ONE

“Self”-Organization

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The baby, assailed by eyes, ears, nose, skin, and entrails at once, feels it all as one great blooming, buzzing confusion.

—William James

Psychotherapy in the twenty-first century is transforming its scope. Medicine, too, is becoming far more integrated. The compartmentalization of the past is dissipating as we address the complexity of the self and the feedback loops that contribute to the emergence of the mind. There is no single reason that someone becomes depressed or anxious. All of the factors that contribute to poor mental and physical health are part of a complex web of interactions and must be understood and addressed together to provide truly integrated psychotherapy.

In the movie Analyze This, Billy Crystal plays a psychotherapist named Doctor Sobel. In one scene a woman, named Caroline, goes on and on about a breakup with a man by saying, “He complained that I was pushing him away! But I was only trying to get in touch with my uniqueness, myself as a separate entity, as a person with my own identity. And he could not understand that!” Doctor Sobel sighs and then responds, “Caroline, things end. It is how we deal with things ending that is important.” She apparently did not hear the wisdom of his feedback and goes on, “I don’t understand why it’s over between me and Steve. Do you think there is still hope?” To that, Doctor Sobel sighs and responds, “Well, he took out a restraining order against you, and usually that’s not a good sign.”

Beyond the silliness in the movie, many people seek therapy for self-discovery, to find their “true essence” or “inner self.” Caroline was reaching for the archetype of the soul, the avatar, the atman, which is assumed to be the pristine “me” in each one of us. What makes you feel like “you” and me feel like “me” with unique characteristics, coherent boundaries, and separate consciousness? The idea that there is an unchanging “true self,” while appealing, is an archaic concept. The self is not a static entity but a complex adaptive system that emerges from but is not reducible to its subordinate subsystems (Arden, 1996).

In the epigraph to this chapter, William James addressed how a baby is first bombarded by confusing sensations and feelings with no central sense of organization. All the sensations, including feelings generated from the immune system, gut, gene expression, and self-care behaviors, contribute to the subjective organization of the self.

This chapter explores how evolving experiences of individuality emerge from the somatic sense of self. In other words, how you feel in your body gives birth to the visceral experience of being an adaptive individual self. From there emerges what we have come to call the mind, composed of thoughts and emotions. An integrated psychotherapy must take into account how mental networks organize or fail to organize all the systems that contribute to the sense of self.

Mental operating networks that include the salience, executive, and default-mode networks serve to organize, stabilize, and provide meaning for a coherent sense of self. They are “self”-organizing networks that derive self-referential information from the implicit and explicit memory systems. Here I focus on how both dysregulation and imbalance among these networks can contribute to psychological disorders. One critical challenge of psychotherapy is to facilitate the integration of these mental networks to help the client gain a coherent and adaptive self. Emotion represents an aspect of the mind that for many people feels out control. For this reason I begin this chapter by exploring how our understanding of emotions has evolved.

BODY AND EMOTION

The paradigm shift that merged body, emotion, and cognition began with Darwin’s observation that there are a common set of emotions across animal species. He described how unique similarities in emotion can be revealed by blushing in one family and that family members born blind display common facial expressions. This evolutionary perspective suggested that emotions are heritable and expressed by the body. But if human emotions are continuous with other species, do they play out in a very limited range of expression?

Some have envisioned emotions as arising from the so-called limbic system. Consistent with this belief, the antiqued triune brain theory envisioned the reptile and mammalian brains encapsulated within the cortex like Russian dolls. Similarly, Jaak Panksepp has proposed that all mammals contain seven basic affective systems: seeking (expectancy), fear (anxiety), rage (anger), lust (sexual excitement), care (nurturance), panic/grief (sadness), and play (social joy). This is a bottom-up perspective derived from extensive animal research (Panksepp & Biven, 2012). Based on a meta-analysis of neuroimaging studies, there is some support for the concept of some basic emotions among mammals (Vytal & Hamann, 2010). But how relevant is this research to humans, who have a significantly larger and more complicated cortex? And how relevant is it to psychotherapy?

