Download No Slide Title

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)