Tag: gut-health

TED Series – Part VIII: The Hidden Conversation: How Nutrition Shapes Emotional States

NeuroAffective-CBT by Daniel Mirea


Daniel Mirea (October 2025)
NeuroAffective-CBT® | https://neuroaffectivecbt.com

Abstract

In this eighth instalment of the TED (Tired–Exercise–Diet) Series, we turn to the neuroscience of food and drink, how what we consume shapes emotional regulation, cognitive performance, and overall mental health. Food is not merely fuel; it is information – biochemical data moving continuously from gut to brain and back again, influencing motivation, focus, mood, and even how we learn and relate.

Introducing TED within the NA-CBT® Framework

Within the NeuroAffective-CBT® framework, TED (Tired, Exercise, Diet) functions as the biologically grounded scaffold of self-regulation that stabilises the Body–Brain–Affect triangle. Here, “D” for Diet is not a list of prohibitions or lifestyle prescriptions. It represents a set of neuro-behavioural levers capable of modulating dopamine, serotonin, immune signalling, circadian rhythm, and the vagus-mediated gut–brain axis, the intricate “wiring loom” that connects body and mind (Mirea, 2023; Mirea, 2025).

Earlier instalments in this series examined the key physiological regulators that underlie emotional and cognitive balance:

• Creatine – cellular energy and motivation (Part I)
• Insulin Resistance – metabolic flexibility and mood (Part II)
• Omega-3 Fatty Acids – neuronal membrane integrity (Part III)
• Magnesium – stress buffering and neural inhibition (Part IV)
• Vitamin C – antioxidant defence and neurotransmitter synthesis (Part V)
• Sleep – the neurobiology of fatigue and recovery within the Tired pillar (Part VI)
• Exercise, Sport Science and Movement – strength and resilience (Part VII)

This final chapter focuses on Diet, how nutrition interacts with the emotional brain and how eating can steady the mind, foster neuroplasticity, and restore a coherent dialogue between body and affect. Each meal sends molecular messages, amino acids, fatty acids, micronutrients that speak directly to our emotional circuitry. If sleep restores and movement activates, diet sustains, it provides the biochemical landscape on which both rest and action depend.

Understanding this hidden conversation allows us to view nutrition not as restriction, but as regulation – a way of cultivating emotional steadiness and cognitive vitality through biochemical literacy. Within NeuroAffective-CBT®, such literacy transforms eating from an automatic behaviour into an intentional act of self-alignment.

Important: TED articles complement, not replace, medical advice! Always discuss changes to diet, supplements, or treatment with your GP or qualified health professional.

When Food Became Feeling

The Evolutionary Roots of Emotional Nutrition

The connection between what we eat and how we feel seems obvious at first glance. Food is survival, and the brain, nature’s master regulator of survival, is inevitably obsessed with what we ingest. To keep us alive, it rewards us for consuming what nourishes and warns us against what harms. In that sense, emotions are communication tools: they push or pull us toward or away from things essential to survival. Pleasure tells us to approach; disgust tells us to avoid.

Emotions are central to every moment of our lives, shaping perception, decision, and meaning. Yet despite their importance, few of us truly understand where emotions come from or how deeply they intertwine the brain and body. Emotion is not a phenomenon that happens in the head alone; it is a full-body event, a conversation between neural circuits, hormones, muscles, and sensory organs (Huberman, 2023).

The scientific story of emotion stretches back centuries, from Darwin’s early theories of universal emotional expression to modern neuroscience. Darwin (1872) proposed that emotions evolved as adaptive action programs, biologically embedded to guide behaviour and secure survival. This idea has since found robust confirmation in neuroimaging and behavioural research (Panksepp, 1998).

According to Dr Andrew Huberman, Professor of Neurobiology at Stanford University, the two most robust and universal emotional responses are approach and avoidance. When we encounter something we like for instance, a pleasant smell or taste, the correspondent behaviour is to lean in, inhale, and expand our posture to take in more of it. When we encounter something we dislike, our default behavioural response or instinct is to lean back, turn away, or even hold our breath, a remnant of ancient mechanisms that once protected us from ingesting toxins or inhaling pathogens (Huberman, 2023).

These primitive body movements reflect the underlying logic of emotion itself: a biological push–pull system that regulates approach and aversion. Deep brain structures such as the basal ganglia contain “go” circuits that promote action and “no-go” circuits that inhibit it – mechanisms that operate beneath conscious awareness yet determine much of our emotional behaviour (Mirea, 2023; Huberman, 2023).

From this perspective, emotions are the brain’s predictions about necessary actions in any given moment. They are not arbitrary feelings but dynamic signals that prepare the body to move, toward nourishment or away from threat. Food, therefore, sits precisely at this decision point. Taste, smell, interoception, and posture converge to produce motivation and choice.

Since the dawn of our species, emotion and nourishment have been partners in survival. The infant’s first emotional learning arises through feeding: hunger, relief, pleasure, comfort. Long before we had words, flavour was communication. Even today, every bite still speaks to the nervous system – an unbroken dialogue between physiology and feeling.

In NeuroAffective-CBT®, emotion is described as a body–brain–affect circuit. The body gathers sensory and chemical data; the brain interprets that data into feeling; affect then drives behaviour – approach or avoidance. Food is part of that loop. Each meal is both nutrition and information.

TED Takeaway: We do not just eat to live; we live through what we eat. Food is our first emotional language. Design your environment so that “move-toward” cues lead you to the foods that truly support you. Make the right choice the easy choice!

The Gut: A Second Brain with Its Own Voice

How the Microbiome Speaks the Language of Emotion

Inside your abdomen lives a civilisation of roughly 39 trillion microorganisms, weighing about as much as your brain. Together, they form the gut microbiome, an ecosystem that digests food, manufactures vitamins, regulates immunity, and produces neuroactive chemicals such as serotonin and GABA, both of which directly influence mood, calmness, and emotional tone (Wei et al., 2022; Appleton, 2018).

Astonishingly, about 95% of the body’s serotonin, often called the “happy chemical”, is synthesised not in the brain, but in the gut’s enterochromaffin cells (Wei et al., 2022). When this microbial community thrives, serotonin and GABA levels rise, helping the brain register safety and satisfaction. When inflammation, stress, or poor diet disturb the microbiome, the system tips into imbalance, and emotional symptoms often emerge as irritability, anxiety, or low mood (Appleton, 2018).

This intricate conversation between the gut and the brain travels along the vagus nerve, the body’s longest cranial nerve, connecting the brain to nearly every major organ. It meanders from the brainstem through the chest to the intestines, touching the heart, lungs, and liver along its route. It is, in effect, the biological internet cable linking your internal organs to your emotional life. When the gut releases inflammatory or distress signals, the vagus nerve carries those alarms upward to the brain; when we breathe slowly, hum, sing, or chew mindfully, it transmits calm signals in the opposite direction (Lu et al., 2024).

