"Surprise" and the Bayesian Brain: Implications for Psychotherapy Theory and Practice

Mentalization-based approach for schizophrenia spectrum disorders: a psychotherapeutic proposal for evolved schizophrenic trajectories and serious mental disorders

There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.

Friston, Free Energy, and Psychoanalytic Psychotherapy

This paper outlines the ways in which Karl Friston's work illuminates the everyday practice of psychotherapists. These include (a) how the strategic ambiguity of the therapist's stance brings, via 'transference', clients' priors to light; (b) how the unstructured and negative capability of the therapy session reduces the salience of priors, enabling new top-down models to be forged; (c) how fostering self-reflection provides an additional step in the free energy minimization hierarchy; and (d) how Friston and Frith's 'duets for one' can be conceptualized as a relational zone in which collaborative free energy minimization takes place without sacrificing complexity.

The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation

BACKGROUND

Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation.

METHODS

Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.

RESULTS

We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.

CONCLUSION

Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.

Placebo and Nocebo Effects as Bayesian-Brain Phenomena: The Overlooked Role of Likelihood and Attention

The Bayesian-brain framework applied to placebo responses and other mind-body interactions suggests that the effects on the body result from the interaction between priors, such as expectations and learning, and likelihood, such as somatosensorial information. Significant research in this area focuses on the role of the priors, but the relevance of the likelihood has been surprisingly overlooked. One way of manipulating the relevance of the likelihood is by paying attention to sensorial information. We suggest that attention can influence both precision and position (i.e., the relative distance from the priors) of the likelihood by focusing on specific components of the somatosensorial information. Two forms of attention seem particularly relevant in this framework: mindful attention and selective attention. Attention has the potential to be considered a "major player" in placebo/nocebo research, together with expectations and learning. In terms of application, relying on attentional strategies as "amplifiers" or "silencers" of sensorial information could lead to an active involvement of individuals in shaping their care process and health. In this contribution, we discuss the theoretical implications of these intuitions with the aim to provide a comprehensive framework that includes Bayesian brain, placebo/nocebo effects, and the role of attention in mind-body interactions.

Neurobiological mechanisms of dialectical behavior therapy and Morita therapy, two psychotherapies inspired by Zen

Psychotherapy is a learning process. Updating the prediction models of the brain may be the mechanism underlying psychotherapeutic changes. Although developed in different eras and cultures, dialectical behavior therapy (DBT) and Morita therapy are influenced by Zen principles, and both emphasize the acceptance of reality and suffering. This article reviews these two treatments, their common and distinct therapeutic factors, and their neuroscientific implications. Additionally, it proposes a framework that includes the predictive function of the mind, constructed emotions, mindfulness, therapeutic relationship, and changes enabled via reward predictions. Brain networks, including the Default Mode Network (DMN), amygdala, fear circuitry, and reward pathways, contribute to the constructive process of brain predictions. Both treatments target the assimilation of prediction errors, gradual reorganization of predictive models, and creation of a life with step-by-step constructive rewards. By elucidating the possible neurobiological mechanisms of these psychotherapeutic techniques, this article is expected to serve as the first step towards filling the cultural gap and creating more teaching methods based on these concepts.

Individual differences in computational psychiatry: a review of current challenges

Bringing precision to the understanding and treatment of mental disorders requires instruments for studying clinically relevant individual differences. One promising approach is the development of computational assays: integrating computational models with cognitive tasks to infer latent patient-specific disease processes in brain computations. While recent years have seen many methodological advancements in computational modelling and many cross-sectional patient studies, much less attention has been paid to basic psychometric properties (reliability and construct validity) of the computational measures provided by the assays. In this review, we assess the extent of this issue by examining emerging empirical evidence. We find that many computational measures suffer from poor psychometric properties, which poses a risk of invalidating previous findings and undermining ongoing research efforts using computational assays to study individual (and even group) differences. We provide recommendations for how to address these problems and, crucially, embed them within a broader perspective on key developments that are needed for translating computational assays to clinical practice.

