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      “Surprise” and the Bayesian Brain: Implications for Psychotherapy Theory and Practice

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          Abstract

          The free energy principle (FEP) has gained widespread interest and growing acceptance as a new paradigm of brain function, but has had little impact on the theory and practice of psychotherapy. The aim of this paper is to redress this. Brains rely on Bayesian inference during which “bottom-up” sensations are matched with “top-down” predictions. Discrepancies result in “prediction error.” The brain abhors informational “surprise,” which is minimized by (1) action enhancing the statistical likelihood of sensory samples, (2) revising inferences in the light of experience, updating “priors” to reality-aligned “posteriors,” and (3) optimizing the complexity of our generative models of a capricious world. In all three, free energy is converted to bound energy. In psychopathology energy either remains unbound, as in trauma and inhibition of agency, or manifests restricted, anachronistic “top-down” narratives. Psychotherapy fosters client agency, linguistic and practical. Temporary uncoupling bottom-up from top-down automatism and fostering scrutinized simulations sets a number of salutary processes in train. Mentalising enriches Bayesian inference, enabling experience and feeling states to be “metabolized” and assimilated. “Free association” enhances more inclusive sensory sampling, while dream analysis foregrounds salient emotional themes as “attractors.” FEP parallels with psychoanalytic theory are outlined, including Freud’s unpublished project, Bion’s “contact barrier” concept, the Fonagy/Target model of sexuality, Laplanche’s therapist as “enigmatic signifier,” and the role of projective identification. The therapy stimulates patients to become aware of and revise the priors’ they bring to interpersonal experience. In the therapeutic “duet for one,” the energy binding skills and non-partisan stance of the analyst help sufferers face trauma without being overwhelmed by psychic entropy. Overall, the FEP provides a sound theoretical basis for psychotherapy practice, training, and research.

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          Most cited references53

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          Lending a hand: social regulation of the neural response to threat.

          Social contact promotes enhanced health and well-being, likely as a function of the social regulation of emotional responding in the face of various life stressors. For this functional magnetic resonance imaging (fMRI) study, 16 married women were subjected to the threat of electric shock while holding their husband's hand, the hand of an anonymous male experimenter, or no hand at all. Results indicated a pervasive attenuation of activation in the neural systems supporting emotional and behavioral threat responses when the women held their husband's hand. A more limited attenuation of activation in these systems occurred when they held the hand of a stranger. Most strikingly, the effects of spousal hand-holding on neural threat responses varied as a function of marital quality, with higher marital quality predicting less threat-related neural activation in the right anterior insula, superior frontal gyrus, and hypothalamus during spousal, but not stranger, hand-holding.
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            Allostasis: a model of predictive regulation.

