The prefrontal cortex (PFC) is the cerebral cortex covering the front part of the frontal lobe. This brain region has been implicated in planning complex cognitive behavior, personality expression, decision making, and moderating social behaviour. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals. The most typical psychological term for functions carried out by the prefrontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social “control” (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes). The frontal cortex supports concrete rule learning, while more anterior regions along the rostro-caudal axis of the frontal cortex support rule learning at higher levels of abstraction. (adapted from Wikipedia – see below for a more complete explanation)
Clinical Relevance In Brief:
- Reduced volume and interconnections of the frontal lobes with other brain regions has been observed in people diagnosed with mental disorders; those subjected to repeated stressors; suicides; those incarcerated; criminals; sociopaths; those affected by lead poisoning; and daily cannabis users.
- Feeling guilt or remorse, and to interpret reality, may be dependent on a well-functioning prefrontal cortex.
- The size and number of connections in the prefrontal cortex could relate directly to sentience, as the prefrontal cortex in humans occupies a far larger percentage of the brain than any other animal.
- The left and right halves of the prefrontal cortex appear to become more interconnected in response to consistent aerobic exercise.
- Practicing mindfulness can enhance prefrontal activation, which is correlated with increased well-being and reduced anxiety.
The frontal lobes are probably of most interest to psychotherapy interventions such as CBT because they are home to the PFC, an area vitally involved in executive functions such as concentration, organization, judgement, reasoning, decision-making, creativity, emotional regulation, social–relational abilities, and abstract thinking—in other words, all the functionality we rely on for healthy relationships with ourselves and others. We will look at the PFC separately because of its special importance to psychotherapy; however, the frontal lobes in general regulate voluntary movement, the retention of non-task-based memories that are often associated with emotions, dopamine-driven attention, reward motivations, and planning, to name just a few.
The PFC is the part of the cerebrum that lies directly behind the eyes and the forehead. More than any other part of the brain, this area dictates our personality, our goals, and our values. When we have a long-term goal, for example, which we are pursuing with value-congruent action, we maintain a neural representation of that goal so as to not be distracted or influenced by competing goals or alternate values (Grawe, 2007). If the PFC is damaged, it affects our personalities and the ability to orient our behaviour in line with our values and goals. The PFC is vital to the sense of self and others necessary for healthy interpersonal relationships and decision making.
As in the case of so many discoveries in neuroscience, we often learn what a brain area can do when it becomes damaged in some way. Phineas Gage was a young, reflective, determined, and goal-oriented man who, despite his youth, had been promoted to foreman on an American railroad construction project. But in an unfortunate accident on September 13, 1848, an explosion drove a tamping rod up through the left side of his face and out the top of his head. The rod passed through and destroyed much of his left PFC. Amazingly, Gage survived, and was even speaking within minutes of the accident. He was still conscious and talking to a physician about half an hour later, having introduced himself saying, “Doctor, here is business enough for you.” Following his recovery, an early observation of a change in Gage’s personality was noted by Dr. John Harlow:
The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage”. (Harlow, 1869, pp. 13-14)
Clearly, some important functions of Gage’s personality had been altered by his injuries, although he did become more functional and socially adaptable as the years went on. Given a structured environment in which clear sequencing of tasks was part of the rehabilitation, Gage managed to retrain his brain to regulate itself in reference to values and goals.
The left and right sides of the PFC have different biases, with the left side oriented more toward approach, positive goals, and emotions, and the right side specialized more in avoidance and negative emotions. It is also worth noting that the left side of the PFC hosts more dopamine receptors/activity (associated with motivation and reward), while the right has greater norepinephrine activity (associated with anxiety). Individuals who appear to have a bias toward positive emotions may have a more activated left PFC, whereas right PFC activation is correlated with more negative emotional experiences. Any suggestion of a clear binary division is an oversimplification, as the experience of positive or negative emotions does not hinge purely on left/right PFC activation, but there is nonetheless evidence of a strong correlation.
