Transcript athens-2005-s7-lavrentiadis

Psychotherapy: The
Biological Dimension
Grigoris K. Lavrentiadis
Assistant Prof. of Psychiatry
B’ Department of Psychiatry
Aristotelian University of Thessaloniki
Greece
The great mistake in an over-ambitious science
has been the desire to study man altogether as a
mere sum of parts, if possible of atoms, or now
of electrons and as a machine, detached by itself,
because at least some points in the simple
sciences could be studied to the best advantage
with this method of so called elementalist.
It was a long time before willingness to see the
large group of facts, in their broad relations as
well as in their inner structure, finally gave us the
concept and vision of integration which now fits
man as alive unit and transformer of energy into
the world of facts and makes him frankly a
conscious integrated psychobiological individual
and member of a social group Adolph Meyer, 1921
Concordance Rates in Twins
Type of illness
Identical T. Nonidentical T.
Autism
Schizophrenia
Bipolar disorder
Coronary artery disease
Depression
Breast cancer
60%
40%
40%
40%
50%
30%
5%
10%
10%
10%
15%
10%
N.Andreasen: Brave New Brain,2001
Techniques that used for the
neuropsychological model
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Lesion method
Tract tracing
Neuroimaging
Animal modeling
Single-cell recording
Electophysiology
Neurophysiology
Experimental Cognitive Psychology
Taxonomy of Memory
• A. Declarative (Explicit) memory: Capacity for conscious
recollection about facts and events. Later in life. Expressed
in words and drawings. (hippocampus, medial temporal
lobe, orbitofrontal cortex and midline diencephalons)
1. Semantic memory: facts about the
word.
2. Episodic memory: the capacity to reexperience an event in the context in
which it originally occurred (frontal lobes)
• B. Nondeclarative (Implicit ) memory: Dispositional
memory that is expressed through performance rather than
recollection. No conscious awareness, presented from
birth. Schema of mental models that are summation of
experiences. (basal ganglia, limbic system, and perceptual
cortices)
Nervous that fire together, wire
together
Donald Hebb, 1949
Regional abnormalities in depression
• More common
Dorsolateral prefrontal cortex
Ventrolateral prefrontal cortex
Dorsomedial frontal cortex
Ventromedial frontal cortex
Dorsal cingulate
Rostral cingulate
Subgenual cingulate
• Less common
Hippocampus
Amygdala
Posterior cingulate
Striatum
Thalamus
Fear-mediating neuronal systems
(LeDoux, 1996)
• A. The Amygdala system
Quick and general alarm system.
Reaction to a wide variety of fearrelated
stimuli.
• B. The Hippocampal system
Reaction to more specific fearprovoking cues and may give rise to
explicit memories.
Learning that occurs in
psychotherapy may influence
the structure and the
function of the brain . Early
attachment relationships are
internalized an encoded as
procedural memory
Eric Kandel, 1998
When a therapist speaks to a patient
and the patient listens, the therapist is
not only making eye contact and voice
contact, but the action of neuronal
machinery in the therapist brain is
having an indirect and, one hopes, long
lasting effect on the neuronal
machinery in the patient’s brain. Our
words produce changes in our patient’s
mind
Eric Kandel, 1998
How Psychotherapy stimulates
the Brain
• 1. Psychotherapy affects cerebral metabolic
rates.
• 2. Psychotherapy affects serotonin
metabolism.
• 3. Psychotherapy affects the thyroid axis.
• 4. Psychotherapy stimulates processes akin
to brain plasticity.
• 5. Psychotherapy normalizes
pathognomonic biological features.
Changes in depression with
treatment
• Cognitive Behavior Therapy:
frontal cortex decrease
hippocampal increase
medial frontal cortex changes
orbital frontal cortex changes
• Pharmacotherapy:
frontal cortex increase
hippocampal decrease
brainstem changes
thalamic changes
• Electro Convulsive Therapy:
frontal cortex decrease
hippocampal decrease
Parallels between brain physiology
and schools of Psychotherapy
• A. Behavior Psychotherapy
Dysfunction in simple forms of learning
and memory (operant and associative
conditioning) and related motor behavior.
Brain structures in amygdala, basal ganglia,
hippocampus
• B. Cognitive Psychotherapy
Dysfunction in define specific verbal thoughts and
assumptions or schemata (automatic negative
thoughts)
Brain structures in neocortex, specifically the
frontal cortex
Parallels between brain physiology
and schools of Psychotherapy
• C. Psychodynamic Psychotherapy
Dysfunction in interpersonal
representations and especially the
expectations about self, others and their
relationship that organizes affect,
thought and behavior.
Brain structures are complex neurocircuitry
incorporating lateralized cerebral
hemispheres and subcortical areas.
Unlike neurological diseases,
psychiatric disorders cannot be
related to discrete localized brain
dysfunctions, but rather to
malfunctioning interconnections
between neuronal modules and
their interaction with the
environment
Parnas and Bovet
The theory of man as person
loses its way if it falls into an
account of man as machine or
as an organism of it-processes
Ronald Laing
A new scientific truth does
not triumph by convincing
its opponents … but rather
because its opponents
eventually die
Max Planck