1. 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

2. MENTAL CONFLICT PROBLEMATIC AFFECTIVE/INTERPERSONAL EXPERIENCESPROBLEMATIC AFFECTIVE/INTERPERSONAL EXPERIENCES NEUROLOGIC CONTRIBUTION TO “AUTOBIOGRAPHY” OF PERSONALITYNEUROLOGIC CONTRIBUTION TO “AUTOBIOGRAPHY” OF PERSONALITY ENCODING DEVELOPMENTAL CONFLICTUAL EXPERIENCESENCODING DEVELOPMENTAL CONFLICTUAL EXPERIENCES

3. MENTAL CONFLICT REPRESENTATIONAL SCHEMATAREPRESENTATIONAL SCHEMATA –RE-EVOKED –NON-ADAPTIVE –NON-ERROR CORRECTING –SELF-SYSTEM –INTERPERSONAL FUNCTION –ENVIRONMENT

4. PERSPECTIVES DEVELOPMENTAL, PSYCHODYNAMIC, ADAPTATIONALDEVELOPMENTAL, PSYCHODYNAMIC, ADAPTATIONAL PAST EXPERIENCEPAST EXPERIENCE HABITUAL MODES OF REACTINGHABITUAL MODES OF REACTING

5. PERSPECTIVES PSYCHOTHERAPEUTIC ENCOUNTERPSYCHOTHERAPEUTIC ENCOUNTER –PSYCHOLOGICAL DEFENSE –RESISTANCE –TRANSFERENCE PHENOMENA –ENACTMENTS –SALIENT DREAMS

6. PERSPECTIVES: PSYCHOTHERAPEUTIC TRANSFORMATION/CHANGE CONSTRUCTIVIST MANIFESTOCONSTRUCTIVIST MANIFESTO –NEW STRUCTURE (QUARTZ SEJNOWSKI, 1997) CONTEMPORARY ADDITIONCONTEMPORARY ADDITION –SPECIFIC TEMPORALNEURONAL ENCODING THROUGH REGENERATION (GOULD/GROSS, 1999)

7. EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY EXPERIENCED EVENTS MEMORY FUNCTIONMEMORY FUNCTION –RECOLLECTIONS/REMINISCENCES –NARRATIVES EMOTIONAL ACTIVATION THROUGH NEUROMODULATORY SYSTEMS INVOLVING AMYGDALOID COMPLEX (AC) (CAHILL, 1996)EMOTIONAL ACTIVATION THROUGH NEUROMODULATORY SYSTEMS INVOLVING AMYGDALOID COMPLEX (AC) (CAHILL, 1996)

8. EMOTIONAL AROUSAL INFLUENCES MEMORY OF BRIEFLY EXPERIENCED EVENTS AC ----> HIPPOCAMPUS MODIFICATION/CONSOLIDATION OF MEMORIESAC ----> HIPPOCAMPUS MODIFICATION/CONSOLIDATION OF MEMORIES ENHANCED RECALL OF LONG TERM MEMORY ASSOCIATED WITH INCREASED GLUCOSE METABOLIC RATE IN RIGHT ACENHANCED RECALL OF LONG TERM MEMORY ASSOCIATED WITH INCREASED GLUCOSE METABOLIC RATE IN RIGHT AC

9. AMYGDALOID COMPLEX SELECTIVE ROLE IN LEARNING/MEMORYSELECTIVE ROLE IN LEARNING/MEMORY MODULATE MEMORY STORAGE DURING EMOTIONALLY INFLUENCED CONSCIOUS RECALLMODULATE MEMORY STORAGE DURING EMOTIONALLY INFLUENCED CONSCIOUS RECALL HEIGHTENED EMOTION/COGNITIVE CONSOLIDATION (FREUD/RAPPAPORT)HEIGHTENED EMOTION/COGNITIVE CONSOLIDATION (FREUD/RAPPAPORT) –PSYCHOLOGICAL DEFENSE –EMOTIONS/MEMORY

10. BRAIN FUNCTION IN BULIMIA NERVOSA CAUDATE HYPERMETABOLISM (BLINDER, 1996)CAUDATE HYPERMETABOLISM (BLINDER, 1996) INCREASE ACTIVITY---AMYGDALA CINGULATEINCREASE ACTIVITY---AMYGDALA CINGULATE DISTINCT FROM DEPRESSION (HAGMAN/BLINDER, 1990; WU/BLINDER, 1990)DISTINCT FROM DEPRESSION (HAGMAN/BLINDER, 1990; WU/BLINDER, 1990) NEUROBIOLOGIC LINK TO OCD/WORRY CIRCUITNEUROBIOLOGIC LINK TO OCD/WORRY CIRCUIT

11. BRAIN FUNCTION IN BULIMIA NERVOSA CAUDATE---FOOD SEEKING, FOOD PREPARATORY BEHAVIORCAUDATE---FOOD SEEKING, FOOD PREPARATORY BEHAVIOR APPETITE/SATIETY IN HYPOTHALAMUSAPPETITE/SATIETY IN HYPOTHALAMUS BASAL GANGLIA ALERTING SENSORY MOTOR FEEDING/PURSUITBASAL GANGLIA ALERTING SENSORY MOTOR FEEDING/PURSUIT INITIAL RX- COGNITIVE BEHAVIORAL AND NUTRITIONAL REHABILITATIONINITIAL RX- COGNITIVE BEHAVIORAL AND NUTRITIONAL REHABILITATION

