How does our brain constitute defense mechanisms? First-person neuroscience and psychoanalysis

"Project for a Spatiotemporal Neuroscience" - Brain and Psyche Share Their Topography and Dynamic

What kind of neuroscience does psychoanalysis require? At his time, Freud in his "Project for a Scientific Psychology" searched for a model of the brain that could relate to incorporate the psyche's topography and dynamic. Current neuropsychoanalysis builds on specific functions as investigated in Affective and Cognitive (and Social) Neuroscience including embodied approaches. The brain's various functions are often converged with prediction as operationalized in predictive coding (PC) and free energy principle (FEP) which, recently, have been conceived as core for a "New Project for Scientific Psychology." We propose to search for a yet more comprehensive and holistic neuroscience that focuses primarily on its topography and dynamic analogous to Freud's model of the psyche. This leads us to what we describe as "Spatiotemporal Neuroscience" that focuses on the spatial topography and temporal dynamic of the brain's neural activity including how they shape affective, cognitive, and social functions including PC and FEP (first part). That is illustrated by the temporally and spatially nested neural hierarchy of the self in the brain's neural activity (second and third part). This sets the ground for developing our proposed "Project for a Spatiotemporal Neuroscience," which complements and extends both Freud's and Solms' projects (fourth part) and also carries major practical implications as it lays the ground for a novel form of neuroscientifically informed psychotherapy, namely, "Spatiotemporal Psychotherapy." In conclusion, "Spatiotemporal Neuroscience" provides an intimate link of brain and psyche by showing topography and dynamic as their shared features, that is, "common currency."

Effects of childhood trauma experience and BDNF Val66Met polymorphism on brain plasticity relate to emotion regulation

Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism may modulate the link between childhood trauma experience and psychopathology by altering trophic signaling on neuroplasticity. However, few multimodal magnetic resonance imaging (MRI) researches have investigated this gene-environment interaction on both structural and functional plasticity, thereby advancing knowledge about the etiology, prevention, and customized therapeutic directions of mental disease in individuals with childhood trauma experience. We recruited a large non-clinical sample of young adults that completed Childhood Trauma Questionnaire (CTQ), behavioral scores, multimodal MRI scans, and genotyping. Morphometric similarity network (MSN) and independent component analysis were adopted to quantify brain structural and functional changes. Gene-environment-brain-behavior relationships were identified by multiple regression and mediation effect analysis. CTQ score was positively associated with depression and anxiety scores. We found interactions on MSN in sensorimotor, temporal, and orbitofrontal cortex. For intra-network connectivity, significant interaction was noted in clusters within sensorimotor network. For inter-network connectivity, connectivity between dorsal attention network and salience network showed an interactive effect. For mean connectivity strength of each network, we found a main effect of CTQ score on self-reference network that was an outstanding mediator supporting the relationship between CTQ score and anxiety. Our findings demonstrate that childhood trauma and the BDNF Val66Met polymorphism are associated with brain plasticity involving emotion regulation, structurally and functionally, which may contribute to understanding psychotic mechanisms and predicting differential susceptibility. Imaging genetics may be useful as biomarkers to provide early assessment and guide cognitive interventions to avoid or decrease the risk of developing psychopathology.

Integration Between Cerebral Hemispheres Contributes to Defense Mechanisms

Defense mechanisms are mental functions which facilitate coping when real or imagined events challenge personal wishes, needs, and feelings. Whether defense mechanisms have a specific neural basis is unknown. The present research tested the hypothesis that interhemispheric integration plays a critical role in defense mechanism development, by studying a unique sample of patients born without the corpus callosum (agenesis of the corpus callosum; AgCC). Adults with AgCC (N = 27) and matched healthy volunteers (N = 30) were compared on defense mechanism use across increasing levels of developmental maturity (denial, least; projection, intermediate; identification, most). Narratives generated in response to Thematic Apperception Test images were scored according to the Defense Mechanism Manual. Greater use of denial and less identification was found in persons with AgCC, compared to healthy comparisons. This difference emerged after age 18 when full maturation of defenses among healthy individuals was expected. The findings provide clinically important characterization of social and emotional processing in persons with AgCC. More broadly, the results support the hypothesis that functional integration across the hemispheres is important for the development of defense mechanisms.

