Course content © Copyright 2023 - 2025 by Hannah Smith, MA, LMHC, CGP. All rights reserved.

Course Outline

Introduction & Course Overview

Learning Objectives

Why Neuroscience? Benefits & Limitations

The Whole-person Approach      

   The triune being – mind, body, & spirit

   Mind versus brain

   Don’t forget the body!

   Does spirit mean religion?

   Final Words on the Whole-person Approach

What Is Neuroplasticity?

Pertinent Brain Structures, Processes, & Functions

   Brain structures & regions of interest

   Left-Right brain functions; Applications for anxiety and trauma

   Sympathetic and parasympathetic systems; Applications for depression and bi-polar disorder

   Sensory processing; Applications for anxiety

   Memory; Applications in trauma

   Learning

Client-friendly Ways to Introduce Brain-based Concepts

   Simplifications & Analogies

Neuroscience-informed Strategies & Practical Applications

   Conscious Awareness Exercises

      Diaphragmatic breathing & centering

      Mindfulness/Wise-mind

      5-point check-in

   Mind-Body Exercises

      Body scan

      Physical Exercise

      Psychodrama

   Left-Right Brain Strategies for Memory Integration

      Narrative therapy/Lifespan Integration/EMDR

      Expressive Therapies: Art, Music, Psychodrama, Writing

      Truth Statements & Labyrinth Exercise

Case Study – Meet Jaylin

Conclusion

References

Introduction & Course Overview

Since the advent of highly precise brain-imaging techniques, such as Positron Emission Tomography (PET) and functional Magnetic Resonance Imaging (fMRI), neuroscientists have been able to see the processes and activities of the brain with superior clarity, noting brain reactions in very specific situations. These breakthroughs in scientific investigative ability have given birth to entirely new fields of study, such as cognitive and developmental neurosciences, psycho-biology, and interpersonal neurobiology. The field of brain science in general is exploding and is producing exciting applications for the treatment of mental health disorders.

That said, some of the “new science” has actually been around for over 20 years. As with any new tool, dissemination to the masses takes time.  The understanding of neuroscience for practical and clinical use may not be in the hands of all practitioners yet. There may be many reasons for this. In the past, the word “neuroscience” has often evoked thoughts of esoteric, “beyond me” or “out-of-reach” material for most people. Thankfully, modern techniques and popular teachers have simplified many neurological principles and increased their relevance in recent years. Participants in this training may have much more understanding of brain verbiage than our predecessors. The hope is lessons such as this is that various, potentially disconnected concepts (anatomy, neurology, and psychology, for instance) will come together in ways that spark new understanding and creativity in its readers.

Overall, this course is based on both traditional understanding and recent advancements in neuroscience as they pertain to the care and treatment of various mental health disorders, such as anxiety, depression, and trauma. As the science is always advancing, at times, a “way of thinking” is suggested that will remain even as more clarity emerges. The benefits, as well as limitations, of all presented will be discussed.

Initially, the reason to consider neuroscience in mental health treatment will be presented. This will be followed by an examination of the definition of “whole-person”. This is a difficult point for some, but an accurate treatment of practical neuroscience makes it clear that the brain is only part of the human equation. The reader will also learn the meaning of neuroplasticity and be exposed to pertinent brain structures, systems, processes, and functions applicable to clinical practice.

A concerted attempt will be made, overall, to make the information relevant and understandable to all readers. This will include a section on how to explain these complex ideas in everyday language that clients can easily assimilate.

After client-friendly explanations have been presented, neuroscience-informed treatment strategies, both evidence- and anecdotal-based, will be presented to target a variety of common issues practitioners treat. Finally, a case-study will bring it all together. With all of this, the individual clinician, remaining in their scope of practice, may be able to broaden and/or modify the application of information learned to other disorders, as well.  After all, ultimately, it is still the relationship and personal experience of each provider, in conjunction with what the client brings, that produces the foundation necessary for healing to occur. You, the care provider, and your unique vantage point, innovation, creativity, and caring are the best strategies out there.

The information contained in this training is not meant to be all-inclusive, but to introduce the reader to concepts in neuroscience. Further exploration and training in areas of interest are encouraged and often necessary to integrate learning into daily practice.

Why Neuroscience? Benefits & Limitations

After all, there are a plethora of therapeutic theories, systems, and tools already available within the field of psychology. Don’t these include information from neuroscience? Why complicate things and make us learn the “bits and pieces” of brain science as well?

Valid question.

Many theoretical orientations do utilize neurobiological principles, sometimes even without knowing it.  However, the missing piece is the clinicians understanding of the principles to such an extent that they can make more targeted choices in which tool to apply to what disorder. A baker knows the principles of chemistry so that they can move away from simple cakes and cookies and create many other wonders. For the mental health practitioner, this type of expansion is now more possible.

In addition to broadening the scope of clinician understanding, there are other benefits. A thorough discussion of the use of neuroscience in treatment must include the concept of “whole-person” care. But, to start, a cursory list of other benefits is presented, followed by challenges and limitations.

As with anything, there are also limitations. Most of us who will use information such as what is presented here are not neuroscientists.  We won’t be able to answer all of our client’s questions. That need not be problematic, but we do need to be aware of it and forewarn and honesty reply to questioning clients. We will likely work with the occasional person who will want more than we can give. It may be beneficial to have a list of journal articles, prominent authors in the science, and books for clients to read (See References for some ideas).

Simplifications, omissions, and the conveyance of misinformation are inevitable. It will be important to present only what information you, the practitioner, have integrated and understood thoroughly yourself as much as possible.  In addition, it is easy to overload clients.  Even as limited as our understanding is, we will know more than most of the people with whom we work. It is not necessary to share everything we know.  It is necessary to use wisdom in what is conveyed to the client.  Perhaps ask yourself “what is the benefit of them knowing this?” before proceeding.

As often happens with technology, the field of science changes at a rapid pace. As soon as something is presented as “a new fact”, something else may come along to negate or expound on it in such a way as to change our basic understanding.  Therefore, presenting information as concepts and “ways of thinking about it” may be more beneficial than pure scientific fact in most cases, as modeled at times in this writing.

Finally, for most people, being able to point to their brain as reason for certain experiences, beliefs, and actions will be helpful to increase motivation and reduce shame.  However, for some, the brain will become the “culprit” and therefore provide an excuse for inaction or irresponsibility.  Teach clients that “awareness” increases responsibility and challenge any, “my brain made me do it” excuses after real learning has been demonstrated. Now, in order to further understand the benefit of the use of brain science in treatment, an understanding of the whole person is required.

The Whole-person Approach

According to the Merriam-Webster Dictionary, Psychology is the science of “mind and behavior”, yet the average mental health care provider may not even know what the word “mind” actually means. They may, in fact, think that mind and brain are synonymous and interchangeable. The average person certainly speaks as if this is the case.

In his work, The Neurobiology of We, Dr. Daniel Siegel (2011) substantiates this by stating that in all his travels, he had not come across many (if any) psychologists or psychiatrists that could even define the term “mind”.  Instead, most talk-based therapeutic focus is on the noise produced in the brain (and a rather small portion of it at that). The empowerment that comes from the understanding of the mind is rarely (if ever) included.

If Webster and what we are learning from neuroscience are correct, then those who care for people who suffer with mental illness need to understand the science of mind and the workings of the brain are two separate things. In addition, the brain is not the “end all, be all” it has been treated as in times past. The term “mind-body connection” is not new, but the idea that actual changes in brain function often derive from input from the mind and body needs to be better understood. Neuroscience and attachment theory also show that “brains need other brains” in order to be healthy (Siegel, 2010). This is curious.  My brain is in my head and your brain is in your head – so what does this mean?

Finally, even with all our methods and techniques, there is no “one-size-fits-all”.  Why not? To address all this, there needs to be a discussion on the whole person. What follows is this teacher’s way of explaining it.

The “triune being” – mind, body, & spirit.

Before one can discuss the working of the brain, it is important to understand the human “machine” as a whole. (Please note that some of the concepts presented here may be new or foreign to the reader and some of the words used are chosen to make a point or draw distinctions such as “machine”. When a word is used in this manner, rather than it’s more common or regular dictionary meaning, some type of explanation or notation quotes or italics will be used. You will find these words to mean something different here as opposed to other venues and discussions. Don’t let this confuse you.)

Try not to let yourself be diverted into too much judgmental thinking here. This discussion needs to be had, but for some, it is somewhat in its infancy and therefore will evolve as it is mulled and debated over time.  As a means to begin the conversation on that which we only scratch the surface currently, consider that each person can be separated into three equally important parts: Mind, body, and spirit.  This is not a new concept, but in times past, some might have equated mind and brain or not have seen the inclusion of spirit as a necessary part of a science-related discussion. For our purposes, think of mind, body, and spirit as three elements of a system, akin to driver, car, and particular journey, respectively. A working definition (meaning it can change and grow) of these three elements follows.