12. BRAIN FUNCTION IN BULIMIA NERVOSA DEVELOPMENTAL PSYCHOPATHOLOGY OF EATING DISORDERSDEVELOPMENTAL PSYCHOPATHOLOGY OF EATING DISORDERS DEVELOPMENTAL STAGES OF FEEDING/ATTACHMENT/ SEPERATIONDEVELOPMENTAL STAGES OF FEEDING/ATTACHMENT/ SEPERATION PSYCHOBIOLOGY---APPETITE REGULATION AND FOOD SELECTIONPSYCHOBIOLOGY---APPETITE REGULATION AND FOOD SELECTION

13. RECOGNITION OF EMOTION IN THE EXTERNAL WORLD DEPRESSED PATIENTS DIMINISHED RESPONSE TO EMOTION IN HUMAN FACEDEPRESSED PATIENTS DIMINISHED RESPONSE TO EMOTION IN HUMAN FACE PET DECREASED ACTIVITY IN TEMPORAL LOBES (BILAT) AND RIGHT INSULAR AREAPET DECREASED ACTIVITY IN TEMPORAL LOBES (BILAT) AND RIGHT INSULAR AREA RESEMBLES DEFICIT IN FOCAL RIGHT HEMISPHERE BRAIN DAMAGERESEMBLES DEFICIT IN FOCAL RIGHT HEMISPHERE BRAIN DAMAGE

14. RECOGNITION OF EMOTION IN THE EXTERNAL WORLD IMPLICATIONS IN DEPRESSIONIMPLICATIONS IN DEPRESSION INTRAPSYCHIC AND INTERPERSONAL CONFLICTINTRAPSYCHIC AND INTERPERSONAL CONFLICT AFFECTIVE RECIPROCITY (INTIMATE/FAMILY)AFFECTIVE RECIPROCITY (INTIMATE/FAMILY) PSYCHOTHERAPY TECHNIQUEPSYCHOTHERAPY TECHNIQUE

15. ANXIETY AND PHOBIA PET PHOBIGENIC/ANXIETY STIMULIPET PHOBIGENIC/ANXIETY STIMULI –ALTERATIONS IN LIMBIC, PARALIMBIC, AND CORTICAL BRAIN REGIONS –COGNITION –AFFECT VISUAL ASSOCATION CORTEX VISUAL ASSOCATION CORTEX –GAD, OCD, PANIC –HYPERVIGILENCE

16. ANXIETY AND PHOBIA PARALIMBIC/FRONTAL REDUCTIONPARALIMBIC/FRONTAL REDUCTION –BEHAVIORAL INHIBITION/DECREASED COGNITIVE PROCESSING –NEUROBIOLOGIC SUBSTRATE OF “DEFENSE”

17. REM SLEEP/WAKING PET STUDY VISUAL AND LIMBIC AREAS OPERATE ACTIVELY DURING DREAMING SLEEPVISUAL AND LIMBIC AREAS OPERATE ACTIVELY DURING DREAMING SLEEP CLOSED SYSTEM DISCONNECTED FROM FRONTAL LOBESCLOSED SYSTEM DISCONNECTED FROM FRONTAL LOBES DREAM FEATURES (DISTORTIONS, BIZARRE CONTENT, EMOTIONALITY)DREAM FEATURES (DISTORTIONS, BIZARRE CONTENT, EMOTIONALITY) AFFECTIIVE VS COGNITIVEAFFECTIIVE VS COGNITIVE DREAMS AND PSYCHOTHERAPYDREAMS AND PSYCHOTHERAPY

18. CONCLUSION PSYCHOTHERAPUETIC PROCESS/CHANGEPSYCHOTHERAPUETIC PROCESS/CHANGE MODIFICATIONS IN NEURAL STRUCTUREMODIFICATIONS IN NEURAL STRUCTURE ALTERATIONS IN GENE EXPRESSIONALTERATIONS IN GENE EXPRESSION FUNCTIONAL & STRUCTURAL CHANGEFUNCTIONAL & STRUCTURAL CHANGE NEW NEURONAL ENCODINGNEW NEURONAL ENCODING

19. CONCLUSION PARADIGMS OF CONDITIONINGPARADIGMS OF CONDITIONING –MODELS OF LEARNING CAPTURE INDICATORS OF CHANGE IN CNS THAT REFLECT ALTERATIONS OF BEHAVIOR AND MEANINGCAPTURE INDICATORS OF CHANGE IN CNS THAT REFLECT ALTERATIONS OF BEHAVIOR AND MEANING CLINICAL IMPROVEMENT/GAIN IN ADAPTATIONCLINICAL IMPROVEMENT/GAIN IN ADAPTATION

20. NEW FINDINGS HIPPOCAMPAL SYNAPTIC PLASTICITY NT ACTIVATION GF RECEPTORS, PROTEIN KINASESHIPPOCAMPAL SYNAPTIC PLASTICITY NT ACTIVATION GF RECEPTORS, PROTEIN KINASES NUC. TRAN. FACTORS --- GENE EXPR--- MEMORY PROTEINS (JOHNSON, 1999)NUC. TRAN. FACTORS --- GENE EXPR--- MEMORY PROTEINS (JOHNSON, 1999) WORKING MEMORY--PREFRONTAL CORTEX NEURONS--MEMORY FIELDS--MODULATION BY DA, 5HT, GABA, GLUTAMATEWORKING MEMORY--PREFRONTAL CORTEX NEURONS--MEMORY FIELDS--MODULATION BY DA, 5HT, GABA, GLUTAMATE NEUROBIOLOGY/MOLECULAR BIOPHYSICS INFORMATION PROCESSING (GOLDMAN- RAKIC, 1999)NEUROBIOLOGY/MOLECULAR BIOPHYSICS INFORMATION PROCESSING (GOLDMAN- RAKIC, 1999)