Lessons From Astronomy and Biology for the Mind-Copernican Revolution in Neuroscience

Neuroscience made major progress in unravelling the neural basis of mental features like self, consciousness, affect, etc. However, we nevertheless lack what recently has been described as "missing ingredient" or "common currency" in the relationship between neuronal and mental activity. Rather than putting forward yet another theory of the neural basis of mental features, I here suggest a change in our methodological strategy how to approach the brain, that is, our view or vantage point of the brain. Learning from astronomy (Copernicus) and biology (Darwin), I suggest that we may want to change our currently pre-Copernican vantage point from within brain to a post-Copernican vantage point from beyond brain. Such post-Copernican vantage point from beyond brain allows us taking into view that what happens beyond the brain itself, e.g., the world, and how that shapes the brain and its neural activity, e.g., world-brain relation. We then lend empirical support to the world-brain relation by converging it with Karl Friston's free energy principle that, as we see it, provides a neuro-ecological and therefore post-Copernican view of the brain. That, in turn, allows us taking into view that mental features are shaped by both world and brain and are therefore truly neuro-ecological rather than merely neuronal. This raises the question for the link, e.g., the "missing ingredient" or "common currency" of world brain relation and mental features. Recent empirical evidence suggests that temporo-spatial dynamics may provide such link as it characterizes both the world-brain relation's free energy and mental features, e.g., their spatiotemporality as described in philosophy. Taken together, I here advocate a change in our methodological strategy on how to approach the brain, that is, a shift from a pre-Copernican vantage point from within brain to a post-Copernican vantage point from beyond brain. The latter allows us taking into view that what happens beyond the brain in the world and how that shapes the brain in such a way that it can yield mental features. This amounts to nothing less than a Copernican turn or revolution in neuroscience akin to the ones in astronomy (Copernicus) and biology (Darwin).

A Theory of Everything: Overlapping Neurobiological Mechanisms of Psychotherapies of Fear and Anxiety Related Disorders

Similarities within the phenomenology, neurobiology, psychotherapeutic, and pharmacological treatments of distinctly categorized anxiety and fear related disorders suggest the involvement of common neurobiological mechanisms in their formation. This theory of integration is the focus of the Research Domain Criteria (RDoC) approach initiated by the NIH. The current article explores potential facets of overlap among mainstream methods of psychotherapy for anxiety, fear, and trauma related disorders. These overlaps include associative learning of safety, cognitive reappraisal and emotion regulation, therapist as a social safety cue, and contextualization. Temporal contextualization and placing memories in their time and place will be suggested as a potentially important, and less explored aspect of psychotherapy.

Sigmund Freud-early network theories of the brain

Since the early days of modern neuroscience, psychological models of brain function have been a key component in the development of new knowledge. These models aim to provide a framework that allows the integration of discoveries derived from the fundamental disciplines of neuroscience, including anatomy and physiology, as well as clinical neurology and psychiatry. During the initial stages of his career, Sigmund Freud (1856-1939), became actively involved in these nascent fields with a burgeoning interest in functional neuroanatomy. In contrast to his contemporaries, Freud was convinced that cognition could not be localised to separate modules and that the brain processes cognition not in a merely serial manner but in a parallel and dynamic fashion-anticipating fundamental aspects of current network theories of brain function. This article aims to shed light on Freud's seminal, yet oft-overlooked, early work on functional neuroanatomy and his reasons for finally abandoning the conventional neuroscientific "brain-based" reference frame in order to conceptualise the mind from a purely psychological perspective.

The Differential Diagnosis and Treatment of Catatonia in Children and Adolescents

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Assess the etiologies associated with catatonia in children and adolescents• Evaluate the differential diagnosis of pediatric catatonia• Interpret the literature regarding the treatment of children and adolescents with catatonia OBJECTIVE: Pediatric catatonia is associated with many medical and psychiatric conditions. Mortality is high, and proper treatment can be lifesaving. Catatonia is increasingly recognized in pediatric populations, in which about 20% of cases are related to underlying medical conditions. To minimize morbidity, clinicians must rule out underlying disorders while simultaneously managing symptoms and causes. In our review we discuss (1) recommendations to aid rapid decision making, both diagnostic and therapeutic, (2) emergent conditions and management, (3) disorders associated with pediatric catatonia, including developmental, acquired, idiopathic, and iatrogenic etiologies, (4) available treatments, and (5) medicolegal considerations.

METHODS

Initial PubMed search without date constraints using MeSH terms related to pediatric catatonia, with subsequent searches on pertinent subtopics using PubMed and Google Scholar.