But this communication is not purely chemical. Within the gut wall lies a network of neuropod cells, remarkable sensory units discovered by Dr Maya Kaelberer and colleagues at Duke University. These cells are equipped with electrical synapses that can detect nutrients such as glucose, amino acids, and fatty acids, and then send rapid signals directly to the brain (within milliseconds), to shape perception, emotion, and appetite (Kaelberer et al., 2018).

This discovery explains why the gut is sometimes referred to as the “second brain.” It does not merely digest; it perceives. The gut continuously samples the external world through food, drink, and bacteria and, informs the brain about what is safe, satisfying, or potentially harmful. It helps explain cravings, aversions, and the emotional resonance of eating. When you enjoy a morning coffee with a biscuit, the gut’s chemical sensors are already communicating with your midbrain reward circuits, producing the pleasurable surge that fuels alertness and comfort.

In NeuroAffective-CBT®, this gut–brain dialogue embodies the biological foundation of interoceptive awareness, also known as, the ability to sense internal bodily states. When we practise mindfulness or direct calm, non-judgemental attention inward, we become more attuned to these subtle signals. Over time, this practice refines emotional regulation by aligning bodily feedback with cognitive understanding (Goldin and Gross, 2010; Mirea, 2024).

From the rectum to the oesophagus, this 9–10 metre canal is not only our largest internal organ but arguably our most socially connected one, continually interpreting the external world through what we ingest and how we feel. As we begin to appreciate this complexity, we can see that mental health is not confined to the brain. It is a networked experience, a dialogue between neurons, microbes, and meaning.

TED Takeaway: When your gut talks, your brain listens. Nourish that conversation!

Good Bacteria, Bad Mood: The Microbiome and Depression

When Emotional Health Depends on Microbial Harmony

The phrase “gut feeling” has never been more literal. In recent years, neuroscience has confirmed what intuition long suspected, that our mental health depends not only on the chemistry of the brain but also on the ecology of the gut. The bacteria, fungi, and viruses that inhabit our intestines do far more than digest food; they influence emotion, immunity, and even identity. When that internal ecosystem becomes imbalanced, mood often follows.

Research has shown that people suffering from depression or chronic anxiety tend to have less diverse gut microbiomes, alongside a higher concentration of bacterial species that produce inflammatory metabolites (Kelly et al., 2016; Foster et al., 2021). These molecules can cross the blood–brain barrier, altering neurotransmitter balance and disrupting neural circuits involved in mood regulation. In a striking series of animal experiments, transferring gut bacteria from a depressed mouse to a healthy one was enough to induce depressive behaviours in the recipient (Zheng et al., 2016).

Early human studies echo these findings. In small clinical trials, faecal microbiota transplants (FMT) from non-depressed donors temporarily improved depressive symptoms in treatment-resistant patients (Valles-Colomer et al., 2019). While the idea of “transplanting happiness” remains more metaphorical than practical, these results demonstrate a powerful biological truth: our emotional wellbeing is influenced by the microbial conversations happening below the diaphragm.

When the microbiome loses diversity, certain gut bacteria begin releasing pro-inflammatory cytokines, immune messengers that signal distress throughout the body. The brain interprets these signals as threat or fatigue, activating neural circuits associated with low mood, lethargy, and loss of pleasure. In this way, inflammation acts as a bridge between gut imbalance and emotional imbalance (Miller and Raison, 2016).

Conversely, cultivating a healthy and varied microbiome supports resilience. Factors that enhance microbial diversity include:

• A fibre-rich, plant-based diet with fermented foods and minimal ultra-processed ingredients.
• Regular aerobic exercise, which increases microbial species richness.
• Consistent sleep patterns, since gut flora follow circadian rhythms of their own.

The connection between gut health and depression is not just theoretical. The landmark SMILES trial (Jacka et al., 2017) demonstrated that a Mediterranean-style diet, rich in whole grains, legumes, vegetables, and olive oil, reduced depressive symptoms by about 30% within twelve weeks. Importantly, these improvements were independent of social support, confirming that what we eat can influence mood directly through biological pathways.

This evolving field, sometimes called nutritional psychiatry, reframes mental health as an ecosystem problem rather than a purely chemical one. As the NeuroAffective-CBT® model suggests, emotional regulation is an embodied skill, a dialogue between body, brain, and affect (Mirea, 2023). The gut microbiome, communicating through the vagus nerve and immune signalling, is an active participant in that dialogue.

When we eat poorly, we’re not just starving our bodies; we’re silencing billions of microscopic allies whose job is to keep our minds in balance. Rebuilding that internal community is therefore not just a digestive act, it is an act of self-care, a physiological form of emotional literacy.

TED Takeaway: A healthy mind begins in a healthy gut. Diversity in your diet builds diversity in your emotions. Feed the bacteria that help you feel alive.

Feeding the Mind from the Inside Out

How Nutrition Speaks the Language of Emotion

If the gut is a second brain, then every meal is a message. What we eat doesn’t just fill us, it informs us, shaping mood, motivation, and resilience through a constant biochemical dialogue between microbes and mind. In the NeuroAffective-CBT® model, this represents the living interface between body, brain, and affect: the nutritional conversation that regulates how we feel and function (Mirea, 2023).

When we eat well, the gut microbiome flourishes. Beneficial bacteria such as Lactobacillus and Bifidobacterium convert dietary fibre and complex carbohydrates into short-chain fatty acids like butyrate, which reduce inflammation and support the integrity of the gut lining (Cryan et al., 2019). These molecules also cross into the bloodstream, where they influence brain chemistry, increasing serotonin and BDNF (brain-derived neurotrophic factor), both critical for stable mood and cognitive flexibility.

By contrast, processed foods rich in refined sugar and saturated fats feed inflammatory microbes, producing cytokines that weaken the gut barrier and signal distress to the brain (Miller and Raison, 2016). The emotional fallout can manifest as irritability, fatigue, and a sense of mental fog – the psychological shadow of biological inflammation.

The Role of Prebiotics and Probiotics

Two categories of food play an especially important role in nurturing the gut–brain connection: prebiotics and probiotics.

Prebiotics are the fibres that feed beneficial bacteria, found abundantly in garlic, onions, oats, bananas, walnuts, and polyphenol-rich foods like olive oil, berries, and red grapes. Regular consumption of these foods maintains a diverse microbial population, strengthening the body’s immune and emotional defences (Gibson et al., 2017).

Probiotics, by contrast, are the bacteria themselves, living microorganisms that, when consumed in sufficient quantities, support the health of the microbiome. These are found in fermented foods such as yoghurt, kefir, sauerkraut, miso, tempeh, and kombucha. When ingested regularly, probiotics can influence the production of neurotransmitters like GABA, the calming chemical that reduces anxiety and promotes relaxation (Sarkar et al., 2016).

Because of their measurable effect on mental health, some clinicians now call these organisms psychobiotics, living agents that support psychological wellbeing through the gut–brain axis (Dinan et al., 2013).

