The social brain and heart rate variability: Implications for psychotherapy

Abstract

Purpose. Humans evolved within the mammalian line as a highly social species. Indeed, sociality has been a major driver of human social intelligence. From birth, social relationships have emotional and self-regulating properties and operate through different body systems. This paper will explore how heart rate variability (HRV), an index of the vagal regulation of the heart and a central element of the physiological underpinnings of sociality, is related to mental health problems, with important implications for psychotherapy.Methods. We conducted a narrative review of the literature on the bi-directional links between prosocial motivations, HRV, and psychophysiological functioning.Results. HRV is associated not only with the ability to downregulate physiological arousal, but also with a variety of psychological and behavioural variables which are usually the target of psychotherapeutic interventions. A modern neurovisceral integration model can be employed to explain the complex intercorrelation between HRV and psychophysiological functioning. In particular, the link between HRV, the experience of inter-and intrapersonal safeness, and the inhibitory function of the prefrontal cortex will be explored in the context of prosocial motives, such as compassion, that alleviate and help prevent mental health difficulties.Conclusions. Our knowledge of the social brain and its physiological underpinnings might influence important elements of a therapeutic intervention, from the initial assessment of patient's difficulties to the evaluation of therapy outcomes. Practitioner pointsSocial relationships have emotional and self-regulating properties. The experience of inter-and intrapersonal safeness is connected to prosocial motives, such as compassion, and the inhibitory function of the prefrontal cortex. Social relationships and compassion influence different body systems, such as the vagus nerve. Many forms of psychopathology represent the activation of evolved, defensive strategies especially in contexts where there are few stimuli indicating safeness and social support. Heart rate variability predicts psychotherapy outcome.

Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial approach

“…Figure offers a simplified way to conceptualize the interplay of these two social mentalities for therapy, and how they might be measured. Also how to help people balance their social mentalities by, for example, reducing the harmful aspects of competitiveness and increasing the health benefits of compassion and prosociality (Petrocchi & Cheli, ).…”

“…It is not negative self‐evaluation itself that causes mental health problems, it is the underlying (evolved) motivational and emotion systems that are linked to fears of exclusion, rejection, and isolation, which have physiological consequences (Gilbert, , ). Helping people to switch into a caring and compassion focused social mentality to themselves and others has far‐reaching effects on a range of physiological systems (Petrocchi & Cheli, ; Weng, Lapate, Stodola, Rogers, & Davidson, ; Weng et al ., ).…”

“You are already all you need to be”: A case illustration of compassion‐focused therapy for shame and perfectionism

“…CFT uses breathing practices, friendly voice tones, facial and body expressions, and imagery practices, that focus on activating and developing soothing-affiliative processing systems (e.g., parasympathetic system) that facilitate the regulation of affect (e.g., downregulation of the threat system), and help soothe and calm individuals when distressed (Gilbert, 2010(Gilbert, , 2014. Extensive studies on HRV and the physiological underpinnings of social brain/motives have empirically supported the CFT model and its practices (Di Bello et al, 2020;Matos et al, 2017;Petrocchi, & Cheli, 2019). CFT also includes psychoeducation and focuses on helping people understand that the way that the human brain has evolved makes us vulnerable to negativity bias, self-critical self-monitoring, fearful imagining, and rumination.…”

Building an integrative science for psychotherapy for the 21st century: Preface and introduction

“…These are crucial issues to get out of old fashion, Descartian dualism and think about bodies, minds, and contexts as integrated systems (see Siegel, ). Hence, future therapies will involve helping people develop the physiological infrastructures they need (e.g., frontal cortical and vagus competencies) to engage in their psychological journey and create better integrated flexible minds (Petrocchi & Cheli ; Siegel, ). One of the reasons psychotherapies may do poorly is that little attention has been given to developing client's physiological competencies and infrastructures needed for psychological flexibility; indeed, this is one reason why compassion‐focused therapy spends so much time on compassionate mind training as a way of developing these competencies (Kirby, Doty, Petrocchi, & Gilbert, ).…”

“…This indicates another challenge, which we have been implying all through this paper, that we cannot understand the causes, relief, and prevention of mental health problems by only looking at a limited number of specific processes, internal to the minds of those who suffer. There is increasing recognition that mental states are final common pathways of multiple complex interacting processes requiring evolutionary rooted, integrative biopsychosocial models (Gilbert, 1989/2016; Rutter, ; Siegel, ; Petrocchi & Cheli, ). These require a broader, integrative cross‐discipline science (Henriques, ), which Wilson () called consilience (Siegel, ).…”