Mind Sculpture: "This trembling web"

The brain and beyond

Joe Griffin talks with Professor Ian Robertson about the role of experience in the sculpting of our brains, and why certain types of counselling may do harm.

Griffin: One of the things that really attracted me to your book is that, unlike most academic textbooks, it has a beautiful, almost poetic literary style to it while communicating clearly hard-nosed ideas about the connections between neurophysiology, psychology and human behaviour. I was particularly struck by the adroit use of metaphor throughout, which is a talent one rarely sees in psychology textbooks!

Robertson: Well, I think a lot of scientific thinking, either explicitly or implicitly is, at least at the creative stage, guided by metaphor. I find that the best way to understand is to try and explain, and for me personally the best way to explain is to use metaphor. I also believe that scientific writing can be precise and elegant at the same time and think it's a real pity, particularly in psychology, that people have felt that they must write in an arid and often unnecessarily jargonised style, in order to try and assume the mantle of chemistry or physics — the kind of physics-envy philosophy.

Griffin: The book's title, Mind Sculpture, is itself, of course, a metaphor. It makes the hugely important point that we have the capacity to sculpt our own brains, and you describe the brain in a wonderful phrase: "this trembling web". Could you talk about what you mean by brain sculpting?

Robertson: The notion is that one can now see marvellous things happening in the two-way interchange between the trembling web of neurones in the brain, and our thoughts, feelings, emotions and memories. Debates about whether such and such is psychologically caused or organically caused are entirely sterile. It should surprise no psychologist that an antidepressant can change mood and it should surprise no psychiatrist that a particular psychotherapeutic intervention can change the biochemistry of the neurotransmitter system and alter the physical structure of the brain, if a mood is prolonged. But it does surprise both of these camps! A lot of people still don't appreciate that every thought has its physiological substrate and vice versa.

Griffin: You suggest that, through the mechanism of attention, we can influence the way we perceive and experience reality — you describe this as nature's gift to the human race. You make the point quite forcefully in the book that it is quality of attention that is important in sculpting the neural web; that passive attention isn't as effective as active attention in sculpting and shaping our models of reality in the brain. Do you have any ideas as to why active attention is so influential?

Robertson: If I hadn't been listening to what you were saying there, actively attending to it, then there would have been all sorts of processing going on in my brain, of memories, of plans, of thoughts. Your actual words, that were being decoded in my auditory cortex and passed into what is called Wernicke's area in my left hemisphere, wouldn't have progressed sufficiently beyond a certain level of analysis to enable them to pass into the episodic memory system that enables us to recall our personal pasts, which is partly based in the hippocampus. The words would have left their imprint in my brain in the sense that, were you to say similar words tomorrow, I'd probably respond faster to them or have a sense of recognition, but I wouldn't be able to recall them for myself. So both for our conscious memory systems (remembering what you did where and when) and for learning and skill learning, it seems that the input of frontal lobe systems, of attentional systems, is required to provide that extra bit of input to the sensory systems decoding that information.

Griffin: Would this be the difference between hearing a joke and recognising it if somebody else tells it, as opposed to being able to tell the joke yourself as and when appropriate?

Robertson: Yes. There are two things there. You would recognise that joke if you heard it again, but you probably wouldn't be able to tell that joke unless you had made efforts to rehearse it. So the difference between retelling a joke and recognising a joke has a lot to do with rehearsal. But it also has to do with the degree of attention one pays. Very little attention is passive. The nearest thing I can think of is attention being suddenly caught by something, such as an advert, a colour or a sudden sound, where temporarily your attention is externally switched on. That's different from attention generated internally in the brain, by you. Without attention you don't get learning of any significant degree except implicit, or unconscious, learning. Without attention, skill learning is much more difficult. And without attention we can lose whole chunks of our day. If you go into headless chicken mode when you've had too much to do, you can end up with a whole day as a blank in your mind. You look back and say, where did that day go? It happens because you were not deploying these particular attention systems to encode and monitor what you were doing. You were letting the brain's automatic processing systems operate the whole time.

Griffin: So learning requires this more concentrated, focused attention, plus maybe some degree of rehearsal to enable the person to digest what they have heard, in a deeper sense.

