What is Wellbeing? There are actually many definitions in the literature.
Some are very simple, some are more complex, but in the past they have
all been based on traits an individual possesses such as being self
directed or cooperative or self-transcended. Now there is a more precise
and elegant definition of wellbeing that comes to us from neuroscience.
Dr. Dan Siegel in his new book, The Mindful Brain, defines what he calls
the triangle of wellbeing which helps us understand wellbeing from the
perspective of the emotional brain and neurobiology. In order to have
well being, one must have a coherent mind, empathic relationships and
neural integration. What does this mean? It means that what we must
work towards as individuals and mental health professionals is to calm
the mind through meditation and other methods that help to reduce chatter
and heal emotional trauma. It means that we need to work towards helping
people feel more secure and safe in their intimate relationships. It
means we need to help them develop more empathy for significant others
and themselves. It means that we must help people toward what Dr. Siegel
describes as neural integration. These three aspects of wellbeing are
mutually reinforcing. The triangle of wellbeing is what most psychotherapists
have always strived to help patients achieve. Now we have confirmation
from studies of the brain that these three aspects create wellbeing
Neural integration is probably the aspect of wellbeing that is the least
self evident and the most difficult to understand. So I will attempt
here to describe what it is and how it helps us. As our brain develops,
neurons connect into neural networks that become more and more specialized.
These networks become highly differentiated. This is a good thing because
it allows us to use various parts of our brain to accomplish all kinds
of tasks, to store memories, to recognize our emotions. Neural integration
links the differentiated components of our brain, the neuron networks,
into a functional whole. An integrated mind creates a sense of coherence
and continuity. So when those neuron networks which are specifically
dedicated to emotion, cognition, sensation and behavior communicate
with one another, emotional wellbeing is promoted.
Emotion is a central integrating process in the brain that links the
internal and interpersonal worlds of the mind. An individual’s
ability to organize emotion directly shapes the ability of the mind
to integrate experience and adapt to stressors. Therefore being able
to organize our emotions promotes affect regulation. Dr. Siegel uses
an acronym to help us understand the characteristics of a mind that
is functionally linked, “F.A.C.E.S.” Minds that are integrated
have these characteristics; they are F-flexible, A-adaptive, C-coherent,
E-energized and S-stable. When there is integration, coherence is achieved.
In other words we can use our brains most effectively.
Psychopathology, on the other hand, is a reflection of suboptimal integration
and coordination of neuron networks. There are many problems that can
cause our brains to lack integration. There can be difficulties in early
caretaking, genetic and biological vulnerabilities or trauma at any
time during the lifespan that can result in lack of integration among
neuron networks. When we have unresolved trauma, it can cause us to
have deficits in the way we process information which disrupts integrated
neural processing. Psychopathology does not exist in any particular
area of the brain. Rather, it is the result of dysfunctional interactions
among participating neural systems. Specifically, brains are either
too rigid in the way they process information or too chaotic. There
is no flexibility of response. A person whose brain tends to rigidity
would have difficulty adapting to new situations and information. A
person whose brain tends to chaos would not be able to tolerate stressful
situations very well without becoming overly anxious or emotionally
activated in some dysfunctional way.
There are nine domains of integration that are related to the emotional
brain. I will discuss each separately. But all are conceived as being
integrated into a whole.
Integration of Consciousness: This is the first task
for any psychotherapist. It is the heart of wellbeing. It involves linking
things together in time and space. The state of consciousness allows
sensation, observation, conceptualization, and knowing. It leads to
an enhancement of emotional self regulation. When people come to therapy,
they often have very little understanding of why they are thinking,
feelings and/or behaving in ways that don’t work for them in their
lives. For example, a couple came to therapy because the new husband
wasn’t able to get along with his stepsons. His father had been
very strict and unyielding with him and he had rebelled, dropping out
of high school and getting into drugs and alcohol. He had never processed
any of his feelings about his father or understood how his self destructive
behavior was related to his father’s treatment of him. So when
he was confronted with three teenage boys, he became as inflexible as
his father, projecting onto the boys all his unresolved and unintegrated
feelings of self loathing.
