Neural Substrates of Psychotherapeutic Change Part II: Beyond Default Mode

Abstract

<p>The development of advanced brains that support transcendence of appetitive urges to satisfy higher-order demands was motivated by strong evolutionary pressures. The unrestrained pursuit of salient stimuli to serve internal drives is not adaptive in a danger-filled world. In addition, the ability to postpone gratification on the basis of context is essential to the development of social groups. For example, the lowest animals in a social hierarchy must wait to eat until more dominant members of the social group are sated. To make such advanced behaviors possible, special circuits evolved to modulate the internal urges and narrow external focus induced by the reward system. These circuits, whose major components are located in the prefrontal cortex, promote the pursuit of reward in a manner that is consistent with contextual considerations, learned rules, and a vision of the future.</p> <h4>ABOUT THE AUTHORS</h4> <p>Dr. Viamontes is regional medical director, United Behavioral Health Inc., St. Louis, MO, and assistant clinical professor, Department of Psychiatry, University of Missouri – Columbia, Columbia, MO. Dr. Beitman is professor and chair, Department of Psychiatry, University of Missouri – Columbia.</p> <p>Address reprint requests to: George I. Viamontes, MD, PhD, Regional Medical Director, UBH, 13655 Riverport Dr., 4th Floor, St. Louis, MO 63043; or e-mail <a href="mailto:viamonte@sbcglobal.net">viamonte@sbcglobal.net</a>.</p> <p>The authors disclosed no relevant financial relationships.</p>