Robertson: Yes, that's right. We remember things to the extent that we rehearse them and we also remember things to the extent that we process them and relate them to things we already know. So, if you go to a lecture, or watch a television programme, and you let it wash over you, you will remember far less than if you go to a lecture thinking, "I know X about this subject. I wonder whether what is said today will confirm or disconfirm it?" Then you are dredging from long term memory what you know about your subject and you are actively comparing that with what's being said. That is called deep encoding: you are encoding the memory into existing structures in your brain and therefore you are learning it more. I guess that, in therapy for instance, therapies that get people to do things are more likely to cause an actual change in behaviour and feelings than therapies where people just talk or respond.

Griffin: And of course the reason most people come into therapy is that they want change. They perceive their lives as being problematical and so some new learnings need to take place.

Robertson: Well, that's right. And that's the problem with insight. Insight is necessary, but it's not sufficient for creating change, I believe. You can understand what has been driving your behaviour, but that doesn't mean you can change it. What we know from rehabilitation in brain damage and from learning in general is that it takes thousands of repetitive trials before you can change an habitual pattern of behaviour and create a new default habitual activity. You can't just say, "Oh, I respond in such and such a way to such and such a situation. I had better not do that any more." Rehearsal or practice, from what we understand about how the brain learns, is a pretty necessary adjunct to self awareness and insight.

Griffin: In this respect, something that you make wonderfully clear in your book concerns imagination. When we misuse our imaginations by rehearsing past failures and past mistakes and past pains, we are sculpting our brains badly, but you also make very clear that imagination is an incredibly powerful tool, if we use it positively, for aiding the development of skills. For example, we can reap many of the benefits of real life practice by just imagining certain activities in our minds. Sports psychologists are making more and more use of this. You describe too how it is possible to become physically stronger from the comfort of one's own armchair, simply by doing exercises in the imagination. This can be enormously beneficial for people recovering from illnesses. Equally, of course, counsellors could make more use of this effect by helping their clients to use their imagination more actively.

Robertson: There is no reason in principle why, of the thousands of practice trials that may be necessary for changing habitual brain patterns, one could not get 90 per cent of them in one's mind and 10 per cent of them in reality. Sometimes it's difficult to get the practice in reality. What you have to be careful of, though, if people are using their imaginations to deal with social phobia or social anxiety, for instance, is that they are successfully imaging successful outcomes.

We know that mental rehearsal requires the real thing as well for it to be optimally effective. So you would have to make sure you planned the experience so that someone doesn't become over confident in their mind and then come a complete cropper in reality. A public speaking phobia would be a classic example of that, where you could get someone rehearsing a successful speech in their imagination and then anxiety takes over on the day. So you have to make sure that the contents of what you're saying don't require a lot of working memory capacity. You have to have rehearsed the speech in your own mind or verbally 20 or 30 times so that it's completely off pat. Then, if you are seized with anxiety, it can still be accessed because it is so well learned.

Griffin: So it's not just positive thinking that does the trick. It is also the actual learning itself that has to be well rehearsed and well produced. You raised a really interesting point there, something that has been made a bit of a fetish in counselling for quite some years. You said that it's important that someone doesn't have too much of a self expectation without having checked out the reality. The idea of high self expectation — high self esteem — is taken universally to be a good thing, but it seems to me that sometimes people can have too much self esteem and it is not connected up to a realistic appraisal of what they are actually doing.

Robertson: Oh yes, we all know people who are perhaps unpopular or difficult because they overestimate some facility that they have!

Griffin: I would like to go back for a moment to what you said before about the need for thousands of repetitions before an habitual behaviour can be changed. While accepting the validity of what you say, it also strikes me from clinical experience that there is a form of rapid learning which isn't based upon prolonged repetition of particular patterns. For example, with hypnosis, people can go into a very relaxed state of mind and rapidly change mindsets. They can rapidly be influenced, for example, to let go of certain traumatic reactions that might take a long time to decondition using just cognitive behavioural methods. One of the papers that we have published recently on hypnosis suggests that all methods of inducing hypnosis replicate part of the way that the brain goes into REM sleep at night. Research shows that REM sleep is the time when instinctive knowledge is programmed into the foetus. If you like, REM sleep is the learning programme for the brain and if, through hypnosis, we can recreate that mindset where the brain is open to new learning, then the brain can perhaps be reprogrammed more quickly than by going at it through the conscious mind, step by step.