Timing, Movement, and Mindfulness

Timing matters too. Probiotic capsules and fermented foods are most effective when taken on an empty stomach or before a light meal, allowing beneficial bacteria to pass through the stomach’s acidic environment without being destroyed (Appleton, 2018).

Movement also plays a part. Aerobic exercise, brisk walking, cycling, swimming, improves microbial diversity, enhances vagal tone, and increases BDNF, reinforcing both mental and emotional resilience (Biddle et al., 2019). Likewise, consistent sleep supports microbial rhythms that align with the circadian cycle, anchoring energy and emotional stability.

Finally, mindfulness serves as the behavioural amplifier of this entire system. Paying attention to what and how we eat, slowing down, tasting, and breathing, activates the parasympathetic nervous system via the vagus nerve, enhancing digestion and emotional regulation. Mindful eating isn’t a trend; it’s neurobiology in action (Goldin and Gross, 2010).

The Emotional Ecology of Eating

Each meal is both nourishment and feedback. The brain interprets the gut’s chemical and mechanical signals, fullness, acidity, nutrient quality, and translates them into emotion. When the body says safe, the mind feels calm. When the body says threat, the mind feels uneasy. Over time, the foods we choose either reinforce stability or erode it.

In this sense, food is not just nutrition; it’s participation in a living ecosystem, one that rewards diversity, balance, and attention. The microbiome is not a silent partner; it is a dynamic community that mirrors how we live. A chaotic diet creates inner noise. A mindful one restores harmony.

TED Takeaway: Care for your microbes as you would a garden: feed them, move with them, let them rest. They return the favour with energy, clarity, and emotional balance. Mindfulness is not a trend; it’s neurobiology in action.

Diet and Depression: What the SMILES Trial Taught Us

How Food Became a Form of Therapy

For decades, the relationship between food and mood has been treated as secondary, a lifestyle footnote rather than a therapeutic pathway. Yet emerging evidence now places diet at the centre of mental health. The food on your plate can influence neurotransmitters, inflammation, neuroplasticity, and ultimately, your emotional resilience.

The clearest demonstration of this came from Australia in 2017, when Professor Felice Jacka and her team published the landmark SMILES Trial (Supporting the Modification of lifestyle in Lowered Emotional States). The study asked a deceptively simple question:
“Could changing one’s diet treat depression as effectively as conventional therapies?”.

A New Kind of Antidepressant

The researchers recruited adults diagnosed with major depressive disorder and divided them into two groups. One group received regular social support sessions, conversation, connection, and empathy. The other met with a dietitian who guided them through a modified Mediterranean diet, rich in vegetables, fruits, legumes, whole grains, fish, and olive oil, while minimising processed foods, sugar, and refined carbohydrates (Jacka et al., 2017).

After twelve weeks, the results were striking. The diet group showed a 32% reduction in depressive symptoms, compared to only 8% in the social-support group. Roughly one in three participants in the dietary intervention achieved full remission from depression, without medication changes.

Follow-up research (Opie et al., 2018; Lai et al., 2013) replicated these findings: when we nourish the brain with anti-inflammatory foods and micronutrients that enhance serotonin, dopamine, and BDNF, mood stabilises and cognition sharpens. The Mediterranean diet wasn’t simply helping people feel better; it was changing their biology.

Why It Works: Inflammation and Neuroplasticity

The mechanism is now clearer. Diets high in refined sugar, processed fats, and artificial additives trigger systemic inflammation, increasing pro-inflammatory cytokines that interfere with neurotransmitter metabolism (Miller and Raison, 2016). Chronic inflammation dampens neuroplasticity, the brain’s ability to form and strengthen neural connections, especially in regions like the hippocampus and prefrontal cortex, both vital for motivation and emotional regulation.

In contrast, Mediterranean-style diets are anti-inflammatory. They deliver omega-3 fatty acids, polyphenols, antioxidants, folate, and B-vitamins, all of which support synaptic growth, mitochondrial health, and neurotransmitter balance (Marx et al., 2017). Within days, high-quality nutrition can raise levels of BDNF, a protein that acts as fertiliser for neurons, improving learning, memory, and emotional flexibility (André et al., 2008).

In NeuroAffective-CBT®, this biological process mirrors the therapeutic one: both involve rewiring, re-establishing communication between disrupted neural circuits. When inflammation drops and BDNF rises, the emotional brain becomes more responsive to therapy, mindfulness, and behavioural change (Mirea, 2023). Diet doesn’t replace psychotherapy; it prepares the terrain for it.

Food as Behavioural Change

From a behavioural perspective, modifying diet is itself a neuroaffective intervention. Choosing whole foods over processed ones engages the prefrontal cortex, the brain’s executive centre, and strengthens self-regulation circuits. This is the same cognitive–emotional skill that therapy trains: recognising impulses and acting intentionally. Each meal becomes an opportunity to practise regulation, reward delay, and self-care.

Moreover, eating well reinforces a positive feedback loop. Balanced blood sugar and nutrient-rich foods stabilise the autonomic nervous system, calming the vagus nerve and reducing emotional reactivity. Over time, people report not only better mood but also a greater sense of clarity and motivation, biological calm translating into psychological coherence.

The SMILES trial and subsequent studies remind us that emotional healing can begin with something as ordinary as lunch. A colourful plate may be the most accessible form of neurochemistry we possess.

TED Takeaway: Changing what’s on your plate can change what’s on your mind. Food is the most consistent, self-administered antidepressant you’ll ever take.

Inflammation, Neuroplasticity, and the Healing Brain

How the Body’s Chemistry Shapes the Mind’s Resilience

For most of the twentieth century, depression was described as a chemical imbalance, a deficiency of serotonin, dopamine, or noradrenaline that could be corrected with medication. That model helped reduce stigma and offered effective treatments for many, but it left out something crucial: why those chemical imbalances occurred in the first place.

Over the past two decades, neuroscience has reframed this understanding. We now know that depression and anxiety are not simply deficits in neurotransmitters but disorders of connectivity and plasticity. In other words, the problem lies not only in the chemicals themselves, but in the wiring that allows brain cells to communicate (Duman and Duman, 2015; Serafini, 2012).

The Fire Within: How Inflammation Shapes Emotion

Inflammation is the body’s ancient alarm system; a protective mechanism designed to fight infection and heal injury. But when the immune system becomes overactive through chronic stress, poor diet, or environmental toxins, this inflammation becomes systemic. Pro-inflammatory cytokines like IL-6 and TNF-α flood the bloodstream and reach the brain, where they disrupt neurotransmission, reduce serotonin availability, and interfere with energy metabolism in neurons (Miller and Raison, 2016).

This inflammatory “fog” particularly affects the hippocampus and prefrontal cortex, regions crucial for motivation, memory, and self-reflection. Inflammation shrinks dendritic spines, weakens synapses, and slows the birth of new neurons, a process called neurogenesis (Kang et al., 2012). The result is a brain less capable of flexibility, learning, and emotional recovery.

