You come home from a long day of work and as you wander past the kitchen you see the refrigerator and the next thing you know, you have opened the fridge door and you are extracting a selection of tasty treats. How did that happen? Did you think it through; make a plan; execute a finely crafted prefrontal cortex organised program? Or did it just happen, without much thought, as if on automatic pilot? Although it may have been because of a consciously created plan, it most likely happened in response to a complex set of biochemical responses and stimuli that were set up inside your cellular structure long before this particular evening or perhaps this month or even this year.
Therapists witness many behaviours as we encounter and engage with our clients. One reason you might feel so weary is because one of your clients today has a social anxiety issue that can build to panic on some occasions. What frustrates the client, and tests your professional experience, is that these feelings seem to emerge from nowhere, for no good reason, and the client—normally such an intelligent and reasonable person—is very frightened by the loss of self control. How does this happen? What inclines your client toward anxiety and panic, whereas her friend, who tries to get her out as often as possible, seems totally comfortable and even eager to enjoy a social life?
There are many possible reasons for these behaviours in you, your client and her friend, including:
- Instinct (Winston, 2003)
- Temperament (Kagan & Snidman, 2004)
- Evolutionary genetic “hardwired” patterns (Watson & Crick, 1953)
- Gene mutations and polymorphisms (Bull, 2000)
- Neural architecture (Oschner & Gross, 2007)
- Immediate levels of demand by the inner and outer environment (Lovallo, 2005)
Each of these elements of human potential contributes to the nature of our being. There are fascinating things going on within us at a macroscopic and microscopic level, but these elements of our nature are just the building blocks. How these elements function together, which may lead us to seek out the contents of the fridge or suffer social anxiety, is a product of one more vital element:
- Ongoing experience (Narvaez et al., 2013)
We arrive in this world with the elements of our nature ready and able to develop in response to experience – the nurturing of our potentials – to enable the emergence of the individual we eventually become. We are each an extraordinary symphony, unique in melody, tone and key, even though we all use, pretty much, the same instruments. Each life is a unique expression of the complex interplay of nature and nurture. Within this seemingly infinite number of possible outcomes, many people will find themselves opening the fridge door, seeking tasty treats, at the end of a long day. So different and yet so similar – how fascinating!
Not only does experience shape the development of our biology from gene expression to neuronal pathways in the brain, but experience can also be recorded, remembered and recalled to help us manage the better in the future. In short, we can learn. Learning is possible because of our capacity to remember. Memory is a fundamental quality of being human (Kandel, 2006).
A Multitude of Memories
Memory is a quality that links the past to the present. It has three essential functions: encoding of information; storage of that information; and retrieval (Baddeley et al., 2009). (The term ‘information’ is being used here in the generic form of ‘anything new’ not just isolated semantic facts). We generally think of memory as a neurological process and that is usually how we experience memory – in our thoughts – but memory is a ubiquitous that manifests in many places and many ways throughout our biology.
Some memory is explicit - in our conscious, reflective awareness. This memory is mostly brain based and comes to us in facts, details, stories, images, sounds and smells in a way that we can think about the memory and consider how to best utilise it. Much of our memory, however, is implicit - it occurs beneath our conscious awareness - and we find ourselves acting out behaviours, emotions and feeling where we don’t really know why we are doing that action or feeling that emotion (Schacter, 1987). This is one of the fundamental issues in therapy. We often need to help clients bring memories that are implicit into the explicit where we can employ our conscious thinking to have a beneficial effect. Implicit memory is stored in various brain areas such as the amygdala (fears and emotion), the striatum (habituated thoughts and behaviours), as well as the cerebellum (automatic procedural actions) and fusiform gyrus (face recognition) (Squire, 2004). But there is much more.
Neuronal circuits are just one form of memory. Epigenetics is one of the most interesting recent developments in understanding how experience is remembered for future use. Epigenetics is a process whereby a biochemical overlay, directly on the structure of DNA, alters the way in which genes are expressed. It is easy to forget that gene expression is the first step in everything that happens in our biology. We create the building blocks (proteins) for everything that goes on in the body through gene expression. When we talk about neurotransmitters like serotonin and dopamine or peptide hormones like oxytocin and corticotrophin-releasing hormone (CRH), we are talking about bio-chemicals that are created by the stimulation of gene expression and the combination of proteins they produce. Receptors for neurotransmitter and peptide hormones are also created by gene expression. Our biology functions through the interplay of chemicals and receptors (Lodish et al, 2000). Epigenetic processes can alter the balance and flow of that interplay.
When there are difficulties in early life experience, which we see in therapy as insecure attachment issues or early life trauma, abuse of war or catastrophe, there can be an epigenetic change to a particular receptor in the hippocampus that is designed to receive cortisol. This receptor is part of the self regulation of the stress response through the HPA Axis. As the level of cortisol rises, the receptors in the hippocampus detect this rise and send information to the hippocampus to slow down the stress response. Epigenetically shutting down the gene that builds this receptor is an implicit form of memory that helps protect the person from the continued possibility of being in unsafe and unreliable surroundings. It is, biologically, better for survival to assume that if things are bad now, it is possible that they will be equally bad in the future (McGowan et al., 2009; McGowan & Szyf, 2010). Epigenetically changing the gene expression for this receptor so that it is ‘silenced’ (harder to express) makes the person more vigilant and even more anxious. This is beneficial because it is likely to be safer for that person to keep struggling to find safety or security or comfort and to be cautious and even distrustful of other people. They are epigenetically prepared for difficulties in the future.
This is a very helpful thing if the environment continues to be harsh and unreliable, but what if it doesn’t? What if the environment improves, but the epigenetic memory remains? Well, then you might find yourself to be less trusting of social situations and generally feeling less safe with other people. You might find yourself visiting a therapist to work out why your friend, who keeps urging you to go out and socialise, is happy and free, but you are wracked with anxiety and fear. It doesn’t seem to make sense when you look around at the immediate environment. You may even have a good cognitive understanding that you should feel better and therefore be a person less responsive to CBT. The question we need to appreciate as therapists is how deep have the memories been stored in the client’s biology? This case of social anxiety may need transformation at the DNA level. Deeper therapeutic techniques may be required, perhaps more somatically based therapy or a metaphoric therapy or perhaps narrative therapy may be best in order to have a beneficial impact on this protective memory buried deep in the structure of DNA.
Epigenetics is relatively new and fascinating and there is a growing body of literature (see Hill, GAINS Quarterly, Spring 2010, The Genetics of Being You). These new, biological understandings can give us invaluable insight into the utilisation of therapeutic approaches in the case of the socially anxious girl. We are still, however, unsure how we ended up at the fridge door, scouring for treats. For that answer we need to review some behavioural science 101 – and then get down to some more biochemistry...
This has been an excerpt from Prepared, Ready and Able: How we biologically prepare ourselves for future experience by Richard Hill. For more excellent material for the psychotherapist, please subscribe to our monthly magazine.