Tullio Scrimali - Neuroscience-Based Cognitive Therapy: New Methods for Assessment, Treatment and Self-Regulation

This edition first published 2012
2012 John Wiley & Sons, Ltd.

This book is a revised and extended version of: Scrimali, Tullio (2010) Neuroscienze e Psicologia Clinica. Dal Laboratorio di Ricerca al Setting con i Pazienti . Milano: FrancoAngeli.

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Library of Congress Cataloging-in-Publication Data

Scrimali, Tullio.
[Neuroscienze e psicologia clinica. English]
Neuroscience-based cognitive therapy : new methods for assessment, treatment, and self-regulation / Tullio Scrimali.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-119-99375-9 (hardback) ISBN 978-1-119-99374-2 (pbk.)
I. Title.
[DNLM: 1. Cognitive Therapymethods. 2. Mental Processesphysiology. 3. Neurosciencesmethods. 4. Psychophysiology. WM 425.5.C6]
616.891425dc23
2011053427

A catalogue record for this book is available from the British Library.

This monograph is dedicated to my wife Wiola, Star of the East , who decided to share her life with me, without regard for common sense or any apparent logic. In this case, the most intense emotion, that of love, took charge and overcame all rational knowledge.

All our knowledge has its origins in emotions

Leonardo da Vinci

Foreword by Arthur Freeman

In the late 1880s, an obscure Viennese physician began his scientific work in neurology by studying the phylogenetic association between the central nervous systems of lower vertebrates and humans. He gained moderate success as a basic science researcher, even developing a gold chloride stain for nerve tissue. His goal was simple: he wanted an academic career that would allow him to study and teach about neurological disorders in lower vertebrates and in humans. His earliest publications were on basic neuroanatomy but ultimately evolved into his studies and publications on infantile and child cerebral paralysis. His plans for an academic career were, however, not to be fulfilled, for a variety of reasons. A mentor suggested that this young man look elsewhere for a career. With a growing family and the need to support them, this physician, one Sigismund Freud, began to treat a variety of disorders that he judged, at the time, to be neurologically based. Although Freud's work over the years encompassed his views on religion, anthropology, psychology, and psychopathology, his neurological interests and roots were always a backdrop for his thinking. Cozolino (2010, p.1) quotes Freud: We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.

The rest we know to be history. Freud's psychotherapeutic insights and developments became the basis for some of the most brilliant, controversial, and illuminating psychological work of the twentieth century. Freud's legacy continues today and has been the basis for all contemporary psychotherapy, whether its models were developed to support or oppose his ideas of the origins of psychopathology and the treatment of those nervous disorders.

Though there were opposing voices to Freud's in the early twentieth century (functionalism, gestaltism, introspectionism, and behaviorism), they did not carry the weight, or influence philosophy, medicine, sociology, or even religion, to the same degree and with the same power that Freud did. Freud's journey was, however, not an easy one. As he explored possibilities regarding the etiology of psychopathology, he ran afoul of the psychiatric establishment, who believed his theories to be unsavory (e.g., those regarding infantile sexuality), and the psychological establishment, who rejected his ideas because they were derived from clinical observation rather than experimental data.

Starting in the 1930s, a significant movement emerged in psychology that focused on directed behavioral change. Salter, Jacobson, and others experimented and treated a broad range of emotional/behavioral disorders with direct interventions designed to alter behavior. Their seminal work was derided by the psychoanalytic establishment as simplistic and nave. The behavioral group did not address the basic (and hypothesized) core unconscious conflicts that were believed by the psychoanalytic group to be the key issues in the development and maintenance of psychopathology. If one looks at the first two volumes of the Diagnostic and Statistical Manual (DSM-I, 1952; and DSM-II, 1968), the influence of psychoanalytic thinking is clear and abundant. Behavioral descriptions, much less targets, were all but missing. Neurological etiology was barely evident.

The behavioral work of the early pioneers laid the foundation for the growth of a behavioral focus in psychology in the 1950s and 1960s. Joseph Wolpe and later Arnold A. Lazarus began treating patients with behavioral technology. Although trained in a psychoanalytic model, Wolpe made brilliant observations regarding the obvious. If an individual were anxious, they were hard-pressed to be calm. Conversely, an individual in a state of relaxation would be hard-pressed to experience anxiety. Looked down upon by the psychoanalysts as simplistic and inelegant, these pioneers persisted. Their work, and that of their students and colleagues, can be viewed as the first wave in the growth of contemporary behavioral and cognitive behavioral therapies. In the 1950s another young and unknown physician working in a ward for the neurologically damaged was told that in addition to his neurological training he would also have to seek some training in psychiatry. This was not something that he wanted to do, inasmuch as he saw psychiatry at that time as far too soft and unscientific. This young doctor, one Aaron T. Beck, has gone on to rival Freud as a major proponent of a new model of psychotherapy. This model, based, in part, on Beck's psychoanalytic training, marked the beginning of the second wave of cognitive behavioral therapy (CBT). The addition of a cognitive focus rooted in an information processing model was not new. The ideas that underlay his model were espoused by the Stoic philosophers, many researchers, and clinicians, notably George Kelly and Albert Ellis. In 1977, Michael Mahoney called cognitive therapists the barbarians at the gates of the psychoanalytic establishments. The cognitivists were pounding on the gates and demanding entrance, but in those early days their calls fell on deaf ears. In the twenty-first century, however, cognitive behavioral work is firmly in place well within the establishment, and trying, as is the custom in our field, to deny access to other possible differing treatments. (Our pattern has been that when we as clinicians and researchers perceive someone or something different, we follow the model set up by nomadic tribes centuries ago: we circle our wagons for protection, and then the tribes shoot at each other.)