In studies of the neural correlates of depression, it has been found that left PFC activity is underactive relative to right PFC activity. It seems that less access to the positive bias of the left PFC may make it more difficult for the depressed individual to engage in positive goal-oriented thought and behaviour. Similarly, the left PFC is more responsive to rewards than the right PFC, which is more responsive to punishment. Studies have found that the depressed individual is generally more sensitive to what may be perceived as punishment and does not respond as well to rewards. Moreover, the relative underactivation of the whole PFC in depressed individuals could account for them having less motivation for planning, problem solving, creativity, and so forth. In depression, not only is there underactivation of the PFC, but its volume has been found to be reduced as well. A depressed person with an underactive PFC of reduced volume is not going to demonstrate the rational problem solving abilities of someone without such deficits—the neural integrity to support such resilience is simply not there. This is where the active, approach-oriented and positively biased PFC of a therapist can be of great value to the depressed client. We will discuss the supportive right brain-to-right brain activity of therapy further when we address specific psychopathologies.
The PFC has been divided into a number of functionally distinct regions, described below.
Dorsolateral prefrontal cortex (DLPFC). The DLPFC is the topmost part of the PFC and is considered to have overall management of cognitive processes such as planning, cognitive flexibility, and working memory. This is an area specialising in problem solving and how to direct and maintain attention to a task. When we are focused on what is happening now, our working memory is engaged with the DLPFC and connecting with the hippocampus for the retrieval and consolidation of long-term explicit memories. A dysfunction in this area may lead to problems with working memory, processing in the hippocampus, and long-term memory, as well as the integration of verbal expression with emotions. Such memory deficits have been associated with PTSD due to an underactive left DLPFC. Other DLPFC deficits can manifest as a lack of spontaneity and affect (flat rather than negative), and attention deficit—due to an inability to maintain sufficient attention to see a task through to completion. In obsessive–compulsive disorder (which we will consider separately in a later section the DLPFC plays an important role in strengthening attentional skills to momentarily break the compulsion circuit and give the orbitofrontal cortex a chance to inhibit the runaway activation of the amygdala. As with many brain regions, there are significant hemispherical differences within the dorsolateral prefrontal cortex, the left DLPFC being associated with approach behaviours and the right with more avoidant behaviours.
Orbitofrontal cortex (OFC). The OFC, like the DLPFC, is involved in the cognitive processing of decision making; however, because of its close connection with the limbic system, it is particularly associated with our ability to make decisions based on emotional information. The OFC also plays a major role in forming social attachments and regulating emotions. This region can be thought of as a convergence zone for sensory and emotional information, effectively integrating external and internal worlds. Social information is processed and used to guide us in our perceptions and interactions, and the OFC plays an important role in the interpretation of these complex social interactions, including, for example, the ability to understand a joke. The OFC may help us predict the reactions of others and modulate our behaviour accordingly. When there is a dysfunction in the orbitofrontal cortex, the normal cortical–subcortical modulation is not optimal—as is likely the case in borderline personality disorder (Schore, 2012). As with other areas of the PFC, the OFC has hemispherical differences. The left OFC is associated with positive emotions, while the right OFC is associated with more negative emotions.
Ventromedial prefrontal cortex (vmPFC). This part of the PFC helps us make decisions based on the bigger picture gathered from connections to the amygdala, temporal lobe, ventral segmental area, olfactory system, and the thalamus. It is very well connected, receiving and sending a lot of information that influences many brain regions, including the amygdala. The vmPFC plays an important role with the OFC in regulating our emotions, especially in social situations. It is also vital for personal and social decision making and the ability to learn from our mistakes. Our capacity to make judgements and allow our emotions to assist in decision making is mediated by this region of the brain. Activation of the vmPFC is also associated with courage, suppression of negative emotions, compassion, shame, and guilt.
Learn more about the brain and psychotherapy from our…
informative article. what do you mean by practising mindfulness can enhance prefrontal activation?
Simply the fact that mindfulness necessarily activates the PFC, developing better PFC- to limbic control mechanisms and like anything that is practiced it becomes more rstablished. PFC activation becomes an easier default when there is a need to control emotional responses – in other words affect regulation becomes easier – enhanced.
He is close to being almost right. Crap article
why is this a crap article?
Meeeechelle, my belle. My prefrontal cortex decided this article is less crap than your comment.
Always open to better understanding and better answers – over to you Michelle…
Michelle cannot respond because she has issues with her prefrontal cortex.