Paul Ekman built on Darwin’s research to develop a method to identify facial expressions associated with specific emotions, referred to as the Facial Action Coding System (FACS). Researchers and their lab associates (including my son) slowed down the videos of subjects to identify microexpressions associated with underlying emotions. The idea is that we cannot completely mask our emotions and they leak out in subtle ways. Ekman also argued that there are subtle culture-specific “display rules” concerning who can show emotion to whom and when. Though we may experience anger or fear at different extremes, there are unique differences and nuances among people. This suggests that emotions such as anger and joy combine with thoughts, which impacts how they are expressed. Other emotions, such as guilt and envy, involve even more top-down influence. And what one person may describe or feel as anger or joy may be quite different from that of another person. This suggests that psychotherapists need to identify each client’s unique subtle nuances of emotion and thought and not assume that all clients experience emotions in the same way.

EMOTION: TOP DOWN AND BOTTOM-UP INTERACTIONS

If emotions are more than simply artifacts of the so-called limbic system, how are they made? Emotions are constructed by the complex feedback loops between bottom-up and top-down networks (Barnett, 2017). The feelings of individuality emerge from the self-organizing feedback loops between cortical, subcortical, and body states and the meaning-making capacity we call the mind. William James argued that emotions are generated by our physiological and behavioral responses to the environment. From this perspective, patterns of autonomic activity and behavior precede the generation and experience of emotions. For James, a bodily feeling is the emotion, and the mind uses the body as a sounding board to make meaning of what is being experienced. This bottom-up theory is characterized by the statement, “He ran from the bear because his heart pounded and his pupils dilated.”

James’s student Walter Cannon rejected the dominancy of bottom-up causation and instead proposed a top-down theory. Believing that thought precedes emotions, he argued that we decide what to do about body sensations such as thirst or hunger. He noted that activation of the sympathetic nervous system is too undifferentiated to identify the many gradations of human emotions. Emotionality is an intrinsic function of the brain, and emotional awareness by necessity involves the cortex (Cannon, 1939/1989). Bear families have roamed my neighborhood at night. Though I may feel like running from the bear, I may decide to stop because I know that a bear can out run me, so running is potentially more dangerous.

Bodily (interoceptive) information without top-down modulation can occur in the range of anxiety disorders, including panic disorder. Rapid heartbeat, hyperventilation, and sweating are experienced as a precursor to catastrophic outcomes. By becoming consciously aware of the body sensations and the fear that has become associated with those sensations, we can dissociate panic thoughts from rapid heartbeat. This is the crux of the exposure paradigm. Exposure exercises form part of the foundation of therapy for people with anxiety disorders: a modified top-down response is applied as the client deliberately stirs up bottom-up sensations.

Of course, most people do not suffer from panic disorder, and top-down modulation helps us remember what is worthy of our concern. James acknowledged that bottom-up feedback can be altered by top-down-directed behavior, as described in his famous phrase, “Whistling to keep up courage . . . go through the outward motions of those contrary dispositions we prefer to cultivate” (James, 1884, p. 198). The colloquial version of this top-down shaping has been promoted by the twelve-step programs with the sayings “Fake it until you make it” and “Act as if.”

Fear is not an encapsulated emotion or a program located in the amygdala but a cognitive construction made possible by the cortex (LeDoux, 2016). This means that therapy necessarily involves harnessing and integrating top-down and bottom-up feedback loops. In other words, as visceral sensations emerge we construct new and more adaptive meanings about these sensations. We do so by integrating and balancing our mental operating networks.

THE MIND’S OPERATING NETWORKS

What we call the mind is composed of self-organizing mental networks that emerge from subordinate sensations, emotions, feelings, and thoughts. Optimally, our mental networks work together to maintain a coherent sense of self as we balance the needs of our body while we adapt to our environment. The mind keeps the self organized by balancing the feedback loops between the salience, executive, the default-mode networks.

The Mind’s Operating Systems

Salience Network

Default-Mode Network

Central Executive Network:

These mental networks organize self-referential information derived from long-term memory and current experience. The disorganization or fragmentation between the networks contributes to psychological disorders. Consider the following examples:

Each of these people worked in therapy to rebalance their mental operating networks.

The Salience Network

The salience network, sometimes called the feeling network, involves somatic sensations and the emergence of emotions. It provides mental operations that “self”-organize somatically derived information. As the name suggests, the salience network selects stimuli that stand out as salient from emotionally irrelevant stimuli competing for our attention. The salience network helps us determine what is relevant to our best interests on an emotional level. Based on visceral and subsequently generated emotional information, the salience network contributes motivation to decisions to act or not to act.