Robertson: That's very interesting. I'd like to see the research on that. It certainly seems to be the case that patterns of brain activity under hypnosis differ from normal waking states. What you are saying sounds plausible, and it becomes an empirical question of what works and what doesn't.

Griffin: That's the bottom line test that counselling and psychotherapy need to adopt. Does it actually work? Does this change people's lives for the better? And that raises the question of what sorts of therapy ought to be practised and what forms of counselling are actually effective. It is becoming clear from efficacy studies and meta-reviews of efficacy studies that certain forms of counselling are quite ineffective in lifting, for instance, clinical depression. When dealing with anxiety and panic attacks and agoraphobia, some of the most widely practised forms of counselling may not only be ineffective but may actually be harmful. I think your book gives a good theoretical basis for understanding why certain forms of counselling might be harmful. For example, if we are focusing our attention on all the bad stuff that has happened in our lives, and if our counselling is encouraging us to do that, then according to your synthesis we would be resculpting our brain to perceive those negative patterns more easily. We would be raising the profile of those patterns in our brains, patterns which are influencing our perception of reality. We would be biasing our brains to see the patterns that went wrong, to look for the negative life experiences, and to have as our model of reality that life is excessively painful. And that would suggest that psychodynamic counselling, where you rehearse past failures, is actually resculpting the brain in a less than helpful way.

Robertson: Yes, I think that's a real danger. We know as a fact that some people are harmed by psychotherapies. Certainly from memory research we know that every time we access a memory, for instance of a famous film star, the effect is long term inhibition of other film stars in a similar category. This is the superstar phenomenon. The more times you access a particular member of a category, the harder it is to access and remember the competitors and, as a result of this, things that you access a lot will spring to mind spontaneously a lot. So if you have a category concerned with childhood or past experiences, and if you are encouraged to ruminate and access particular memories repeatedly, then not only are you making it more likely that these memories will spring to mind, but you are also reducing the probability of accessing other memories which might have less negative effects on mood.

Griffin: And perhaps that's why empirical research shows that when people are depressed they give a much more negative version of their childhood than they do when they are out of depression.

Robertson: Ah yes, the mood state. There's a phenomenon that I'm sure you know about, called state-dependent learning, which means that people are more likely to access memories if the state is re-invoked with which these memories are associated. So if you had traumatic experiences in your youth and you were depressed and anxious for a time as a result of them, these memories are the ones likely to be accessed if you become depressed and anxious again in later life. And the more you access them, the more likely you are to access them, so it's a vicious circle of positive feedback. I've little doubt that people are at risk from any therapy that focuses on ruminating on the past.

Griffin: And that kind of therapy is still widespread. There was a research study done, involving most of the GP practices in Oxfordshire, which compared those which had a large amount of counselling input, those which had a moderate amount and those which had a very small amount. The finding was that the higher the counselling input, the higher the prescription rates of antidepressant medication.

Robertson: Very interesting. There was a famous randomised study done in the United States during the 1930s with children in deprived neighbourhoods who were at high risk of delinquency and other things. They set up a counsellor support system for children in the treatment group, involving home visits, getting the children to go out to programmes and trying to enrich their impoverished environment. The control group had none of this. The children were followed up for years, and 25 to 30 years later there was an incredible difference between the two groups in terms of imprisonment, alcoholism, delinquency. But it was in favour of the control group!

Griffin: My goodness!

Robertson: The control group did far better. And the interpretation of the study was to question the psychological effects of being seen as someone whose family cannot cope and who is in need of this paternalistic input. What are the consequences of being labelled in such a way? So I think one should not lightly refer someone to a professional for counselling or therapy! Obviously, there are certain cultural contexts. In New York in the 1980s, if you didn't have your therapist, who were you? But a lot of children are being referred for counselling and psychological assessment these days and you have to wonder what the consequences of that are.

Griffin: And not just for the people going in for counselling. One of the things that we have reservations about is the fact that most counsellors trained in Britain are required themselves to have long term personal counselling.

