第四章 同理理解：进化对我们大脑的影响

48CHAPTER 4 Compassionate Understanding: How Evolution Has Shaped Our Brains As I’ve mentioned, shame and self-­criticism underlie a wide range of mental health problems (Gilbert & Irons, 2005; Gilbert, 2014). A primary goal in CFT is to help clients shift the relationship they have with their internal experiences from a perspective of judgment and condemnation to one of understanding and compassion. A core theme in this work is to help clients recognize that many aspects of their experience are not their fault—­things that they neither chose nor designed—­while helping them take responsibility for working directly and actively to improve their lives. This shift to compassion begins with helping clients understand their emotions and motives in relation to how their brains and minds have evolved, and how evolution has presented human beings with some interesting problems. So in CFT, compassion begins with understanding the mind. OLD BRAINS AND NEW BRAINS In the 1990s, Paul Maclean introduced the concept of the triune brain (Maclean, 1990), which described the human brain in terms of three parts, reflecting different stages of brain evolution. The triune brain included a reptilian brain, which is responsible for basic bodily functions as well as aggressive and reproductive drives; a paleo-­mammalian brain—­the limbic system, having to doCFT Made Simple with memory, emotion, and learning; and the neo-­mammalian brain (the cerebral cortex), which does the heavy lifting in terms of things like self-­awareness, symbolic thought, problem solving, and other higher-­order cognitive processes. While the reality of how the brain works isn’t quite so straightforward (Cozolino, 2010), Maclean’s work highlights some of the challenges presented by how evolution has shaped our brains, and gives us a nice way to explore these dynamics with our clients. In CFT, we discuss this concept with clients using the language of “old brain” and “new brain” (Gilbert 2010). In therapy, it can sometimes be useful to use the term “emotional brain” synony- mously with “old brain” when we’re specifically talking about the dynamics of emotion. Because different parts of the brain evolved at different times in our evolutionary history and served differ- ent purposes for our ancestors, the ways our old brains, new brains, and bodies interact can be tricky and can create problems for us. Understanding this can be very freeing for our clients, as it helps clarify why their emotions can feel so out of control, and why it’s not their fault. Let’s look at some ways to explore this idea with clients. When we’re introducing it, we want to provide information, but not go on with lengthy monologues. Here’s an example of how we might initially approach the concept with Josh: Therapist: Josh, we’ve been discussing your anger, which you’ve struggled with for some time. In learning to work with emotions like these, it can be useful to explore where they come from, and how they work in our brains and minds. How about we chat about that for a bit? Josh: All right. Therapist: If we look through the lens of evolution, we see that the human brain is actually very tricky. It’s kind of like we have an old brain, which takes care of all the stuff that kept our ancient ancestors alive—­basic emotions and motivations that helped them protect themselves from threats and do the things needed for survival—­and a new brain, responsible for things like problem solving, mental imagery, self-­awareness, and deep thinking—­about what sort of person we want to be, what it all means, that sort of thing. Does that make sense? Josh: Yeah, I think so. Therapist: Let’s think about this in terms of a situation you’ve discussed. You mentioned that you sometimes become angry at work. Could you talk a bit about that? Josh: It’s mostly when my coworkers question me, or don’t do something they said they were going to do. I get really pissed off then. Therapist: So your coworkers question something you’ve asked them to do, and your old, emotional brain registers that as a threat, and here comes the anger. Does it come up pretty quickly? 