The Affect Avoidance Framework adopts a modern view of mind to make lucid the problems psychotherapy is designed to treat as well as precisely how words and human interaction can produce enduring change. Today I’ve made a substantial addition to a previously shared diagram. It’s the inclusion of the last of the three known change mechanisms underlying all psychotherapies. In this post I want to focus first on two important aspects of psychotherapy’s infrastructure, then summarize the three change processes. First, I’ll talk about the nature of “limbic emotion,” then list the “products” of the limbic problem solver, and finally the three change mechanisms.
It’s not the first time I’ve talked about how the limbic system tells the mind it needs to attend to a danger, but it can't be underemphasized as the essential link in the causation of the problems that clinical therapists deal with. Limbic emotion is the best term I have found to describe the neural activation of areas in the amygdala and other limbic structures that trigger the avoidant maladaptive responses that therapy aims to change. I call it “emotion” because when animals and babies have those kinds of activations, we think of them as having emotions. What is really happening is that “limbic emotion” is triggering a response in the form of involuntary bodily changes and automatic actions. As adults, we identify those in ourselves, animals, and babies, as emotion. The adult human version carries a lot more complexity in the form of associations and meanings attached to the raw experience, while, in animals and babies, we see a relatively pure response to “limbic emotion.”
Limbic emotion is important to therapists because this is the single link that connects appraised circumstances to the responses that are of clinical concern to us. That link is at the center of therapeutic change. Furthermore, as evolution has shaped the brain for protection, the goal of the mind’s responses is to lower the volume on limbic emotion and only indirectly to protect. For techies, that’s a negative feedback loop, known to bring stability to a system. For our mammalian relatives, it works just fine because flight, fight, and freeze are what is needed for survival. For humans, the same system gets reused in the context of our complex, socially oriented lives, and that doesn’t always work so well. For example, public speaking is often good for us, yet many people’s problem solving inner mind treats it as a dangerous activity and sets off limbic emotion. Rather than assessing the overall benefit, the mind responds in a way designed to lower the alarm signal. It does so by motivating us to avoid the opportunity to speak. Limbic emotion is the central focus of the "Affect Avoidance Framework."
Psychotherapy seeks to reduce or eliminate maladaptive avoidance of limbic emotion through mindful acceptance and by encouraging adoption of more effective coping strategies.
Products of the inner problem-solving mind
To understand the information processing system we are working with, we need to know its inputs and outputs. The inner mind processes all forms of information, emotions, associations, vague senses of things, words, etc., and relates them to past experience and built in sensitivities to predict threats. Threats are signaled by activation of limbic emotion and trigger a response, which may be less than desirable. Let’s look at the composition of those responses
The important point, here is that this “inner child” (since the logic it uses tends to be binary) has limited tools at its disposal. They are depicted in the mirror part of the diagram, chosen to symbolize consciousness. They include spontaneous bodily changes such as tears and sighs that we experience in common with animals and children. They can also include semi-voluntary actions like crying out or even attacking. In addition, arising into consciousness are automatic thoughts, conscious feelings, and impulses to do something. These conscious contents can influence voluntary decision making and lead to further maladaptive choices.
In particular, this is the domain of the ABC theory of behaviorism, where Antecedents interact with Beliefs to produce choices that have Consequences. CBT doesn’t always acknowledge the purposefulness of automatic thoughts, feelings, impulses, and implicit beliefs, but even in behaviorally oriented therapies, change may happen at the level of infrastructure as well as conscious free will.
Armed with clarity about the products of the inner problem solving mind, we can then raise questions about the implicit beliefs and values that have shaped the interpretation of data and inquire about the specific limbic emotion driving a response we would like to change. These are forms of “reverse engineering,” asking about the problem a response is designed to solve. That curiosity is of practical use in crafting a disconfirming message that will speak to the inner mind and lead to change.
Three Change Processes
In the diagram, change processes are shown in red. The new addition is a change mechanism that has been part of the Affect Avoidance Framework for some time, new learning. I am increasingly aware of how often gains in therapy come from acquiring a new narrative, internalizing a new value system or acquiring new skills. These are all components of new response patterns that initially compete with old ones and will hopefully replace them. What makes new learning distinct is that the old pattern stays accessible and can return under particular circumstances. That is different from memory reconsolidation, where the old pattern is at least partially erased and is no longer part of the mind’s repertoire. It is also different from extinction, in which the response is inhibited but only temporarily, because the danger signal, the limbic emotion, remains unchanged. That’s why new learning belongs in the diagram as a way of adding new, healthier coping to the mind’s collection of available patterns of response.
Jeffery Smith MD
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Diagram and text ©Howtherapyworks.com 2023
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