Psychodrama: neurocognitive bases in the therapeutic process

Old age is the last evolutionary stage in people’s lives, and extends from the age of 65 until we die. According to the National Institute of Statistics, the average life expectancy in 2019 was 80.9 years for men and 86.2 years for women.

In general, cognitive processes decline with age, without reaching levels of severe deterioration as occurs in dementias. This is due to changes in the central nervous system (hereinafter, CNS), which are progressive and begin at birth (Vallejo Ruiloba, 2011). These gradual changes at the brain level are difficult to predict, since there are large interindividual differences and a multitude of variables that exert their effect on the overall cognitive status. For example, according to survival studies (Finch & Tanazi, 1997) there is the influence of three environmental variables (socio-educational level, profession and daily stimulation) on the cognitive functioning of the elderly. Specifically, how differences in these variables require technical adaptation in psychodramatic intervention.

Both sources of influence, genetics and environment, mediate cognitive reserve, which is a protection against brain pathogens, thus hindering the onset of symptoms. Therefore, it is a decisive variable when it comes to suffering from some type of dementia, but not independent, because it depends on genetic and environmental factors.

What are the main impairments?

The most significant impairments that occur in normal aging are: short-term memory; learning potential; attention (visuo-motor speed and working memory); abstract thinking; executive functions; language (comprehensive and expressive).

However, this evolutionary profile of impaired capacities is not universal. There are a number of variables that modulate cognitive functioning and the development of cognitive reserve: socio-educational level, profession and daily stimulation received.

In relation to educational level, studies show that more schooling during life is associated with lower cognitive deficits in old age. The stimulation provided by education favors the connectivity and growth of different neural circuits (González et al., 2013).

On the other hand, the profession exercised in adulthood is also a factor to be taken into account. Professions requiring mathematical, reasoning and language skills are associated with greater maintenance of cognitive processes. On the other hand, people with manual professions have a greater probability of presenting greater deterioration in the above processes.

With respect to the third variable, daily stimulation received, its effect has been related to a better general cognitive status. This happens both in stimulating phases of adulthood and old age (Labra Pérez & Menor, 2014). Daily stimulation has an enhancing effect on cognitive function, as it favors the development of new neural pathways.

How is the therapeutic process carried out?

During the dramatizations, the patient is exposed to a multitude of stimuli (interventions of the auxiliary self, intermediary objects – intra-intermediary, music…) which are not random, but are born from the therapeutic hypotheses of the director.

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The general objective that follows the stimulating presentation is the catharsis of integration on the part of the patient. This is the process by which the patient achieves a double awareness: on stage, experientially and emotionally; and in the audience, integrating what is experienced through language and intellectually. By relating to them through the body, and following a sub-symbolic processing, subcortical circuits are stimulated, both emotional, perceptual and memory-learning. When the therapeutic hypothesis is correct, the activation of these circuits corresponds to the stimulation of mnemic imprints (physiological registers containing information about experiences and emotions associated with them). At first, it facilitates the emotional expression that was felt during the first time, paving the way for, in stages after the therapeutic process, associating them with new emotional responses (through creativity and spontaneity).

For the catharsis of integration to be fully realized, the passage of this experience to cortical areas is necessary. For this reason, a verbal feedback stage is necessary for the person to integrate the experience.

In this sense, people with cortical TNC have singularities in all these physiological processes (perception, emotion and learning-memory), which lead the psychologist to make adaptations in the psychodramatic psychotherapeutic process. In these cases, the pathogens are in cortical areas, affecting the conscious part of all the processes mentioned above. They perceive, remember, learn and feel; although they cannot do so explicitly through language or other forms involving cortical activation. This must be taken into account if we want to carry out an effective therapeutic process.

The implementation of techniques should have the purpose of stimulating subcortical, implicit and subsymbolic processes, which are those that are not sustained in damaged areas. That is, body and emotion. Moreover, this “change of point of view” must be followed in the evaluation of its effectiveness, because it is not possible to observe changes attending to processes such as language, and explicit learning.

For this reason, from a psychodramatic perspective, there is a therapeutic benefit in patients with cortical dementia. Although the emotional work in the scenario does not end with the conscious and cortical integration, there is a complementation at the emotional and subcortical level that allows bringing the emotions to term, and facilitating the emotional stability of the patient, reducing episodes of agitation and wandering, for example. However, these changes are more momentary due to the lack of cortical integration.