The Active Inference Model of Coherence Therapy

Coherence Therapy is an empirically derived experiential psychotherapy based on Psychological Constructivism. Symptoms are viewed as necessary output from an implicit model of the world. The therapist curates experiences and directs attention toward discovering the model. Rendered explicit, the model is juxtaposed with contradictory knowledge driving memory re-consolidation with resolution of the symptom. The Bayesian Brain views perception and action as inferential processes. Prior beliefs are combined in a generative model to explain the hidden causes of sensations through a process of Active Inference. Prior beliefs that are poor fits to the real world are suboptimal. Suboptimal priors with optimal inference produce Bayes Optimal Pathology with behavioral symptoms. The Active Inference Model of Coherence Therapy posits that Coherence Therapy is a dyadic act of therapist guided Active Inference that renders the (probable) hidden causes of a client's behavior conscious. The therapist's sustained attention on the goal of inference helps to overcome memory control bias against retrieval of the affectively charged suboptimal prior. Serial experiences cue memory retrieval and re-instantiation of the physiological/affective state that necessitates production of the symptom in a particular context. As this process continues there is a break in modularity with assimilation into broader networks of experience. Typically, the symptom produced by optimal inference with the suboptimal prior is experienced as unnecessary/inappropriate when taken out of the particular context. The implicit construct has been re-represented and rendered consciously accessible, by a more complex but more accurate model in which the symptom is necessary in some contexts but not others. There is an experience of agency and control in symptom creation, accompanied by the spontaneous production of context appropriate behavior. The capacity for inference has been restored. The Active Inference Model of Coherence Therapy provides a framework for Coherence Therapy as a computational process which can serve as the basis for new therapeutic interventions and experimental designs integrating biological, cognitive, behavioral, and environmental factors.

Functional contextual implementation of an evolutionary, entropy-based, and embodied free energy framework: Utilizing Lagrangian mechanics and evolutionary game theory's truth vs. fitness test of the veridicality of phenomenological experience

The Bayesian approach of cognitive science largely takes the position that evolution drives perception to produce precepts that are veridical. However, some efforts utilizing evolutionary game theory simulations have shown that perception is more likely based on a fitness function, which promotes survival rather than promoting perceptual truth about the environment. Although these findings do not correspond well with the standard Bayesian approach to cognition, they may correspond with a behavioral functional contextual approach that is ontologically neutral (a-ontological). This approach, formalized through a post-Skinnerian account of behaviorism called relational frame theory (RFT), can, in fact, be shown to correspond well with an evolutionary fitness function, whereby contextual functions form that corresponds to a fitness function interface of the world. This fitness interface approach therefore may help provide a mathematical description for a functional contextual interface of phenomenological experience. Furthermore, this more broadly fits with a neurological active inference approach based on the free-energy principle (FEP) and more broadly with Lagrangian mechanics. These assumptions of how fitness beats truth (FBT) and FEP correspond to RFT are then discussed within a broader multidimensional and evolutionary framework called the extended evolutionary meta-model (EEMM) that has emerged out of the functional contextual behavioral science literature to incorporate principles of cognition, neurobiology, behaviorism, and evolution and are discussed in the context of a novel RFT framework called "Neurobiological and Natural Selection Relational Frame Theory" (N-frame). This framework mathematically connects RFT to FBT, FEP, and EEMM within a single framework that expands into dynamic graph networking. This is then discussed for its implications of empirical work at the non-ergodic process-based idiographic level as applied to individual and societal level dynamic modeling and clinical work. This discussion is framed within the context of individuals that are described as evolutionary adaptive and conscious (observer-self) agents that minimize entropy and can promote a prosocial society through group-level values and psychological flexibility.