MIND.  According to Dr. Daniel Siegel (2010), the mind is, “An embodied and relational [entity] which regulates the flow of information and energy”. The mind is “non-physical”.  Rather than being the brain, it is more useful to think of the mind as that which uses information from the brain, body, others/environment, and the big picture; analogous to the driver using information from the engine, dashboard, other cars, landscape, and route to make decisions about how to interact with and/or drive the car.  This analogy is limited, but gives the idea.

BODY.  It may seem odd to even define this term. Everyone knows what our body is – right? Sure – but it needs to be said simply and directly, the body is the physical [entity or aspect] that houses the blood, organs, and other structures that enable lifegiving/life-continuing functions. The noteworthy point is that it is physical – the only part of the system that is. Breakdowns in the brain and body affect the mind and spirit, and vice versa, but the reaction to these breakdowns is unique because of the distinctions between the three. This is the difference on which we capitalize when we use the whole-person approach in treatment.    

SPIRIT.  This is a tricky one – and there does not appear to be consensus as to the precise definition.  One way to think of the spirit is another “non-physical” part of each human that makes them unique. Most definitions include a person’s nature, character, and/or “inner” or “true” self. Like the mind, the spirit seeks/needs connection to others, to something “greater than ourselves”.  Social connection and other spiritual practices (such as deep breathing, meditation, and prayer) are therefore vital to health. These practices, if specifically engaging one’s spirit, have been shown to positively affect the brain and are perceived as beneficial to both mind and body. Box 3

Mind versus brain.  Let’s go even deeper into this distinction. The concept of the mind and the brain being different entities is complex. It may be new for some and therefore requires further explanation.

We have all had experiences that reflect the difference between the brain and the mind. Have you ever said, “Why did I do that?” Or, maybe you had a thought (i.e. information from the brain) something like, “I’m going to fail at my next work assignment” – and yet, you take it on anyhow.  How does that work if “the brain drives the car”? A more helpful way to think is that the brain (engine) produces “information” that the mind (driver) interprets and uses to make decisions, along with a myriad of factors, such as moral base, character, social connection, and life experience (particular journey). Sometimes, when the car and driver are in sync, it feels they are the same. Driver need not make any decisions or changes when car is running according to due course.

For more understanding of mind, let’s return to Dr. Siegel’s definition. The first part says: “An embodied and relational [entity]…” There is a sense with us that our mind is locked inside our head – which lends to sense that brain and mind are the same. Most would agree that the mind is certainly “part” of us, but that is generally where it ends, or so we think.

However, recent advances in neuroscience (backed up by millennia of conventional wisdom) demonstrate that our mind extends outside of us to include others, so much so that our own brains and states of being can be altered by social experience.  This has been demonstrated scientifically with the identification of certain elements in our brains known as, “mirror neurons”. Mirror neurons (which may reside in the inferior frontal cortex and superior parietal lobes of the brain) are a particular group of neurons that fire in response to what others do (See Pertinent Structures section for more information on neurons). 

These neurons were discovered somewhat “by accident” in the late in the twentieth century. In short, during a research study conducted by Rizzolatti et al. (1992), while observing Macaque monkeys in an attempt to explain how they made choices. As the monkey ate a peanut while being tracked with brain-imaging machinery, one of the monkeys saw one of the scientists eating a nut. Amazingly, the imaging results lit up the same way they did when the monkey ate by itself. This odd and remarkable result demonstrated that neurons in one brain fire in the same way when certain things happen in another brain/body/person.  This is understood to be the basis of our understanding of empathy.

Further, studies in attachment theory have shown that brains are changed, energized, and develop best in relation to others. Yes! Our brain needs other brains in order to survive and thrive! This is stunning information. Connection isn’t just “a nice feeling” – it’s an actual (and essential) brain function!

What does this look like in the real world? Think about times in the past when you have seen someone fall down, and just by watching them, you winced as if it had happened to you (albeit with different felt intensities in the body). This brings us to the second half of the definition, “to regulate the flow of information and energy”.  You wince when the other person falls…you don’t then automatically fall down yourself. Information given by “the other” is perceived in the brain and the mind uses what is received (or “felt”) to make changes in brain, behavior, and affect.  In psychology, affect is the experience of emotion.  It is that which is felt in the body in response to emotion and is reflected non-verbally (or, not). When we attempt to describe a client’s presentation, for example, we might say they have a “flat” or “labile” affect, which means, respectively, they are not outwardly demonstrating any response to emotion, or they are bouncing around emotionally.

This is tough, I know. Chew on it for a while. More or less, happenings in the body, brain and elsewhere need to be coordinated and fit into a bigger picture.  This is the work of the mind. Practically speaking, it all comes down to this: You are not your brain.

What about the body? You understand now that the mind receives, directs, channels, and uses energy and/or information from the brain, but is not, itself, the brain. The brain is part of the body. The brain is also just one part of the entire neurological system – which includes the central nervous system, as well. Overall, the body is the physical part of the human system – but the brain is not “the whole thing” as we “in our heads” folks often treat it.

Western society prizes cognitive prowess (the workings of the brain and mind) and does little to teach us about finding wisdom and information in other ways, such as in the human body.  In his enlightening book, The Body Keeps the Score, Bessel van der Kolk (2015) expounds on ways the body (not just the brain) has information to provide to the mind.  The details of this are beyond the scope of focus for this article, but if you want more information, this would be a great resource.  For our purposes, it is necessary to understand that the brain’s connection to the rest of the body (and its environment) is imperative for healthy brain function and mind development.

Does spirit mean religion?  No. When referring to spirit in our context, we do not mean religion.  Religion is a set of specific practices. The spirit referred to here is a part of the human system. The implication that one’s spirit seeks to connect to that which is greater than them lends to talk of God, but even this does not equate to religion. One may engage in religious practice with or without engaging their spirit.  For example, one may attend a church or serve in a local soup kitchen because they “think it is the right thing to do”. This may have nothing to do with their spirit. A way to think of it is a spiritual practice, religious or otherwise, involves a mindful connection to one’s “inner being” or “true self”. 

Final Words on the Whole-person Approach. There is so much to this discussion that all that has preceded has been meant only to whet one’s appetite for further pursuit. The moral of the whole story for us today is simply this: We cannot make the human well if we do not treat the entire system. In all your work with others, remember that they are not their brains. They are not their emotions. They are (at least to a degree) a mystical mixture of physical and non-physical. Respecting and addressing the mystery of this means that we do not simply apply techniques and are not shocked when one treatment works for one but not another in similar situations. Knowing the person as a whole is necessary if we want to include all information at our disposal and understand the uniqueness of each person we treat.

Finally, now that we understand that our three-part system works together to create well-being, we can begin talk of the brain without confusing it for the system itself.

What Is Neuroplasticity?

Suppose you want a cup of coffee and you are in your car driving to work. After the (sometimes semi-) conscious awareness of wanting coffee occurs, it is unlikely that you would ever consciously think, “Pull car over. Put on brake. Stop car. Park. Left arm, open door.  Left foot, step onto ground…” and so on. No. After the original decision to find coffee has been made, you somehow end up in the lounge in front of the automatic coffee machine.  Ever wonder how that happens?

In short, when you sought out and found coffee the first time, a particular set of neurons in your brain fired. The next time you want to find that same cup of coffee (in that same place), the identical set of neurons will fire (provided it was an easy learn…it can take some time to create a fixed firing pattern). This is often referred to as, “the Hebbian Principle”, after Donald Hebb (1949). A famous saying coined in response to this is, “Neurons that fire together, wire together”.

All the various structures and regions of the brain talk to each other via what are known as “neural pathways”. These pathways are made up of millions of “neural connections”, the base element of which is a neuron.  A neuron is a specialized cell that helps to conduct electrical impulses.  Each neuron has dendrites – the “tendrils” that are attached to the central cell through which the electricity flows. Finally, electrical impulses jump between cells at a junction called a synapse.  A single neuron can have thousands of dendrites and therefore make thousands of connections to other neurons. This happens as neurons “fire” in a patterned and connected way. 

Therefore, if a fly is coming at you, a different firing pattern is engaged as your arm “automatically” bats the fly away. As you can imagine, this “firing pattern” principle makes us rather efficient. In fact, if we do the same actions again and again, they become easier and eventually most will occur without conscious thought (generally through a process called “learning”).

Hmm…sounds like “neurorigidity” to me…

Understandable.  However, if you want to pet your cat or grab your fly swatter, new or alternate pathways can be chosen as well.