Emotions are constructed from bottom-up sensations and top-down cognitions, which are generated and modulated through brain-body feedback loops (Damasio, 1994; Craig, 2015). The neuroanatomical pathways that carry interoceptive information from the body are read by the insula cortex (insula means “island”) located deep within the large fold called the Sylvian fissure. The mid-insula contributes to interoceptive awareness, the subjective feeling of being alive as the “material me” (Craig, 2015). These interoceptive feelings come to awareness in the anterior insula, with the experience of ourself as an emotional being with subjective emotions such as happiness, sadness, anger, disgust, and fear.

Because of its proximity to the prefrontal cortex, the anterior insula generates intuitive visceral (gut) feelings to influence the decisions we make. Only a few other species, including whales, dolphins, elephants, and our close ape cousins, are endowed with a large anterior insula. All these species are considered to have a rich emotional life and relatively complex social systems and thrive from close bonding. This makes the insula a key intersection between the emotional feelings of being an individual and the feelings of being with other individuals. The insula and anterior cingulate cortex are endowed with spindle cells, with long axons that transfer immediate and emotionally compelling insights.

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Figure 1.1: The Salience Network as detailed above includes the dorso anterior cingulate cortex (dACC), the rostral anterior cingulate cortext (rostral ACC), subgenual anterior cingulate (subgenual ACC), thalamus, amygdala, basal ganglia, and insula.

“Figure 3.1”, “Figure 8.5”, “Figure 8.7”, “Figure 8.11”, from THE NEW MIND-BODY SCIENCE OF DEPRESSION by Vladimir Maletic and Charles Raison. Copyright © 2017 by Vladimir Maletic and Charles Raison. Used by permission of W. W. Norton & Company, Inc.

In the examples above, Barbara personified the old proverb, “Too much of a good thing can be a bad thing.” She was so overwhelmed with her own body sensations and emotions that she was anxious around other people. Therapy for her involved cultivating the talents of her other networks to be present and engaged with others, and to reflect on those relationships. It also involved enhancing the sensitivity of the salience network to become more socially intuitive.

The subjective experience of pleasure contributes to Barbara’s felt sense of self. The mid-insula is directly modulated by the nucleus accumbens, which functions as one of the principle pleasure centers of the brain. With rich connections to the thalamus, amygdala, insula, cingulate, and prefrontal cortex, the nucleus accumbens is well positioned to receive input about potential reward opportunities. When it receives dopamine, the potential opportunities are coded in so that Barbara becomes motivated to achieve the reward. Successful top-down reappraisal enhances emotional regulation of how she labels and approaches an experience. For example, Barbara might say about her social anxiety, “I am excited to meet new people.”

Because much of the environment may be ambiguous or irrelevant to her needs, assessing relevance was critical for Barbara. Serving as a relevance detector, the amygdala plays a role in guiding choices in ambiguous and unpredictable situations. Compelling her to act with little attention to the subtleties and nuances, especially when detecting potential threats, Barbara’s amygdala may have become overactive. When coupled with overactivating the right insula, she felt at times that the salient threat was coming from her own body and spurred a panic attack. By leaning toward instead of avoiding body sensations, Barbara activated her left insula, which is associated with the alleviation of panic. I pick up this thread in Chapter 7.

The Executive Network

Our prefrontal cortex (PFC) is larger than in any other species, comprising approximately 30 percent of our brain. Our species has evolved the apacity for complex decision making, holding more than one thought in mind, and planning for the future. These enhanced cognitive skills require the ability to regulate our emotions so that immediate gratification does not sabotage long-term gain. The expansion of the PFC made these skills possible through the emergence of the executive network.

More than any other species, we can maintain and enhance top-down control over bottom-up circuits. For example, my family once had a cat that had been abused before we adopted him. In response to low voice tones and abrupt moments, he flinched or ran away. Despite the years of living in our nurturing home, he never grew out of those responses. With a PFC consisting of only 3.5 percent of his brain, he had little to no top-down control over those immediate responses. We, on the other hand, do possess or have the potential to develop those skills through our sophisticated executive network.

Due to its size and complexity, our PFC features areas with a variety of different executive functions. The dorsolateral prefrontal cortex (DLPFC) is the most evolutionary advanced part of the brain and does not fully myelinate until we are in our midtwenties. Executive functions, including attention, problem solving, and working memory, equip the DLPFC with the capacity to provide executive skills that enable us to focus on a task to completion. Working memory is more complex than simple short-term memory, as it provides a significant measure of executive control over what information can be held “in mind” for roughly twenty to thirty seconds. Accordingly, the DLPFC provides the infrastructure to perform goal-directed behaviors by linking together in conscious awareness the complexities of the task at hand so they can be attended to and manipulated. In therapy, these capacities play an indispensable role in regulating follow-through on behaviors that reduce anxiety and depression.

