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THE NEUROBIOLOGY OF PSYCHOSTRUCTURAL AND PSYCHOTHERAPEUTIC CHANGE: CONFLICT, DEFENSE, AND TRANSFORMATION BARTON J. BLINDER, MD, PHD VISANT SANATHARA, BA, BS DEPARTMENT OF PSYCHIATRY AND HUMAN BEHAVIOR UNIVERSITY OF CA, IRVINE MENTAL CONFLICT • PROBLEMATIC AFFECTIVE/INTERPERSONAL EXPERIENCES • NEUROLOGIC CONTRIBUTION TO “AUTOBIOGRAPHY” OF PERSONALITY • ENCODING DEVELOPMENTAL CONFLICTUAL EXPERIENCES MENTAL CONFLICT • REPRESENTATIONAL SCHEMATA – – – – – – RE-EVOKED NON-ADAPTIVE NON-ERROR CORRECTING SELF-SYSTEM INTERPERSONAL FUNCTION ENVIRONMENT PERSPECTIVES • DEVELOPMENTAL, PSYCHODYNAMIC, ADAPTATIONAL • PAST EXPERIENCE • HABITUAL MODES OF REACTING PERSPECTIVES • PSYCHOTHERAPEUTIC ENCOUNTER – PSYCHOLOGICAL DEFENSE – RESISTANCE – TRANSFERENCE PHENOMENA – ENACTMENTS – SALIENT DREAMS PERSPECTIVES: PSYCHOTHERAPEUTIC TRANSFORMATION/CHANGE • CONSTRUCTIVIST MANIFESTO – NEW STRUCTURE (QUARTZ SEJNOWSKI, 1997) • CONTEMPORARY ADDITION – SPECIFIC TEMPORALNEURONAL ENCODING THROUGH REGENERATION (GOULD/GROSS, 1999) EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY EXPERIENCED EVENTS • MEMORY FUNCTION – RECOLLECTIONS/REMINISCENCES – NARRATIVES • EMOTIONAL ACTIVATION THROUGH NEUROMODULATORY SYSTEMS INVOLVING AMYGDALOID COMPLEX (AC) (CAHILL, 1996) EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY EXPERIENCED EVENTS • AC ----> HIPPOCAMPUS MODIFICATION/CONSOLIDATION OF MEMORIES • ENHANCED RECALL OF LONG TERM MEMORY ASSOCIATED WITH INCREASED GLUCOSE METABOLIC RATE IN RIGHT AC AMYGDALOID COMPLEX • SELECTIVE ROLE IN LEARNING/MEMORY • MODULATE MEMORY STORAGE DURING EMOTIONALLY INFLUENCED CONSCIOUS RECALL • HEIGHTENED EMOTION/COGNITIVE CONSOLIDATION (FREUD/RAPPAPORT) – PSYCHOLOGICAL DEFENSE – EMOTIONS/MEMORY BRAIN FUNCTION IN BULIMIA NERVOSA • CAUDATE HYPERMETABOLISM (BLINDER, 1996) • INCREASE ACTIVITY---AMYGDALA CINGULATE • DISTINCT FROM DEPRESSION (HAGMAN/BLINDER, 1990; WU/BLINDER, 1990) • NEUROBIOLOGIC LINK TO OCD/WORRY CIRCUIT BRAIN FUNCTION IN BULIMIA NERVOSA • CAUDATE---FOOD SEEKING, FOOD PREPARATORY BEHAVIOR • APPETITE/SATIETY IN HYPOTHALAMUS • BASAL GANGLIA ALERTING SENSORY MOTOR FEEDING/PURSUIT • INITIAL RX- COGNITIVE BEHAVIORAL AND NUTRITIONAL REHABILITATION BRAIN FUNCTION IN BULIMIA NERVOSA • DEVELOPMENTAL PSYCHOPATHOLOGY OF EATING DISORDERS • DEVELOPMENTAL STAGES OF FEEDING/ATTACHMENT/ SEPERATION • PSYCHOBIOLOGY---APPETITE REGULATION AND FOOD SELECTION RECOGNITION OF EMOTION IN THE EXTERNAL WORLD • DEPRESSED PATIENTS DIMINISHED RESPONSE TO EMOTION IN HUMAN FACE • PET DECREASED ACTIVITY IN TEMPORAL LOBES (BILAT) AND RIGHT INSULAR AREA • RESEMBLES DEFICIT IN FOCAL RIGHT HEMISPHERE BRAIN DAMAGE RECOGNITION OF EMOTION IN THE EXTERNAL WORLD • IMPLICATIONS IN DEPRESSION • INTRAPSYCHIC AND INTERPERSONAL CONFLICT • AFFECTIVE RECIPROCITY (INTIMATE/FAMILY) • PSYCHOTHERAPY TECHNIQUE ANXIETY AND PHOBIA • PET PHOBIGENIC/ANXIETY STIMULI – ALTERATIONS IN LIMBIC, PARALIMBIC, AND CORTICAL BRAIN REGIONS – COGNITION – AFFECT • VISUAL ASSOCATION CORTEX – GAD, OCD, PANIC – HYPERVIGILENCE ANXIETY AND PHOBIA • PARALIMBIC/FRONTAL REDUCTION – BEHAVIORAL INHIBITION/DECREASED COGNITIVE PROCESSING – NEUROBIOLOGIC SUBSTRATE OF “DEFENSE” REM SLEEP/WAKING PET STUDY • VISUAL AND LIMBIC AREAS OPERATE ACTIVELY DURING DREAMING SLEEP • CLOSED SYSTEM DISCONNECTED FROM FRONTAL LOBES • DREAM FEATURES (DISTORTIONS, BIZARRE CONTENT, EMOTIONALITY) • AFFECTIIVE VS COGNITIVE • DREAMS AND PSYCHOTHERAPY CONCLUSION • PSYCHOTHERAPUETIC PROCESS/CHANGE • MODIFICATIONS IN NEURAL STRUCTURE • ALTERATIONS IN GENE EXPRESSION • FUNCTIONAL & STRUCTURAL CHANGE • NEW NEURONAL ENCODING CONCLUSION • PARADIGMS OF CONDITIONING – MODELS OF LEARNING • CAPTURE INDICATORS OF CHANGE IN CNS THAT REFLECT ALTERATIONS OF BEHAVIOR AND MEANING • CLINICAL IMPROVEMENT/GAIN IN ADAPTATION NEW FINDINGS • HIPPOCAMPAL SYNAPTIC PLASTICITY NT ACTIVATION GF RECEPTORS, PROTEIN KINASES • NUC. TRAN. FACTORS --- GENE EXPR---MEMORY PROTEINS (JOHNSON, 1999) • WORKING MEMORY--PREFRONTAL CORTEX NEURONS--MEMORY FIELDS--MODULATION BY DA, 5HT, GABA, GLUTAMATE • NEUROBIOLOGY/MOLECULAR BIOPHYSICS INFORMATION PROCESSING (GOLDMANRAKIC, 1999)