Certain neuronal groups that need to or frequently work together are referred to as “neural pathways” (or “circuits”) and may become hard-wired. Several like pathways working together form a neural network.  In action, this may look something like what is seen in the picture below.

Neural networks work together and form patterned responses in the brain. This is an amazing truth that is both wonderfully helpful, but as indicated above, can be frighteningly problematic at the same time. Just as breathing carries on without conscious thought but can be controlled if one desires, so also with hard-wired neural circuits.  When working on desired tasks, the efficiency of an automatic system is desirable.  However, when responding in rote to that which would best be handled with flexibility, challenges arise.  The brain, when left to its own devices, can land a person in trouble.  Therefore, the flexibility of the mind (sometimes referred to as “the mindful brain”) is needed to make adjustments in brain circuitry (also known as learning). The ability to make these changes is neuroplasticity.

Pertinent Brain Structures, Processes, & Functions

You understand the importance and applicability of the whole person and have been introduced to neuroplasticity. To expound further, we can delve into the various parts of the brain itself.

The brain is immensely complex with manifold structures that interact in a myriad of ways.  It is not necessary for the average care provider to know all the intricate mechanics.  What follows is a presentation of information pertinent to the treatment of mental health issues. A brief introduction to a few structures is included, but the focus will be on acquiring a working knowledge of certain systems, functions, and processes so the reader can use the information to make more informed decisions in treatment.  In addition, to help with understanding, each new concept discussed will be followed with a specific example of its application to therapeutic treatment.

Brain structures & regions of interest.  The human brain is made up of the brain stem, Cerebellum, and four specialized regions called lobes. Each lobe has a right and left side separated by a membrane called the Corpus Callosum.  Each lobe consists of many smaller regions that are responsible for a multitude of specific tasks.  However, for this discussion, only areas of primary function for each major area relevant to this training is presented.

Starting from the back and base of the skull, there is the brain stem and Cerebellum.

The brain stem is responsible for basic life functions, such as breathing, heart rate, and swallowing (i.e. eating). Directly above the brain stem lies the Cerebellum, which facilitates communication between the brain and the rest of the body.  This part of the brain regulates movement in the body and processes input from our senses. Even lizards and hedgehogs have a brain stem and Cerebellum.

Above and behind the brain stem is the first major brain region, the Occipital lobe.  This area specializes in processing visual information.  As the brain is traced from lower back toward the front, the next set of lobes are the Temporal lobes, which are positioned in the skull near each ear.  These lobes process auditory information, tag the information with certain memory and time-related tags, and process language.  Moving upward in the brain will bring us to the Parietal lobes. The motor cortex and major sensory processors of the brain are housed here.  Finally, the forward-most region is known as the Frontal lobe, which is the seat of awareness, executive functioning, judgment, and overall social behavior.

In order to better understand and explain the brain to clients, the brain can be thought of as divided into three main parts, also known as “the three brains” or “the triune brain”.  Unlike the lobes, which consist of 4 sets of lobes and were described from base of the brain, upward and forward, the “three brains” can be thought of as lower, central, and outer structures.

The first, or lower, brain consists of the brain stem and Cerebellum. It is referred to in many different ways, such as “the hind brain”, “the Reptilian brain”, and “the Lizard brain”.  This area of the brain primarily focuses on survival and baser life functions. Moving directly upward into the brain is the “central brain” or “Mammalian brain”. This area is responsible for emotional and certain memory processing. “Fight or flight” originates in this part of the brain and it may also be called, “the emotional brain”. Finally, there is the “forebrain”, otherwise known as the “Cortex” or “Neocortex” and this includes the entire rest of the brain.  This is where “thinking” occurs. Therefore, it is sometimes called, “the thinking brain”.

Within these regions are further areas of specialization that are particularly important in understanding the role of neuroscience in mental health practice. These are listed in the chart below with their associated primary functions.

Working our way bottom-to-top, we begin with the Pons.  This is a specialized, spider-looking structure that connects various regions of the brain together.  Simply speaking, the Pons acts as the communication hub for the brain and also has some effect on sleep. This region is in the survival part of the brain.

Moving upward into the emotional part of the brain is the Hippocampus, which adds emotional tags to memories and holds those memories for later retrieval. Working together with the Pons, which aids in sleep, memory storage and consolidation are achieved (see Memory).  Further up, but still in the emotional part of the brain, is the Thalamus. A major function of the Thalamus is sensory and motor relay – it is the part of the brain that makes us want to move when “fight or flight” is enacted.  Interestingly, as it is in the emotional part of the brain. Therefore, thinking may not always be involved in the urges one feels.

A final, crucial structure of the emotional brain is the Amygdala.  This is often referred to as the “fear center” of the brain.  This is an over-simplification for sure (it also contributes to intense feelings of love and joy, for example), but much in scientific literature and research shows the Amygdala to be an important structure related to the fear response. For our purposes, it will work to think of it in this manner.

The cortex is the rest of the brain that folds over the emotional and survival structures. The mechanisms and functions of cortex are vast and complex, but the primary focus is on information processing, especially in relation to interpersonal issues. It is useful to think of this part of the brain as geared toward “social survival” while the lower areas focus on “life survival”. 

Left-Right brain functions. The structure of the brain can also be described in terms of hemispheres, right and left. These hemispheres are connected via a group of fibers known as the Corpus Callosum, a thick bundle of nerve fibers that allow for communication between both sides. 

Each hemisphere has very specific functions.  Perhaps counter to expectation, the left hemisphere controls the right side of the body and the right hemisphere controls the left. The left side of the brain is primarily focused on logical, linear, and linguistic activities. In other words, when you are speaking, doing math, and thinking about the order of events, neuronal networks are firing in the left side of the brain.  An easy way to remember is: Left – Logic. It is the left brain that is the source for worry (fear about the future) and rumination (focus on details of things that went or are going wrong or on one’s own failures).

The right side of the brain is much more creative and flexible than the left.  It is responsible for non-verbal, emotional processing, and holistic perception – and is responsible for the frightening mental images that provoke anxiety.  When you do exercise, pay attention to your body, imagine the “big picture” or engage in expressive arts, the right side of the brain is engaged.

Traditionally, modern psychotherapy makes use of only a small part of the left side of the brain as you can see by analyzing the figure above. Talking, therefore – especially abstractly – does not engage the whole brain.

Applications for anxiety and trauma. Anxiety often a presents outwardly as left brain “rumination” or “worry”. Worry occurs when fearful thoughts about the future are the focus. Rumination is when the left-side of the cortex attempts to solve whatever the perceived problem is through over-analysis of details. The left side will supply worry thoughts and will “mull them over” ad nauseum sometimes. However, the creative and emotional right-brain is also involved in anxiety as it may provide fearful images and sensory-based stories. Right now, notice what happens as you read the following words:

                Bread        Book         Tidal wave          Sunset

It is likely you will have an image of each flash in your mind.  It is pretty quick, however, and you may not have conscious awareness of it. Unless a client reports nightmares or flashbacks, it makes sense to focus on the left-brain cognitions. We often may not think to ask what images they experience. Without the prompt, they may not report anything.

We have all had the experience of trying to explain what is experienced in the non-verbal brain. This is one reason why simply rehashing facts and logical thoughts cannot stop anxiety in the long-run.  For long-term relief, it is necessary to engage the right side of the brain in the effort to rewire the whole. As just eluded to, one way to do this is with visual imagery. With this technique, a person attempts to visualize a stored memory in order to modify some aspect of it. They may also create an imaginary “safe place” to go to in order to reduce trauma-based reactions. Another helpful, right-brained technique is to ask a client to perform a movement-based activity (use a fidget tool, throw a ball, or do some tapping). Finally, drawing a feeling may be helpful as art involves engagement of the right side of the brain.

A huge component of Interpersonal Neurobiology as it relates to the treatment of trauma in the brain (Siegal, 2010) is integration. This is an overarching term, but can be thought of at this point as the homeostasis produced when various brain structures (such as the hemispheres) “listen” properly and work together in balance. Two especially popular methods to achieve integration come from Narrative Therapy and Lifespan Integration (see “Strategies” section below for a brief explanation of these). Having one tell their story is indeed helpful, but sometimes details of the story may be missing, or a strong visceral response may be present when a person recounts their trauma.  Once trust and the ability to deal with stress has been established, it may be beneficial to ask the client questions that engage their senses.  “What do you remember hearing then? Or seeing? Smelling? This will create more holistic images in the right side that may allow a person to make a whole, cohesive picture of an experience.

Sympathetic and parasympathetic systems. All of the human system functions best when it is in balance. In fact, it may be said that the overall goal of mental health treatment is balance within and for mind, body, and spirit.