RESULTS

Pediatric catatonia is a dangerous but treatable neuropsychiatric condition. Psychiatrists need to be aware of differential diagnoses and to be able determine appropriate treatment within a short time frame. With prompt diagnosis and treatment, outcomes can be optimized.

CONCLUSION

Pediatric catatonia is underdiagnosed and requires rapid evaluation and management.

The bridge between two worlds: psychoanalysis and fMRI

In recent years, a connection between psychoanalysis and neuroscience has been sought. The meeting point between these two branches is represented by neuropsychoanalysis. The goal of the relationship between psychoanalysis and neuroscience is to test psychoanalytic hypotheses in the human brain, using a scientific method. A literature search was conducted on May 2015. PubMed and Scopus databases were used to find studies for the inclusion in the systematic review. Common results of the studies investigated are represented by a reduction, a modulation, or a normalization of the activation patterns found after the psychoanalytic therapy. New findings in the possible and useful relationship between psychoanalysis and neuroscience could change the modalities of relating to patients for psychoanalysts and the way in which neuroscientists plan their research. Researchers should keep in mind that in any scientific research that has to do with people, neuroscience and a scientific method cannot avoid subjective interpretation.

Psychopathological Functioning Levels (PFLs) and their possible relevance in psychiatric treatments: a qualitative research project

BACKGROUND

Symptoms description is often not enough to provide clinicians with guidelines for treatments and patients' clinical history does not represent an exhaustive source of data. Psychopathological dysfunctions are known to relate to the core disturbances that underlie different forms of psychopathology so the identification of such dysfunctions could be helpful for treatments. Some tools are available although highly complex and lengthy. This study aimed to provide clinicians with an easy-to-administer instrument able to capture different levels of impairment in psychopathological functioning, namely the Psychopathological Functioning Levels - Rating Scale (PFL-RS).

METHODS

The Psychopathological Functioning Level - Research and Training Committee (PFL-RTC) has been established in Turin since 2002 including psychiatrists and clinical psychologists with extensive clinical and research experience. Our research was grounded on the Qualitative Research Criteria (QRC) 1-7 and conducted with subsequent steps in order to identify those core psychopathological dysfunctions to be rated by this tool.

RESULTS

From 2002 until 2014, 316 outpatients were administered the clinical interview on at least two different occasions. Diagnoses were mixed and included: Schizophrenic and Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, Post- Traumatic Stress Disorder, Somatic Symptoms Disorders, Eating Disorders and Personality Disorders. Focus groups were conducted to identify those psychopathological dysfunctions which needed to be rated, according to two Phenomenological Selection Criteria (PhSC) and four Etiopathogenetic Selection Criteria (EtSC). As a result, five dysfunctional areas emerged: Identity (ID); Comprehension (CO); Negative Emotions (NE); Action-Regulation (AR); Social Skills (SS). After checking such dimensions for consistency with the existing instruments, 7 levels of severity were identified for each area. Finally, a provisional Italian schedule of Psychopathological Functioning Levels - Rating Scale (PFL-RS) was obtained and checked for semantic comprehension and then administered gathering preliminary data.

CONCLUSIONS

Psychopathological dysfunctions underlying mental disorders have been recognized in the present study with the PFL-RS. This instrument seems promising to inform in a specific way treatments strategies and goals, specifically concerning psychotherapy. Notwithstanding, further research is needed in order to confirm validity, sensitivity and reliability of this instrument.

Psychotherapy and Its Role in Psychiatric Practice: A Position Paper. II. Objective, Subjective, and Intersubjective Science

In the first article in this 2-part series, we outlined a psychobiological model of psychiatric treatment and reviewed the evidence showing psychotherapy to be a form of biological intervention that induces lasting alterations in brain structure and function. In this second article, we focus on the adaptive model of psychopathology, the effectiveness of psychotherapeutic interventions, the synergistic effects of combined psychotherapy and psychopharmacology treatments, and attention to the patient's subjective experience and the doctor-patient alliance to complement an "objective" case formulation. The evidence strongly suggests the need for an integrated treatment approach based on the objective, subjective, and intersubjective science that forms the foundation of psychiatry as a clinical discipline, in which psychotherapy and psychopharmacology are seen as complementary treatments within a systemic approach to psychiatric care and training. What emerges is the integrated psychobiological model of care with a complex treatment matrix unique to each patient-provider pair and comprised of biological, experiential, and relational domains of treatment which form the foundation of psychiatry as a science of attachment and meaning.