Vertical Integration: The way in which circuits are
brought together from head to toe. This is the mind/body connection.
Input from the body is brought through the spinal cord and bloodstream
into various areas of the brain to form a vertically integrated circuit.
Bodily states directly shape our feelings which then influence our reasoning
and decision making. For example, a woman I was seeing for therapy kept
complaining that she felt excessively guilty about smoking and didn’t
know why. She would smoke in secret and then hide the fact from her
husband. When we explored how she felt while smoking, she was able to
relate it to feelings in her body that were evoked when her father who
was angry, unpredictable and abusive would come home from work. The
rest of the family would make themselves scarce. She described the feeling
as her “I’m in trouble.” feeling. So whenever she
smokes that early traumatic, “I’m in trouble” feeling
would come up viscerally from her body and she would admonish herself
Horizontal Integration: Our brains are highly specialized,
especially the frontal lobes. The cerebral cortex which is where we
do most of our higher level thinking is divided into two hemispheres
that have different functions. The right cerebral cortex develops first
and registers sensory impressions and feelings. It is nonverbal and
includes the capacities to sense another person’s emotions, to
understand another’s mind and to express one’s emotions
via facial expressions and tone of voice. The left brain comes on board
later and specializes in linguistics, linearity, logic and literal thinking.
It is the verbal side of the brain. The left brain explicates what the
right brain is feeling when the two sides are integrated. If they are
not integrated, an individual will have a very hard time expressing
and analyzing verbally what he or she is feeling. For example, a patient
of mine grew up in a family in which no one ever acknowledged, monitored
or discussed his feelings. So when at eighteen years old his parents
divorced, he was not able to process verbally and analytically the feelings
he was having. Instead he married three times in quick succession possibly
trying to find some security after his own family disintegrated. But
he was never able to articulate what he felt about the divorce and how
it affected him.
Memory Integration: This type of integration allows
for the reflection on feelings and impressions from the right nonverbal
part of the brain. Early feelings and impressions that are stored in
the right brain become accessible to verbal memory which is a function
of the left brain. The perceptions, feelings, bodily sensations and
behavioral impulses coming from the right brain are woven together with
our verbal and analytical processes to produce new understanding of
what happened to us and how it affected us. This type of integration
may be of greatest importance in the resolution of trauma. Another patient
of mine was having panic attacks when his girlfriend and he were arguing.
He was terrified that she would leave him but he had no idea why this
affected him so intensely. As we began to explore his background he
could hardly remember anything that happened to him as a child or teenager.
So I asked him to ask his mother. She told him that when he was about
sixteen years old, his father, now deceased, had been drinking heavily
and attempted suicide. My patient was the one who found him and took
him to the hospital. He had no memory of the event until his mother
reminded him. This is an excellent example of how lack of memory integration
affected this man’s ability to tolerate threats of separation
Narrative Integration: The creation of a life narrative
involves having a sense of self that is able to observe and comment
on past events. Narrative integration allows us to weave together the
story of our lives into a coherent whole. A coherent narrative is a
story that makes sense of our lives in a deep and emotionally connected
way. Research has shown that people who are able to develop a coherent
narrative have more secure and emotionally healthy children. They have
a greater capacity for empathy possibly because they understand how
childhood experiences affected them and recognize what they want to
do or don’t want to do when raising their children. Many adopted
children struggle with their identity in adolescence because they are
missing important information about their birth parents that would help
them make sense of who they are and why they feel the way they do.
State Integration: A state of mind is a cluster of
neural firing patterns that have a transient but potent quality to them
in the moment. Self states are enduring patterns of firing clusters.
We have many aspects of self such as the self that reads a book, makes
love, takes care of children or is an employee. Each has a history with
rules and memories attached to them for that state of mind. Pathological
states of mind may force the system into chaos or rigidity which limits
the movement of the system as a whole toward adaptation to the environment.
Being aware of our states of mind allows us to understand our intentions.