Some structures in various areas of the brain and body work together for certain overall processes and functions that lead to balance. These systems demonstrate how the brain and body rely on and inform each other.  Examples of this process can be seen in the sympathetic and parasympathetic systems. These systems (within the greater system of the person as a whole) work together to regulate physical states.

To work properly, these systems incorporate certain areas in the brain, some of the sensory system, and various organs and nerves along the spinal cord.  The sympathetic system is responsible for the activation and acceleration of body systems and the parasympathetic system inhibits and slows down bodily functions.  In short, the sympathetic system leans toward or engages in “fight or flight” and/or “up regulation” and the parasympathetic system results in “rest and digest” and/or “down regulation”. The following illustration points out what each system does with specific areas of the body.

An important function that is regulated by this system is breathing.  Most therapists have heard of, and may even teach, diaphragmatic breathing. Diaphragmatic breathing is a specialized way to breathe to re-set the physical system. It may be helpful to know how it works so that it is taught accurately to clients.

When one inhales, the sympathetic system is activated. Exhaling engages the parasympathetic system.  Therefore, to do relaxation breathing correctly, one must breathe in (through the nose, to limit the stream) for a particular count (say 2 or 4), hold the breath (for, say, a count of 2 or 4), breathe out through the mouth with some controlled force (like blowing out a candle) – but always longer than when breathing in (say for a count of 4 or 6). Finally, hold breath again for a couple of beats and do it again, mindfully. Rapid breathing or simply “belly breathing” without the elements of control to activate the necessary system is not proper diaphragmatic breathing.

Applications for bi-polar disorder and depression. Mania can be thought of as occurring when neurotransmitters in the brain are off kilter and sensations throughout the body compel or delude people into unhelpful behaviors. It is a key feature of bi-polar disorder and can be difficult to manage. One way to think of bi-polar mania is a “system in extreme up-regulation”.  Everything is too big and too fast.  Outward symptoms of this may include impulsivity, risky behavior, grandiosity, pressured speech, and restlessness. In extreme situations, psychosis may occur.

An understanding of how to activate the parasympathetic system can be helpful here. If a person in therapy is talking with pressured speech, one useful technique is to have the person tap each finger on their hand with their thumb and allow only one word per tap. This will help the client slow down in a methodical way until they reach a place of physical calm. This works best at the onsite of symptoms and may not be as effective when in full mania.

Conversely, in depression, the system can be described as overly “down-regulated”.  Here, a focus on engaging the sympathetic system via “behavioral activation” may be fruitful. Take clients for a walk or have them make a list of physical activities they are willing to do (ones that get the blood pumping and the breathing a little quicker). Physical activity can return these systems to better balance.

Limitations. All techniques are limited by scope and particular area of practice.  Be mindful of your and the client’s skill level before attempting a technique (do you fully understand and can they see mania coming?). Make sure the client is cleared medically, if applicable.

Sensory Processing. As we move through the world, our brains take in stimulation from our surroundings and our own bodies and processes it into usable bits of information. Brain processing is not localized to only within our skull. It involves a stimulus, emotions, body responses, and cognition. As with the left and right hemispheres and the sympathetic/parasympathetic systems, which perform related but different functions, likewise, there are two main systems involved in sensory processing. These are top-down processing and bottom-up processing.

Top-down processing or front (Frontal lobe)-to-back (Occipital lobe) processing is known most commonly as top-down processing.  With this type of processing, the stimulation in the environment passes first through the frontal lobe (where rules and previous learning are activated). The frontal lobe analyzes it and then stimulates emotion as a result and we respond.  In other words, we apply thinking to what we perceive.  By use of information and understanding we already have, we make and/or add meaning of what we see and experience. See the following example of top-down processing.

With something like this, you already know all of the words, the syntax, and at least some of the context cues. Therefore, the perception of the words is made understandable by language rules you’ve already learned.  As opposed to being able to understand:

Fgodaok, hgoy nem tduod ellvonasi ezt!

Looking at this, it may appear to be simply a bunch of letters grouped together. For native English speakers, that is exactly what it is. However, those born in Budapest, it may be clear as it is Hungarian for “I bet you can’t read this one!” (Per Google Translate!) Unless you know Hungarian, your brain won’t make any sense of this. Therefore, the perception (words in front of me) is made understandable by cognition (rules for understanding words already in the brain).

Bottom-up processing or back (Occipital lobe)-to-front (Frontal lobe) is more holistic. This is a pure form of processing wherein the brain takes in stimulation from the environment first in the Occipital and Parietal lobes. Once analyzed there, emotion is stimulated and then thinking may occur.  This may be the type of processing most active in intuition and/or “gut feeling”.  To demonstrate this, take a look at the following picture (you may need to blow it up some).

There are several pictures in one here. However, your brain first took in what you perceived as “the whole”. If you stopped there, you may label the picture as of “a man’s face”. However, as time went on, you added cognition and can began to see other things emerge, such as the lady in the coat and the canal tunnels. It is also possible, given your history and experience, that you either saw all the pictures instantly or that you saw the lady first and the man later.  It depends on what your brain was able to interpret with “stimulus only”. Most likely, at some point, you would have seen only one aspect and the rest would have come as you pondered it.  This is the same phenomenon that happens when a small child sees a horse but calls it a dog because it has four legs. This is “generalized” thinking and may be partly responsible for some anxiety reactions.

Applications for anxiety. These processing systems become extremely important when we consider anxiety.  Anxiety cannot be ignited without the Amygdala, but there are two potential pathways to incite a reaction there.  First, of course, is to go directly to the Amygdala (sometimes called “the short path”).  The other is to tickle the amygdala via the pre-frontal cortex (sometimes called, “the long path”). The “short path” may also called “Amygdala-based” or “bottom-up” anxiety.  The “long path” can be referred to as “Cortex-based” or “top-down” anxiety.

The amygdala is an almond-shaped structure in the lower back side of the brain (hence the name, which is Greek for “almond”).

When not engaged, the amygdala does not trouble the body with the flood of neurotransmitters (such as adrenaline and cortisol) that are typically responsible for the subjective experience of anxiety (or jitters or nerves).  Anxiety is evoked via the short path/bottom-up processing when the stimulation is perceived as a known threat. A soccer ball flying right at your face is a known threat and you will likely be out of its way before you are even fully aware it was coming at you. Clients who sit balled up and behind pillows in the chair across from you may perceive you as a known threat. Slow down. Take your time. They are unlikely to be aware of why they feel that way.

The top-down or long-path is taken wen thinking is necessary for analysis of the stimuli. For example, suppose you are walking down the street and you hear a fire truck. Initially, you might not feel nervous at all. However, once you have the thought, “Oh no! I wonder if it’s my house that is on fire!?” Then, instantly, panic shoots through your body. A clue that a client is experiencing this type of anxiety would be when they repeat themselves, ruminate, or express a great deal of worry. In such cases, a cognitive-behavioral approach may be a helpful.

There can be miscommunications within or misperceptions by the brain.  The short path can be taken for benign stimuli and the long path can delay response when it is needed more quickly.  In other words, we can jump out of the way of our own shadow and we can talk ourselves into holding still when our partner takes a swing at us.  These misfires can result from internal or external issues and are often fodder for shame. A compassionate and “brain-based”/whole-person explanation may be very helpful.

Memory. Ah memory…the culprit in a great deal of mental health issues, as you may begin to see.  The full treatment of memory is way beyond the scope of this lesson, but a few points will be explained briefly.

Memory can be thought of as the encoding and storage of internal and external stimuli in such a way as to be retrieved at a later time.  For fun, see if you can pass the following “memory quiz”:

As a way of exploring memory, let’s take these one at a time.

We are always conscious of our memories. False

Memories are tagged and stored in many areas of the brain, such as the hippocampus, thalamus, parietal lobes, and frontal lobes.  Much memory has to do with how we do things, such as walk or talk, or experiences we may not remember consciously.  Therefore, we are not aware of all memory. Think, for example, of the time you asked your fidgety client what was upsetting them and they said they didn’t know. Their body does…

We accurately remember our experiences. False

What did you do for your last birthday? What about Christmas? Think about it. What details come to mind?  If your friend asks you, you may remember cake and presents.  If your coworker asks, you may remember that you took the day off or had to work. Depending on the context in which something is recalled, the memory can change. In addition, our likes, dislikes, perceptions, and preferences can influence memory.  If your favorite color is red, then you may remember a red boat on that fun trip you took last summer, only to be surprised to find a picture of a blue boat.

Memory is what we consciously recall about the past. False

Like the example above, you may also have asked a client how their childhood was only to see them tense up. Yet, the client may say things were fine or that they don’t remember.  This has to do with the kind of memory being accessed in the moment (see Implicit memory below for more).