Underdevelopment and underactivity in the executive network can contribute to attentional disorders. Also, a person with DLPFC deficits may develop the paradoxical syndrome known as “pseudo-depression,” which is marked by a lack of spontaneity and affect, rather than negative affect. In other words, the person looks depressed but denies depression when asked.

The DLPFC, along with the posterior parietal cortex, which is key in registering where we are in space (like a GPS), is involved in executive decision making about where to move and potential long-term outcomes. The executive network, sometimes referred to as the central executive, operates like the CEO of the mind. I expand on its role in generating belief and attention to the present moment in Chapter 10.

In the examples at the start of this section, Aaron’s executive network functioned like a laser. His attention, working memory, and goal-directed behavior brought him accolades at his tech firm. Unfortunately, he was mocked as a Spock-like Star Trek character. His coworkers, who generally considered him emotionally unavailable and socially inept, preferred to work with him only at arm’s length. Therapy with him entailed cultivating his salience network to augment the talents of his executive network. He was also encouraged to reflect on his relationships with his default-mode network.

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Figure 1.2: The Executive Network as detailed above includes the dorsolateral prefrontal cortex (DLPFC) and the posterior parietal cortex (PPC).

“Figure 3.1”, “Figure 8.5”, “Figure 8.7”, “Figure 8.11”, from THE NEW MIND-BODY SCIENCE OF DEPRESSION by Vladimir Maletic and Charles Raison. Copyright © 2017 by Vladimir Maletic and Charles Raison. Used by permission of W. W. Norton & Company, Inc.

The Default-Mode Network

In the movie Analyze This that I referenced at the beginning of this chapter, Doctor Sobel fades off into daydreaming while Caroline complains about her breakup. In his imagination he jumps up from his chair and shouts, “You are a tragedy queen! ‘Steve doesn’t like me’?! . . . ‘Steve doesn’t respect me’?! . . . Get a f—ing life!!” The scene fades into showing him sitting in his chair looking off into space, imagining that scene. Perhaps wondering if he was listening, Caroline says, “Doctor Sobel? Doctor Sobel?” He is shown consciously reentering the room from his fantasies, with his executive network back in control, and then responding by saying, “Oh . . . I was just reflecting on your situation. I will think about it, you will think about it, and we will pick this up at our next session.”

Just as Doctor Sobel faded off in the movie, most people spend up to 30 percent of their non-sleep-time daydreaming, ruminating, and simply not engaging in the present moment. During these periods we tend to operate on autopilot, functioning throughout the day performing habitual tasks without our conscious attention, such as driving with “highway hypnosis” or brushing our teeth while reflecting on the day. You may reminisce about last night’s dinner or plan the one for tonight, but when a car swerves into your lane your executive and salience networks kick into gear to be attentive to the present moment and the danger it presents.

We all daydream, fantasize, plan for the future, and hold imaginary conversations in our mind. In the field of hypnotherapy they have been referred to as ultradian rhythms (Rossi, 2002). These periods of reverie have only recently been the subject of inquiry in neuroscience. The midline area of the medial prefrontal cortex and the parietal areas are active during times when we are not focused on our immediate environment. The more our focus is self-referential—that is, on our feelings, emotions, and self-related thoughts, including fantasies about the future and ruminations about the past—the more these midline areas are active.

These self-referential reflections are associated with what is referred to as the default-mode network (DMN). When the mind is not engaged in the immediate environment, it falls back to a “resting state,” the default mode (Raichle et al., 2006). It draws upon autobiographical memory and personal judgments. While the DMN is active during the retrieval of episodic memories, it is inhibited during the encoding of them. In other words, when you are remembering something that happened, your DMN is active, but when you are experiencing the event that you will later remember, your executive and/or salience network is active.

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Figure 1.3: The Default Mode Network as detailed above include the the dorsomedial prefrontal cortext (dmPFC), ventral medial prefrontal cortex (vmPFC), subgenial anterior cingulate cortex (sgACC), posterior cingulate cortex (PCC), and the hippocampus, deep with the temporal lobes.