Neural Mechanisms and Psychology of Psychedelic Ego Dissolution

Neuroimaging studies of psychedelics have advanced our understanding of hierarchical brain organization and the mechanisms underlying their subjective and therapeutic effects. The primary mechanism of action of classic psychedelics is binding to serotonergic 5-HT2A receptors. Agonist activity at these receptors leads to neuromodulatory changes in synaptic efficacy that can have a profound effect on hierarchical message-passing in the brain. Here, we review the cognitive and neuroimaging evidence for the effects of psychedelics: in particular, their influence on selfhood and subject-object boundaries-known as ego dissolution-surmised to underwrite their subjective and therapeutic effects. Agonism of 5-HT2A receptors, located at the apex of the cortical hierarchy, may have a particularly powerful effect on sentience and consciousness. These effects can endure well after the pharmacological half-life, suggesting that psychedelics may have effects on neural plasticity that may play a role in their therapeutic efficacy. Psychologically, this may be accompanied by a disarming of ego resistance that increases the repertoire of perceptual hypotheses and affords alternate pathways for thought and behavior, including those that undergird selfhood. We consider the interaction between serotonergic neuromodulation and sentience through the lens of hierarchical predictive coding, which speaks to the value of psychedelics in understanding how we make sense of the world and specific predictions about effective connectivity in cortical hierarchies that can be tested using functional neuroimaging. SIGNIFICANCE STATEMENT: Classic psychedelics bind to serotonergic 5-HT2A receptors. Their agonist activity at these receptors leads to neuromodulatory changes in synaptic efficacy, resulting in a profound effect on information processing in the brain. Here, we synthesize an abundance of brain imaging research with pharmacological and psychological interpretations informed by the framework of predictive coding. Moreover, predictive coding is suggested to offer more sophisticated interpretations of neuroimaging findings by bridging the role between the 5-HT2A receptors and large-scale brain networks.

Learned uncertainty: The free energy principle in anxiety

Generalized anxiety disorder is among the world’s most prevalent psychiatric disorders and often manifests as persistent and difficult to control apprehension. Despite its prevalence, there is no integrative, formal model of how anxiety and anxiety disorders arise. Here, we offer a perspective derived from the free energy principle; one that shares similarities with established constructs such as learned helplessness. Our account is simple: anxiety can be formalized as learned uncertainty. A biological system, having had persistent uncertainty in its past, will expect uncertainty in its future, irrespective of whether uncertainty truly persists. Despite our account’s intuitive simplicity—which can be illustrated with the mere flip of a coin—it is grounded within the free energy principle and hence situates the formation of anxiety within a broader explanatory framework of biological self-organization and self-evidencing. We conclude that, through conceptualizing anxiety within a framework of working generative models, our perspective might afford novel approaches in the clinical treatment of anxiety and its key symptoms.

Psychoanalytic psychotherapies and the free energy principle

In this paper I propose a model of the fundamental components of psychoanalytic psychotherapies that I try to explicate with contemporary theories of the Bayesian brain and the Free Energy Principle (FEP). I first show that psychoanalytic therapies require a setting (made up of several envelopes), a particular psychic state and specific processes (transference, free association, dreaming, play, reflexivity and narrativity) in order to induce psychic transformations. I then analyze how these processes of transformations operate and how they can be enlightened by the FEP. I first underline the fact that psychoanalytic therapies imply non-linear processes taking time to unfold and require a setting containing high entropy processes. More precisely, these processes are characterized by an interplay between extension and reduction of free energy. This interplay also favors the emergence of new orders of subjective experience, which occur following states of disorder, according to a certain energetic threshold allowing the modification and improvement of mental functioning. These high entropy states are also characterized by random functioning and psychic malleability which favors the exploration of subjective experience in an original manner. Overall, the approach proposed in this paper support the dialogue between psychoanalysis and other fields of research while underlining how psychoanalytical theoretical and conceptual constructs can also be useful to other disciplines, in particular the neurosciences of subjectivity.

Beauty and Uncertainty as Transformative Factors: A Free Energy Principle Account of Aesthetic Diagnosis and Intervention in Gestalt Psychotherapy

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change.

Friston's free energy principle: new life for psychoanalysis?

The free energy principle (FEP) is a new paradigm that has gain widespread interest in the neuroscience community. Although its principal architect, Karl Friston, is a psychiatrist, it has thus far had little impact within psychiatry. This article introduces readers to the FEP, points out its consilience with Freud's neuroscientific ideas and with psychodynamic practice, and suggests ways in which the FEP can help explain the mechanisms of action of the psychotherapies.