50Compassionate Understanding: How Evolution Has Shaped Our Brains Josh: Oh yeah. I get angry sometimes even before they ask a question. If they make a face, or look at me like they disagree with what I’m saying, I start getting angry. I just want to set them straight, like “Can’t you ever just shut up and do what you’re asked to do?” Therapist: From an evolutionary perspective, our old, emotional brains are designed to help us identify and respond to threats—­just like they did for our ancestors, who lived in a world with lots of real physical threats. You know—­lions, tigers, bears, and the like. Anger is a threat emotion that prepares us to fight. It sounds like your emotional brain has learned that your coworkers questioning you or not doing what they’ve agreed to do are potential threats, and your brain responds like they’re tigers out to get you. Josh: (With a look of consideration.) I guess so. I mean, it is threatening. Therapist: Let’s explore that. Let’s explore what’s going on in your new brain while this is happening. When your coworkers are questioning you or fail to do what you’ve asked of them, what thoughts are going through your mind? What are you thinking? Josh: (Pauses, thinking.) I’m thinking that they’re challenging me—­like they don’t respect me or trust me. If they respected me, they’d just do what I ask, right? And then I’m thinking that things aren’t going to get done, or aren’t going to get done right, which will then come back to me. My boss is going to let me have it, even though I did everything I was supposed to do. Therapist: (Nods.) Is there any mental imagery—­like pictures or movies playing out in your mind—­that goes along with those thoughts? Josh: (Thinks for a moment.) Yes. It’s like I can see it happening in my mind. I can picture them rolling their eyes, talking about me behind my back, and blowing me off. I can just see my boss coming to me, asking me what the problem is—­blaming me for stuff not getting done. It’s maddening, you know? Therapist: (Nods and speaks sympathetically.) That does sound maddening. So in addition to that old-­brain anger, the new brain is piling on a lot of other stuff—­thoughts of being mocked and blown off, and images of the consequences—­your boss coming down on you. There’s a lot of stuff going on when that anger comes up. Josh: Yeah, I guess there is. 51CFT Made Simple The Old Brain: Powerful, But Not Very Wise One thing you’ll frequently hear CFT therapists say when exploring the idea of the old brain and the new brain with clients is that our “old, emotional brains are very powerful, but they aren’t very clever or wise.” Many of us may have experience explaining the basic cognitive behavioral model to our clients and using Socratic dialogue to explore how different patterns of thinking can lead to different types of emotion and behavior (and vice versa). In CFT, we want to understand and explore these dynamics in relation to the evolved brain. Our old brains evolved to motivate our ancestors to do what was necessary to survive, and they did this via the evolution of basic emotion systems (fear, anger, desire, lust, and so on; Panksepp & Biven, 2012; Panksepp, 1998) and archetypal motives (caregiving, competitive, sexual), many of which are socially oriented (Gilbert, 2010; 2014). When triggered by an external or internal stimu- lus, working through the action of various neurotransmitter and hormonal systems, these emotions and motives can very powerfully orient and shape our attention, thinking and reasoning, mental imagery, and motivation (Panksepp & Biven, 2012; Gilbert, 2010). We’ll discuss this process further in chapter 5, but the idea is that these old-­brain emotions and motives can organize our minds and bodies in ways that make it easy for us to feel trapped inside challenging affective experiences. For example, when Josh is feeling anger related to his coworkers’ behavior, he experiences a narrowing of attention onto the perceived threat (their questioning him, things not getting done, the idea of being humiliated and reprimanded), threat-­related perseverations in the form of thoughts and imagery, and the motivation to set his coworkers straight. Of course, our old, emotional brains are also associated with patterns of bodily experience as well, patterns which play a large role in shaping how the emotion is felt. While the old, emotional brain is powerful in how it can organize our minds, it’s not very good at distinguishing thoughts and fantasies from actual stimuli coming in from the external world. Our emotions occur largely as a result of implicit (nonconscious) processing systems that are triggered by various inputs—­information from the outside environment; from our own thoughts, memories, and imagery; and from our bodily experience (Gilbert, 2010). As a result, our emotional brains and underlying biological systems can respond powerfully to thoughts and imagery, almost as if they were real. This is why we engage in things like sexual fantasies—­sexual imagery stimulates parts of the brain and endocrine system that produce sexual feelings, with corresponding activity in the body to produce sexual responses. Changing emotion is all about working with and changing implicit inputs to the emotional brain. The good news is that we can choose to focus our thoughts and mental imagery in ways that help produce the sorts