“Figure 3.1”, “Figure 8.5”, “Figure 8.7”, “Figure 8.11”, from THE NEW MIND-BODY SCIENCE OF DEPRESSION by Vladimir Maletic and Charles Raison. Copyright © 2017 by Vladimir Maletic and Charles Raison. Used by permission of W. W. Norton & Company, Inc.

A client can benefit by your inquiries about what he reflects on during quiet moments. When the stories are negativistic, gently nudging him toward a “can do” instead of “can’t” storyline can help him use his default-mode network more constructively.

The DMN appears to develop over time, with a coherent network operating by age seven. At this point we begin to develop the ability to have a mental life and reflect on our relationships. While mature reflection parallels the development of the medial PFC, damage to this network can severely compromise self-experience (Northoff & Bempohl, 2004).

The DMN provides flexible self-relevant mental explorations to anticipate, plan, and evaluate future events before they happen (Buckner, Andrews-Hanna, & Schacter, 2008). This network allows us to mentally time travel, playing out how situations may have occurred differently in the past or how they can turn out positively in the future. The DMN is engaged when we are telling ourselves stories about ourselves or about other people. Because activity in the DMN also involves thinking about other people, we play out past or potential conversations by fantasizing about how things could have been different or how we hope relationships may develop.

The fantasies generated in the DMN can boost or undermine self-esteem. A person can ruminate about past unfortunate experiences or imagine positive future ones. Women who incurred adverse childhood experiences have been found to have less functional connectivity within the DMN, and it appears that early trauma interferes with its development (Bluhm et al., 2009). In the examples given above, Kyle’s excessive inward orientation with excessive rumination promoted depression, facilitated by an abnormally active DMN (Grimm et al., 2008a, 2008b). Depression may reflect the inability to inhibit the DMN during external tasks. Consistent with the DMN overactivity hypothesis for depression, discussed in Chapter 9, those who have been treated successfully have been shown to normalize DMN activity (Posner et al., 2013).

Constructing solution-oriented stories is fundamental to mental health. The extent to which we can portray ourselves as someone who can affect the course of our life, as opposed to being the victim of external causes, is fundamental to the narrative of self-agency (Bandura, 1997). Therapy essentially retrained Aaron’s DMN storyline. Imaging potential future positive scenarios built his sense of self-esteem to promote healthy “self”-organization.

Teaching clients to tell themselves coherent realistic and positive stories about their life and repeat them between sessions can be an important part of therapy.

BALANCING THE NETWORKS

Optimally, the three self-referencing mental networks maintain balance and work together to provide the self with dynamic stability. Balance among the self-referencing networks contributes to a person’s coherent sense of self. By reflecting on the past and projecting to possible positive futures, we use our DMN to maintain continuity over time and use our executive network and salience network to think or feel in the present moment. The switching between the mind’s operating networks depends on the demands of our immediate environment. Facilitating balance among the feedback loops between these networks represents a critical goal of therapy.

During the performance of cognitively demanding tasks the executive network increases in activation while the DMN decreases. However, there can be a dynamic coupling of the two systems, where they work together to produce creativity. Brain activity that is more lateral (outside) tends to be more cognitive and part of the executive network, while reflection that is more medial (inside) tends to be more self-referential, emotional, and more associated with the DMN and salience network. So, in addition to the top-down/bottom-up feedback loops, outside/inside work together. Balance among these networks is critical for mental health.

The anterior insula and anterior cingulate cortex that form much of the salience network provide the capacity to identify what stands out as noticeable, meaningful, and behaviorally relevant. The salience network monitors information from within (internal input) and from the external world and functions as a controller or network switch that decides what information is most urgent. With its insula and anterior cingular cortex components, the salience network identifies relevant sensory information worthy of attention and acts as a central switch, regulating relationships among the DMN and executive network. Such as when a car swerves in your lane, it switches off the DMN so that the executive network can marshal its cognitive and attentional resources for the task at hand.

A person who has been traumatized may find it difficult to encode new, more positive memories. Resting-state connectivity between the DMN and the right amygdala correlates with the presence and severity of posttraumatic stress disorder symptoms (Lanius et al., 2005). The goal of psychotherapy is not to eliminate DMN activity but to limit of how much time a client spends ruminating and disconnected from the immediate environment. This means therapy promotes more engagement in the present moment by the action-oriented executive network. Enhancing attention to recent positive events and engaging in future-oriented thoughts and behaviors can inhibit negative rumination.

