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The Clinical Importance Of The Limbic Dump



This week I am speaking at the LATAM Obesity Summit in Santaigo, Chile, where I again had occasion to hearing my Canadian colleague Michael Vallis (Halifax), speak about behavioural change.

In his talk, he discussed an important strategy in counselling patients, whch he referred to as the “limbic dump”. As readers will know, the limbic system is responsible for holding our emotions – anxiety, fear, apprehension, disappointment, frustration, but also, joy, optimism, anticipation, motivation.

In a classical doctor-patient encounter, the doctor generally focusses on analysing the problem (making the diagnosis) and giving advice (providing treatment) – both are functions that largely rely on the cognitive or “logical” part of our brains. The general idea is that, the doctor will provide rational information and advice to the patient, and the rational part of the patient’s brain will take in this advice and “follow instructions”.

Unfortunately, in most situations, this “rational” approach is overriden by the limbic or “emotional” part of the patient’s brain, which is far too busy dealing with feelings (shame, fear, anxiety, disappointment, frustration, etc.) to take in the “rational” information that is being provided.

This is where the “limbic dump” comes in. As Vallis points out, before getting into the “rational” part of any encounter, it is far more useful to begin by allowing the patient to first “dump” their concerns (or successes) on the table. Once these are out in the open, have been duly acknowledged, and discussed, the conversation can move on to the more “logical” transactional part of the encounter. Now, after the “limbic dump” you actually have a patient who is able to listen to what you have to say.

Of course, all experienced clinicians probably already know this. I, for one, generally start any patient encounter with an open ended question as to how the patient is feeling about how things are going. This gives them the opportunity to “dump” their feelings on the table – positive or negative. Only after acknowledging these (sometimes prompting them for details), do we move on to the more objective part of the encounter (I’m a big believer in motivational interviewing, so generally, I let my patients do most of the talking).

Now, thanks to Vallis, I have an explanation and term for what I have been doing all along – long-live the “limbic dump”.

@DrSharma
Santiago, Chile

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