But here lies the hopeful paradox: if the brain can become unwell through maladaptive plasticity, it can also heal through adaptive plasticity. The very circuits that fall silent under inflammation can reignite when nourished, exercised, and engaged through therapy.

Food as Neural Fertiliser

Anti-inflammatory diets, particularly Mediterranean-style nutrition, provide the building blocks for neuroplasticity. Omega-3 fatty acids, B-vitamins, folate, and antioxidants all contribute to the production of Brain-Derived Neurotrophic Factor (BDNF), a protein that promotes the growth and repair of synaptic connections (André et al., 2008).

In both humans and animals, increased BDNF correlates with reduced depressive symptoms and enhanced learning capacity (Duman and Duman, 2015). Even more striking, changes in BDNF can occur within days of improving diet, exercise, or sleep patterns (Serafini, 2012). Antidepressant medications, mindfulness training, and aerobic activity all elevate BDNF through similar pathways, demonstrating that biological and psychological interventions converge on the same neural mechanisms (Yang et al., 2016).

This overlap helps explain why the NeuroAffective-CBT® model emphasises a multi-system approach: emotion, cognition, and physiology are not separate domains but parallel feedback loops. When diet reduces inflammation, therapy becomes more effective. When therapy enhances self-regulation, it reduces physiological stress. The brain heals through both bottom-up and top-down signals, food and thought working in tandem.

The Practice of Rewiring

In clinical terms, neuroplasticity means that the brain can literally change its structure in response to experience. New synapses form as we learn, and old, unused ones dissolve. This principle, “neurons that fire together wire together”, describes both learning and healing.
Every act of mindful eating, exercise, or reframed thought in therapy strengthens certain circuits and weakens others. Over time, these microscopic changes accumulate into a macroscopic shift in emotional stability. Healing is not a switch; it’s a training process, a gradual re-sculpting of the brain’s networks through repeated experience.

From Inflammation to Integration

Understanding depression as an inflammatory and connectivity disorder allows us to see recovery as a process of integration, not correction. The goal is not to “fix” a broken brain but to create the conditions, nutritional, psychological, and relational, in which it can heal itself.

When inflammation subsides, BDNF rises, and neuroplasticity reawakens, the brain regains its natural rhythm of adaptation. The world begins to look different not because it has changed, but because the neural machinery perceiving it has been renewed.

TED Takeaway: Depression isn’t just in your mind it’s in your wiring. Reduce inflammation, nourish your brain, and practise new ways of thinking: that’s how neurons learn hope.

Energy, Glucose, and the Emotional Roller-Coaster

How Blood Sugar Shapes Behaviour and Mood

Every emotion has a metabolic signature. The brain’s ability to focus, regulate mood, or recover from stress depends on a steady supply of energy, and that energy runs almost entirely on glucose. Yet, like a child on a sugar high, our modern diets deliver glucose in erratic bursts rather than balanced waves.
The result is what many of us recognise intuitively: the mid-morning energy crash, the irritability that accompanies hunger, or the brain fog after a sugary lunch. These are not signs of weak willpower but of metabolic turbulence – fluctuations in blood sugar that the brain interprets as emotional instability.

The Brain’s Hunger for Balance

Although the brain represents only about 2% of body weight, it consumes nearly 20% of all glucose available in the bloodstream (Mergenthaler et al., 2013). Because it cannot store much energy, even brief drops in blood sugar can trigger fatigue, distractibility, or irritability. Conversely, sharp glucose spikes from refined carbohydrates or sweetened drinks cause transient dopamine surges followed by cortisol rebounds, leading to the emotional equivalent of a sugar hangover (Ludwig, 2002).

These rapid fluctuations affect the prefrontal cortex – the region responsible for self-control, focus, and emotional regulation. When glucose levels fall too low, this part of the brain becomes less efficient, and impulsive, reactive behaviours take the lead (Gailliot and Baumeister, 2007). In NeuroAffective-CBT® terms, this is when cognitive regulation gives way to affective overwhelm, when physiology outpaces psychology.

The Glucose–Mood Connection

Clinical evidence supports this link. People with insulin resistance or poorly controlled blood sugar show higher rates of depression and anxiety, while those who stabilise glucose through diet and exercise experience improved mood and cognitive function (Luo et al., 2022). Chronic glucose variability increases oxidative stress and inflammatory cytokines, which impair both neuronal health and neurotransmitter balance — especially serotonin and dopamine, the “mood messengers” that govern motivation and reward (Treadway and Zald, 2011).
In practical terms, mood stability often mirrors glucose stability. A diet rich in whole grains, fibre, protein, and healthy fats slows digestion and moderates glucose absorption. This prevents extreme highs and lows, sustaining steady energy to the brain throughout the day. The difference may feel subtle, fewer cravings, clearer thinking, a calmer baseline, but over time, these micro-adjustments translate into significant emotional resilience.

How to Flatten the Curve

Small, mindful habits can smooth the emotional and metabolic roller-coaster:

• Start the day savoury. A protein-based breakfast (e.g., eggs, yoghurt, or nuts) reduces morning glucose spikes and keeps dopamine stable through the first stressors of the day.
• Eat vegetables before starch. Fibre and phytonutrients slow carbohydrate absorption, flattening post-meal glucose peaks (Jovanovic et al., 2009).
• Walk for ten minutes after meals. Even light physical movement enhances insulin sensitivity and improves glucose uptake, translating into a calmer nervous system.
• Avoid “naked carbs.” Pair carbohydrates with protein or fat to delay glucose release and prevent sharp insulin responses.

These strategies are not merely nutritional tricks, they are self-regulation tools. They train the body to maintain equilibrium, and the brain to interpret safety instead of scarcity.

From Sugar Spikes to Emotional Stability

When blood sugar stabilises, the body–brain–affect loop settles into coherence. The vagus nerve signals calm, the limbic system reduces alarm responses, and the prefrontal cortex resumes executive control. In this synchrony, the emotional brain becomes less volatile and more available for reflection, empathy, and learning, the core functions of psychological growth.

From a NeuroAffective-CBT® perspective, managing glucose is a form of embodied mindfulness: paying attention to the body’s energy patterns and adjusting behaviour to sustain internal balance. It’s not a diet; it’s emotional literacy in biochemical form.

TED Takeaway: Flat glucose curves make flat emotional seas. Balance your blood sugar to balance your behaviour, stability in biology creates stability in being.

The Body Remembers What the Mind Forgets

Integration as the Final Language of Healing

By now it is clear that mental health is not confined to the skull. The mind is not a separate entity floating above the body; it is a conversation within it — a continuous feedback loop between cells, organs, microbes, and meaning. Every thought has a heartbeat. Every emotion has a chemical echo.

In NeuroAffective-CBT®, we call this the body–brain–affect triangle, a living system of regulation in which physiology, cognition, and feeling inform one another. When that dialogue is coherent, we experience emotional balance and clarity. When it breaks down through exhaustion, poor diet, or chronic stress, the body begins to speak in symptoms the mind may not yet understand.