The Mental Operating Systems and Therapy

Together these mental operating networks construct meaningful patterns that help us adapt to our environment. For clients who suffer from anxiety or depression, the gains from therapy help them balance the activities among the networks so that they are better able to feel safe, develop the capacity to attend to the present moment, reflect positively on experiences, and imagine a hopeful future.

LONG-TERM MEMORY SYSTEMS

So far I have focused on the mind’s salience network, executive network, and DMN and how we “self”-organize. By keeping these mental operating systems in balance and flexibly responsive, we can calm ourselves down or lift ourselves back up, while we stay engaged in the world. Those networks emerge and draw self-referential information from cohesive memory systems to provide ongoing feedback to maintain continuity for a sense of a coherent self.

Multiple memory systems form the background fabric of the self and provide a dynamic information bank for the mental operating networks. The memory systems are always in the process of being modified in response to the changing vantage point of present challenges. Ongoing memory modification feeding back to the mental networks helps us update self-referential information to anticipate future events based on what has happen in the past. Unlike working memory, long-term memory systems require neuroplasticity to encode information, making actual structural changes in the brain. Long-term memory is organized in two broad forms: nondeclarative and declarative memory. Nondeclarative memory is also referred to as the implicit system because it provides feedback to what we do and how we feel implicitly without having conscious awareness of it. The salience network derives information from it to generate emotional states. Declarative memory is also referred to as the explicit memory system because it feedbacks into our explicit awareness and can be declared into recall by our executive and default mode networks.

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Figure 1.4: The long-term memory systems and the mental operating networks. Note how much larger the implicit memory system is relative to the explicit. Actually, it should be depicted larger than the image above permits.

The Long-Term Memory Systems

Implicit/Explicit

Nondeclarative/Declarative

Procedural Episodic

Emotional Autobiographical

Generalized Context specific

Classical conditioning Semantic

The implicit memory system is much broader than the explicit memory system. In other words, what we are aware of about ourselves is only the tip of the iceberg of much larger nonconscious fabric of emotional patterns and habits. The implicit memory systems include procedural and emotional subsystems. Procedural memory involves motor skills coded in our basal ganglia, especially the stratum. These are habits that we learn, such as when we riding a bicycle, type, or drive a car, all of which we do without needing to think about it. These habits represent what we do automatically as if on autopilot; once learned, they are immediately expressed if cued. For the most part they are practical, but sometimes they include habits that have morphed into addictions, as explored in Chapter 6. Much of the implicit memory system includes emotional reactions. Because the implicit memory systems go online first, they influence and set the tone for encoding of explicit memories. When we retrieve autobiography memories, the parameters for those memories are set by implicit emotional memory tones.

The durability of our implicit memories is much greater than for our explicit memories. While the amygdala-based implicit memories are hard to forget, as if written on a stone tablet, the hippocampal-based explicit memories are constantly being modified within the current contextual situation. The acquisition of new habits requires repetition and concerted effort to achieve neuroplasticity initially. For example, when learning a new custom of greeting in the Western world, we fuse implicit, striatum/habit-driven behavior with various semicognitive constructs as we reach out to shake a hand of someone we meet. We respond to his greeting, “How are you?” by replying, “Fine, thanks. How are you?” Neither of us may actually feel fine, but we nevertheless respond automatically with courtesy. We can also read an entire page while daydreaming in our DMN and not remember what we read. Implicit, habit-driven behavior may utilize very little of the executive network, but our DMN and salience network many be quite active.

Just as water flows downhill, so too the brain does what comes easily. This means that the development of new habits requires more input from the executive network initially before the new habit becomes automatic. Once established, the habit comes easy. These habit-based memories will eventually take little attention or energy to occur automatically.

Because cells that fire together wire together, learning new habits must be repeated to strengthen them, so that they come easy. Habits are strongest if the cues are varied and accessed easily. Clients need to know that it is always harder in the beginning to establish a new, healthy habit. If they hang in there long enough, their brain will rewire so that the habit will come easy, with little effort, because cells that are wired together will fire together each time.

Procedural memory can provide cues for explicit memory. For example, while driving a car we can listen to the news and comment on what we just heard to a friend in the passenger seat. Later when driving through the same neighborhood we may begin thinking about that same news story. Or we may implicitly feel the anger we felt while driving in that neighborhood but not experience the explicit memory of the news story.