Clinical Manifestations of Body Memories: The Impact of Past Bodily Experiences on Mental Health

Bodily experiences such as the feeling of touch, pain or inner signals of the body are deeply emotional and activate brain networks that mediate their perception and higher-order processing. While the ad hoc perception of bodily signals and their influence on behavior is empirically well studied, there is a knowledge gap on how we store and retrieve bodily experiences that we perceived in the past, and how this influences our everyday life. Here, we explore the hypothesis that negative body memories, that is, negative bodily experiences of the past that are stored in memory and influence behavior, contribute to the development of somatic manifestations of mental health problems including somatic symptoms, traumatic re-experiences or dissociative symptoms. By combining knowledge from the areas of cognitive neuroscience and clinical neuroscience with insights from psychotherapy, we identify Clinical Body Memory (CBM) mechanisms that specify how mental health problems could be driven by corporeal experiences stored in memory. The major argument is that the investigation of the neuronal mechanisms that underlie the storage and retrieval of body memories provides us with empirical access to reduce the negative impact of body memories on mental health.

Piloting the Update: The Use of Therapeutic Relationship for Change - A Free Energy Account

We apply the Free Energy Principle (FEP) to cognitive behavioral therapy (CBT). FEP describes the basic functioning of the brain as a predictive organ and states that any self-organizing system that is in equilibrium with its environment must minimize its free energy. Based on an internal model of the world and the self, predictions-so-called priors-are created, which are matched with the information input. The sum of prediction errors corresponds to the Free Energy, which must be minimized. Internal models can be identified with the cognitive-affective schemas of the individual that has become dysfunctional in patients. The role of CBT in this picture is to help the patient update her/his priors. They have evolved in learning history and no longer provide adaptive predictions. We discuss the process of updating in terms of the exploration-exploitation dilemma. This consists of the extent to which one relies on what one already has, i.e., whether one continues to maintain and "exploit" one's previous priors ("better safe than sorry") or whether one does explore new data that lead to an update of priors. Questioning previous priors triggers stress, which is associated with increases in Free Energy in short term. The role of therapeutic relationship is to buffer this increase in Free Energy, thereby increasing the level of perceived safety. The therapeutic relationship is represented in a dual model of affective alliance and goal attainment alliance and is aligned with FEP. Both forms of alliance support exploration and updating of priors. All aspects are illustrated with the help of a clinical case example.

Flights and Perchings of the BrainMind: A Temporospatial Approach to Psychotherapy

This article introduces a process-oriented approach for improving present moment conceptualization in psychotherapy that is in alignment with neuroscience: the Temporospatial movements of mind (TSMM) model. We elaborate on seven temporal movements that describe the moment-to-moment morphogenesis of emotional feelings and thoughts from inception to maturity. Temporal refers to the passage of time through which feelings and thoughts develop, and electromagnetic activity, that among other responsibilities, bind information across time. Spatial dynamics extend from an undifferentiated to three dimensional experiences of emotional and cognitive processes. Neurophysiologically, spatial refers to structures within the brain and their varying interactions with one another. This article culminates in the development of an atheoretical temporospatial grid that may help clinicians conceptualize where patients are in their cognitive and emotional development to further guide technique.

Instability and Uncertainty Are Critical for Psychotherapy: How the Therapeutic Alliance Opens Us Up

Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client's behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one hand, specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston's systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client's functioning due to therapy can be conceptualized as a reduction in the precisions (certainty) with which the client's prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance (characterized by successful interpersonal synchrony of the sort described by Friston and Frith) results in the emergence of a new hierarchical level in the client's generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client's priors, which allows the client to 'open up': to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial (or potentially harmful) for therapy, are considered.

The Role of Expectation and Beliefs on the Effects of Non-Invasive Brain Stimulation

Non-invasive brain stimulation (NIBS) techniques are used in clinical and cognitive neuroscience to induce a mild magnetic or electric field in the brain to modulate behavior and cortical activation. Despite the great body of literature demonstrating promising results, unexpected or even paradoxical outcomes are sometimes observed. This might be due either to technical and methodological issues (e.g., stimulation parameters, stimulated brain area), or to participants’ expectations and beliefs before and during the stimulation sessions. In this narrative review, we present some studies showing that placebo and nocebo effects, associated with positive and negative expectations, respectively, could be present in NIBS trials, both in experimental and in clinical settings. The lack of systematic evaluation of subjective expectations and beliefs before and after stimulation could represent a caveat that overshadows the potential contribution of placebo and nocebo effects in the outcome of NIBS trials.

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.