Michelle.You need a hug?My doctors name is Michelle and she is gorgeous.I have never met a Michelle who wasnt.
SO HOW BOUT THAT HUG?
Lamictal combine w/risperdal help? schii?
So wait……this is why I couldnt decide between mustard or ketchup the other day???
Seriously though with my depression worsening,it all makes sense.Especially the social aspect and decision making.
I do have a high logical capacity though so its quite odd that depressed people/bi-polar have high intellect and or creativity yet certain ares (pfc in this case) are disconnecting slowly.
This explains why my IQ is above the standard yet I have gotten literally nowhere in life.Sad part is that I still make better financial decisions than anyone I knowI will be starting neurofeeback soon and am hoping for the best.I dont want to start medication due to …well it being medication.I have so far been somewhat maintaining by clean lifestyle,no drugs ,healthy food etc but still reached a point where I needed treatment .
Hey Willshii. How did neurofeedback go? Seriously. Sounds interesting.
I will be very grateful if you could let me know as to the following:
I would like to know as to why some men rape.There are so many men with lots of opportunities but don’t exploit those to commit rape just as it’s also said that many women have fantasies of being raped but never want it in reality.So what distinguishes a rapist? Of course marital rape or excessive demand for sex from an unwilling wife,is a case in point which could also add more men to the criminal lot.
There was an article elsewhere wherein it was mentioned that the Dorso-Lateral PFC is structurally or functionally dysfunctional.If this is indeed the case then all kinds of abhorrent behaviour should be associated with some region or another.
Another issue is about the so called third eye.The late Dr.Shafica Karagulla( a neuropsychiatrist) has has expressed an opinion that the caudate nucleus could be involved here( and therefore thine eye be single thy body will be full of light) and not only the pineal gland.What’s your esteemed opinion on this issue as well?
Is there any research being done formally in the Kundalini phenomenon ,which is not entirely an oriental concept( Moses raising the snake in the wilderness).In India some people have mentioned this phenomenon initially producing gastrointestinal symptoms such as diarhhoea and a severe sense of impending disaster with swooning followed by very great bliss.It’s also equated with thousands of orgasms simultaneously felt( in terms of the magnitude).Could the neural pathway be the same of this process and sexual gratification?Yogis have mentioned that one needs a body to experience this evolutionary process so it’s not something spiritual or mystical but should necessarily be physical.
Thank you for posing such interesting questions. These are all probably too complex to answer in a forum and I think there are a number of specialists that you need to search out for deep responses. As an overarching comment, I would like to remember that things don’t happen in isolation nor in a linear fashion. There is always a complexity from which various things, including behavior, emerges. Why it is that some men rape and others don’t will include their neural activity, but in the context of their history, culture and also possible neuropathology. How people respond in later like to the impact of their experience along the way is interesting and requires much thought. How much of our behavior and our thinking is fundamental and how much is a response to a long history. I encourage you to continue to find what might be the connecting thread between your comments. They are connected a the moment because you are thinking them. why are these the collection of ideas and activities that you notice and gather together? There will be fascinating and perhaps wonderful answers in your deliberations. Best wishes 🙂
Thanks very much indeed,Dr.Hill and regret the delay in responding.
Since these crimes are worldwide ,I was very curious about the neuro-psychiatric origin of criminal behaviour.
Are sudden outbursts of anger controlled by this region of the brain?
My anger and sensitivity to things that most people do not get overly upset about seem to be getting worse as I grow older causing issues with my closest loved ones.
Hi Michael – It is more likely reactive aggression (anger) is coming from brain areas like the amygdala, hypothalamus and periaqueductal gray, (the basic threat system) – to name but a few regions. The prefrontal cortex can down-regulate the anger response.
Hello I would like to know how the pre frontal cortex of the brain can affect/cause schizophrenia ?
Hi Billie-Jo – The prefrontal cortex is certainly implicated in symptoms of schizophrenia. Many studies have shown differences in the prefrontal cortex of those with schizophrenia compared to those without. Differences like reduced connectivity between the amygdala and medial-prefrontal cortex when trying to work out the emotions on faces, deficits in dopamine release, and deficits in the connectivity between the hippocampus and the prefrontal cortex (just to name a few). There are hundreds of papers looking just at differences in the PFC and schizophrenia symptoms. Suffice it to say that the PFC differences do play an important role in producing symptoms.