Implicit memories form much of the fabric of our “self”-organization. These varied, intertwining threads include not only procedural memories, composed of movement patterns, such as the way we express ourselves with body language and tone of voice, but also emotional memories, such as reacting with fright to a person speaking with a particular accent. These self-representations include our skilled movements, customs, cravings, and habitual speech patterns, as well as autonomic thoughts, obsessions, and compulsions (Grabiel, 2008). These implicit memories are learned habits, some classically conditioned, repeated, and woven together so that body sensations, movements, and emotions represent each person’s sense of individuality. As Caroline told Doctor Sobel, her desire was to find herself as “a person.”

Declarative (explicit) memory is recalled through the executive network and DMN. Nondeclarative (implicit) memory represents feedback from subcortical areas, such as the amygdala, basal ganglia, and nucleus accumbens, circuits of the salience network. Accordingly, implicit memories are associated with emotion, movement, habit, and reward and are drawn up by the salience network, which gets reactivated as feelings in the moment.

Explicit semantic memory includes facts about what happened in the past represented symbolically, with words, so that the facts have meaning. Because the mind comprises meaning-making operations, semantic memory contributes to the cognitive skills necessary to facilitate complex meaning. A type of explicit memory referred to as episodic contains self-reference information about prior experience. Episodic memory, dredged up to use during DMN phases, allows us to reexperience events in our lives.

Explicit memory depends on the hippocampus, which serves as a librarian. It codes novel memories and integrates them within circuits in the cortex, which serves as the library. The hippocampus is a novelty detector that compares incoming information to already stored knowledge. Its specialty is binding new to old information.

Whereas nondeclarative implicit memories are often encoded nonconsciously, it may be difficult to recall them later consciously. There is an old joke with some truth to it that, if you lose your keys when you are drunk, it is easier to find them while drunk than while sober. In other words, where you left your keys is coded more in your implicit than your explicit memory. Combined and referred to as state-based memory, the mood you are in when you code an explicit memory represents the same neurocircuits that cue best for recall. State-based memories are quite relevant when working with people recovering from trauma, as we will discuss in Chapter 8.

The mental operating networks derive self-referencial information from the long-term memory systems to provide “self”-organization. The DMN especially draws on long-term explicit memory to reflect on the past and to draw meaning from it. The executive network uses the logical explicit information to make decisions. And the salience network uses the emotional and somatic implicit memories to generate feelings about ourselves. Together, the mental operating networks and implicit and explicit memory help us make decisions about the future.

Implicit forms of emotional regulation can be quite effective (Johnston & Olson, 2015). For example, one study examined how a person integrated incongruent implicit information such as seeing a picture of a happy face overlaid by the word fear. He experienced an emotional dissonance that prepared him to exert the control needed to override the conflicting verbal information, producing an “emotional conflict adaptation effect” (Etkin et al., 2006).

When prior knowledge comes into conflict with new knowledge, processing the disparity involves a top-down inhibition of the implicit habitual reactions (Morris, 2007). This means that areas of the prefrontal cortex and hippocampus help compare past knowledge with the new verified knowledge. The anterior cingulate cortex plays a role in conflict resolution by monitoring the person’s new behavior compared with old assumptions (Braver, Barch, Gray, Molfese, & Synder, 2001).

THE FAST AND SLOW TRACKS TO THE AMYGDALA

Many people find it confusing when they feel a surge of panic feelings before explicitly understanding the implicit cues for those feelings. Implicit emotional memories are by nature relatively immediate. From an evolutionary perspective the implicit memory system is more ancient than the explicit memory system because threat detection is directly associated with survival. Because the amygdala is a relevance detector, when a threat is present there is nothing more relevant than that threat. The speed of responding could mean life or death.

Accordingly, there are two tracks to activate the amygdala: the fast track and the slow track. In response to an immediate threat in the environment, the fast circuit sends sensory information to the thalamus (the central router of the brain) and then directly to the amygdala. Consequently, a person can sense threat without explicit knowledge or thoughts about that threat. The fast track to the amygdala can trigger the fight-or-flight response and cue flashbacks in posttraumatic stress disorder through this “bottom-up” track. For example, after settling in the United States, Hesham, a Syrian refugee, felt panic when firecrackers boomed on New Year’s Eve. He felt what sounded like gunfire before he consciously thought through whether it is actually gunfire. This reaction occurred through his implicit memory fast-track circuit, triggering a flashback.