It is intention which integrates emotions and thought. Stable systemic
coherence across self states is one of the central goals of emotional
development and self regulation. Children who are emotionally neglected
develop a state of mind about relationship that protects them from the
pain of asking for comfort and being rejected. But it creates rigidity
about the value of relationship. These children often grow up devaluing
relationship and focusing on other things like sports, academic achievement
and hobbies. When they marry, they tend to be emotionally neglectful
of their spouses and children. Even when spouses complain, they cannot
change their behavior.
Temporal Integration: Learning to live with the awareness
of our own mortality and the transience of time is an important aspect
of emotional wellbeing. There are three major aspects of time that are
significant: uncertainty about the future, the impermanence of our lives
and the reality of death. Religion and meditation promote temporal integration
by allowing people to gain awareness of and have acceptance for our
existential fears. A young woman I was seeing in therapy had lost her
mother to cancer the year before our sessions. She was at this time
still living with her stepfather even though she had a very well paying
job. They had left the house exactly as her mother had decorated it.
They were celebrating her mother’s birthday and the holidays exactly
as they had when her mother was alive. This young woman was deeply depressed
and felt very guilty that she had not done more for her mother when
she was dying. But as we talked, it became clear that her mother had
not been willing to accept her impending death. So she had not prepared
any of her loved ones. She would not talk about dying or plan for their
welfare. She did not even leave a will although she was ill for several
years. When she did die, they were devastated and unable to process
Interpersonal Integration: Parents who are available,
responsive and reliable promote the growth of integrative fibers in
their children which connect autonomous areas of neuron networks to
each other. An attuned state is an alignment with another human being
on an emotional level. It is being able to understand how another person
feels. When children have parents who provide this kind of attunement
to their emotional needs, they develop empathy for themselves and others.
This serves them well in their significant relationships. In severe
neglect, the integrative fibers are damaged and integration on many
levels is impaired. Children who are abused also develop various deficits
some of which are related to how they regulate affect. Attunement is
a necessary aspect of the therapeutic alliance. It involves a right
brain to right brain connection. Being able to sense how another is
feeling is a crucial aspect of psychotherapy. Without it, there usually
is little progress that can be made because lack of attunement would
interfere with most aspects of neural integration.
Transpiration Integration: This is the outcome of all
the other types of integration. It involves the feeling that the person
is a part of a much larger whole. People feel a sense of connection
not only to other people but to a greater good. This is often spoken
of when individuals reach deeper levels of meditation and as an aspect
of enlightenment. But it can probably also be achieved when therapy
is successful in helping people with neural integration which results
in compassion for themselves and others.
In this new definition of wellbeing, psychotherapy can be understood
to enhance the growth of neurons and the integration of neural networks
in several ways. The primary focus of psychotherapy is between networks
of affect and cognitions. Individuals gain new information and experiences
across domains of cognition, emotion, sensation and behavior. Psychotherapy
establishes a safe and trusting relationship. It attempts to create
an empathic relationship in which the therapist is deeply attuned to
the feelings and emotional needs of the patient. It allows for moderate
levels of stress or emotional arousal alternating with periods of calm
and safety. This avoids retraumatization and the lack of integration
that is an outcome of trauma. It promotes the integration of conceptual
knowledge with emotional and bodily experience through narratives that
are con-constructed with the therapist. It helps individuals develop
a method of processing and organizing new experiences so as to continue
ongoing growth and integration outside of therapy.
Cozolino, Louis; The Neuroscience of Psychotherapy, (2002)
W,\.W. Norton and Company, New York, New York.
Main, Mary; The Organized Categories of Infant, Child and Adult Attachment:
Flexible vs. Inflexible Attention Under Attachment-Related Stress, in
Attachment: From Early Childhood Through the Lifespan, UCLA
Extension and the Lifespan Learning Institute, March 9-10, 2002, Los
Siegel, Daniel; The Developing Mind: Toward a Neurobiology of Interpersonal
Experience, (1999), Guilford Press, New York, New York.
Siegel, Daniel; The Mindful Brain: Reflection and Attunement in
the Cultivation of Well-Being, (2007), W.W. Norton & Company,
New York, New York.
The author of this article, and founder of the Therapyinla.com website, Joyce Parker, passed away in 2011. To honor her we are keeping her articles posted at this website.