            The premise of the standard regulatory model, "homeostasis", is flawed: the goal of regulation is not to preserve constancy of the internal milieu. Rather, it is to continually adjust the milieu to promote survival and reproduction. Regulatory mechanisms need to be efficient, but homeostasis (error-correction by feedback) is inherently inefficient. Thus, although feedbacks are certainly ubiquitous, they could not possibly serve as the primary regulatory mechanism. A newer model, "allostasis", proposes that efficient regulation requires anticipating needs and preparing to satisfy them before they arise. The advantages: (i) errors are reduced in magnitude and frequency; (ii) response capacities of different components are matched -- to prevent bottlenecks and reduce safety factors; (iii) resources are shared between systems to minimize reserve capacities; (iv) errors are remembered and used to reduce future errors. This regulatory strategy requires a dedicated organ, the brain. The brain tracks multitudinous variables and integrates their values with prior knowledge to predict needs and set priorities. The brain coordinates effectors to mobilize resources from modest bodily stores and enforces a system of flexible trade-offs: from each organ according to its ability, to each organ according to its need. The brain also helps regulate the internal milieu by governing anticipatory behavior. Thus, an animal conserves energy by moving to a warmer place - before it cools, and it conserves salt and water by moving to a cooler one before it sweats. The behavioral strategy requires continuously updating a set of specific "shopping lists" that document the growing need for each key component (warmth, food, salt, water). These appetites funnel into a common pathway that employs a "stick" to drive the organism toward filling the need, plus a "carrot" to relax the organism when the need is satisfied. The stick corresponds broadly to the sense of anxiety, and the carrot broadly to the sense of pleasure. This design constrains anxieties to be non-adapting and pleasures to be brief -- fast-adapting -- to make way for the next anxiety. The stick/carrot mechanisms evolved early and expanded so that in humans they govern higher level learning and social organization. Correspondingly, the "funnel" widened to allow innumerable activities and experiences to each provide non-adapting anxieties and brief pleasures, their reward values depending partly on the effort expended. But modern life narrows the variety of small pleasures and reduces effort, thereby reducing their reward value and requiring larger portions for equivalent satisfaction - a cycle that generates addictive behaviors. Homeostasis and allostasis locate pathology at different levels. Homeostasis identifies proximate causes; for example, it attributes essential hypertension to excess salt water in too small a vascular reservoir. Thus it directs pharmacotherapy toward reducing salt and water, expanding the reservoir, and blocking feedbacks that would counteract these measures. Allostasis attributes essential hypertension to the brain. Chronically anticipating a need for higher pressure, the brain mobilizes all the low level mechanisms in concert: kidney to retain salt and water, vascular system to tighten, and salt appetite to rise. Correspondingly, allostasis would direct therapy toward higher levels - to reduce demand and increase sense of control -- so that the brain can down-shift its prediction and relax all the low-level mechanisms in concert. For disorders of addiction homeostasis pursues pharmacological treatments: drugs to treat drug addiction, obesity, and other compulsive behaviors. Allostasis suggests broader approaches - such as re-expanding the range of possible pleasures and providing opportunities to expend effort in their pursuit. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Life as we know it

              This paper presents a heuristic proof (and simulations of a primordial soup) suggesting that life—or biological self-organization—is an inevitable and emergent property of any (ergodic) random dynamical system that possesses a Markov blanket. This conclusion is based on the following arguments: if the coupling among an ensemble of dynamical systems is mediated by short-range forces, then the states of remote systems must be conditionally independent. These independencies induce a Markov blanket that separates internal and external states in a statistical sense. The existence of a Markov blanket means that internal states will appear to minimize a free energy functional of the states of their Markov blanket. Crucially, this is the same quantity that is optimized in Bayesian inference. Therefore, the internal states (and their blanket) will appear to engage in active Bayesian inference. In other words, they will appear to model—and act on—their world to preserve their functional and structural integrity, leading to homoeostasis and a simple form of autopoiesis.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                28 March 2019
                2019
                : 10
                : 592
                Affiliations
                [1] 1 University College London, Anna Freud National Centre for Children and Families , London, United Kingdom
                [2] 2 Department of Psychology, College of Life and Environmental Sciences, University of Exeter , Exeter, United Kingdom
                Author notes

                Edited by: Jim Hopkins, University College London, United Kingdom

                Reviewed by: Patrick Connolly, Hong Kong Shue Yan University, Hong Kong; Tamara Fischmann, International Psychoanalytic University Berlin, Germany

                *Correspondence: Jeremy Holmes, j.a.holmes@ 123456btinternet.com

                This article was submitted to Psychoanalysis and Neuropsychoanalysis, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2019.00592
                6447687
                30984063
                0c1efe15-2698-45d8-96bc-191c3fcd0858
                Copyright © 2019 Holmes and Nolte.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 November 2018
                : 04 March 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 102, Pages: 13, Words: 0
                Funding
                Funded by: Wellcome Trust 10.13039/100010269
                Categories
                Psychology
                Hypothesis and Theory

                Clinical Psychology & Psychiatry
                bayesian brain,psychoanalysis,active inference,psychotherapy,free energy principle,mentalization

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