The memory of past events can affect future function. True

This is of huge importance. We tend to think of memory as something specifically about the past.  This is true, it is about the past…but it is for the future.  This means that memory is tagged and stored the way it is in order to make our ability to forecast and react appropriately in the future more and more possible. Think about it.  Remember the coffee you go to get every day without thinking? If you didn’t have a memory of how you got there, what it was for, how much you liked it, and so on – then finding coffee every day would be a much more involved procedure.

Memories are like puzzles – they come in pieces. True

Return again to the remembrance of your last birthday or Christmas. As you think about it, as you delve deeper into the memory, incorporating sensory information, you remember more and more. This is because memory is tagged and stored differently and in various parts of the brain. Some memories are tagged with language-based recall mechanisms and others are sensory or emotion-based. This is why a trauma survivor may remember the clock that was hanging on the wall but not the assailant’s face at first. Sensory-based, emotional memory may be stronger in some senses than word-based (see Explicit versus Implicit memory below for more).

Memories are primarily located in one area of the brain. False

Memories can be stored and tagged in various areas of the brain. The location matters.  Memories stored local to the parietal lobe may have time tags while those in the emotional enters may not.  Can you imagine the implications of this?

Memories are only constructed by external factors. False

Another important consideration – memory can be constructed by our internal states. This is why two people doing the same activity could remember it differently.  If riding a roller coaster is thrilling to me but dreadful to you and we both do it, we’ll remember it differently, as well.

Memories can be changed and refiled. True

This is good news (though it can be problematic, as well). Have you ever had a memory of something that was unpleasant, but then someone revealed something about it that you did not previously know or recall and then the experience of the memory changed? Yes – you can retrieve, modify, and refile memories. It isn’t an easy process, but it can be done. Think of the implication of this to relationship issues and trauma.

Many of the above references involved two important types of memory: Explicit memory and Implicit memory.

Explicit Memory, or declarative memory, is memory that is tagged and filed in the brain via language.  It is “episodic”, meaning that it relies on contextual cues and experience. There is a sense of “time” inherent with it. Autobiographical memory is a type of explicit memory.  It is clear that both the right and left brain is involved with explicit memory as when asked about one’s last birthday, it is unlikely that mere lists of items and actions will be conveyed.  Sensory setting will also be included.  This is the type of memory most often accessed in talk-based therapy.

The other type of memory encoding is Implicit, otherwise known as procedural memory. This is primarily sensory-based, not time-tagged, and is the memory most used for “second-nature” actions.  Try teaching a small child to tie their shoes or a teenager to drive a car and you will run into challenges of implicit memory.  This may be the type of memory most troublesome in trauma as they can seem random and feel as if they are “happening in the now”.  For all intents and purposes, then, flashbacks may be experienced by the body and brain as if they are actually happening again.

With respect to therapy, consolidation an important memory-related concept. Consolidation occurs when memory is “properly filed” in the brain. In other words, it is what happens in the brain when neural pathways form a “trace” to a memory once it is “stabilized”. Memory consolidation is crucial for a sense of coherence and well-being.  Consolidation may best occur when passing from short- to long-term memory and/or during sleep.  It is possible for the process to be interrupted and for files to be retrieved in some sort of error based on implicit, emotional tags.  For example, if your birthday cake fell, you may remember “the whole birthday” as terrible or feel an actual knot in your stomach every time you hear the word “birthday cake”.  When memory is misfiled (or, not filed at all but has a feeling of “floating around”), it can be reconsolidated.  Reconsolidation is what happens when a memory is recalled and then re-stored.

Sit quietly (if you can) and close your eyes (after you read this next sentence).  Try to remember your last birthday or Christmas (open your eyes when you have a visual image).  Now, on a piece of paper, write down a few things you can remember from that occasion.  Now…imagine your boss is asking you about the day.  Write down more aspects of the day.  Finally, imagine your grandma is asking.  Write down a few more.  Look at your list.  Now, imagine your boss says, “Is that all you did?” and your grandma says, “That sounds lovely, Sweetheart!”.

Do you see any differences in the types of information you recall depending on who’s asking? Then, depending on how each person comments on it, you may “re-file” it with some color (or, lack thereof).  It may be that the very act of conjuring up the memory changes it in some way, as does filing it after input.  This makes reconsolidation an incredibly important therapeutic tool.

Applications in trauma. There is so much that can be said here.  Memory is a huge component in trauma.  Memory, at such times, is highly implicit and right-brain-oriented. Therefore, it is not as linear as one would suppose. It generally has a far more sensory-based, as opposed to cognitive, component. This provides challenges for some forms of therapy. When asked about the details of a trauma in an explicit-only, predominately left-brained manner (i.e. “Tell me what happened that day.”), a great deal can be left out. However, there is good news – great, even.  We now know that memories of traumas can be retrieved, tagged in time and meaning, and reconsolidated in a way that reduces negative somatic experiences!

With relation to reconsolidation as a therapeutic tool, a few important, memory-related facts may be helpful.

Learning. The final piece in the brain puzzle that we will look at is learning, which is the foundation for all clinical treatment. Learning is a process by which experience and knowledge are acquired and integrated and it occurs with the help of all areas of the brain. In fact, it requires the entire body as well as environment.  Yes, the whole kit and kaboodle!

The process of learning begins at the point where we do not know what we do not know; before we know there is something to learn.  This level of learning is called unconscious, unskilled.  We are generally pretty content at this place on the continuum. Here, for example, we would have no idea that bicycles exist and therefore do not care that we cannot ride one. Suppose, however, a time comes when we decide we want to learn to do ride a bicycle. That state-of-being is called conscious unskilled. As a general rule, people are uncomfortable in this stage.  We struggle with not knowing how to do something we want to do. This may be particularly difficult if we assume that simply knowing about something means we should know how to do it – a virtual mischief-maker in therapy.

Eventually, though, we jump on the bike and practice and learn to ride it. That is all well and good, but at that point, we use a great deal of conscious energy as we have to think through every step over and over. This is where we hear complaints of, “It doesn’t feel natural”. We have many wipe-outs.  This level of learning is called conscious, skilled.  We really don’t tend to like this level of learning at all. Humans tend to want to look like pros at everything at all times. Therefore, this is where most people would quit if not encouraged in some way.

With consistent practice (the length of which depends on many factors), we one day jump on the bike and off we go – no highly conscious thought involved any longer.  This final stage is called unconscious, skilled.  Here is where we spend most of our life (also known as “automatic”) and it is the place where we are happiest. Well, until we’re not.

Sometimes, we learn something that is not really all that effective for us. For example, if a parent was covert in how they spoke with us and questions were disguises for digs and insults (such as, “Don’t you want the light on, Sweetie” as code for “What are you, lazy? Can’t you turn the light on by yourself?”). If this is our experience, we could hear all questions as accusations and may snap at anyone who asks something. 

If this type of learning occurs, would we have to start all over?  No, we couldn’t go all the way back to unconscious, unskilled because we already have awareness. We may spend some time on the second level, learning skills we were not previously exposed to – but mostly, we will have to use what we have learned in a very conscious, careful manner in order to become more proficient at skilled use.

Those of us who provide care to people with mental illness often have to take people back to level two or three – very uncomfortable places – in order to help them acquire more effective skills.  Knowing this, we can communicate early on that therapy is a learning process and the goal is eventually to reach unconscious, skilled; automatic; easier. This can relieve some distress along the way.

Client-friendly Ways to Introduce Brain-based Concepts

Whew! Still with me?  You’re doing great!  Now, it is time to synthesize all that you’ve learned and consider how to explain it to clients. It is not necessary to try to explain all the brain processes and functions to clients that you have learned.  It is important for you to understand the underlying processes so you know when to apply what concept.  However, clients only need to have a cursory knowledge.

Simplifications & Analogies. Dr. Dan Siegel (2010) uses a “hand model” of the brain that is relatively straightforward.  This uses a simplification that includes the “lizard brain” (brain stem and Cerebellum), the “emotional brain” (amygdala, thalamus, etc.), and the “the thinking brain” (frontal, temporal, and parietal lobes). This language is not always clear or acceptable to all clients.  You may need to experiment to figure out the correct wording to use.  What follows is a potential “script”, created by this author, you can use to explain the brain to clients. Extra information for very inquisitive and/or high-functioning clients are in parentheses. Be encouraged to make adaptations to this to fit your understanding and personality.  It will be best if conveyed authentically (or, you may use the following transcript as a reading assignment, with due credit included).

