Tag Archives: brain science

Brain Science May be Shiny, but Exposure Therapy is Pure Gold

Spidey Cropped

In honor of Joseph Wolpe, let’s start with mental imagery.


Imagine you’ve travelled back in time. You’re in your first week of high school. You look around and notice that one of your classmates is named Mary Jones.

Mary is an ordinary girl with an ordinary name. Over the years, you don’t notice her much. She seems like a nice person, a fairly good student, and someone who doesn’t get in trouble or draw attention to herself.

Four years pass. A new student joined your class during senior year. His name is Daniel Fancy Pants. Toward the end of your senior year, Daniel does a fantastic Prezi presentation about a remarkable new method for measuring reading outcomes. He includes cool video clips and boomerang Snapchat. When he bows at the end, he gets a standing ovation. Don’t get me wrong. Daniel is a good student and a hard worker; he partnered up with a college professor and made a big splash. Daniel deserves recognition.

But, as it turns out, over the WHOLE four years of high school, Mary Jones was quietly working at a homeless shelter; week after week, month after month, year after year, she was teaching homeless children how to read. In fact, based on Daniel’s measure of reading outcomes, Mary had taught over 70 children to read.

Funny thing. Mary doesn’t get much attention. All everybody wants to talk about is Daniel. At graduation, he wins the outstanding graduate award. Everyone cheers.

Let’s stop the mental imagery and reflect on what we imagined.


Like birds and raccoons, humans tend to like shiny things. Mary did incredible work, but hardly anyone noticed. Daniel did good work, and got a standing ovation and top graduate award.

The “shiny-thing theory” is my best explanation for why we tend to get overly excited about brain science. It’s important, no doubt. But brain imaging isn’t the therapy; it’s just a cool way to measure or validate therapy’s effects.

Beginning in at least 1924, when Mary Cover Jones was deconditioning fear out of little children, behavior therapy has shown not only great promise, but great outcomes. However, when Schwartz (and others) showed that exposure therapy “changes the brain,” most of the excitement and accolades were about the brain images; exposure therapy was like background noise. Obviously, the fact that exposure therapy (and other therapies) change the brain is great news. It’s great news for people who have anxiety and fear, and it’s great news for practitioners who use exposure therapy for treating anxious and fearful clients.

This is all traceable to neuroscience and human evolution. We get distracted by shiny objects and miss the point because our neural networks and perceptual processes are oriented to alerting us to novel (new) environmental stimuli. This is probably because change in the form of shiny objects might signal a threat or something new and valuable. But we need to stay focused in order to not overlook that behavior therapy in general, and exposure therapy in particular, has been, is, and probably will continue to be, the most effective approach on the planet for helping people overcome anxiety and fear. And, you know what, it doesn’t really matter that it changes the brain (although that’s damn cool and affirming news). What matters is that it changes clients’ lives.

Exposure therapy, no matter how you package it, is highly effective for treating anxiety. This statement is true whether we’re talking about Mary Cover Jones and her evidence-based counterconditioning cookies or Francine Shapiro and eye movement desensitization reprocessing (EMDR). It’s also true whether we’re talking about virtual reality exposure, imaginal exposure, massed exposure, spaced exposure, in-vivo exposure, interoceptive exposure, response prevention (in obsessive-compulsive disorder) or the type of exposure that acceptance and commitment therapists use (n.b., they like to say it’s “different” from traditional classical conditioning exposure, but it works, and that’s what counts).

In the end, let’s embrace and love and cheer brain imaging and neuroscience, but not forget the bottom line. The bottom line is that exposure therapy works! Exposure therapy is the genuine article. Exposure therapy is pure gold.

Mary Cover Jones is the graduate of the century; she’s the bomb. Because of her, exposure therapy has been pure gold for 93 years. And now, we’ve got cool pictures of the brain to prove it.

Note: Mary Cover Jones passed away in 1987. Just minutes before her death, she said to her sister: “I am still learning about what is important in life” (as cited in Reiss, 1990). We should all be more like Mary.