of affective experiences we want to have. We’ll be exploring this dynamic a great deal in the second half of this book. The challenging news is that interactions between old brain, new brain, and body can create an emotional inertia, in which conditioned emotional activation in the limbic system triggers new-brain thoughts, imagery, and memories (as well as bodily responses) that then feed back to old-­brain structures like the amygdala to fuel the very emotional response that created them. Of course, it can work the other way around, beginning with a memory, thought 52Compassionate Understanding: How Evolution Has Shaped Our Brains (he doesn’t respect me), mental image, or bodily sensation that the old brain registers as a threat, leading to related emotional experiences, with the process continuing. This is fertile ground for exploration with clients, as they begin to understand how different emotions and motives are associated with specific patterns of attention, thinking, imagery, motivation, and bodily experience, and then learn skillful ways to work with these experiences and the emotions and motives that underlie them. This is a simplified version of how things play out in the brain, but it’s based in affective neuro- science research (e.g. Panksepp & Biven, 2012). Learning about these brain and body interactions can also have a number of positive effects for our clients, all of which fit with our focus on compassion: • Shifting from judging and avoiding their challenging emotions to curiously examining and understanding how they play out in the mind. • Recognizing that the way their emotions work isn’t their fault, but occurs because of how our brains evolved and the ways different parts of our brains and bodies interface with one another. • Giving clues as to how they can begin to compassionately work with their emotions—­ through creating new, helpful inputs to their old, emotional brains. Let’ consider how we might introduce this concept: Therapist: Jenny, I’d like to chat a bit more about this old-­brain/new-­brain piece, because I think it might help us understand your anxiety a bit better. To start, I’d like to use an analogy. Do you have any pets? Jenny: Yes, I love pets. I have a dog named Penelope. Therapist: Penelope—­what a wonderful name! We have a dog named Sadie. Do you have a fenced-­in yard for Penelope? Jenny: Yes, I’ve got a fenced backyard. Therapist: We don’t—­the area behind our house is wooded, so we’ve decided to leave it open, to enjoy the view of the woods. Jenny: Nice. Therapist: It is nice, but it sometimes presents challenges. We let Sadie outside sometimes, and she’ll hang out in our backyard. But because we don’t have a fence, sometimes another dog will wander through—­you know, sniff around, pee on a few rocks, that sort of thing. Jenny: (Nods.) 53CFT Made Simple Therapist: When another dog wanders in, Sadie can get pretty defensive. Jenny: She’s defending her territory. Therapist: Exactly! So she’ll sort of size up the other dog. If she thinks she can take it, she’ll make a threat display—­stand tall, with the hackles on the back of her neck standing up, growling a bit. On the other hand, if the dog looks big and scary, she might make a submissive gesture instead—­maybe cowing down, as if to say, “No need to have any trouble here.” (Makes bowing-down gesture.) Jenny: (Laughs.) Yeah, I’ve seen Penelope do the same thing at the dog park. Therapist: (Smiles.) So let’s imagine that this happens to Penelope or Sadie. Things get a bit tense, but after a little while, the other dog gets bored and wanders off to pee on someone else’s yard. Five minutes later, how is Penelope? Jenny: She’s fine. Right back to normal. Therapist: Sadie, too. While she was initially upset because this dog invaded her territory, five minutes later she’s coming to get scratched, begging for a treat. (Moves head back and forth a bit, smiling.) Jenny: Exactly. (Smiles.) Therapist: So now let’s imagine that this same thing happens to you or me. We’re at home, and a stranger walks into the house, wanders around looking at things, maybe grabs something out of the fridge, pees on the corner of the couch… Jenny: (Laughs.) Therapist: Sorry…took the dog analogy a bit too far! If this were to happen, we might respond like Sadie or Penelope. We’d likely feel somewhat threatened, and probably want to protect our territory. If the situation seemed manageable, we might get assertive—­“Hey, this is my house. I’d like you to leave at once.” Jenny: Yeah. (Nods.) Therapist: On the other hand, if the intruder seemed very dangerous—­say, he was holding a gun, we might make a submissive display. (Holds hands up in an open gesture.) “It’s okay. Take whatever you want…there’s no need for anyone to get