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Agency in Mental Health Treatment

New York Times article by Prof. Joseph LeDoux describes some of my experience with the application of neuroscience findings in the treatment of anxiety.  Here I expand on some of the points mentioned there.

The article describes neuroscience findings about the importance of agency in learning how to be safe and productive, and in regulating emotional state.

Agency is the sense that one’s actions have impact on the world and that one can influence one’s own mental and emotional state.  This can be impaired by severe symptoms of anxiety, depression, addiction, trauma, and other conditions, where instead one may have the experience of being a passive sufferer of uncontrollable events, moods and emotions.

The importance of agency, or mastery, in mental health treatment is not a novel idea.  However, the findings described by Dr. LeDoux, which is the most recent publication in a line of research that began in his lab in 2000 with the work of  Dr. Karim Nader and colleagues,  highlight the dynamic properties of agency, and its position as an evolved, adaptive feature with clear impact on the behavioral and emotional outcome of fearful experiences.

Inspired in part by this research,  I have found it useful to use cognitive, behavioral, and mindfulness techniques to reinforce the client’s sense of agency in the course of treatment.

Mindfulness techniques have many potential benefits, but one of the most immediate is the strengthening of agency that results from a person’s deliberate use of simple techniques that have a readily experienced, and welcome, effect on mental and emotional state. Though, in the short-term, these effects are generally transient, they nonetheless can provide significant new experiences of one’s ability to regulate mental and emotional state. With this preparation, people develop a greater ability to address problematic habits, responses, and patterns of mind and behavior.

An essential element of learning mindfulness is the training of attention – cultivating an ability to notice how one’s attention can be captured and held by mental events that have an intense emotional charge, and an ability to deliberately place attention on physical sensation as a way to orient to the present moment and displace maladaptive thoughts and emotions from present experience.  This has many potential benefits, including a gradual recalibration of the exaggerated emotional charge of troublesome thoughts.  But even at the beginning of training, this process of attentional control through mindfulness can provide a vivid and convincing experience of how it is possible to have an impact on experience through the deliberate use of simple techniques, even on a “bad day.”