Three Pounds of Theoretical Elegance in 888 Words

Rita and Driftwood 2017

As you may or may not recall, we have several new features in our forthcoming Counseling and Psychotherapy Theories in Context and Practice (3rd ed.) text. Here’s a draft of what we’ve tentatively titled a “Brain Box” from Chapter One.

Brain Box 1.1

Three Pounds of Theoretical Elegance

John Sommers-Flanagan

This Brain Box is a brief, oversimplified, description of the brain. I apologize, in advance, to you and to brains everywhere for this oversimplification and likely misrepresentation. The problem is that even if I took a whole chapter or a whole book to describe these three pounds of elegance, it would still be an oversimplification. Such is the nature of the human brain.

You may already be familiar with the concepts described here. If so, it’s a review. You may be less familiar; then, it’s an introduction. For more information on neuroscience and therapy, we recommend Neuroscience for counselors and therapists: Integrating the sciences of mind and brain by Chad Luke.

Brain Structure: The human brain has indentations, folds, and fissures. It’s slick and slimy. Put simply, it’s not a pretty sight. But the brain’s form maximizes its function. One example: If you could lay out and spread its surface area onto a table, it would be about the size of two pages of a newspaper. The folds and fissures allow more surface area to fit within the human skull.

Scientists describe the brain as having four lobes: The frontal, parietal, occipital, and temporal (see Figure 1.2). The fissures or sulci of the brain demarcate the four lobes. At the bottom of the brain is the brainstem and cerebellum.

Each lobe is generally associated with different brain functions. I say generally because brains are specific and systemic. Although individuals have similar brain structures, individual brains are more unique than a fingerprint on a snowflake.

The frontal lobe is primarily associated with complex thought processes such as planning, reasoning, and decision-making (much, but not all, of what psychoanalysts refer to as ego functions). The frontal lobe also appears involved in expressive language and contains the motor cortex.

The parietal lobe includes the somatosensory cortex. This surface area involves sensory processing (including pain and touch). It also includes spatial or visual orientation.

The temporal lobes are located symmetrically on each side of the brain (just above the ears). They’re involved in auditory perception and processing. They contain the hippocampus and are involved in memory formation and storage.

The occipital lobe is located in the back of the brain and is the primary visual processing center.

I’m using all four lobes right now to type, read, edit, re-think, re-type, re-read, shift my position, and recall various relevant and irrelevant experiences. The idea that we only use 10% of our brains is a silly myth. They even busted it on the Mythbusters television show.

The brain includes two hemispheres. They’re separated by the longitudinal fissure and communicate with each other primarily via the corpus callosum. The hemispheres are nearly mirror images of each other in size and shape. However, their neurotransmitter quantities and receptor subtypes are quite different. The right hemisphere controls the left side of the body and is primarily involved in spatial, musical, and artistic/creative functions. In contrast, the left hemisphere controls the right side of the body, and is involved in language, logical thinking, and linear analysis. There are exceptions to these general descriptions and these exceptions are larger in brains of individuals who are left-handed. Woo-hoo for lefties.

The limbic system is located deep within the brain. It has several structures involved in memory and emotional experiencing. These include, but are not limited to the: amygdala, basal ganglia, cingulate gyrus, hippocampus, hypothalamus, and thalamus. The limbic system and its structural components are currently very popular; they’re like the Beyoncé of brain science.

Neurons and Neurotransmitters: Communication within the brain is electrical and chemical (aka electrochemical = supercool).

Neurons are nerve cells (aka brain cells) that communicate with one another. There are many neuron types. Of particular relevance to counseling and psychotherapy are mirror neurons. Mirror neurons fire when you engage in specific actions (e.g., when waving hello) and the same neurons fire as you observe others engaging in the same actions. These neurons are central to empathy and vicarious learning, but many other brain structures and systems are also involved in these complex behaviors (see Chapter 5).

Neurotransmitters are chemicals packed into synaptic vesicles. They’re released from an axon (a part of a neuron that sends neural transmissions), travel through the synaptic cleft (the space between neurons), and into a connecting dendrite (a part of a neuron that receives neural transmissions), with some “leftover” vesicles re-absorbed into the original axon (referred to as “reuptake,” as in serotonin-specific reuptake inhibitors).