The Syndrome of Catatonia

Catatonia is a psychomotor syndrome which has historically been associated with schizophrenia. Many clinicians have thought that the prevalence of this condition has been decreasing over the past few decades. This review reminds clinicians that catatonia is not exclusively associated with schizophrenia, and is still common in clinical practice. Many cases are related to affective disorders or are of an idiopathic nature. The illusion of reduced prevalence has been due to evolving diagnostic systems that failed to capture catatonic syndromes. This systemic error has remained unchallenged, and potentiated by the failure to perform adequate neurological evaluations and catatonia screening exams on psychiatric patients. We find that current data supports catatonic syndromes are still common, often severe and of modern clinical importance. Effective treatment is relatively easy and can greatly reduce organ failure associated with prolonged psychomotor symptoms. Prompt identification and treatment can produce a robust improvement in most cases. The ongoing prevalence of this syndrome requires that psychiatrists recognize catatonia and its presentations, the range of associated etiologies, and the import of timely treatment.

The "Feeling of Movement": Notes on the Rorschach Human Movement Response

Human movement responses (M) on the Rorschach have been traditionally viewed as lying neither completely in the inkblot (external reality) nor within the subject's mind (inner world). The authors contend that M is not reducible to the "body that I have" but to the "body that I am," which is a higher level organization of bottom-up and top-down brain networks, integrating body implicit awareness, psychological functioning, and social cognition. Two sources of evidence suggest the close relationship among M, psychological functions, and brain mechanisms. One comes from meta-analytical evidence supporting the close association between M and higher level cognitive functioning or empathy. The second comes from some preliminary studies showing that M activates brain circuits included in the mirror neuron system (MNS). Two conclusions can be drawn: (a) M is related to the effective use of the mentalization function; and (b) future neuroscientific investigations could lead to an understanding of the neuropsychological mechanisms underlying Rorschach responses and variables.

Neuroanatomical differences between men and women in help-seeking coping strategy

Help seeking (HS) is a core coping strategy that is directed towards obtaining support, advice, or assistance as means of managing stress. Women have been found to use more HS than men. Neural correlates of sex differences have also been reported in prefrontal-limbic system (PLS) regions that are linked to stress and coping, yet structural differences between men and women relating to HS in the PLS are still unknown. Thus, the association between gray matter volume (GMV) and HS was investigated using voxel-based morphometry (VBM) in a large healthy sample (126 men and 156 women). Results indicated women reported more HS than men did. VBM results showed that the relation between HS scores and GMV differed between men and women in regions of the bilateral orbitofrontal cortex extending to the subgenual anterior cingulate cortex(OFC/sgACC). Among women, higher HS scores were associated with smaller GMV in these areas while a positive correlation between GMV and HS scores was observed among men. These results remained significant after controlling for general intelligence, stress, anxiety and depression. Thus, this study suggested that structural differences between men and women are correlated to characteristic brain regions known to be involved in the PLS which is considered critical in stress regulation.

Altered neurochemical metabolites in Alzheimer's disease patients with unawareness of deficits

BACKGROUND

Unawareness of deficits is common and is associated with poor outcomes in Alzheimer's disease (AD); however, little is known about correlated neurobiochemical changes.

METHODS

Proton magnetic resonance spectroscopy was used to examine neurobiochemical correlates of unawareness of deficits as assessed by the Dementia Deficit Scale in 36 patients with AD. Magnetic resonance spectroscopy spectra were acquired from the anterior cingulate area and right orbitofrontal area. Concentrations of N-acetyl-aspartate (NAA), total creatine, and other neurometabolites were calculated.

RESULTS

Nineteen (52.8%) participants had relative unawareness of deficits. This condition was negatively correlated with NAA/creatine in the anterior cingulate area (β = -0.36, p = 0.025) and positively correlated with NAA/creatine in the right orbitofrontal area (β = 0.41, p = 0.009) after controlling for dementia severity.

CONCLUSIONS

These findings suggest unawareness of deficits in AD was associated with the altered neurochemical metabolites in the anterior cingulate area and right orbitofrontal area. However, the two areas might have opposite neuronal functions in unawareness of deficits.

Neuroimaging for psychotherapy research: current trends

OBJECTIVE

This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research.

METHOD

We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research.

RESULTS

We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive compulsive disorder (OCD), and schizophrenia.