The Biology of Memory and Emotion

The body remembers what the mind forgets because experience is not stored in words but in networks: of neurons, hormones, and sensations. Emotional memories, joy, fear, loss, are distributed across the nervous system, woven into posture, breathing, digestion, and sleep. Chronic inflammation, unstable glucose, or poor gut health can reactivate these circuits, producing what feels like psychological distress but is, in fact, physiological dissonance.

Conversely, when we restore the biological foundations of safety, balanced nutrition, restorative sleep, consistent movement, the same networks become available for reprocessing through therapy and reflection. The emotional brain can only heal when the body feels safe enough to listen.

This is why the TED framework (Tired, Exercise, Diet), is more than a lifestyle checklist. It is a neurobiological protocol for emotional coherence. By regulating fatigue, movement, and nutrition, we restore the stability that allows higher cognition – empathy, creativity, and self-awareness, to flourish (Mirea, 2023).

From Self-Regulation to Self-Understanding

Healing begins with self-regulation but matures into self-understanding. Each meal, each breath, each night of sleep becomes a message to the nervous system: You are safe enough to grow. When inflammation recedes, BDNF rises, and neural connections strengthen, therapy deepens. Mindfulness becomes easier. The world feels less like a threat and more like an invitation.

In this light, diet is not only about nutrients; it is about relationship with one’s body, with the environment, and with others. Sharing food, preparing it mindfully, and consuming it with gratitude engage ancient neural pathways of belonging and calm. The microbiome thrives not just on fibre and polyphenols but on human connection itself.

The Integration of Knowing and Feeling

Modern neuroscience and ancient wisdom converge on the same insight: we cannot think our way out of a dysregulated body. Emotional regulation begins in the viscera, in the gut that senses, the heart that signals, the breath that synchronises. The task of psychotherapy, then, is not to escape biology but to integrate it, to build bridges between inner experience and outer awareness.
When the mind listens to the body, and the body trusts the mind, coherence emerges. This is the moment when therapy, nutrition, and neuroscience meet, not as separate disciplines, but as languages of the same truth: that to feel well, we must live in alignment with what our biology has always known.

TED Takeaway: The state of your gut is the tone of your thoughts. Heal one, and the other learns to sing again.

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If my gut could talk to me, what would it say ?

NeuroAffective-CBT by Daniel Mirea

Introducing James…

James is a successful banker enjoying significant authority and respect at work. Being into sports and a healthy lifestyle, he is tall and handsome, he has a beautiful wife and two children. On paper all is well, and so he would be taken by surprise every weekend when visiting his parents’ home for Sunday lunch, by the experience of intense, discomforting, and painful butterflies, in anticipation of this recurring event. He is left confused, without an explanation.

Allowing for an earlier narrative to unfold within the first few hours of therapy, childhood experiences were revealed, where he experienced similar painful feelings, generated by a critical and highly demanding father, the kind of parent that would be difficult to please. His mother never interfered and to James, this was as bad as his father’s attitude. His childhood was dotted with various episodes of unfavourable comparisons with a younger and brighter sister. 

Despite his success and handsome appearance, he sees himself as ugly, unattractive, unwanted, enjoying some professional success through sheer luck, an impostor, and a trickster. He remained hypervigilant throughout the years around his father and eager to be validated. He gets overwhelmed with anticipatory anxiety before every single meeting with his parents.

When gently exposed to these issues during therapy, he acknowledged a connection with early experiences right away, he realised that he feels the same way around other men or women in authority, and yet he remained equally confused and troubled by these dominant, painful gut-feelings1.

******

‘I can feel it in my gut‘ or ‘trust your gut’ we often say to ourselves or each other, perhaps for very good reasons. Scientists have recently established clear links between our gut and the brain, not necessarily through an analysis of the diversity of the microbiome that exists within our gut, although this turns out to be equally relevant (Skonieczna-Zydecka K et al., 2018), but also by paying attention to the actual structure of the gut at a cellular level (Kaelberer M et al., 2020).

The biological dimension

Dr Kaelberer and colleagues identified a direct pathway from the gut to the brain, that essentially allows sensing of what is happening in the gut, in order to inform specific emotions whether pleasure or disgust, and the resulting behaviours. This would, at least in part, explain cravings and associated compulsive actions, and furthermore, it helps explain why the regular practising of mindfulness or paying calm, non-judgemental attention inwards, could lead to a shift in feelings and better emotional-regulation (Golding and Gross, 2010).

The gut-brain communication happens through versatile and adaptable neuropod cells with electrical sensors within the gut structure, which are able to select and specialise in various essential chemicals like glucose, proteins or amino acids. These cells can program to organise digestion and send information via electrical signals straight to the brain, which will make further informed decisions on what to feel and how to respond to certain products, in a given situation. Although not the only sensorial command centre, it does appear that, the human 9- to 10-meter-long gut, could be the largest internal organ with immediate access to the external world.  Running through the upper body, from the rectum to the esophagus, and in constant communication with the brain, the gut is able to provide an individual, with a fuller experience of what it means to engage with useful edible products, like enjoying a coffee with a cookie in the morning, where the individual is likely to experience both pleasure and a sudden increased in energy. Seems ‘the gut’ may indeed be one of the biggest organs inside our body, but reaching as far as the external or the social world, is not something psychologists would have taken into account until now.

Inside the gut something equally fascinating takes place, which further strengthens the relationship between the human gut and the brain. Our intestine has about 39 trillion microorganisms called microbiome and it consists mostly of bacteria, viruses and fungi – the microbiome produces chemicals which can send messages to the brain through the vagus nerve. This nerve starts in the brainstem, it travels down the neck and alongside the carotid arteries and into the chest branching out towards internal organs, as a result it can manage gut contractions (peristalsis) and heart rate – this makes the vagus nerve relevant when it comes to the human relaxation response.

We now know, that people who suffer from chronic stress have very different microbiomes and ‘bad’ bacteria that produce inflammation, as opposed to a healthy individual who would have a diverse population of bacteria strains. This has serious clinical implications and recent research has in fact shown, that levels of depression would improve when injected with a specific bacteria (faecal). Although these bacteria is proving difficult to reproduce artificially in a lab, the link between the gut micorbiome and the brain explains why certain diets, like the Mediterranean diet, and foods (like pre/probiotics) would have a direct impact on the mood. A healthy diet is associated with a 30% reduction in depression.

Good gut health means good overall health !

The psychosocial dimension

Humans like most other mammals have rituals around eating, drinking and socialising. Such events are usually inter-linked and incredibly important to evolution. Those are ideal occasions to get to know one another, to court each other, to test our emotions, bond and reproduce. Often a potential partner is treated to a freshly cooked meal with a personal touch. This enhances the possibility of having a relationship. Social rituals such as feeding a child, courtship or even kissing, demonstrate how the gut is constantly interacting with the brain and through a perfect symphony of electrical signals, enzymes, and various chemicals, it assists with social bonding, and the selection of the most appropriate partner. This is where the notion of ‘butterflies in the stomach’ takes a completely different meaning when two lovers meet, versus two people shouting at each other in extreme anger. All individuals involved in these very different scenarios, would report experiencing butterflies in the stomach with different levels of intensity. This turns out to be nothing short of cells and electricity at work, dutifully completing their shift. Just another day in the office.