There are somewhere between 30 and 100 (or more) neurotransmitters (NTs) in the brain, divided into three categories: (a) Small molecule NTs (e.g., acetylcholine, dopamine, GABA, Glutamate, histamine, noradrenaline, norepinephrine, serotonin, etc.); (b) neuropeptides (e.g., endorphins, oxytocin, etc.); and (c) “other” (e.g., adenosine, endocannadinoids, nitric oxide, etc.). Neurotransmitters are classified as excitatory or inhibitory or both. For example, norepinephrine is an excitatory neurotransmitter, dopamine is both excitatory and inhibitory, and serotonin is inhibitory. Although several chemical imbalance hypotheses regarding the etiology of mental disorders have been promoted (e.g., “low” serotonin at the synaptic cleft causes depression), when it comes to the brain, I caution you against enthusiastic acceptance of any simplistic explanations. A significant portion of the scientific community consider the dopamine and serotonin hypotheses to be mostly mythical (see Breggin, 2016; Edwards, Bacanu, Bigdeli, Moscati, & Kendler, 2016; Moncrieff, 2008, 2015).

Figure 1.2: A Look at the Brain — If the image was here, you would see it. In its absence, use your brain to imagine it. Yes. It’s beautiful. In the real textbook, we’ll have a real image of a brain and not my snarky suggestion that you use more than 10% of your brain to imagine a brain.

When Teens Talk Back

Sara P Boy Photos

A big thanks to Rick McLeod for inventing this title for a class he taught many years ago at Families First in Missoula.

For tips on how parents can handle it when teens talk back, listen to the latest episode of the Practically Perfect Parenting Podcast. You can catch it on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or Libsyn: http://practicallyperfectparenting.libsyn.com/

Here’s the blurb for When Teens Talk Back:

In this episode, Dr. Sara decides to consult with Dr. John about her hypothetical “friend’s” teenage and pre-teen boys, who coincidently, happen to be the same ages as Sara’s own children. Other than being a disastrously bad consultant, John ends up complaining about how disrespectful our culture is toward teens. This leads Sara and John to affirm that, instead of lowering the expectation bar for teens, we should re-focus on what’s great about teenage brains. Overall, this turns out to be a celebration of all the great things about teenagers . . . along with a set of guidelines to help parents be positive and firm. Specific techniques discussed include limit-setting, do-overs, methods for helping teenagers calm down, role modeling, and natural, but small consequences.

If you want more info on this topic, check out the re-post below, originally posted on psychotherapy.net

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric dismiss and disrespect teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Stephen Colbert once quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would rather not be treated.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations for teenagers are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

What Brain Science Says about Becoming a Better Professional Writer

This piece on professional writing is in anticipation of our upcoming John Wiley & Sons sponsored ACA presentation on April 1 in Montreal titled: Writing for Publication: Insights and Strategies

The “Decade of the Brain” started way back in 1990. It’s been over for more than 15 years. So you would think everyone could get over it and move on. But obviously that’s not how things pertaining to the brain work. Too many neuroscientists, journalists, and other people are happily riding along on the brain science bandwagon to just let it go. Most things would be perfectly satisfied with their own decade and the attention that goes with that, but the brain is a selfish organ and obviously interested in hogging all the decades. And so the brain discoveries just keep rolling in and eager journalists keep on writing and talking about the brain, which is why the popularity of neuroscience is now officially off the map. Neuroscience’s reach has far exceeded its grasp, but such is the nature of popular things. Just think about bell-bottoms.

We still know very little about the brain. That’s partly why neuroscience excites people. The excitement is more related to our collective brains collective imagination of what neuroscience might be than neuroscience reality. This has turned neuroscience into a projective test (think of the Rorschach Inkblots). There’s some vague information or structure out there and so everyone takes some of it in, blends it with their unique personality and past experiences, and then projects hypothetical possibilities about brain science onto the blank canvass of reality. Then voila, people start talking about ridiculous things like male brains and female brains and teen brains.