Robertson: Yes.

Griffin: I recently heard a professor of psychology boast that his trainee counsellors had to have 450 hours of personal counselling. Now if that personal counselling takes the form of rehearsing what went wrong in their lives, the counselling is resculpting their brains and their own mindsets. And both I and other colleagues have had a number of trainee counsellors come to us who weren't emotionally unbalanced prior to the onset of this form of long term counselling but, in the process of their counselling training, became emotionally disturbed.

Robertson: I can believe that. I have to say that I and others have noticed a change in the personality of friends or acquaintances who have gone into long term psychoanalytical therapy for training purposes. It may be that spending so much time introspecting about yourself may take away some of the idiosyncrasies from the personality that one presents to the outside world. Too much introspection, I think, can have negative effects.

Griffin: Indeed, if you look at almost all cases of emotional disturbance that one comes across clinically, whether it's clinical depression or people who are highly anxious, what they have in common is a very high level of emotionally arousing introspection.

Robertson: Exactly.

Griffin: And they seem to get better when they switch to an external focus and start connecting with reality and generating positive life experiences.

Robertson: Yes. One of the studies of depression treatment that I've been most impressed with recently is the one by John Teasedale and his colleagues in Cambridge, which was published in the Journal of Consulting and Clinical Psychology last year. They used mindfulness meditation training for people with a history of depression who were in remission and achieved a statistically significant reduced level of relapse. The people were trained to develop a certain detachment from the thoughts and emotions associated with downward spiral into depression by learning to control their attention and not allow themselves to be dragged down into their highly habitual, almost hard-wired processing system. That's an example, I think, of the therapeutic use of attention.

Griffin: And of course it's an approach that's been used for thousands of years in the traditional psychologies of the East, where they talk about stepping back into more objective awareness.

Robertson: And to me, in the context of what we were talking about earlier, that is almost the antithesis of the ruminative replaying of traumatic events.

Griffin: Yes it is.

Robertson: It's teaching people to maintain a broad focus of attention in the presence of these thoughts and thereby helping break some of the synaptic connections between these memories and the usual cognitive processes that follow on from them.

Griffin: The nice thing about the study you mentioned is that it shows there is not just one route for achieving that therapeutic effect. Cognitive therapy achieves it by teaching people to dispute the emotionally arousing negative thinking that's going on and here we're getting the same benefit using a different method. When you get similar effects from two different theoretical approaches it often suggests that there's a more fundamental underlying pattern there. Most of the major inputs into cognitive therapy, for example, were formulated 40 or 50 years ago and it seems to me that it doesn't accurately reflect the neurophysiology of the brain as we understand it today.

Robertson: Absolutely true.

Griffin: For example, there is much more awareness now that a lot of data processing is done at a subconscious level, through the sensory and limbic systems, before it ever reaches consciousness, which receives only a very small, selected output from that. If data is first of all processed at a subconscious level, surely that would indicate that emotions can arise prior to the thought, which is rather the opposite of what cognitive therapy implies.

Robertson: Yes, cognitive therapy's theoretical model is that faulty cognitions cause emotional distortion, yet if you treat depression pharmacalogically, people come out of it. So it seems that the causality might be the other way — that thoughts change in line with the mood changing. But that again is the problem of Cartesian duality. It is the bi-directionality of the physiology and the cognitive systems that we have to be thinking about.

Griffin: And again, developing your point that it might be the other way around, the more emotionally aroused we get, the more the limbic system is in control, and then the more polarised and simplified our thought processes become, so we go into more black and white thinking. All forms of distortion which the cognitive therapists have identified can be classified as forms of polarised or black and white thinking. And that's the sort of distortion we would expect from emotional arousal because it's relating to a part of the brain that thinks in 'either/or' terms: am I going to run away or am I going to fight? It is the neocortex which is able to paint in the thousands of shades of grey between the extreme poles. So if people are emotionally aroused we might expect them to have distorted thought processes.

Robertson: Yes, exactly. One consequence of high arousal is a considerable narrowing of the focus of attention to the stimulae which are causing the anxiety. These may be internal or external. Our working memory systems have very limited capacity, and homing attention in on the threat stimulae uses up that capacity. Which means that there isn't the cognitive room to engage in more sophisticated non-black and white thinking. So I completely agree with what you've said.