Through stories we reach the world around us…

 Homo-sapiens are also ‘homo-narrans’ (Meichenbaum D, 2017). We have an innate ability to observe our own thoughts, to think about our thinking in vivid images, pictures, or even short video clips, and ultimately describe with various details, the content of our thoughts and conclusions. This is what we label as ‘stories’. In fact, we rarely think in clear and brief thoughts, but instead our minds, seem to be dominated by stories involving all sensory modalities, a pleasant memory of a sensual encounter has sounds, smells and tastes, alongside vivid video-reels which unconsciously lead to arousal.

  ‘The early bird catches the worm’.

We grow up ‘feeding’ on stories, symbols and metaphors; most of us will remember with great pleasure childhood messages and proverbs repeated to exhaustion by our parents and grandparents, in the hope that we would learn to behave more appropriately, in line with our social context and culture. The messages we remember the most, have an interesting narrative behind them, rich in details and sensorial pleasures. The teacher that inspired us during school years, was most likely, the best storyteller. Story telling is a natural gift often unexplored and unnourished.

Stories we tell ourselves reflect earlier experiences and are used as a learning platform. They have to make contextual sense of the world we live in, and as such, our personal narratives, are influenced and adapted over time in order to fit in, with continuously evolving circumstances (Hickes and Mirea, 2012). This would of course, in turn, ensure survivability and psychological resilience over the course of lifetime. Failure to update old narratives can create psychological rigidity, which leads to internal distress and therefore, predispose individuals to mental illness.

Indeed, this fascinating oval-shape mass of grey, which we refer to, as the ‘brain’, is plastic. In other words, it has the ability to biologically modify itself and adapt to new circumstances (another area the conscious mind1 is not consulted about), with only one important mission that supersedes everything else – keeping us alive! Therefore, the stories we tell ourselves are not designed to generate feelings of happiness or sadness, since those are not essential to our survival. Although we know this is at times possible, the brain’s main priority is to keep the organism or the body as a whole, functional and alive.

The cognitive-behavioural dimension

 When the gut communicates with the brain, it is purposeful, and it demands an immediate reaction. Intense emotions lead to compulsive behaviours, bypassing the mind completely, e.g., when one is hungry, the resulting senses, known as cravings or feelings of pain and discomfort in the gut area, lead to an urgency to find something to eat, the mind is simply trying to resolve this problem by going to previously memorised solutions.

Therefore, cognitions are products of an extremely busy brain with no time off. Best understood as essential components of a regulatory system informed by thought, experience, memory, language, sensorial data or felt-sense2, and deeply-rooted beliefs3. It may not always be easy, but it is possible to override one’s felt-sense or gut-feelings, if we start engaging our prefrontal abilities by reframing the experience and simply view DRBs as, the dialectical expression of a felt-sense. This can be achieved through new learning, and new experiences. Humans, unlike other mammals, do this all the time, we are very good at convincing ourselves that something is good for us, through repetition or rehearsal, when in fact, our gut is telling us that the opposite is true. For example, eating lots of sugar, drinking alcohol or smoking. In a different context, it could be argued that learning how to override painful gut-feelings, might be the very purpose of a psychotherapeutic treatment specifically, helping individuals overcome painful gut-feelings, or felt-senses which internally suggest they are flawed or not good enough.

Deeply-rooted beliefs might be best understood as the first layer of defence, a deeper screening or filtering system that helps an individual navigate through the complexities of life, in spite of a dominating gut-feeling that he is not good enough. These types of senses are reminders of previous experiences and nothing short of ‘brain statements’ or brain’s best possible interpretation of early life experiences. Whether frequent exposure to extended periods of affection, or at the other end of the spectrum exposure to neglect, characterised by intense pain signals and experienced mostly by the gut, and felt within the upper body regions. Since our brain does not use language per se, to ‘shout out’ warnings to the mind, various electrical signals are sent back and forth between brain structures and different parts of the gut, on every single occasion we find ourselves in a situation that points toward a reward or indeed a threat (i.e., neglect). Sensorial signals alerting an individual of a potential reward or threat, depending on the developmental stage, could be processed linguistically and translated into deeply-rooted beliefs of lovability (pleasure) or unlovability (rejection), but this is rarely needed outside of a therapy session. And of course, lack of awareness and language speeds up the process of getting a reward or running away from neglect or threat. Once the Mind gets involved, everything slows down and is investigated with the curiosity of a scientist.

We have now understood that DRBs are not seen or heard but felt deep inside the body at a gut level and they are not interpreted by a mind which does not even fully develop before the age of two. Therefore, not only that language is not needed when chasing a reward or running away from a threat, but DRBs have no immediate linguistic correspondent, since the gut-brain axis is bypassing the temporal lobe responsible for language processing. Studies suggest that the prefrontal cortex, or the ‘mind’, starts developing within the first two years of life, since basic brain structure and connectivity is present by this age (Huttenlocher & Dabholkar, 1997), but continues until the mid-twenties, which marks an end to our adolescent stage and a slowing down of brain neuroplasticity (Siegel D, 2020). 

Attachments and emotional neglect

British developmental psychologist and psychiatrist John Bowlby is one of the most recognisable names associated with attachment research (1988). His evolutionary theory suggests that children come into the world biologically pre-programmed to form attachments with others, since this will help them survive. Indeed, a child that has been emotionally neglected by one of his main caregivers, might not have been a victim of a physically or sexually aggressive parent, nonetheless the child would internalise the absence of warmth and physical affection as threatening, incredibly painful, confusing and difficult to navigate. A child depends for many years on his parents, in order to survive and thrive. And therefore, to a child, the prospect of disappointing a parent is a risky business. Chronically it would be painful, with many types of manifestations and physiological symptoms, like muscle spasms or butterflies inside the body. Not being able to process the experience of rejection or make any sense of it, the gut-brain axis constantly makes decisions on what is healthy and what is not. Eventually these decisions are introduced into our contextual world via stories that we imagine and tell ourselves. These early narratives have implicit deeply-rooted beliefs, not yet linguistically formulated but with clear sensorial messages and themes centred around unlovability, rejection, unworthiness or unacceptability. When finally expressed or spoken ‘out loud’, the language is as varied as individuals’ backgrounds, largely subjected to individuals’ culture, education, imagination and linguistic skills.

Perceived social threats such as criticism and rejection or the prospect of living alone, can be frightening because the gut does not like neglect or going without. Emotional neglect is a real threat in childhood, because it is synonymous with deprivation of essentials, including food and ultimately death. Humans bond to survive. The threat of being alone is basically unbearable to the gut and body by extension.