hurt…” We’d respond in ways that aren’t terribly different from how Sadie or Penelope might. Jenny: 54 (Continues to nod along.)Compassionate Understanding: How Evolution Has Shaped Our Brains Therapist: So here’s the question. Let’s imagine that after a while, the intruder gets bored and leaves. How would you or I be doing five minutes later? Five hours later? Five days later? Jenny: (good-­naturedly) I’d be freaking out! Therapist: (smiling) I probably would, too. Why would we be freaking out? What would be going on in our minds? What thoughts or images might play out for us? Jenny: I’d be thinking about what could have happened. That he could have really hurt me. I’d be worried that he might come back, thinking about what he might do the next time. Therapist: What images might be coming up in your mind? Jenny: I’d probably be picturing it happening again and again. Therapist: And those thoughts and fantasies might fuel your fear, keeping you afraid? Jenny: They sure would. Therapist: Exactly! That’s the difference between you or me and Penelope or Sadie. It has to do with the tricky way our old and new brains communicate with each other. The dogs have those old-­brain threat reactions, but when the threat is gone, they’ll tend to calm down fairly quickly. We, on the other hand… Jenny: We keep it going. Therapist: Our thoughts and mental images feed back to our emotional brains, and fuel the fear that caused them—­like pouring gasoline on a fire. So our emotions can focus our attention and trigger thoughts and images in our minds—­ thoughts and images that can then come back and fuel the very emotions that triggered them. Does that make sense? Jenny: (nodding) Like how those thoughts I have in the classroom about people laughing at me fuel my fear. Therapist: Just like that. It’s important to realize that this isn’t our fault. You and I didn’t choose to have brains that work in such tricky ways; it’s just how they work—­ what we were born with. But if we’re going to work with emotions like fear and anxiety, it can help to know how these brains work. Jenny: Mmm-­hmm. Therapist: One last thing. Thinking scary thoughts can fuel feelings of being scared. One of the scariest thoughts we can have is, There’s something wrong with me. (Pauses.) 55CFT Made Simple Jenny: (Pauses and looks down.) I have that thought all the time. Therapist: (Pauses, then continues with a kind tone of voice.) And how does it feel when that thought comes up? Jenny: Terrible. Therapist: (Nodding.) It does feel terrible. That’s why in CFT we focus on developing compassion and kindness for ourselves and others—­we want to find ways of thinking and acting that help us feel safe, rather than threatened. Jenny: That would be really nice. Therapist: Well, let’s work on that, then. The example above demonstrates how a CFT therapist might introduce old-­brain/new-­brain dynamics with a client. The use of the dog analogy is meant to reinforce the evolutionary model, initially demonstrating the evolved aspects of our emotional responses and behaviors that are similar to other mammals, and then exploring differences (the tricky old-­brain/new-­brain dynam- ics) that set us up for unique problems. You’ll note that there was a good bit of therapist talking there, as the analogy was explained. While it’s hard to convey in print, I’ve tried to give a sense of how the therapist would monitor the client’s nonverbal behavior and use questions, pacing, body language, tone of voice, and attempts at humor to maintain engagement and create an interactive experience, even when the focus is on explanation. Whenever possible, we want to link such dis- cussions to the client’s experience early and often—­even within the analogy (which is why the therapist asked Jenny about her own dog). We also see the therapist doing some mirroring of the client’s affective experience—­using humor when she is smiling and nodding along, and then rever- ently slowing things down when the discussion bridges to the Jenny’s own experience of self-­ criticism and things get a bit heavy. In doing this, we want to keep our focus on the process we’re trying to explore with the client. Some clients might argue that the threat-­driven thoughts that accompany fear of the intruder are completely valid, and could trigger behaviors (installing an alarm system, for example) that could help us avoid victimization in the future. They’d be right about this. We’re not trying to convey that the ability of our thoughts and imagery to fuel and be fueled by our emotional brains is bad. It’s neither good nor bad—­it’s just the way things work. The point is that this dynamic can be tricky for us, and can sometimes fuel threat responses that aren’t terribly helpful. This sort of inter- change