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When thinking about the brain, it can be helpful to think in terms of “roles” rather than structures. For example, the frontal lobe, or more specifically, the prefrontal cortex, houses what is known as, executive function. This area can be thought of as the Executive Assistant – the part that “man’s the ship” or “drives the machine”, so to speak. 

The Executive Assistant (EA) does many things at once, but is limited to a maximum of seven internal and/or external processes (such as processing cold skin, thoughts of anger, bright lights, a stomach ache, and someone shouting your name).  This is called working memory.  When working memory is overloaded or impaired, you may feel easily overwhelmed and unable to think clearly. This is common in many mental health disorders.

The rest of the brain beyond the prefrontal cortex, can be thought of as a file cabinet. For our purposes, we can say the non-conscious is in the file cabinet. Therefore, the file cabinet includes experiences, perceptions, and memories. The neural networks that connect the EA to the file cabinet can be described as “Couriers” (or for children, as “Minions”). Couriers/Minions use a sort of “map” to find files.

Much like breathing, the files can be accessed in two different ways: manually or automatically. As you know, if you don’t pay any attention, you will breathe without any conscious effort.  However, if you want to, you can speed up, slow down, or stop your breathing. Likewise, if the EA is not “watching”, then the couriers can retrieve files on their own.  Imagine you grew up with a sibling who did not value your time. They were always late. This left you feeling uncared for and angry. Flash forward a few years. You are waiting at a restaurant for your friend, who turns out to be 10 minutes late and you want to scream! It’s a minor infraction in the scheme of things, but because you were not consciously aware of what the experience means in this present moment, the minions heard the EA say, “she’s late!” and minions ran off to the “Get mad” file.

However, with some training, the EA can learn to pay attention to something else.  Then, when the friend is late, the courier retrieves the, “Concern” file or the “Draw a new boundary” file.  In this case, no strong emotional files are needed and the system stays in balance (there’s that word again!).

There are other important qualities of the files to note, namely: you may not be the main filer, the files cannot be replaced easily, they are not always accurate, and they can be changed or misplaced.

It may be surprising (and disconcerting) to know that you may not be the main one in charge of choosing what is in the file cabinet. What do I mean?

Learning and experience are processes by which files come to be filed.  Sometimes, we learn by sheer repetition.  If you hear something enough, you might come to believe it. Or, you may learn by “borrowing” it by believing the person who told you or by liking what you hear. Sometimes, you never actually analyze what is in the file system. You may actually never know a belief you hold until you become aware of the actions, words, or thoughts that come from the belief. It is important to create a way to stay mindful of what is “steering the ship” (what is “in the files” directing your behavior and thought patterns).

As for the files not easily being replaced, this is actually a safety issue.  If you have a “people can’t fly” file in your brain (which, I hope you do) and I came along and said, “Hey! I read in the newspaper that people can fly now!” Well, suffice it to say, you’d not be around long if you could quickly change your thought patterns and emotional states.  It is important that the file cabinet only contain well trusted and tried files.

This said, though, not all the files are accurate, even the ones that have been around a long time. This means that just because you feel a certain way or think something is true, does not make it true. For example, just because your dad calls you lazy doesn’t make it true.  You need patience, wisdom, and experience to sort through the files and weed out errors.  Then, you need perseverance to replace them with the truth.

Finally, the files can be changed and misplaced. An example of a changed file is when you recall your birthday and remember your friend, Joe, there – and he says he never went that year.  A misplaced file is when you cannot remember something.

Meet SAM. As you have learned, the EA is that part of you which produces flexible, in-the-moment information that you can use to make decisions and to understand your world.  Your brain is very complex and the “aware” part of yourself is not the only part at work at any time. You also have another significant player we’ll call, “SAM”.  SAM is an acronym first coined by a man named Dr. Dan Siegel (2010), and it stands for Search, Alert, and Mobilize.  SAM’s job is to keep you safe from physical danger.  SAM lives in the survival part of your brain, relatively close to the fear center. In other words, SAM has direct connections to your emotions.  However, the connections to the EA do not always go both ways.  By this, I mean, you may not always know why SAM is on the alert.

There are some more helpful things to know about SAM.  First, SAM is very, very fast in comparison to the EA.  Think of SAM as the Cray Super Computer and the EA as the first IBM computer in 1961. This means that SAM is often aware of danger and begins to ring the warning bell (which is felt as anxiety in your body) and push you out of the way (via your motor cortex) before the EA even knows what has happened.  In other words, anxiety and other upsetting emotions can be triggered from something that SAM can see, but the EA doesn’t or hasn’t yet. The trigger is often something that was hurtful in the past and is noticed physically through your senses (such as seeing a familiar pattern of behavior, smelling a particular food, or hearing a door slam). You may not be aware of the trigger.  You may just feel bad.

However, SAM does not always act first. Sometimes, SAM is doing just fine, minding their own business thinking everything is going fine, when the EA says something scary. Imagine you are walking down the street and you hear a siren blasting. You may feel fine initially, but if the EA says, “Hey! Wait! What if it’s my house on fire?” this could greatly upset SAM.  Therefore, sometimes, your thoughts ignite anxiety and upset – and you guessed it, these thoughts are also not always accurate.  This is the reason a therapist or other care provider will focus on both helping you change the way you think and calming your anxious body (when the source of the fear is not accurate or not present).

Neuroscience-informed Strategies & Practical Applications

Take a deep breath.  Let all that has gone before soak in some.  You have learned about the complexities of the brain have some idea of how to explain it all to a client – a strategy in and of itself in some cases. What follows are examples of brain-based or neuroscience-informed techniques you can apply in practice. Some ideas will be new, but many will be familiar – you will just see them “anew” as “brain-based” now. As most of these strategies require more extensive training, a limited explanation of each (including some history and example applications in some cases) will be provided.

These strategies have been organized in terms of different stages of treatment.  The first step in healing is awareness.  Therefore, we will start with ideas to raise conscious awareness.  Next, the needs of the body will be addressed in brain-body-enhancing practices.  These include ways to soothe the body and manage stimulation of the amygdala.  Finally, methods to utilize the whole brain to integrate memory and increase coherence will be suggested.

These are by no means exhaustive.  They are either common practices chosen to illustrate their connection to neuroscience-informed care or chosen to be illustrative of concepts learned in this module. As mentioned earlier, your fuller understanding of the “human machine” may provide for far more robust use of techniques and strategies you already know, and you may be able to elaborate and create new approaches, as well.

Conscious Awareness Exercises. As described earlier, we are whole people and benefit from being treated as such. Without that knowledge, we can take every thought and emotion as true representations of what is happening in the world (a state known in psychology as “cognitive fusion”).  We have a thought, “He’s late. He doesn’t care” and we think this is true. This is a function of a brain on automatic accessing a file “rule” as result of a perceived threat (or other stimuli). Some people have never learned to question their thoughts or emotions.

However, in order for the mind to make good use of what comes from files, it will be important to slow down and to notice what is truly happening in the present moment.  Therefore, conscious awareness and mindfulness of the present moment are crucial keys in the whole-person treatment of people in distress.

Diaphragmatic breathing & centering.  Centering is a mental/visual technique that is popularly used in martial arts and certain mindfulness and religious-based practices.  There are many methods out there to help one to “center”, which means to find a way back to a place of calm and peace in body and mind. For some it’s a “peaceful place” visualization. For others, it’s a “body scan”-type activity. For more information, you can read Jon Kabot-Zinn’s website at The Center for Mindfulness: (www.umassmed.edu/cfm/)  

Diaphragmatic breathing was presented earlier while some of the systems of the body were discussed.  However, as a method to address mental health, important keys are to remember that these can be used proactively as well as reactively. Also, nothing else can happen in our awareness if we can’t think due to high stress, anxiety, or anger. Breathing calms the system and allows the EA to return to fuller function.

If you need, return to the section on sympathetic and parasympathetic systems to refresh your memory on how to properly breathe.

The Harvard School of Medicine (2015) suggests that people who make it a concerted practice to slow down and breathe or center themselves may experience overall improved stress levels.

Mindfulness/Wise mind. We cannot have a discussion on awareness without talking about Mindfulness and, by extension, Wise Mind. These are the base from which everything else must occur.

According to Jon Kabat-Zinn (2017; Front page), a leader in Mindfulness-based therapies, the definition of Mindfulness is, “…awareness that arises through paying attention, on purpose, in the present moment, nonjudgmentally.” Most of us have a rather low level of awareness of what is happening in the present moment.  Imagine yourself sitting in a restaurant full of people.  You have a sense that others are there, but at any point, if I ask you what people are wearing or where they are sitting, you may not be able to say with much certainty. This goes for awareness of what is going on in our own minds, as well.  If we are not careful, the “Principle of the Noisiest” will take over (in other words, whatever is loudest or most painful in our inner world will receive most of our attention, and often “feel true”).