Sex and Prediction Error, Part 2: Jouissance and The Free Energy Principle in Neuropsychoanalysis

Jouissance refers to an excess enjoyment beyond (yet tied to) speech and representation. From the perspective of some Lacanian analysts, jouissance is precisely what testifies against any relationship to the brain-jouissance "slips" out of cognition. On the contrary, it is argued here that jouissance has a central place in contemporary neuropsychoanalysis. In part 1 of this series the metapsychology of jouissance was presented in relation to the real and symbolic registers. Here, in part 2, Mark Solms's neuropsychoanalytic model of Karl Friston's free energy principle is summarized. In this model, "predictions" aim to resolve prediction errors-most notably, those signaled by affective consciousness. "Surplus prediction error"-prediction error that arises at the point where the predictive model fails-is proposed to be a neural correlate of jouissance. This limit within prediction is analogous to the real as a structural negativity within the symbolic.

Sex and Prediction Error, Part 3: Provoking Prediction Error

In parts 1 and 2 of this Lacanian neuropsychoanalytic series, surplus prediction error was presented as a neural correlate of the Lacanian concept of jouissance. Affective consciousness (a key source of prediction error in the brain) impels the work of cognition, the predictive work of explaining what is foreign and surprising. Yet this arousal is the necessary bedrock of all consciousness. Although the brain's predictive model strives for homeostatic explanation of prediction error, jouissance "drives a hole" in the work of homeostasis. Some residual prediction error always remains. Lacanian clinical technique attends to this surplus and the failed predictions to which this jouissance "sticks." Rather than striving to eliminate prediction error, clinical practice seeks its metabolization. Analysis targets one's mode of jouissance to create a space for the subject to enjoy in some other way. This entails working with prediction error, not removing or tolerating it. Analysis aims to shake the very core of the subject by provoking prediction error-this drives clinical change. Brief clinical examples illustrate this view.

Beyond the death drive: Entropy and free energy

In this paper I offer an overview of the possible links between psychoanalytical metapsychology and contemporary work in neuroscience concerning entropy and the free energy principle. After briefly describing the theory of living systems put forward by the neuroscientist Karl Friston based on the notion of entropy, we sum up the use of the notion of free energy by Friston and Freud. I then analyze how these notions improve the intelligibility of psychic functioning and can be associated with several psychoanalytical concepts, in particular the death drive. I approach from the same perspective the regulation of free energy associated with psychic envelopes and early intersubjectivity. It thus appears that the psychic apparatus can be considered at its different levels, from the most primary to the most secondary, as having the essential function of reducing entropy and free energy. Various forms of "failure" of this process of linking, regulation and transformation of energy within the psychic apparatus could be considered as the origin of different psychopathological manifestations as suggested in the last part of this paper.

The Embodied-Enactive-Interactive Brain: Bridging Neuroscience and Creative Arts Therapies

The recognition and incorporation of evidence-based neuroscientific concepts into creative arts therapeutic knowledge and practice seem valuable and advantageous for the purpose of integration and professional development. Moreover, exhilarating insights from the field of neuroscience coincide with the nature, conceptualization, goals, and methods of Creative Arts Therapies (CATs), enabling comprehensive understandings of the clinical landscape, from a translational perspective. This paper contextualizes and discusses dynamic brain functions that have been suggested to lie at the heart of intra- and inter-personal processes. Touching upon fundamental aspects of the self and self-other interaction, the state-of-the-art neuroscientific-informed views will shed light on mechanisms of the embodied, predictive and relational brain. The conceptual analysis introduces and interweaves the following contemporary perspectives of brain function: firstly, the grounding of mental activity in the lived, bodily experience will be delineated; secondly, the enactive account of internal models, or generative predictive representations, shaped by experience, will be defined and extensively deliberated; and thirdly, the interpersonal simulation and synchronization mechanisms that support empathy and mentalization will be thoroughly considered. Throughout the paper, the cross-talks between the brain and the body, within the brain through functionally connected neural networks and in the context of agent-environment dynamics, will be addressed. These communicative patterns will be elaborated on to unfold psychophysiological linkage, as well as psychopathological shifts, concluding with the neuroplastic change associated with the formulation of CATs. The manuscript suggests an integrative view of the brain-body-mind in contexts relevant to the therapeutic potential of the expressive creative arts and the main avenues by which neuroscience may ground, enlighten and enrich the clinical psychotherapeutic practice.