I say all this as a balancing introduction that will help me not sound completely trite and ridiculous when I write,

Coming up next: What brain science says about how you can become a better writer.

Let’s pause and self-reflect here. This statement is both bad writing and bad science. It’s bad writing because I’ve transformed (through grammatical magic) the inanimate field of brain science into an entity that has something to say. It’s bad science because the first rule of becoming a better writer, although supported by neuroscience, is such numbingly basic common sense that it’s inappropriate to gift it the charade of scientific authority.

Put another way, brain science can’t talk; people talk. But if brain science could talk, and you asked it, “What can I do to become a better writer?” it would likely respond with something like:

The first rule to good writing is WRITER’S WRITE. This is what literary and professional writers have said over and over for centuries and you didn’t need me, brain science, to tell you something you already knew. (see also: https://johnsommersflanagan.com/2013/09/04/professional-writing-for-us-professionals-who-may-not-quite-be-writers-yet/)

If there’s one thing we know from brain science (and common sense), it’s that practice leads to improvement. Neuroscientists might say it this way, “Your behavior directly influences your brain structure and chemistry; when you repeatedly practice something, you’re actually creating specific neurons and neural pathways to make that something easier.” Common sense (if it could talk) might say, “Repeated practice generally leads to skill development.” Speaking (apparently) on behalf of common sense, the renowned science fiction writer Ray Bradbury wrote:

Just write every day of your life. Read intensely. Then see what happens. Most of my friends who are put on that diet have very pleasant careers.

The take home message here is simple. If your goal is writing success, then you must make time to write.

There is, of course, a caveat to this general brain-based common sense rule. Yes, practice leads to improvement, but there are always exceptions.

Sometimes, even when you practice with great effort, consistency, and sincerity, you don’t improve much. The good news about this exception is that in the world of writing there are usually fascinating reasons for why diligent writers aren’t improving . . . and I’ll get to that important content at some point in the future. For now, remember this: The first step to becoming a successful professional writer involves taking Bradbury’s advice—which I repeat and elaborate on below:

  • Write every day
  • Read intensely
  • Get feedback
  • Engage in self-editing—produce a 2nd, 3rd, and 4th draft
  • Schedule more time to write
  • Identify your target audience and then learn more about them
  • Deal with multiple distractions
  • Reward yourself
  • Get more feedback so that you can be certain that you’re not rewarding yourself when you should be engaging in more self-reflection and scrutiny
  • Read your 4th draft aloud to yourself, then read it aloud to someone you trust to get even more feedback
  • Find somewhere to submit your precious manuscript
  • Hope for the best, but prepare for rejection
  • When you get your rejection, stay calm and integrate the feedback into your writer-identity
  • Revise your manuscript again, read it aloud again, get feedback again
  • After dealing with your neuroses, improving your manuscript, and gnashing your teeth, find the courage and strength to face your fears and resubmit your precious manuscript to somewhere that will recognize its greatness
  • Hope for the best, but prepare for rejection—again
  • Repetitively do all these things to help your brain structure and chemistry develop itself and you into a better writer who has a better chance of writing success

Before moving on I should say that I realize Bradbury was advising fiction writers and fiction writers fall within the literary writing domain. This is an important distinction. If you’re reading this blog, you’re probably busy juggling numerous professional activities. These activities might include a combination of teaching, research, service, attending classes, clinical practice, supervision, and more. Traditionally, writers with literary ambitions only juggle their daily writing and reading with a job delivering pizza or waiting tables. It’s likely that you have a more rigorous and full professional life. This is one good reason why your immediate goal shouldn’t be to publish your first novel or personal memoir. You probably don’t have time for those more ambitious goals; most human services professionals who write novels and memoirs do so during sabbatical or after retirement. For now, our goal for you and your goal for yourself should be to begin taking small steps toward becoming a professional writer. The best-selling novel will have to wait.

John hanging out with Robert Wubbolding

With Wubbolding