Griffin: A crude example of that might be where a student goes in to write their finals and they are so tense that their mind just blanks.

Robertson: That's right, particularly if the type of learning that they have engaged in a night or two before has been last minute rote learning as opposed to more reflective learning, in which information has been encoded into their existing knowledge structures more gradually over the previous two weeks. If the information has been encoded in a deep form by relating it to existing knowledge structures, then that knowledge is going to be much more easily accessed in spite of the anxiety-filled working memory system.

So there might be an interaction between the type of learning and the type of anxiety and it may be that the anxiety partly comes because the type of learning that is done on a shallow level at the last minute is much more unstable and harder to access. And that might cause more anxiety and a vicious cycle again.

Griffin: So some good advice implied there for any readers studying for exams in the near future!

Robertson: Yes, that's right! It is true also, I guess, of handling stressful situations. If people are well practised and well rehearsed in coping strategies suited to a range of situations, then the more these have been applied in different situations, the better able people will be to deploy them in a given stressful situation.

Griffin: I understand that. I think this idea of sculpting our brains by the way we focus attention is an exceptionally fruitful way of understanding mind/body connections. You mention attention deficit hyperactivity disorder (ADHD) in your book and the massive increase now in children, particularly, apparently, in boys. Do you have any thoughts on what might be going on there? Or what we might do about it and why it's arising?

Robertson: Yes. I do some work in attention deficit disorder and I take quite a biological approach to it, in the sense that there is no doubt a small percentage of children, as you say mainly boys, whose brains seem a bit different. But there is a much larger percentage who show similar patterns of behaviour — problems of attention, problems of impulse control, etc — but whose brains probably aren't all that much different. There's no doubt that one of the things we learn from our parents and schools is how to attend and how to deploy our own attention — you know, what to look at and how to keep looking. We're told, "Be patient", or "just wait and you'll see it". In this way we're learning to avoid our brain’s predominant tendency to seek novelty. If children are brought up in an atmosphere where parents don't have time to interact with them playing a game, or reading, or even when watching television, then a very important input is missing in the sculpting of the attention systems of the brain.

Griffin: Do you think there's a critical period for that?

Robertson: We know that the frontal lobes of the brain aren't fully in place until the late teens; the synaptic pruning isn't complete. But there's a hugely greater degree of plasticity up until age seven. All the wiring is in place by age seven, but there's still a lot of things happening at a decreasingly accelerating curve until the late teens. So to that extent I think, yes, that the earlier effects will be the more potent.

Griffin: And do you feel that there's more that psychological input from parents and others could contribute to reduce the incidence of ADHD, rather than go the route of treating it massively with Ritalin, as in the United States?

Robertson: Yes, I've no doubt that appropriate, consistent interactions by interested, loving adults who give priority to their interactions with their children and who provide appropriate structure would cause a considerable reduction in the number of diagnosed ADHD children.

Griffin: Your concept of how we can continually develop and nourish the human brain through the types of input we give it also has particular ramifications for elderly people and people who are isolated. If brains, to function optimally, need certain forms of stimulation, it is important to help such people in a way that encourages their brains to stay healthy. Are there any suggestions that you might give to those of our readers who are working with the elderly and people who are isolated?

Robertson: There is a very interesting set of studies done by Gordon Winocur and his colleagues in Toronto. They found that in Canada people often move into semi-sheltered care not because they actually need it at that time but because they anticipate having difficulties with, say, the bad weather in winter and things like that. The researchers found that on average, in these people, you can plot a decline in cognitive function as measured by standardised neuropsychological tests, compared to that in people who stay in their own homes, coping albeit with some difficulty.

They found that the critical psychological variable in those who opted for the semi-sheltered accommodation was a sense of control. Those who had a tendency to perceive themselves as victims of external forces as opposed to having a more internally driven role in their own lives were the ones who were much more likely to show this cognitive decline. So, in terms of people who are looking after elderly people, the British government's policy of trying to keep people as much as possible in their homes and providing supports for them is absolutely the right one from this perspective.

