In this first post, I want to explore why our bodies, our physiology in particular, are important in feeling better and maintaining good mental health. Psychophysiology is a fancy word for the important processes happening in the body that are intimately related with our psychological well-being. If we think about what “psychological“ really means, that could include a lot! When I talk about psychophysiology with my patients, I’m really specifically referring to the body processes that are most relevant to things that people go to therapy for ~ fear, anxiety, worry, anger, depression, shame, guilt, trauma. All of these experiences have physiological impacts … check out this graphic from the Nummenmaa Lab in Finland that shows different heat signatures across emotional states:
We live in a really exciting time where we are learning SO much about the body and how it relates to these problems of living and difficult emotional experiences. I’m not a physiologist or a researcher, my perspective is that of a clinical health psychologist specializing in psychophysiological psychotherapy (biofeedback) who sees patients every day and uses this scientific knowledge to help normal people like you and me.
With that in mind, here are the psychophysiological systems that, to me, are some of the most important in understanding and improving mental health:
The Autonomic Nervous System: You may have heard of it? If not, you’ve likely heard of the “fight or flight“ or the stress response or the Sympathetic Nervous System? That’s a part of the Autonomic Nervous System (ANS). The ANS is a wide-ranging series of nerves that innervate our viscera (organs) and communicates that visceral information back & forth with the brain. The ANS has two famous parts that we’ll focus on (and a third called the enteric nervous system related to the gut that we aren’t going to discuss today; another aspect of the ANS for another day is Dr. Steven Porges’ Polyvagal Theory): the Sympathetic Nervous System (SNS; most people associate this with “fight or flight“) and the Parasympathetic Nervous System (PNS; many call this “rest & digest“). I’ll go into more detail in the future about how to understand the ANS, but suffice it for now that the SNS is our “go“ system and the PNS is the “slow“ system; while it’s a little more nuanced, one easy way to think about the PNS is as a system that reduces / calms SNS activation.
Why is the ANS important for mental health when it’s not even part of the brain??
Well, as it turns out, most of the problems that bring people to therapy have at least somewhat to do with an ANS that isn’t functioning so well ~ another way to put it is that the ANS is out of balance. PTSD, Depression, Generalized Anxiety Disorder - the list goes on … and, not just for mental health concerns, but for other stress-related issues such as Irritable Bowel Syndrome, Migraines, Tension Headaches, Hypertension and even Blood Sugar Control. Please note that when I discuss medical issues, I’m referring to medical issues that have a stress-related component, not that they are 100% stress-related.
Usually the ANS imbalance is either that the powerful, regulating PNS isn’t present enough to tamp down SNS activity; or, in some cases, it’s a case of SNS over-activation all the time (though this is not as common as people think; PNS, or vagus, withdrawal is usually what’s happening physiologically instead of the “fight or flight“).
Can we do something about an imbalanced ANS? The ANS was named autonomic because it was originally thought that we had no conscious control of the functioning of our organs. Thankfully, that hasn’t turned out to be true. We can improve the functioning of our ANS and many studies show that doing so helps common mental health concerns as well as stress-related medical conditions. We can measure the health and functioning of our ANS and directly train it through biofeedback!
Improving our ANS to improve stress-related mental & physical health is a bottom-up strategy (body to mind).
The importance of the Prefrontal Cortex (PFC; part of the frontal lobe): I’m not a neuro expert, but I’m totally blown away by the importance of the part of the brain above our eyes. Not only does this brain structure differentiate us from almost all other animals, but we know enough now to suggest that parts of the frontal lobe help keep our healthy emotion-related neural circuits in check. In particular, there appears to be a relationship between parts of the frontal lobe and parts of the amygdala (yes there are different parts of the amygdalae that are related to different functions) that is inhibitory.
Let’s decode that: many correctly associate the amygdala with fear, rumination and other emotional experiences that we tend to experience as unpleasant or even getting in the way of life. Parts of our frontal lobes can tamp down the activity of the amygdala.
In my thinking, most of modern, evidence-based psychotherapy is aimed at improving the functioning of the pre-frontal cortex … I think of psychotherapy, particularly the kinds that work most directly with thoughts, as a rehabilitation for the PFC and related circuits. I have so many patients tell me, even after they have completed therapy, that they hear my voice in their head (and this is a good thing according to them!!). Without having an fMRI in my office, I see this inner voice as a development of their own frontal lobes. Whether it’s restructuring thoughts, making our self-talk more compassionate and less critical, identifying and predicting which behaviors may help our mood … all of it likely involves this critical brain structure.
Improving PFC activation to improve mental health is a top-down strategy (mind to body).
For some reason, there are camps of therapists that prefer top-down and those that prefer bottom-up … I don’t personally see why you wouldn’t want help from both directions!
Here’s where it gets really interesting to me. There is a connection between the ANS and the neural circuitry described above … In fact, there’s absolutely brilliant research by Dr. Julian Thayer and colleagues that proposed a Neurovisceral Integration Model … that is, a connection between the functioning of the ANS and the heart with the emotional regulation circuits in the brain. This system has been called the neurovisceral system, the heart-brain system and more recently the fronto-vagal system.
What’s really amazing to me, and what’s actionable about it, is that regulating from bottom-up helps top-down regulation and vice versa. Put in other words, calming your heart and other organs calms your brain … and calming your brain calms your organs. The graphic below, from Drs. Ottaviani (love this researcher!) & Vanderhasselt, shows how the vagal nerve (i.e. the main part of the PNS) connects the brain circuits we’ve talked about as well as the heart. The graphic below says resonance and has a person breathing … that’s because daily breathing at what is called resonance frequency stimulates this system and improves both ANS functioning as well as connections between the PFC - amygdala. More in the future on resonance frequency …
Are there other important psychophysiological systems? For sure! The Hypothalamic-Pituitary-Adrenal axis, the enteric nervous system and the default mode network immediately come to mind … But at this point, these two above are the ones I, and my patients, find most helpful in understanding mental health & the body.
I hope there was something in here that helped you feel a little more awe about yourself and your experiences. I’ll write when I feel inspired or, better yet, get great questions that my patients want answers to.
References:
Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of affective disorders, 61(3), 201-216.
Vanderhasselt, M. A., & Ottaviani, C. (2021). Combining top-down and bottom-up interventions targeting the vagus nerve to increase resilience. Neuroscience & Biobehavioral Reviews.