How does one become more mindful?  There are many practices. The Center for Mindfulness and Marsha Linehan’s “Behavioral Tech” website (www.behavioraltech.org) are good places to start. Keep in mind, there are many practices, such as meditation, that can help you cultivate the state of mindfulness, but is not mindfulness in and of itself.  Mindfulness is a stance and way of being.  In every situation, to return again, as mentioned above, to paying attention in the present moment with all your senses.  The idea “return again” is crucial because we all stray from center and from the present.  It is fine to go into the future for planning – not for worrying or rumination.  It is fine to go into the past to reminisce or learn – not to regret endlessly or stay stuck.  The moral of the story is go to wherever you go – past, present, or future – mindfully, with intention and for a purpose. Solve the real problem in the moment rather than the problem you wish you had or think it is. 

Once one determines what the problem is, it is important to access the Wise Mind – which means to take information from both the thinking mind (cortex-based, left brain cognitions) and the emotional mind (image and sensory-based, right brain activities). Imagine you have been at work for three hours when you pick up your phone and notice several missed calls and text that say “call me!” on your phone. A typical tendency would be to panic in such a situation. You may get up and run right out of the office. However, if you slow yourself down, you can take more into consideration than just your feelings.  You will want to consider your experience (focusing on accurate aspects of your past) and the big picture (important aspects of your future in relation to past and present) as well as fact-based understanding of the overall situation. Including all of this: past, present, future, emotion mind, and thinking mind, is Wise Mind.

There are many ways to learn to access the Wise Mind (referred to by some as intuition).  Again, a scan of well-known mindfulness teachers can illuminate this.  Before one can reach this state of being, though, it is necessary to be fully aware of this present moment. For that, a well-rounded “check-in” routine can be helpful.  The following is an example.

5-point check-in.  As most people who seek help do not really understand what is happening within themselves, another strong first step (and way to achieve mindful living) can be to raise their awareness of what is occurring in their bodies, minds, and lives throughout the day.  Many clinicians try to encourage this by asking clients to “check in” with themselves.  However, this may be too vague.  Once they check in, they may also not have any idea what to do with what they find.  Enter the “5-point Check-in”, a practice developed by this author (in conjunction with information from Mind over Mood (2016) and Overcoming Anxiety, Worry, & Fear (2016) – see references for source information) and used daily with hundreds of clients at The Center; A Place of Hope, a partial-hospital program in Seattle, Washington.

Within the human system, there are five key points wherein we can gain information and make adjustments to positively affect the whole.  These are:

The world rushes quickly past most of us each day.  The 5-point Check-in allows us to stop and look at what is happening in each of these areas.  It is most useful to look at only small chunks of time so one can remember the information a bit easier.  Therefore, several times a day, one could ask the following questions:

This is the check-in. Now, imagine one’s answers to these questions are, respectively: ruminating thoughts, anxious, snippy, tense, hot, and isolating. What does that tell us?  Well, for most, the answer is simply, “I’m miserable”. Knowing this alone may not be helpful.  Now, we need “the magic question”.  After answering the 5-point questions above and gathering the information, teach clients to ask themselves: “What might I need?”  Let’s look at this by answering a few more questions.  Looking back at each point, think about what your answers might be to:

As you can see, there is not just one answer to these. It is a bit of a quest. Therefore, it is important to say, “what might I need?” – at least at first.  Some people do not know what they need.  Once they understand themselves better and feel confident of what works for them in patterned situations, they can ask more directly, “what do I need”. 

One last note on this…what if the answer to the questions are good things?  What if you find that you are having happy thoughts, excitement, friendly, calm, and out at the fair?  Then, do you still ask the “What might/do I need?” question?  Yes! Absolutely.  The answer then is: more of this!!  It is just as important to track what’s going well as what isn’t! This is a paradigm shift for some people. By using awareness exercises proactively and consistently, people can begin to track their patterns, notice what works, and even catch themselves feeling good!          

Mind-Body Exercises

Once a person gains awareness of their state-of-being, exercises that help explore and express themselves can reduce therapy-interfering behaviors by reducing stress, anxiety, and providing motivation.         

Body scan. Many people these days do not pay much attention to their body. Instead, they spend a vast majority of their time in the head, thinking, thinking, thinking. A body scan is a mindfulness exercise that guides a person to attend to each area of their body in a calm and orderly fashion. There are many versions of the body scan, such as the one on the Berkeley Greater Good website: https://ggia.berkeley.edu/practice/body_scan_meditation

It is generally best to start with the feet and go up so that the exercise starts with grounding. It is also important to realize, as mentioned in the memory section, the body itself contains memory that can be released when awareness is brought to it. It is important to complete a thorough history before trying it and to know for what goal it is to be used due to the potential toward sensory triggering.

To more fully understand how it works, please find a quiet place to read and try the above body scan (or one of your choosing that takes you through your entire body). Even if you did it “once before back in school”, do it again.  What was it like? What did you notice?  Were you able to stay on track?  Did anything stand out as surprising, odd, or bothersome? What was your state of relaxation before and after?  How can you make this a common practice for yourself?

Physical Exercise. Much research has been conducted that demonstrates the benefits of exercise.  Aerobic exercise positively engages the sympathetic system and can “reset” the amygdala.  Yoga provides a focus on metered breathing, which can bring balance to the body. When done proactively, exercise can result in an overall feeling of calm more of the time, or a “go-to outlet” for anxiety and anger. These emotions generally carry higher levels of physical energy. Therefore, exercise is a healthy focus for dissipating physical discomfort.

Psychodrama.  In the early twentieth century, Jacob L. Moreno, a psychiatrist and educator from Romania, founded the practice of psychodrama.  A psychodrama is a group therapy activity wherein one member of the group chooses other members of the group to “act out” a pivotal event in life.  The therapist acts as clarifying observer.  The lead participant moves other people and goes through the motions and dialogue of a hurtful time making changes and adjustments as they go.  Before the time of advanced imaging, brilliant people like Dr. Moreno, understood the benefit of whole-brain work.  Therefore, psychodrama is one of those therapy tools that brings mind and body together and integrates the entire brain. Therefore, it provides a good segue to the next section on left and right brain strategies.

Left-Right Brain Strategies for Memory Integration

A key to long-term change is rewiring the brain. This requires use of both sides of the brain. A summary of what we learned above is that the left-brain provides upsetting thoughts while the right-brain provides disturbing images. Both of these can be below our awareness and in order to fully integrate, it is important to bring them into our awareness in a particular, ordered way. Below are various therapy modalities and exercises that do this.

Narrative therapy/Lifespan Integration/EMDR. Traditional talk-based therapies, such as Cognitive Behavioral Therapy, primarily target the left side of the brain (language, logic).  However, in cases of traumatic or anxious memory, aspects of the more creative right side, as well as access to implicit, non-language-based memory needs to occur. To address this, several novel therapy approaches are helpful.  A brief description of each follows.

Narrative therapy. Michael White of Australia and David Epston of New Zealand developed Narrative Therapy in the 1970s.  The idea for this approach was to “separate client from problem” and to have the stories that stand out to the client be processed. This can be done by talking through the story, writing it, creating an art representation, or even with music and lyric.  The therapist joins in with the client in exploring their own life through story and helps them reach their own decisions regarding what they discover.

Lifespan Integration. With this treatment, created by Marriage & Family Therapist, Peggy Pace, a person is brought to a particular memory of a past trauma and systematically creates a timeline of visual memories that help to integrate the difficult experience into their memories, along with happier, more constructive thoughts.  The trained clinician is able to guide them via specific types of questions.

EMDR. Eye-movement Desensitization and Reprocessing, or EMDR, was developed by Dr. Francis Shapiro.  Dr. Shapiro noticed that in REM sleep, our eyes move back and forth.  This is a key process in consolidating our memories (see the Memory section above for more information).  Shapiro hypothesized that creating a way in which this same function – eye movement – could occur while the client was awake and processing a traumatic or troublesome event, perhaps reconsolidation of the memory in a more integrated fashion could occur. She was right!

This therapy involves taking a brief history of a client and then helping them learn very specific relaxation techniques (building a “container” or a “safe space”).  After this, a light bar (or other apparatus) is used to promote side-to-side eye movement.  The specially trained therapist then leads the client back to the memory and, while it is being processed, uses specific leading or clarifying questions.  No “therapy” per se is done.  In this modality, it is the brain itself that does the work and it has been shown to be highly effective in dealing with traumatic memories and nightmares.