The Digital Phenotyping Project: A Psychoanalytical and Network Theory Perspective

A new method of observation is currently emerging in psychiatry, based on data collection and behavioral profiling of smartphone users. Numerical phenotyping is a paradigmatic example. This behavioral investigation method uses computerized measurement tools in order to collect characteristics of different psychiatric disorders. First, it is necessary to contextualize the emergence of these new methods and to question their promises and expectations. The international mental health research framework invites us to reflect on methodological issues and to draw conclusions from certain impasses related to the clinical complexity of this field. From this contextualization, the investigation method relating to digital phenotyping can be questioned in order to identify some of its potentials. These new methods are also an opportunity to test psychoanalysis. It is then necessary to identify the elements of fruitful analysis that clinical experience and research in psychoanalysis have been able to deploy regarding the challenges of digital technology. An analysis of this theme’s literature shows that psychoanalysis facilitates a reflection on the psychological effects related to digital methods. It also shows how it can profit from the research potential offered by new technical tools, considering the progress that has been made over the past 50 years. This cross-fertilization of the potentials and limitations of digital methods in mental health intervention in the context of theoretical issues at the international level invites us to take a resolutely non-reductionist position. In the field of research, psychoanalysis offers a specific perspective that can well be articulated to an epistemology of networks. Rather than aiming at a numerical phenotyping of patients according to the geneticists’ model, the case formulation method appears to be a serious prerequisite to give a limited and specific place to the integration of smartphones in clinical investigation.

Entropy, Free Energy, and Symbolization: Free Association at the Intersection of Psychoanalysis and Neuroscience

Both a method of therapy and an exploration of psychic reality, free association is a fundamental element of psychoanalytical practices that refers to the way a patient is asked to describe what comes spontaneously to mind in the therapeutic setting. This paper examines the role of free association from the point of view of psychoanalysis and neuroscience in order to improve our understanding of therapeutic effects induced by psychoanalytic therapies and psychoanalysis. In this regard, we first propose a global overview of the historical origins of the concept of free association in psychoanalysis and examine how Freud established its principles. Then, from Freud's distinction between primary and secondary processes, we proceed to compare the psychoanalytic model with research originating from cognitive psychology and neuroscience. The notions of entropy and free energy appear particularly relevant at the intersection of these different domains. Finally, we propose the notion of symbolizing transmodality to describe certain specificities of symbolization processes within free association and we summarize the main functions of free association in psychoanalytic practices.

The Predictive Processing Model of EMDR

Eye Movement Desensitization and Reprocessing Therapy (EMDR) is an effective treatment for Post-traumatic Stress Disorder (PTSD). The Adaptive Information Processing Model (AIP) guides the development and practice of EMDR. The AIP postulates inadequately processed memory as the foundation of PTSD pathology. Predictive Processing postulates that the primary function of the brain is prediction that serves to anticipate the next moment of experience in order to resist the dissipative force of entropy thus facilitating continued survival. Memory is the primary substrate of prediction, and is optimized by an ongoing process of precision weighted prediction error minimization that refines prediction by updating the memories on which it is based. The Predictive Processing model of EMDR postulates that EMDR facilitates the predictive processing of traumatic memory by overcoming the bias against exploration and evidence accumulation. The EMDR protocol brings the traumatic memory into an active state of re-experiencing. Defensive responding and/or low sensory precision preclude evidence accumulation to test the predictions of the traumatic memory in the present. Sets of therapist guided eye movements repeatedly challenge the bias against evidence accumulation and compel sensory sampling of the benign present. Eye movements reset the theta rhythm organizing the flow of information through the brain, facilitating the deployment of both overt and covert attention, and the mnemonic search for associations. Sampling of sensation does not support the predictions of the traumatic memory resulting in prediction error that the brain then attempts to minimize. The net result is a restoration of the integrity of the rhythmic deployment of attention, a recalibration of sensory precision, and the updating (reconsolidation) of the traumatic memory. Thus one prediction of the model is a decrease in Attention Bias Variability, a core dysfunction in PTSD, following successful treatment with EMDR.