Deeply-Rooted Beliefs and Contextual-Acceptance

When He says, He is ugly, He also means ‘’The world does not like Me’… and this is the part that really frightens.

 It could be speculated that emotional neglect is more impactful on the gut because of the physiological deprivation suffered by the organism. Deprivation of positive affection is associated with lack of appetite or compensatory appetite which leads to the production of specific enzymes and hormones. Whereas, with other types of exerted aggression, the gut suffers less organic deprivation, refocuses on healing, and learns to reprogramme itself allowing for adaption of the whole organism (Kaelberer M, et al., 2020). This could explain why in certain cultures, where physical discipline is widely spread, the actual ‘physical abuse’ does not lead to post-traumatic stress, and it has little or no impact on the immunity and physical health. This type of parenting is not perceived as abusive within the community at large because biologically, it is not significantly harmful, and the emotional dimension is invisible and easier to ignore. The parenting model is therefore normalised, perceived as efficient and often replicated by other families. These sophisticated lines of defence could be viewed as a type of socio-homeostatic process or organism’s attempt to repair and adapt itself through the practice of cultural values and contextual-acceptance.

 Deeply-rooted beliefs therefore, may have a regulatory purpose and essentially teach the organism, or the body to adapt.

‘My dad was a little hard on me yesterday, sorry I could not meet you but, I was in a bit of a state’… Friend replies: ‘your dad is fine, you should meet mine… but to be fair, I still hate my homework and love to sneak out for a smoke’.

In a practical sense, to survive and even thrive in, what could be perceived as a harsh environment, requires normalising and acceptance of external living conditions, also coined in this paper, as ‘contextual-acceptance’. Whilst seeing the world through myopic unlovability lenses, James has to adapt to various contexts and whatever else life throws at him, in order to continue to survive and grow in spite of, a dominating felt-sense which strongly suggests he is unappreciated, and likely to be rejected.

‘Since nobody likes me, I have to make more effort than anyone else and behave in ways that will ensure I am safe – despite what everyone really thinks of me’, James would often think to himself, during moments of self-reflection. This type of contextual-acceptance can override the dominating gut-feeling, it leads to psychological adaptation and resilience. When contextual-acceptance is denied, an episode of emotional crisis would be inevitably triggered.

 The regulatory quality of deeply-rooted beliefs, also means that they can be accompanied by both negative and positive affective experiences. Someone falling in love or desiring someone sexually feels an acute pain inside the body, within areas of the gut, but this is not registered in a negative manner by the brain and, since it is not a threat, it does not activate fear and avoidance.

By contrast, just thinking about food when hungry can lead to secreting specific enzymes and further compulsive eating behaviours. Going for a driving test can lead to feeling sick in spite of being well prepared.  At times, people throw up when faced with social fears and other times they avoid a challenging test all together. It all seems to depend on the lenses the individual uses, because sure enough, when individuals look at the outside world through their unlovability lenses, the whole world would appear likely to reject them, no matter how well behaved they are. It takes effort and motivation to override the gut-feeling. Deeply-rooted beliefs therefore, create myopic lenses but contextual-acceptance heals the pain that comes with it.

Conclusions

Deeply-rooted beliefs have been characterised in the psychotherapeutic literature as schemas by Jeffrey Young (2003) and Paul Salkovskis (1996), core organising principles, often sounding like a code of honour, which the individual cannot afford to break, the cost would be too high, and yet consciously unknown. As such, James’ life was rigidly governed and guided by his unlovability and worthlessness telescope-type lenses. 

DRBs are the lenses through which we see the world and ourselves. Supported and confirmed by the gut and with help from specific brain structures, they act as deeply rooted filters, allowing into our consciousness only what the gut-brain-axis feels is relevant to our survival. And as we have already established, the human gut and brain, are not concerned with our happiness or material wealth.

However, the axis is capable of both good and evil and can be persuaded to change and reprogramme the lenses through which we see our life, through an ample process of education and self-awareness, new learning and new coping practices, all key aspects of change. It appears that, just like with any other muscle, all organs inside our body need retraining with consistency over time. 

There is nothing more captivating than an authentic story which can send clear motivational messages about meaningful changes and potential solutions. People have been preoccupied with sharing their ideas, personal stories, discoveries, and inventions for thousands of years.  Historical writings and drawings on the cave walls are testimony to that fact. Telling ourselves and each other stories, is so embedded within our psychological framework, it has become an essential part of our existence, for where would we be, if it was not for our stories? We tell stories to confirm and justify our very existence. 

It appears that stories are very likely, part of our genetical make up and therefore it is not much of stretch to consider that internal storytelling or the narratives we repeat to ourselves, are not only generated, but also perpetuated by our felt-senses or gut-feelings, designed to cement beliefs about who we are, how we could fit into our world, how we need to behave, and what our future prospects are.

Some of our gut decisions are truly worthy of our trust, but we have demonstrated how at times, the gut is misinformed by neglect and emotional deprivation. It falls onto the therapist to guide the patient4 with sensitivity, kindness and compassion, through the sea of vast, often stormy narratives, in order to make sense of the deeply-rooted beliefs’ images, sounds and smells, covert meanings and values.

Perhaps because deeply-rooted beliefs are primarily supporting a survival instinct, those are not always in sync with ideal and current personal values, generated by a fast pacing, ever-changing society. The modern world, the speed of development supported by human creativity, forces us to constantly work on redefining what authentic living means, based on contextual-acceptance.

Whatever this means for each individual, it can only be achieved by constantly refocusing the lenses through which we see ourselves and others, and override deeply-rooted beliefs that support an older way of living or dated values. Charles Darwin, a passionate evolutionary biologist, and author of ‘The origins of species’ (1859) might have been among the first to note that organisms, much like the human organisms with all their guts and brains, would never fail to either adapt or die. It is simply a question of survival.

The ‘Gut – Brain – Affect’ triangle: paving the way to future research and development

Traditionally, psychotherapists have been more interested in the interplay between mind, feelings and actions that lead to ‘psychological pain’ often without being able to answer questions about the subjective feeling of ‘suffering’. Where is all the ‘suffering’coming from, and what are its main characteristics?

  The notion of ‘deeply-rooted beliefs’ attempts to answer this dilemma by proposing an investigation into the fascinating world of the ‘gut-brain-affect’ triangle. Searching for answers in an area, that has not been fully explored by psychology just yet, is more than challenging and leads to more questions than answers. At the same time, new and older research studies from physiology, nutrition, attachments, and neuroaffective-biology seem to open a world of therapeutic possibilities.  

If the gut and the brain are in constant and autonomous communication (or outside of our awareness), and they make behavioural decisions for us all the time, then it is safe to assume that nutritional and other daily occupational habits, such as the proverbial rest, work, and play, could impact more significantly on our mental health, than ever anticipated (Mirea, 2023). We have always known this instinctively, but the bio-psycho-social processes operating in the background remain a mystery.