I think, if there is one single critical variable, it is ensuring or fostering a sense of control on the part of the elderly person, even in a tiny way. There was one study by Ellen Langer at Yale claiming that just giving people in an elderly residential home the duty of keeping a certain plant watered had significant effects on the residents' survival and quality of life. And I'd lay money on it that, when you give control like that, what you are doing is forcing activation of the systems in the brain that make plans and monitor and form intentions — namely, the frontal lobes.

Griffin: And presumably there are also implications from the findings in your book for what people should do as they get elderly. Perhaps, for instance, the idea that we've had for so long of retiring early is not such a brilliant one?

Robertson: Ooh, retirement is a terrible thing, unless you are retiring for something. If you are retiring, saying "It's all getting too much for me and I just want to put my feet up", then I think you'd have to be careful or at least you'd have to make plans to be doing something else. I guess in Britain something like 40 per cent of all people over 55 are no longer working — it may not be quite that but it is some enormous number, one of the biggest in Europe — so there are a lot of people who in a sense are stopping work extremely early in their lives. If I had to retire early, I wouldn't call it retirement even to myself. I'd call it my new career. Now that career might not involve money, it might not involve traditional career ideas. It might be that my new career will be walking or exploring or writing or gardening. I think you have to represent it to yourself as something positive.

Griffin: And whatever it is presumably needs to involve mental stimulation. The brain has to be continually resculpting to stay flexible, needing new learnings, new education, new life experiences ...

Robertson: Well, we already know by studying older people's brains as they try and remember that, if they are given faces to remember, they will show less activity in the left frontal lobe than younger people. Now that may be because there's some structural change in the connectivity of that part of the brain, meaning there can be less activity. But it may also mean, and there's some evidence for this, that they are less used to engaging in the act of learning that as younger people we are forced to do, by necessity, all the time. So we do our training when we're young, in school, at university or during an apprenticeship, but then there's a tendency for us to say, "Ah! That's me trained now. I'll get into a job and I will practise this skill." Increasingly we run off well rehearsed routines and we're not learning in the way we had to learn as students.

In my job now, I don't do many statistical analyses on the computers, I don't run many experiments. I'm in a mainly supervisory role, so there are a whole set of cognitive skills that I'm no longer using. There is some evidence that not all but a proportion of age-related cognitive deficits is attributable to the fact that we are not engaging in the learning that we had to do when we were younger. You can't write off all age-related deficits like that, but a proportion is due to being out of the habit of learning new things. And, you know, I think that's one reason you can see judges who are mentally acute at age 68 or 70. Partly it is that they tend to be very intelligent people in the first place, but it may also partly be that they are forced to use their reasoning and memory capacities constantly to their full limits, because every case they hear is different.

Griffin: Then we'll leave that there! Before we draw our conversation to a close I want to come back to counselling. We feel that there is a need to reground psychotherapy and counselling in an awareness of the various levels within which we operate as human beings. For example, we are biological creatures as well as sociological creatures, and sources of information germane to the practice of counselling can come variously from biology, physiology, sociology, anthropology, social psychology and so on. We have to be willing to look at psychotherapy in a more holistic way and also in a more objective way. So we must look at evidence, and move past old ideologies to look for what's actually working.

Robertson: I wish you well because I think that's a brilliant enterprise. I am dismayed at how counselling and psychotherapy practice in many areas has become wilfully divorced from evidence and science, to the extent of becoming self perpetuating cults in some cases. I'm just delighted to hear that there's a movement like this and I don't think there's any alternative to what you're proposing.

Griffin: You yourself, of course, are an example of what we're talking about because you are both a clinical psychologist and a neuropsychologist, actively investigating in both these very strongly connected but often differently perceived domains of activity.

Robertson: Absolutely. I would love to see the curricula and the British Psychological Society regulations about the operating of counselling psychology degrees revised completely in accord with the principles you've just outlined because I've agreed with almost everything you've said today, and particularly the fact that no one has a right to pick and choose a theory as a matter of personal preference and then offer it as a service to someone when there is a possibility that that service might do harm, as you've pointed out. We have to progress towards evidence based practice and get away from cults and ideologies, I really couldn't agree more.

This article first appeared in "Human Givens Journal" Volume 7 - No. 3: 2000