can be useful in modeling compassionate reasoning—­helping clients shift from judging and labeling (thoughts and emotions as either right or wrong, good or bad) to a perspective that instead is focused on understanding (thoughts and emotions as mental experiences, and the sometimes tricky dynamics between them). Finally, you’ll note that as the vignette concludes, the therapist links the example back to a larger theme in the therapy—­how Jenny’s self-­criticism functions to keep her threat response activated, and how compassion can help with this. 56Compassionate Understanding: How Evolution Has Shaped Our Brains Emotional Inertia As the above vignette demonstrates, we can explore how interactions among old-­brain emo- tions, new-­brain thoughts and imagery, and bodily sensations can work to maintain the energy of an emotion. For example, if a threat is registered in either the new or old brain (via a thought such as She doesn’t like me or a previously conditioned threat trigger—­like smelling the cologne that was worn by a rapist), it can trigger emotions of fear or anger, which themselves can give rise to thoughts and imagery associated with the emotion, as well as bodily sensations of arousal and tension (racing heart, shakiness, tensed jaw, tight shoulders, and so on). Once this cascade of experience occurs, each element of the system (new brain, old brain, bodily experience) can serve to trigger the others, fueling the ongoing emotional response. New-­brain images and thoughts, bodily experi- ences, and the environments we are in (themselves shaped by emotion-­driven behaviors) can all serve as ongoing inputs to the old, emotional brain—­for good or ill. This exploration can be useful to clients, as we can frame much of the work we do in therapy (and homework) as working with various inputs to the emotional brain. We work to develop com- passionate ways of thinking and compassionate imagery to help ourselves feel safe rather than threatened, and to find helpful ways of working with situations rather than threat-­based rumina- tion. We work to develop ways of behaving that are effective in getting our needs met. And we work with the body to help ourselves find balance rather than panic. In facilitating this discussion, I sometimes find it useful to draw it out on a piece of paper or whiteboard. I start by drawing a rudimentary brain. Then I’ll mark a red area in the middle of the brain, about where the limbic area is, to represent the old, emotional brain. I’ll then draw a box around the front fourth of the brain to represent the new-­brain thinking centers. While discussing things, I’ll draw arrows from the emotional brain to the new-­brain “thinking box,” and then back, to demonstrate the cyclical nature of how old and new brain can interact to fuel an ongoing emo- tional response. We can also draw similar arrows going down to and back from the body, to dem- onstrate how bodily responses can be a part of the cycle that maintains an emotion. SOOTHING RHYTHM BREATHING As I mentioned above, our emotions occur largely as a result of implicit processing systems which respond to a wide range of inputs—­information coming in from the outside world through our senses, information coming down from the newer parts of the brain that produce thoughts and imagery, and information coming up from the body. Increasingly, we’re discovering that working with that input from the body can play a powerful role in helping to balance emotions. So one of the very first interventions we introduce in CFT is specifically targeted at the body. In CFT, we call this soothing rhythm breathing (SRB), and it involves purposefully slowing down the breath. In SRB, we guide clients to slow down the pace of their breathing and focus their attention on the sensation of slowing. It’s important to note that this is different from mindful breathing, which 57CFT Made Simple we’ll introduce later, in chapter 7. With mindful breathing, we focus attention on the normal process of breathing as an anchor for the attention, and bring our attention back to the breath again and again. In SRB, the focus is on creating a sense of slowing—­slowing down the body, and slowing down the mind. This slowing can help clients soften the intensity of threat emotions by activating the parasympathetic nervous system, and hence begin to shift away from the new-­brain/old-­brain/ body inertia that drives these emotions. Let’s consider how we might introduce SRB to a client: SOOTHING RHYTHM BREATHING Now, I’d like to introduce a practice called soothing rhythm breathing. This practice involves slowing down our bodies and minds by working with the breath. Specifically, we’re going to be slowing down the breath, and focusing our minds on the sensations