This review barely scratches the surface of an intricate world of internal highways of communication, hidden within the human infrastructure, which ultimately leads to behavioural and social decisions, every moment, of every single day. Decisions that ultimately, impact on our wellbeing, quality of life and overall existance.

The article certainly raises more questions than answers, we do not seem to fully understand all the mechanisms that support gut’s constant communication with the brain. But if indeed ‘we are what we eat’ then, psychologists and psychotherapists need to start paying more attention to how nutrition is impacting on our mental health, not just the physical health. Perhaps it falls on the domain of evidence-based psychology to align itself with relevant research from the fields of nutrition, physiology, or neuroscience, in order to better understand the individuals’ relationship with food, digestion, hormones and mental health as well as the environmental impact.

Some progress has been noted in understanding the links between the gut microbiome and depression, but much remains undiscovered and sadly, the psychotherapy community continues to remain silent and uninvolved.  This article therefore assumes the risk of going into unchartered territories, potentially exposing many gaps within psychotherapy research. It points toward the sophisticated inner technology of the gut-brain-affect axis with significant implications for mental health treatments. Let’s consider for instance, the relationship between our integumentary system5, emotions, sensations of pain, pain management and mental health. This is an area insufficiently explored within psychology outside of the CBT and Hypno-CBT6 arena.

An example much closer to the subject discussed in this article, would be the potential value of investigating the intestinal chemical formula, that informs us when and if, a product is good for us, and as such, is it worth pursuing in the future. Products consumed are only good, when they are not poisonous for the system, but also when the situation or the context is favourable, in other words, where and when these are consumed. An example would be, when a serious meat eater goes to a new vegetarian restaurant in town that serves an almost too ‘adventurous’ menu for him. On paper this should be a failed event but the ‘context’ takes over completely and so if the individual is in good company, like a date or with someone he actually likes to spend time with, the affective-response changes to joy and pleasure. Through associated learning, a product becomes even more rewarding, and the experience is more likely to be repeated, if the place where the product was discovered, as well as the company kept at the time, were equally rewarding. Culture, existential and personal values, conditioning and social learning theories, memory and language processing, neuroscience, biology and nutrition, all these research domains come into this one simple social experience, which is repeated by tens of thousands of humans every day. Learning theories only partly explain these social decisions and bonding events because, there is an entire domain of the digestive and sensory system that we haven’t even began to articulate in this paper. The same could be said about the links between the digestion system, memory, and language processing. How we describe linguistically an experience, impacts on how we feel about it!

Developing psychotherapy tools such as NeuroAffective-CBT (NA-CBT), which successfully integrates research from all of above mentioned domains, could pave the way for a fourth-wave7 of evidence-based psychotherapy practices (Mirea, 2012). NA-CBT is a transdiagnostic approach, which means that it does not rely on a psychiatric diagnosis and a prescribed treatment protocol, that integrates successfully nutritional advice, physical strengthening programmes, sleep training, and bloodwork analysis (i.e., the TED model, Mirea 2005/2023) alongside traditional behavioural and cognitive interventions. Similarly, future fourth-wave schools of Integrative-CBT8 would aim to improve self-efficacy and enhance individuals’ ability to listen to their bodies, essential skills that claim control over immunity and health overall.

No longer separating the mind from the body in at least, some of the research, might be an obvious step in the right direction.  And, perhaps accepting the inevitable – the practice of positive, evidence-based psychology, may be in total contradiction with what we are taught by society that we need, in order to be high achieving and forward moving in life. Modern culture is about learning to override the signals from the body though it seems, at least some of the time, the exact opposite is what humans need. Learning to listen to the signals from the body might be the one of the keys that open the door to healthier living.

Glossary:

1The Mind, or the conscious mind, these terms simplistically refer to higher structures of the brain including the prefrontal cortex (PFC), the section of the brain located behind the forehead; this particular area may be responsible for decision making and finding solutions.

2Felt-Sense, Gut-Sense, Gut-Feelings are senses which act as reminders of previous experiences, designed to alert us of a potential reward or indeed, a threat. These terms are used interchangeably through the paper.

3DRBs: abbreviation for Deeply-Rooted Beliefs. DRBs could be defined as the dialectical expression of (internally experienced) felt-senses, which are translated linguistically later in life when language becomes available, those could in fact, be (verbally) expressed as late as adulthood, often during therapy for the first time. DRBs forge a rigid identity within individuals at an earlier stage in their lives and therefore are harder to modify outside of the therapeutic environment, evidence against DRBs is disregarded through mechanisms like mental filters, described in detail in this paper.

4Patient or Client are the same terms, used interchangeably through the article, usually depends on the situational context or where the therapist is likely to have a practice, at times we refer to our clients as patients or vice-versa.

5Integumentary system refers to the human skin and its structures, the other largest human organ, besides the human gut, which makes up to 16% of the body weight, and also interacts with the external world and further communicates with different parts of the nervous system constantly and autonomously.  

6Hypno-CBT – Cognitive Behavioural Hypnotherapy, a transdiagnostic third-wave CBT approach introduced by Donald Robertson and further developed by Mark Davis. Training in Hypno-CBT is offered online and can be accessed here.

7Fourth-wave CBT or the fourth-wave of evidence-based psychotherapy practice refers to the stages of development within the field of evidence-based psychology, CBT in particular. First-wave is marked by extensive behavioural research, this is the foundation of CBT essentially; second-wave brings together research from cognitive psychology and behaviourism; third-wave introduces philosophy and emotional-regulation; fourth-wave is likely to bring along more digital interventions, neuroscience, neurobiology and physiology. For instance, having routinely a blood-test before psychotherapy starts could be considered good practice – since a blood test would point towards physical conditions that have mental health symptoms, like pre-diabetes (Mirea, 2023).  

8Integrative-CBT, on short I-CBT was mentioned for the first time at the 9th International Congress of Cognitive Therapy in Transylvania in 2017 @Babes-Bolyai University, event which brought together more than 400 researchers and clinicians from all over the world, event was hosted by Prof. Daniel David, Beck J, Clark D, Hays S and, other renowned clinicians. 

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Main papers and online research retrieved during June 2024:

Articles – NeuroAffective-CBT (neuroaffectivecbt.com)

M. Maya Kaelberer, PhD | Center for Gastrointestinal Biology and Disease (unc.edu)

Dr Donald Meichenbaum’s Psychotherapy Programme – UK College of Hypnosis & Hypnotherapy – Hypnotherapy Training Courses (ukhypnosis.com)

Acknowledgements:

This article could not have been finished without valuable guidance and input from Dr Donald Meichenbaum. Dr Meichenbaum is considered by most the ‘Freud of CBT’, one of the three main pioneers, alongside Aaron T Beck and Albert Ellis, of early cognitive and behavioural therapies. Dr Meichenbaum subsequently played an instrumental role in understanding violent trauma, aggressive behaviours, and human resilience.

Editing by Dr D Meichenbaum, SIT and CBT founder; proof reading by Ana Ghetu psychosocial researcher and Dr S Reilly clinical researcher and general practitioner.