THE NEUROBIOLOGY OF PSYCHOSTRUCTURAL AND PSYCHOTHERAPEUTIC CHANGE: CONFLICT, DEFENSE, AND TRANSFORMATION

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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

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MENTAL CONFLICT

• PROBLEMATIC AFFECTIVE/INTERPERSONAL EXPERIENCES
• NEUROLOGIC CONTRIBUTION TO AUTOBIOGRAPHY OF
  PERSONALITY
• ENCODING DEVELOPMENTAL CONFLICTUAL EXPERIENCES

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MENTAL CONFLICT

• REPRESENTATIONAL SCHEMATA
• RE-EVOKED
• NON-ADAPTIVE
• NON-ERROR CORRECTING
• SELF-SYSTEM
• INTERPERSONAL FUNCTION
• ENVIRONMENT

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PERSPECTIVES

• DEVELOPMENTAL, PSYCHODYNAMIC, ADAPTATIONAL
• PAST EXPERIENCE
• HABITUAL MODES OF REACTING

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PERSPECTIVES

• PSYCHOTHERAPEUTIC ENCOUNTER
• PSYCHOLOGICAL DEFENSE
• RESISTANCE
• TRANSFERENCE PHENOMENA
• ENACTMENTS
• SALIENT DREAMS

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PERSPECTIVES PSYCHOTHERAPEUTIC
TRANSFORMATION/CHANGE

• CONSTRUCTIVIST MANIFESTO
• NEW STRUCTURE (QUARTZ SEJNOWSKI, 1997)
• CONTEMPORARY ADDITION
• SPECIFIC TEMPORALNEURONAL ENCODING THROUGH
  REGENERATION (GOULD/GROSS, 1999)

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EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY
EXPERIENCED EVENTS

• MEMORY FUNCTION
• RECOLLECTIONS/REMINISCENCES
• NARRATIVES
• EMOTIONAL ACTIVATION THROUGH NEUROMODULATORY
  SYSTEMS INVOLVING AMYGDALOID COMPLEX (AC)
  (CAHILL, 1996)

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EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY
EXPERIENCED EVENTS

• AC ----gt HIPPOCAMPUS MODIFICATION/CONSOLIDATION
  OF MEMORIES
• ENHANCED RECALL OF LONG TERM MEMORY ASSOCIATED
  WITH INCREASED GLUCOSE METABOLIC RATE IN RIGHT AC

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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

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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

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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

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BRAIN FUNCTION IN BULIMIA NERVOSA

• DEVELOPMENTAL PSYCHOPATHOLOGY OF EATING DISORDERS
• DEVELOPMENTAL STAGES OF FEEDING/ATTACHMENT/
  SEPERATION
• PSYCHOBIOLOGY---APPETITE REGULATION AND FOOD
  SELECTION

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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

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RECOGNITION OF EMOTION IN THE EXTERNAL WORLD

• IMPLICATIONS IN DEPRESSION
• INTRAPSYCHIC AND INTERPERSONAL CONFLICT
• AFFECTIVE RECIPROCITY (INTIMATE/FAMILY)
• PSYCHOTHERAPY TECHNIQUE

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ANXIETY AND PHOBIA

• PET PHOBIGENIC/ANXIETY STIMULI
• ALTERATIONS IN LIMBIC, PARALIMBIC, AND CORTICAL
  BRAIN REGIONS
• COGNITION
• AFFECT
• VISUAL ASSOCATION CORTEX
• GAD, OCD, PANIC
• HYPERVIGILENCE

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ANXIETY AND PHOBIA

• PARALIMBIC/FRONTAL REDUCTION
• BEHAVIORAL INHIBITION/DECREASED COGNITIVE
  PROCESSING
• NEUROBIOLOGIC SUBSTRATE OF DEFENSE

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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

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CONCLUSION

• PSYCHOTHERAPUETIC PROCESS/CHANGE
• MODIFICATIONS IN NEURAL STRUCTURE
• ALTERATIONS IN GENE EXPRESSION
• FUNCTIONAL STRUCTURAL CHANGE
• NEW NEURONAL ENCODING

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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

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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 (GOLDMAN-RAKIC, 1999)