Mirror neurons in humans are not limited to simple movements. Watching dance leads to activation in the brains of other dancers. Greater activation occurs when dancers watch movements they already know. Mirror neurons activate while watching facial expressions and seem to be partially impaired in individuals with autistic disorders. Human mirroring networks also exist for pain and emotional distress. Researchers created pain by sticking subjects with a needle and monitored which areas of the brain were activated.9 Similar pathways were activated when the researchers brought the needle close to the subject but did not make contact and when subjects watched researchers pricking their own fingers. Witnessing others display disgust activates many of the same areas that are activated when one smells an unpleasant odor.
Mirroring neurons also fire when observing others being rejected or embarrassed. The areas most involved in mirroring physical pain, emotional distress, and social discomfort are the anterior cingulate cortex and insula. These areas help individuals automatically imagine themselves experiencing what they witness others experiencing. It should be noted that the studies of mirror neurons in humans are preliminary and not without controversy.
The posterior portions of the superior temporal sulcus have similar activities. This region activates when witnessing social behavior and predicting future actions. When a figure is walking toward you, activation of the superior temporal sulcus is greater when the figure is looking at you, which indicates the prospect of an upcoming interaction. Activation also increases when the other person’s behavior is different than expected.
In a study by Wyk and colleagues,10 an actor displayed pleasure or disgust to one of two identical objects and then randomly picked up one of the objects. When there was incongruent action (picking the object after showing disgust or not picking the object after a display of pleasure), there was increased activity in the observer’s posterior superior temporal sulcus region.
Experiencing empathy appears to require proper activation of portions of the insula and anterior cingulate cortex as we seek to understand the emotional experience of others. A properly functioning posterior superior temporal sulcus allows us to determine and predict the social actions of others, and will tend to activate when someone violates societal expectations.
Oxytocin and arginine vasopressin are also implicated in empathy. A study of polymorphisms in the genes of 367 young adults found that variations in the emotional aspect of empathy were associated with the oxytocin receptor gene, while the cognitive aspect of empathy was associated with the gene for the arginine vasopressin 1a receptor.11 A highly complex interaction of neurotransmitters and brain activation allows the therapist to understand the patient’s experience (Table 2).
Early in the 20th century Cajal proposed that the brain stored information by modifying neuronal connections. Learning involved changing individual neurons and their connections with each other. In the mid-20th century Hebb proposed his rule stating that when one neuron’s repeated excitation is involved in the excitation of a neighboring neuron, the connection between the two of them grows more efficient. Put colloquially, “Neurons that fire together wire together.” This implies that synapses change over time.
The first demonstration of this in the hippocampus occurred in 1973. After exposing neurons to strong, high-frequency stimulation, their connection to other neurons in the hippocampus became stronger.12 The discovery of hippocampal neurogenesis established the process of neuronal plasticity and upended the long-held belief that CNS cells were neurophysiologically and neuroanatomically incapable of growth.
Using the California sea slug (Aplysia californica), Kandel13 demonstrated that habituation—a decrease in response to a stimulus—could be attained with a single training session of 10 stimulations. These effects lasted minutes to hours and appeared to be a result of changes in the amount of neurotransmitter released with the stimulation. Training sessions on 4 consecutive days resulted in an effect that lasted weeks. This long-term learning was associated with changes in interneuronal connections.
Preliminary studies in humans have found measurable changes in the brain based on learning stemming from juggling and playing video games.14,15 Experimental data demonstrate that the neurons in the brain are capable of learning-induced change. Psychotherapy includes components of experiential and didactic learning that is expected to create change in the patient’s brain. Many psychotherapies focus on thoughts or patterns that are initially outside the awareness of the patient. Therapy creates new memories to modify older, dysfunctional ones and in some cases creates new psychic structures. This learning must involve changes in interneuronal connections (Table 3).
Patients in psychotherapy are taught to understand, accept, or manage their emotional responses in new ways. Researchers are looking into how emotion regulation modifies brain activity. One common strategy for altering emotions is reappraisal, when the individual deliberately tries to alter the meaning or relevance of an event. Reappraisal strategies link cognitive control with emotional experience. Attempts to deliberately decrease aversive emotions, sadness, and sexual arousal through cognitive reappraisal have found that reappraisal strategies most commonly activate multiple areas within the prefrontal cortex and posterior parietal cortex. Activation of these areas during reappraisal leads to decreased activity in portions of the amygdala. These studies have demonstrated specific neuronal circuitry, for example, between the hippocampus, prefrontal cortex, and amygdala, which are strengthened by psychotherapeutic treatment.16,17
Dr Welton is Associate Professor of Psychiatry and Director of Residency Training and Dr Kay is Emeritus Professor of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, OH. The authors report no conflicts of interest concerning the subject matter of this article.
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