Greetings, Dr Dahlitz.
As a psychologist, I find the mapping of the brain fascinating. The practical application of accrued knowledge to the field of psychotherapy, however, engages me much less. I cannot see how it can direct a therapists approach to a client, allowing of course for extreme cases of, eg, demonstrable brain injury or abnormal behaviour, given the vast number of variables contributing to episodes of behaviour and the vast number of cerebral connections in play. Don’t you think that psychotherapy will always be closer to an art, scientifically informed of course, rather than a text book exercise.
Hi Dan – Great point. The direct application may not be an obvious nor linear one, nevertheless I find there is an application of accrued scientific knowledge to the field of psychotherapy over time that better informs psychotherapy (take Bruce Ecker and his memory reconsolidation as a case in point). And it is “accrued” – I’d be the first to admit that just knowing the names and functions of a few brain parts is unlikely to make you a good therapist. At the very least it gives us more empathy and insight into why a client is behaving the way they are and in my experience gives them something scientific to make sense of their experience. But that is at the very least – at the pointy end of the stick an understanding of brain function (or whole body function for that matter) can well inform the psychotherapist as to the best intervention for the moment for the particular client, rather than mindlessly gravitating to the same tools for everyone – I think it makes you more artful in practice. From mapping the connections in the brain to an understanding of the genome, the immune system, gut health, heart-brain dynamics, and a whole range of other scientific discoveries over the last couple of decades has very much informed the way we approach mental health in general – granted the actual practice has to catch up. I agree with you that psychotherapy is not a text book exercise and is an art, but as you say, a scientifically informed practice of art.
The leading edge of science is often perceived as a mere fascination with little practical application – but in time, like a jig-saw puzzle, it comes together to provide the foundation of all practical application.
Oh and I’m not a Dr. or a PhD – I’ve a couple of masters degrees but never had the focus of attention to do a PhD – my interests are too broad.
Which sense affects our prefrontal cortex the most? Which sense does it use the most?
I feel sorry for Gabe.
My husband is an alcoholic. He has an abnormal mri . White matter lesions. An old brain bleed. He behaves very poorly and is abusive. He says he don’t want a divorce but refuses to give me a penny. I can’t continue living like this but he won’t get better even though he says he’s sorry. He won’t stop drinking and refuses to deal w mri . He functions for work but has a social impairment all same as pre frontal cortex damage syndrome.
What part of the prefrontal cortex is activated during a lucid dream and what effect does this have on the person’s life?
Amazing article this helped me a lot. It is very informative, although my vocabulary is not so great, I had used google for help. I think if you want to change your own behavior you should understand how your brain works, this did exactly that for me. I am trying to change my compulsive behavior (constantly checking my phone/social media, drugs, and entertainment).
After practicing mindfulness, its much easier to take a moment, and realize you are indulging and quickly exit the behavior.
I think strengthening my prefrontal cortex will be my first step to changing my life to happiness.
take aways *do aerobic exercise
Thank you for this, I was extremely interested in science when I was younger but my environment “grew” me out of it. This article made me remember the young “scientist” I was, and how beautiful and complex but also at the same time, simple our world is.
hi. good artical, i am doing this for a project, and this is very informitive.
Could anybody say how the functioning of the prefrontal cortex can be effected by regular practise of the Wim Hof Method (Deep breathing followed by cessation of, for as long as possible, Ice cold showers/Baths, Physical exercises). From my unsteranding of what Mr Hof say’s, the insula does the interoception, it observes what is going on in the body, and the PFC makes decisions about what it thinks the body needs. Using focus you can experience consiousness of the insula and communicate with your body and influence and train the body responses. When I did the cessation of breath, it started off calm and focused. Then you can experience the body calling for more oxygen, it starts as a whisper that can be easily overridden and the call gets louder and you have to breathe. Is this training the PFC to be less reactive and respond to insula. Does this lessen OCD and anxiety. It feels like there is a part of the brain that promotes calmness (insula) and a part that promotes survival. Any thoghts?
This article is helpful to my Master’s Thesis writing, thanks a lot!