"Surprise" and the Bayesian Brain: Implications for Psychotherapy Theory and Practice.

Jeremy Holmes,Tobias Nolte

doi:10.3389/fpsyg.2019.00592

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 FEP parallels with psychoanalytic theory are outlined, including Freud’s unpublished project, Bion’s “contact barrier” concept, the Fonagy/Target model of sexuality, Laplanche’s therapist as “enigmatic signifier,” and the role of projective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.

Highlights

It has been established beyond doubt that psychodynamic psychotherapy “works” (Leichsenring, 2008; Shedler, 2010; Leichsenring et al, 2015; Taylor, 2015)
Our approach is based on the “free energy” (FE) principle developed by Friston as one formulation of “the Bayesian Brain” (Friston, 2010; Hobson and Friston, 2012; Hohwy, 2013; Friston and Frith, 2015; Hopkins, 2016)
The discrepancy between these top-down predictions and the actuality–and accuracy–of bottom-up sensations is “prediction error.”. These unavoidable “errors” are “minimized” by converting prior beliefs into posteriors4. This process of Bayesian inference simulates past experience and ensures posterior beliefs align with newly sampled data

Summary

Introduction

It has been established beyond doubt that psychodynamic psychotherapy “works” (Leichsenring, 2008; Shedler, 2010; Leichsenring et al, 2015; Taylor, 2015). Friston presupposes that the brain’s aim, like that of the organism as a whole, is to maintain homeostasis and resist the entropic forces of chaos and homogenization. To do this we–along with our fellow living creatures–need information about the environment, our place within it, and the likely outcomes of our actions. These unavoidable “errors” are “minimized” by converting prior beliefs into posteriors (i.e., the newly assigned probability after the relevant evidence, the observed data, is taken into account) This process of Bayesian inference simulates past experience and ensures posterior beliefs align with newly sampled data

Objectives

Conclusion