How a cognitive perspective can help solve a national crisis.
Posted Jun 22, 2019
By Nicklas Balboa and Richard D. Glaser, Ph.D.
As mental health illnesses and suffering from emotional and mental distress continue to rise in America, so will the usage of psychiatric drugs. As more people seek clinical help for mental health problems, more will be treated for their respective conditions. How are patients being treated?
Look to the Medical Expenditure Panel Survey (MEPS), which gathers information on the cost and use of health care in the United States, for the answer; 1 in 6 adult Americans take a psychiatric drug (Miller 2016). For those who cannot afford mental health care, which is an increasing issue with health care coverage for those below the poverty line, the answers are even bleaker; drug abuse, self-harm, depression, anxiety, and the list goes on.
This proposes a unique research question: How do biological and genetic contributions to the development of psychological disorders obscure the over-arching and necessary integration of a cognitive perspective into treatments?
Symptoms of mental illnesses often arise long before diagnosis, and their effects are critical factors in the lives of those who suffer. Increasingly, as the causes of mental illnesses are better understood, those with metal health problems are being treated biologically. When it comes to reporting symptoms of a mental illness to clinicians, a recent study illustrates how biological explanations can influence levels of empathy in practicing clinicians.
Yale University Psychologists Matthew Liebowitz and Ahn Woo-kyoung conducted a study where 132 practicing mental health clinicians (psychiatrists, psychologists, and social workers) reviewed fictional vignettes about patients suffering from several mental health illnesses (Liebowitz 2014). In the study, each patient’s symptoms were described from either a psychosocial perspective or a biological perspective. After reading each vignette, the clinicians would report their levels of empathy for the patient. The results show that empathy for patients is reduced when symptoms are explained through biological accounts relative to when they are explained with psychosocial accounts (Liebowitz 2014).
The clinicians were also more likely to endorse medication and less likely to endorse psychotherapy. Although the sample size used in this study is small, the results of this study offers relevant information for establishing a set of best practices for building empathetic, trusting relationships between clinicians and patients.
How can better understanding our brain help?
When addressing a mental health issue it is important to consider the individual's conscious experiences. For fear states and anxiety-related disorders, let's turn to modern neuroscientist Joseph LeDoux and his research as to how a cognitive perspective can provide potential applications for treatments. LeDoux's work shows that the difference between non-emotional cognitive states and emotional-cognitive states are the kinds of inputs that feed into the cortical consciousness networks (LeDoux 2016). Feelings of fear and anxiety are narrowly defined by the circuits we evolved for predatory defense, and often neglect the notion that these circuits feed into a general-purpose cognitive network.
That is, although affectively charged stimulus is first processed in the limbic system, we humans experience these fears and anxieties consciously. This is why language is so powerful and can affect the way we experience states like fear and anxiety; when we ruminate on the past we can produce fears and anxieties that are not an apparent, present danger in the environment but are still a part of everyday conscious experiences.
The potential implications of LeDoux’s discovery creates a new perspective on chronic anxiety and fear disorders, focusing on how these circuits shape attention and memory for both pharmacologic and psychotherapeutic treatments. LeDoux suggests that both medications and psychotherapies could be tailored to the specific activities of the patients underlying circuitries. For example, patients suffering from altered activity in cortical circuits (i.e. working memory, prefrontal cortex) can utilize therapies that emphasize reappraisal strategies, like Cognitive Behavioral Therapy (LeDoux 2016). For patients with hyper-activity in the subcortical circuits (i.e. amygdala), emotional regulation strategies may not serve best as the dysfunction is related to subcortical defense circuits and reflexive behavior (LeDoux 2016).
As more forward thinkers embrace the truths of conscious experiences as they relate to personal suffering, we will see the popularization of therapies like yoga, herbalism, meditation, breathing techniques, and marijuana. When considering the individual’s experiences, it is important to remember that the best way to draw out others’ perspectives is by grafting Conversational Intelligence® rituals into our interaction dynamics. You will discover new doors opening up in your mind and in your reality.
- Listening to Connect, not Judge or Reject : Too often we listen to understand – which is more about listening to confirm what we know. Listening to connect is about focusing our attention on the other person: What are they trying to say? What are they thinking? How can we connect to their world?
- Asking Questions for Which We Have No Answers : Think of asking questions for which we have no answers as a way of exploring beyond what we already know to what we don’t know. Too often we ask questions for which we already have answers, guiding people toward where we want them to go. When we ask questions for which we have no answers, we are co-creating a space of ‘sharing and discovering’, elevating our ability to co-create and partner with others.
- Sustaining Conversational Agility : Conversational Agility enables us to move in and out of conversations with ease and agility. When a conflict is brewing, or we see a better way to frame the conversation, we can interrupt the pattern by Reframing, Refocusing and Redirecting the conversation. Conversational Agility enables us to create a new ‘conversational space’ that enables wisdom and insight to emerge. For example, we can use Reframing to set a new context for a situation from ‘difficult to different.’ For Refocusing we can move a conversation from ‘looking at the situation as a problem, to looking at it as an opportunity.’ For Redirecting, we can redirect people to ‘Aspirations, instead of problems.’ Each one of these Agility skills can totally change a conversation from ‘low trust to elevated trust.’
- Priming for Trust : Think of this Essential as the foundation of Conversational Intelligence®. Trust is when we believe others will deliver on their promises. Distrust is when we doubt others are telling the truth and assume they will not deliver on their promises. Reflect on the following ways we can elevate trust and co-creation: How can I create a safe environment? Can I be more transparent about desired outcomes and share threats that may stand in the way?
- Double-clicking : Double-clicking is a great tool to use with all of the other Essentials. When we Double-click on an issue, we are uncovering and exploring what is in the other person’s mind. Double-clicking is ‘opening the deeper connections’ that are linked deeply in others’ minds. Asking “What does that mean to you?” or “How do you envision next steps?” are very powerful questions that deepen the conversation. Double-clicking allows us to better understand how others see the world. We gain clarity and understanding of what triggers others and also gain deeper understanding of others’ perspectives, their deeply held beliefs, and their unique points of view.
Miller, S. G. (2016, December 13). 1 in 6 Americans Takes a Psychiatric Drug. Retrieved from https://www.scientificamerican.com/article/1-in-6-americans-takes-a-psychiatric-drug/?redirect=1
LeDoux, J., & Pine, D. (2016, September). Using Neuroscience to Help Understand Fear and Anxiety: A Two-System Framework.
Retrieved from http://www.cns.nyu.edu/ledoux/pdf/LeDoux%20Pine%20Two%20Systsem.pdf
Matthew S. Lebowitz, W. A. (2014, December 16). Effects of biological explanations for mental disorders on clinicians' empathy. Retrieved from https://www.pnas.org/content/111/50/17786