Expressive Therapies: Art, Music, Movement, Writing. In order to fully capture the wisdom of the right brain, expressive therapies are necessary.  Color, shape, proximity, movement, and expressive writing all engage the non-verbal and creative side of us.  In practice, this is probably the most difficult to integrate as it is not always apparent to clients why these techniques work.  Following are a few examples of activities you may want to try, explaining that each will help you access “the whole brain” at once:

Truth Statements & Labyrinth Exercise. For primarily cortex-based anxiety, cognitive behavioral therapy (CBT) can be helpful.  Explanation of that method is beyond the scope of this lesson, but one whole-brain-based, CBT activity one can try is called, “The Labyrinth Exercise”, which is an activity this writer has used in practice for several years.

Most of us have heard of “affirmations”.  These are positive statements one can make about themselves.  Repeating these statements can start a person down the road of improving self-esteem.  However, if the person does not believe the statement, this can be an issue and can halt progress.

Imagine you have a client who has been repeatedly saying to themselves, “I am not enough”.  If you, as the therapist, prescribe saying, “I am enough” twenty times per day, the results could vary.  If the client feels a strong connection with you and believes that you believe it, they may say it with some level of conscious acceptance.  If, however, rapport or trust has not yet been built to that level (or, the client is simply too skeptical to override their own opinion with yours), then the client may either not be willing to repeat the statements or may not take them seriously when they do. Therefore, enter “truth focus statements”.

With most negative self-talk, there are likely instances of behavior or experience that a client can point to that “proves” to them that they are whatever the negative they say to themselves.  If, for example, a client tends to say, “I’m so dumb!”, it is likely that they have done something (failed a test, committed a social blunder, or the like) and this is where the label is derived.  However, the person could likewise give examples of themselves “not dumb” (they passed their driver’s test or finished college, or the like).

Therefore, with truth focus statements, a client is asked to identify a “positive opposite or constructive” statement that correlates with the negative self-talk they exhibit. A positive opposite is just that: “I am dumb” becomes, “I am smart”.  However, not all statements can be made into positive opposites.  An overweight person who says, “I am fat” can’t say, “I am thin”, for example.  Therefore, choosing a related constructive statement is better, such as, “I am beautiful” or “I can make smart health choices”. These statements, on their own, are affirmations. Once a particular affirmation is chosen, then the client can search for at last one or two statements of “evidence” to go with it. For example:

        “I am smart because I finished school and chose to do the hard work

         of going to counseling”

Or

        “I am beautiful because I take good care of my animals and I am kind

         to my family”

A statement of proof or fact added to an affirmation to give it more “believability” (i.e. so the brain can have a file to grab onto) so that a client may be more willing to choose to focus on it as opposed to a negative thought is a Truth Focus Statement (as coined by this author). It is important to point out to clients that if both lists (positive and negative self-talk statements) were written out, it would be most beneficial to focus on what uplifts and motivates us in a positive and/or healthy direction rather than paying too much attention to what’s wrong.

It is true and valid that there may be a problem to solve with the negative self-talk (“I’m ugly” may mean “I don’t like how I dress” – which can be corrected, for example). Otherwise, there is no good reason to focus on the negative things we don’t like about ourselves.  The goal is to create a plan to address any issues and then move on with a more positive focus. One problem with this is that the truth-focus statement won’t feel true at first. It will be better with the evidence statement, but some people’s self-esteem is so low that it could take some time to start to believe it.  Packaging this as an exercise to do could make a big difference. Once the statement is created, then the labyrinth can be used.  Below is an image of a labyrinth:

The client is instructed to trace the labyrinth (with finger or pen or whatever) and repeat the truth focus statement over and over while doing so. This brings elements of both the left-brained language and the right-brain special creative/movement-based work together, which could more effectively integrate the information being repeated. Prescribing proactive labyrinth sessions throughout the day is a good way to reinforce newly-found truth into a client’s life.

Neuroscience-informed Case Study

What would it look like if we put this all together?  Let’s take a look. 

What are your thoughts initially?  What stood out to you after what you have read in this training? Where does she need to start? It is pretty clear that anxiety and depression play a part in Jaylin’s struggles and that she is somewhat unaware of why.  She may also have a level of trauma experience. From a neuroscience-informed point-of-view, a couple of important clues stand out.  First, a great deal of the anxiety-related description is around ambiguous feelings in the body that Jaylin is either ignoring or belittling.  Remember, our bodies hold wisdom.  Next, she is beating on herself because of her anxiety – a primary “cortex/left-brained trying to figure it all out” activity.  Therefore, she has engaged both paths to anxiety. Finally, she eludes to problems with sleep and some level of hypervigilance, due most probably to having to drive to work now. After taking a brief history, it may be beneficial to psycho-educate Jaylin on the brain-body connection, SAM, and how natural functions of the left and right brain contribute to her depression and anxiety (defining both as you go along). Then, introduce a self-awareness activity (such as the 5-point Check-in) and have her do that for a few weeks to help her become aware of her states-of-being. After that, a neuroscience-informed treatment plan may include the following:

For the long-path/cortex-based/left-brain focus/depression: Using a narrative approach to learning Jaylin’s history (which, by itself, could provide for some level of integration as you go), identify common negative and self-defeating thoughts. Identify any distortions and create truth-focus statements to counter or “turn” her thoughts. Provide both language-based (talk therapy, affirmations) and creative (art, writing, lyrics/music) options. Actual goals may be:

         Jaylin will identify at least 2 self-defeating thoughts and construct an associated truth-focus statement and turn her mind to it each time she is aware

         of the negative thought. She will engage with labyrinth exercise two times daily to be proactive.

         Jaylin will write a list of at least 3 gratitude statements each night. If she cannot think of three that happened that day, she will decide on

         three activities to add to the next day that might result in a feeling of happiness or gratitude.

If any functional issues arise (such as the discovery that Jaylin fears talking to her boss), more goals can be added.  In the beginning, the idea is to teach how to rewire old reactions.

For the short-path/amygdala-based/right-brain focus/anxiety: Create and engage in a self-care plan that addresses body, mind, spirit, and social aspects of her life. This plan will include self-discipline as well as fun, “everyday” activities as well as periodic and/or distracting activities. An actual goal may be:

         Jaylin will have lunch with a co-worker at least once a week

         Jaylin will develop a healthy morning routine that will include exercise, coloring, and journaling.

There are many ways to write goals.  These are just a couple of examples that demonstrate how goals that are likely familiar can be targeted specifically based on the issue presented.  Rather than prescribing a bath for someone who is ruminating, for example, you can more clearly see when and with what to use cognitive-based versus somatic strategies.

Conclusion

Whew! You made it! How was the journey?  My guess is this will take some time and many resources and readings to truly integrate into your repertoire of treatment modalities.  That’s okay! Take your time.  This is meant to give you the idea that more is out there and it includes the whole person!

To recap what has been learned in this module, let’s start at the beginning. We learned the importance of using principles of neuroscience in mental health care. The “whole person” was explained as mind, body, and spirit. Relevant brain structures, systems, processes, and functions were explained in both technical and “client-friendly” ways. A few examples were shared of how the information could be applied therapeutically. After this, a brief explanation of brain-based/neuroscience-informed strategies was given. Finally, a case study helped us “put it all together”.

We now know certain functions of the brain – or, malfunctions – lead to specific presentations in treatment. Mental illness is not a character issue and one cannot successfully treat somatic anxiety in the long-term with purely talk-therapies. It is important to realize each person is both similar and different to others and to seek balance in treatment.

Thank you for taking time and effort to go on this learning journey. At this point, you may benefit from creating a Specific, Measurable, Attainable, Relevant, and Timely (SMART) goal for yourself based on all you have learned. After all – knowing is not enough. Now it’s time to do!

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About the Author

Hannah Smith, MA LMHC CGP is the founder of Potential Finders Network, LLC. She is a Licensed Mental Health Therapist and Certified Group Psychotherapist with nearly 20 years of experience and Master’s degrees in Special Education and Counseling Psychology. In addition, she is a certified Interpersonal Neurobiologist through the Mindsight Institute. She has done extensive study and work in neuroscience-informed treatment of Anxiety and Trauma and she worked as a trauma therapist and educator for many years.

She is the author of Lasting Change; Overcoming the Grip of Anxiety, Depression, and Trauma with User-friendly Neuroscience and has written many blogs on sites such as Therapy.com. With her varied background of work in both the US and abroad, and in her own, personal journey, she has found the incorporation of knowledge of brain-related responses in therapy reduces shame and increases the sense of self-regulation and efficacy in her clients. Therefore, she has integrated neuroscience in all she does. Her passion is to help her clients build a life that brings them joy and fulfillment and to educate clinicians on this very important and practical subject matter. You can learn more about her by visiting her website: www.potentialfinders.com or by e-mail at [email protected]