Psychiatry of the future

We do not agree when a loved one cruelly accuses himself. But why should cruel thoughts concerning ourselves be closer to the truth?

It feels like I accidentally ended up in a medical clinic of the future. Dr. Greg Siegle is director of the Emotion Neuroscience Laboratory at the University of Pittsburgh (USA). Now he is talking to a young woman suffering from depression. Instead of asking Alexandra about her condition (as any good psychiatrist would do to sort out her medical history), he shows her the results of her brain scan, pointing to an area that is clearly overactive in her.

It’s about the almond. It is hidden in the depths of our emotional brain – the most ancient part of the brain in general. This is the part of it that is already present in reptiles. It does not have the ability for complex analysis inherent in the cortex. But on the other hand, it is she who first perceives visual images, sounds, smells, sensations that come to us from outside. The rest of the brain is not yet aware of what was perceived, but it already triggers an instant emotion: fear, anger, rage. The amygdala is the sentinel of the body: it is always on guard, its task is to watch for any signs of a threat and sound an alarm when needed.

But for Alexandra (like most of the depressed patients Dr. Siegle works with), her amygdala has become overly sensitive, probably due to the wounds inflicted by life. It is worth such patients to read words reminiscent of their troubles, as the amygdala sounds the alarm. The words “weak,” “failed,” “incapable” often serve as such triggers.

“Abandoned”, “loneliness”, “death” act in the same way. Alexandra describes to Dr. Siegle how her brain is idly working on what excites her. Starting to think about the conflict with her sister or about the pile of things at the office, she can no longer stop scrolling unpleasant thoughts in her head. She knows perfectly well that it’s useless, but she just can’t stop.

Greg Seagle shows her another area of ​​her brain that is not working as it should, the frontal lobes. This zone is responsible for controlling emotions and for ideas about the future; it is she who allows you to give up immediate pleasure (for example, from a chocolate bar) for the sake of a more abstract and distant goal (in this case, a slender figure). As the scan results show, in Alexandra (and other patients with depression), this zone functions at half strength. As a result, investing energy in future-oriented projects becomes much more difficult.

And to restrain the hyperactivity of the amygdala, which reacts to the slightest signs of negativity, is becoming more and more problematic. Then Alexandra gets the feeling that she can neither block her black thoughts nor imagine a more positive future *.

Cognitive therapy has long been shown to be effective for depression**. First, she identifies the “automatic” destructive thoughts that are so characteristic of depression: “I’m good for nothing”; “I won’t succeed”; “I’m never lucky anyway.” The patient is then asked to look at himself from the outside, as a person with such thoughts, instead of taking them directly and literally. After all, these are just dark thoughts. Are they based on real facts? Is this more than just grossly exaggerated generalizations? What would we say to a friend or son if they so severely blamed themselves? Why should these accusations be closer to the truth if they concern ourselves?

By mastering the ability to step back from self-blame provoked by an excitable amygdala, we gradually strengthen our frontal lobes, much like strengthening muscles, forcing them to work. And when the frontal lobes become more active, they can take control of the situation, calm the amygdala, and allow us to think about the future with determination and confidence again.

This is exactly what happened to Alexandra during therapy. And everyone can learn this. By training to control negative thoughts, we take care of restoring balance in our brain!

* G. Siegle, C. Carter, M. Thase. «Use of FMRI to Predict Recovery from Unipolar Depression with Cognitive Behavior Therapy». American Journal of Psychiatry, vol. 163 (4), 2006.** O. Canceil, J. Cottraux, B. Falissard, M. Flament et al. “Psychotherapy, three evaluated approaches”. Edition Incerm, 2004.

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