CONCLUSIONS

The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research.

Essentials of psychoanalytic process and change: how can we investigate the neural effects of psychodynamic psychotherapy in individualized neuro-imaging?

The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to "remember, repeat, and work through" concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved it corresponds to neuronal transformation. Individualized neuro-imaging requires controlling and measuring of variables that must be defined. Two main methodological problems can be distinguished: the design problem addresses the issue of how to account for functionally related variables in an experimentally independent way. The translation problem raises the question of how to bridge the gaps between different levels of the concepts presupposed in individualized neuro-imaging (e.g., the personal level of the therapist and the client, the neural level of the brain). An overview of individualized paradigms, which have been used until now is given, including Operationalized Psychodynamic Diagnosis (OPD-2) and the Maladaptive Interpersonal Patterns Q-Start (MIPQS). The development of a new paradigm that will be used in fMRI experiments, the "Interpersonal Relationship Picture Set" (IRPS), is described. Further perspectives and limitations of this new approach concerning the design and the translation problem are discussed.

Struggle for life, struggle for love and recognition: the neglected self in social cognitive neuroscience

In the following article we present a view that social cognition and social neuroscience, as shaped by the current research paradigms, are not sufficient to improve our understanding of psychopathological phenomena. We hold that the self, self-awareness, and inter-subjectivity are integral to social perception and actions. In addition, we emphasize that the self and self-awareness are, by their very nature and function, involved over the entire lifespan with the way the individual is perceived in the social environment. Likewise, the modes of operation and identification of the self and self-awareness receive strong developmental contributions from social interactions with parental figures, siblings, peers, and significant others. These contributions are framed by a competitive and cooperative struggle for love and recognition. We suggest that in humans social cognitive neuroscience should be informed by a thoughtful appreciation of the equal significance of the struggle for "life" and that for love and recognition. In order to be better positioned to improve the research agenda and practice of clinical psychiatry, we propose that cognitive and social neurosciences explicitly incorporate in their models phenomena relative to the self, self-awareness, and inter-subjectivity.

Psychoanalysis and the brain - why did freud abandon neuroscience?

Sigmund Freud, the founder of psychoanalysis, was initially a neuroscientist but abandoned neuroscience completely after he made a last attempt to link both in his writing, "Project of a Scientific Psychology," in 1895. The reasons for his subsequent disregard of the brain remain unclear though. I here argue that one central reason may be that the approach to the brain during his time was simply not appealing to Freud. More specifically, Freud was interested in revealing the psychological predispositions of psychodynamic processes. However, he was not so much focused on the actual psychological functions themselves which though were the prime focus of the neuroscience at his time and also in current Cognitive Neuroscience. Instead, he probably would have been more interested in the brain's resting state and its constitution of a spatiotemporal structure. I here assume that the resting state activity constitutes a statistically based virtual structure extending and linking the different discrete points in time and space within the brain. That in turn may serve as template, schemata, or grid for all subsequent neural processing during stimulus-induced activity. As such the resting state' spatiotemporal structure may serve as the neural predisposition of what Freud described as "psychological structure." Hence, Freud and also current neuropsychoanalysis may want to focus more on neural predispositions, the necessary non-sufficient conditions, rather than the neural correlates, i.e., sufficient, conditions of psychodynamic processes.

Linking neuroscience and psychoanalysis from a developmental perspective: why and how?

This paper aims to develop the rational to support why and how we should link neuroscience and psychoanalysis. Many of these points are derived from child development and child psychiatry. Neuroscience investigates developmental questions in a different way than psychoanalysis, while psychoanalysis itself has shifted towards new developmental paradigms. The rapprochement between neuroscience and psychoanalysis allows a new understanding of some concepts, including embodiment of mind, consciousness and attachment. The "double reading" paradigm allows a better understanding of symptomatic configurations. Linking neuroscience and psychoanalysis may improve treatments and result in new experimental neuroscientific paradigms involving changing the research object, changing the state of the research object, and investigating the structural changes in the brain following psychotherapy. The last aim is to create an epistemology of the articulation between the theoretical frameworks through phenomenology, "complementarism" and neuropsychoanalysis. We argue that it is necessary for clinicians to be aware of the advancements in each field. This is not only an epistemological question; we assume that new findings in neuroscience will change the way psychoanalysts think and approach treatment of their patients. We hope the present research will contribute to change the way that neuroscientists think and will provide new options to their set of experimental paradigms.