he reported that he was able to stop drinking completely. When he wanted to drink, he used the device to handle the urge. In doing so, he learned that his mind could override the physiological sensations of craving.
Chapter 1 has presented an overview of the BCT approach, which uses brain–mind state change as a focus of treatment. It recognizes the necessity of positive state stability, which may require attention training, noting that there are numerous ways in which that can be accomplished. BCT also involves the active monitoring and directing of the therapist’s brain–mind state as he or she holds and models states for the client.
In Chapter 2 we lay the foundation for the brain–mind interventions BCT uses by exploring the basics of the brain: its anatomy, neuroanatomy, neurophysiology, and electrochemical processes, and the rhythms of the brain, the body, and nature.