“What is the next big breakthrough you are waiting for in mental health?”
Iam obviously biased about the next major breakthrough based on my own area of interest. As many readers are probably aware, there are two massive projects which have some of the competitive fervor of the cold war “space race.” The massive European Union’s Human Brain Project (Markram, 2012) and the proposed United States Brain Activity Map Project (Alivisatos et al., 2013) have both stated that they hope an understanding of the brain code will lead to improved treatment for psychological disorders. A major criticism of both projects is that they rely on new technology and data mining without any theoretical model to guide them.
Since 1984 I believed the cortical column (i.e., macrocolumn) is the binary unit (“bit”) involved in all cortical processing and memory storage. This was the same time that much of the work on hippocampal memory storage was ongoing and it was difficult to reconcile how memory storage could occur in both locations. This confusion is still present today as witnessed by Miller’s (2012) Science article last year. He noted the controversy, but said there is some consensus tied to episodic memories. These are purportedly encoded and stored initially in the hippocampus with long-term storage occurring in other areas, including the neocortex. I sharply disagree with this view.
It took 22 years for enough empirical support to emerge to publish the first refereed article on the columnar brain model (Moss, 2006). The next year (Moss, 2007), I was able to publish a theoretical article on how the brain model related to the treatment of negative emotional memories. With the updated columnar model paper last year (Moss, Hunter, Shah, & Havens, 2012) and the detailed paper on how this relates to psychotherapy that has just been published (Moss, 2013) I am hopeful these have hit at a time that the fields of neurophysiology, neuropsychology, and psychotherapy are ready for integration.
I believe the breakthrough will most logically occur if the massive projects demonstrate the column is the cortical “bit” and that the circuits of columns are arranged in a consistent and logical fashion to allow higher cortical functions to occur. The fMRI technology already exists which has allowed the identification of columns in several cortical areas in humans. Based on this model the suggested role of hippocampal neurons is as a pacemaker in a hippocampo-thalamo-cortico-hippocampo circuit, with the goal being the strengthening of synaptic connections among the columns involved in the original processing of the information. The 2013 article explains a number of applied aspects in relation to psychotherapy. A few of these points are as follows:
- All complex sensory memory storage occurs at the cortical level. This contrasts with proposals that there is subcortical negative emotional memory storage tied to such things as traumatic memories. However, it explains why psychotherapy at the cortical level can impact such memories.
- The left lateral ventral frontal region (some of you know part of this as Broca’s area) is the location of active verbal-thinking or self-talk (i.e., verbal interpreter). This area has limited connections intrahemispherically, and very limited connections interhemispherically. Data support the location of the non-verbal sensory aspects of negative emotional memories as being in the posterior cortical regions of the right hemisphere. Since there are no direct connections between the right posterior and left frontal cortices, there is no direct way that the verbal interpreter can influence the non-verbal emotional memories. Thus, it is possible to verbally think one way about a situation, but feel differently about the same situation, based on memory activation. The verbal interpreter has traditionally been regarded as “conscious” and the right hemisphere functioning as “unconscious.” The suggested cortical design can explain why it is necessary to use therapies involving experiential techniques and visual imagery to successfully impact problematic emotions resulting from right hemisphere memories. It also has implications for how we define consciousness. In the 2013 article I suggested a definition of consciousness as “referring to the outputs of cortical action columns, based on receptive column information, that allow meaningful external and internal interactions.” In this regard, internal self-talk is only one small part of consciousness.
- Based on the hemispheric design, the right frontal area contains the action columns involved in the non-verbal aspects of interpersonal interactions (i.e., “personality”). The right posterior sensory columns are the major ones which determine what feels positive versus negative when those memories are activated in current situations/interactions. Therefore, just as we have a native interpersonal spoken language based on our left hemisphere receptive and action memories, we also have a native interpersonal emotional language based on right hemisphere memories. The right hemisphere memories are the ones which explain both personality (i.e., a relatively stable pattern of behaviors) and personality disorders.
- Regardless of psychotherapy orientation, effective therapy always involves new frontal columns in one or both hemispheres. This is the level at which techniques leading to “memory reconsolidation” theoretically have their impact. Self-referential and internal stimuli memory storage involves the medial and insular regions while external stimuli memory storage involves the lateral cortex. Thus, the most effective therapy would necessarily lead to frontal activation in lateral, insular, and medial regions.
Obviously, I can only list a few of the points. I invite the interested reader to look at the articles which are posted on my website under current papers. However, I believe this gives some idea as to where I think the field of neuropsychotherapy is headed and why the next major breakthrough is closer than you might think.
Alivisatos, A.P., Chun, M., Church, G.M., Deisseroth, K., Donoghue, J.P., Greenspan, R.J., et al. (2013). The brain activity map. Science, 339, 1284–1285. doi: 10.1126/science.1236939
Markram, H. (2012). The human brain project. Scientific American, 306, 50–55. doi: 10.1038/scientificamerican0612-50
Miller, G. (2012). Mysteries of the brain: How are memories retrieved? Science, 338, 30-31.
Moss, R.A. (2006). Of bits and logic: Cortical columns in learning and memory. Journal of Mind and Behavior, 27, 215–246.
Moss, R.A. (2007). Negative emotional memories in clinical treatment: Theoretical considerations. Journal of Psychotherapy Integration, 17, 209–224. doi:10.1037/1053-04188.8.131.52
Moss, R.A., Hunter, B.P., Shah, D., and Havens, T.L. (2012). A theory of hemispheric specialization based on cortical columns. Journal of Mind and Behavior, 33, 141–172.
Moss, R. A. (2013). Psychotherapy and the brain: The dimensional systems model and clinical biopsychology. Journal of Mind and Behavior, 34, 63-89.