The slow track to the amygdala in the same scenario may result in Hesham using his executive network to draw up explicit memories and think, “That sounds like gunfire that I heard in my village. But I know it is not.” This top-down control allows him to tell himself how to respond based on a reality check, given the context of the situation. If the booming sound is simply a firecracker, he may then wonder why someone set off a firecracker. He may even say, “Oh, yes, it’s New Year’s Eve, and people celebrate this way!”

The slow track activates the executive network before the subcortical areas of the salience network. The sensory information to the thalamus is relayed to the cortex and hippocampus and finally to his amygdala. Part of the work in therapy with Hesham bolstered his slow track to keep his amygdala activity contained by enhancing the feedback from his executive network. By applying exposure to periodic loud noises, the cued implicit memories combined with new thinking so that his feeling of threat generating a flashback was neutralized by strengthening his slow track in a top-down process. He dampened the threat-detector functions generated by the fast track by strengthening the connections between his executive and salience networks. Top-down control enhanced his capacity to regulate affect to neutralize threat when there was none. Through this method his previously dysregulated memory systems were reintegrated so that he no longer experienced overwhelming waves of fear that had little to do with the nonthreatening situations.

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Figure 1.5: The fast and slow track to the amygdala.

“Figure 5.1”, “Figure 5.2”, from THE SOCIAL NEUROSCIENCE OF EDUCATION: OPTIMIZING ATTACHMENT AND LEARNING IN THE CLASSROOM by Louis Cozolino. Copyright © 2013 by Louis Cozolino. Used by permission of W. W. Norton & Company, Inc.

The slow track can be hijacked by the amygdala so that unrealistic thoughts can emerge fueling fears and phobias. These fears and/or phobias can be attended to in the moment: Hesham may use his executive network to consciously avoid public events such as New Year’s and Fourth of July celebrations, or he may use his DMN to ruminate about his fears and phobias. Because explicit memory depends on conscious awareness for encoding, his executive network encompassing focused attention and working memory were needed to form new explicit memories so that Hesham later could “declare” those memories when appropriate. Hesham compared the new the information about celebration to compete with the danger signals he learned previously.

Hesham remembered how planes bombed his village. For him the capacity of subjective time travel was overused and distorted with ruminations about picking through the rubble and finding his uncle dead. During extended DMN periods these episodic memories plagued him. In therapy he learned to use DMN to imagine and project ahead to a positive future. Episodic memory allowed him the capacity to see himself with a past and project ahead to a potential future.

Maximizing Hesham’s executive network attentional skills and working memory as well as salience network skills of emotional engagement were critical to transfer information gained in therapy into long-term memory. Because his amygdala is a relevancy detector and his hippocampus is a novelty detector, by maximizing both emotional engagement and novelty, new safety associations were co-constructed in therapy.

Because therapy integrated his long-lingering implicit memories with newly constructed explicit memories, the context of what happened in the past in his village could be reconsolidated within a newly constructed sense of self-efficacy in the present. Therapy simultaneously promoted greater self-knowledge and affect regulation. This was achieved by reconsolidating and integrating the memory systems to match the retrieval cues that promoted self-efficacy.

And what about the questions posed at the beginning of this chapter about a central “me” of individuality? Hesham’s identity was challenged and then transformed. Initially, his implicit memory cues complicated his adjustment to a safer community. Through therapy the balance among the feedback loops between his executive network, salience network, and DMN involved progressive nonlinear leaps to higher levels of organization of affect regulation, insight, and memory. “Self”-organization generated by his integrated and reconsolidated memory systems transformed his thoughts and feelings about what he had previously experienced. In short, Hesham’s self-image transformed from of a casualty of war to that of a durable survivor.

Therapy involved building a cohesive and positive model of himself by facilitating self-exploration and self-reference, so he could identify, label, and accept feelings and practical needs. His growth and development as an individual included a positive self-reflective internal life within the DMN, the feelings of coherence of the salience network, and productive self-determination directed by his executive network.

For mental health the mind’s operating networks—the salience network, executive network, and default-mode network—need to be in balance so that the feedback loops between them work toward enhanced “self”-organization. As the following chapters illustrate, mental health can be undermined and dysregulated by insecure attachment, neglect, and abuse, leading to gene expression or suppression, changes in immune system regulation, and poor lifestyle practices. When the mind’s operating networks become out of balance and unintegrated, psychological disorders emerge. Mental and physical health depends on the therapeutic rebalencing of the mind’s operating networks and the integration of the long-term memory systems.

 

 

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