of slowing. •Let’s start by sitting in an upright posture, with both feet flat on the floor, and perhaps folding the hands in the lap. The head is held in an upright, dignified but relaxed posture. As you gain experience with the practice, you’ll be able to use it in all sorts of situations and body postures, but we’ll start like this, with a nice, comfortable, upright posture. •If you like, allow your eyes to close, and bring your attention to the sensation of your breath entering and leaving your body. Just notice this sensation of breathing. (Pause ten to twenty seconds.) •Now we’re going to slow down the breath. Allow your rate of breathing to slow, taking four to five seconds on the in-­breath, pausing for a moment, and then taking four to five seconds on the out-­breath. Breathing in deeply—­1—­2—­3—­4. (Pause for a moment.) Then slowly breathing out—­1—­2—­3—­4. •Let’s take a couple of minutes to breathe in this way. As we do, let’s focus our attention on the sense of slowing—­slowing down the body, slowing down the mind. If this rate of breathing is too slow, see if you can find a rate that is comfortable and soothing for you. The idea is to breathe in a way that is slowing and soothing. •(Wait two minutes, or however long you choose to do the practice. The timing should be based on making it a successful learning experience for the client—­not an aversive one in which he loses himself in thoughts about how much he hates it! So if it’s clear that the client is resistant, we can start with thirty seconds.) •When you’re ready, allow your breath to return to its normal rate, and gently allow your eyes to open. (Wait until client’s eyes are open.) Let’s explore what that was like. Once the SRB exercise is over, we’ll take a few minutes to explore the client’s experience of the practice. As with all relaxation exercises, the effects of SRB increase with practice, so we shouldn’t expect clients to have immediate dramatic effects. We can explain that slowing down our breathing 58Compassionate Understanding: How Evolution Has Shaped Our Brains in this way doesn’t make threat emotions go away, but can soften them, and create some space for other things to happen (like mindful observation of our thoughts and emotions, and shifting into compassionate ways of thinking). I usually assign SRB as homework after the first session—­often having clients practice it for thirty seconds at a time, two or three times per day. We’ll need to problem-­solve with clients around how they will remind themselves to do it, as the biggest obstacle is often forgetting to practice. Setting phone alarms can serve as a prompt for SRB practice, as can planning regular times to do it (for example, at specific times of day, or—­if the person is a televi- sion watcher—­during the first commercial of every program). SRB also provides us with a nice way to introduce the idea that therapy will involve regular home practice, and to shape homework participation—­almost anyone can find thirty seconds to practice a couple of times per day. This gives us the opportunity the create a nice routine in which we explore, at the beginning of each session, how the home practice went. We can then give them positive reinforcement for practicing, work collaboratively with them to overcome obstacles that may have arisen, and then help to develop a new home practice plan as the session winds down. Some clients may hate focusing on the breath or body, due to trauma conditioning or other factors. If this is the case, we don’t want to turn the exercise into an exposure trial (which we may very well want to explore later)—­the purpose here is to help them focus their attention in a soothing way. For these folks, we can choose one of the many excellent progressive muscle relaxation prac- tices that have been developed, or even work with them to find something they could focus their attention on that would be soothing. (One group of Paul Gilbert’s decided to hold tennis balls and focus on their texture.) The point is to come up with ways for clients to focus their attention in soothing ways that don’t take extraordinary amounts of time or effort. SUMMARY In this chapter, we explored ways to help clients consider the manner in which their brains evolved and how this can create challenges for them. The goal is to begin facilitating a shift away from judging and attacking themselves (and others) for their emotions and reactions, replacing these habits with a curiosity-­driven understanding of how and why their brains (and minds) work the way they do. In the next chapter, we’ll deepen this discussion to explore three evolved emotion-­ regulation systems, and how evolution shaped these systems to organize our minds and bodies in very different ways.