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FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS

FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS Cordoba, Marzo 2009. PRESENTE Y FUTURO DE LAS PSICOTERAPIAS DINAMICAS SYMPOSIUM EN HONOR DE AARON T. BECK , M.D. Manuel Trujillo, M.D.

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FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS

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  1. FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS Cordoba, Marzo 2009

  2. PRESENTE Y FUTURO DE LAS PSICOTERAPIAS DINAMICAS SYMPOSIUM EN HONOR DE AARON T. BECK , M.D. Manuel Trujillo, M.D. Professor of Psychiatry New York University

  3. BIOLOGICAL CORRELATES OF PSYCHOTERAPYFIGURE I -3 -2 -1 0 2 3 1 Average (no treatment) control effect size Average psychotherapy effect size (.82) Average Minimal Treatment (placebo) effect size (.42) Adapted from Lambert, et al. 1993

  4. Leichsenring F ( 2004)

  5. Leichsenring F , JAMA ( 2008)

  6. Core features of the LTDP • Development of insight • Identification and interpretation of transference and resistance • Integration of Cognitive and Affective components

  7. New Models of STDP Panic-Focused ( B. Milford) • Panic symptoms carry psychological meanings the aim is to un-cover such unconscious meanings, and • To work through conflicts related to separation-individuation and abandonment • To work through conscious or unconscious anger

  8. Panic- Focused PsychotherapyResults- RCC • Twice as many experimental psychotherapy patients met response criteria at termination than controls • 73% of PFPP patients vs 39% of the controls met the response criteria for panic (40% red. in scale score). • PFPP patients also achieved > control reduction in functional impairment.

  9. New Models • Transference-Focused P. for Borderlines (Clarkin, Kernberg) • STDP for Narcissistic P.D and Self-Disorders) (Trujillo) • Affect-Focused STDP (Fosha) • Impulse-Focused P. for Borderlines (Complutense Group)

  10. Psychotherapy and Neurobiology • The growth of neural science in general, and of cognitive neuroscience and neuropsychology , affords contemporary psychoanalysis a second chance to anchor classical meta-psychology in a newly evolving neural science.

  11. Psychotherapy and Neurobiology Pathways include: • the modulation of basic neurophysiological brain functions (Shear et al) • altering serotonergic function (Viinamäki, Baxter) • modifying synaptic plasticity and gene expression ( Kandel, Brody) • changes in the function of the anterior cingulate cortex (Saxena), various limbic structures, the prefrontal cortex and other brain centers which play key roles in the processing of key emotions and views of self and others

  12. PSYCHOTHERAPY AND NEUROBIOLOGY Cortex Pre Frontal Cortex - + Stimulus Amygdala Hippocampus Thalamus

  13. Psychotherapy and Neurobiology

  14. Psychotherapy and Neurobiology

  15. THE MIRROR NEURON SYSTEMRizzollati 1995 • Subset of multimodal neurons (Simultaneous activation by different sensory modalities) • F5 in monkeys • Broca 44, 45 in humans (Prefrontal Cortex)

  16. THE MIRROR NEURON SYSTEM Activated by: • Observing a meaningful action • Performing the same action • Basis for primitive learning/communicating with others

  17. THE MIRROR NEURON SYSTEM Plays a role in: • Affect resonance • Empathy • Group behaviors: hunting, dancing • Language development

  18. Psychotherapy and Neurobiology Towards an Integration The models links • GENETICS, with • ADVERSE DEVELOPMENT • Altered NEUROPHYSIOLOGY • Dysfunctional COGNITIONS • Stressful TRIGGER • DEPRESSION

  19. Links and Steps • Genetics : 5 HTTPLR s/l alleles • Reactive amygdala- Cognitive biases • Exaggeration of stressful events (HPA act.) • Dominance of limbic over PFC • Deficient Reappraisal of (-) Cognitions • DEPRESSION

  20. “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic structure.” Sigmund Freud, “On Narcissism” (1914) PSYCHOTHERAPY AND NEUROBIOLOGY

  21. PSYCHOTERAPY AND NEUROBIOLOGY “We may expect [physiology and chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have to put to it. They may be a kind that will blow away the whole of our artificial structure of hypothesis.” Sigmund Freud, “Beyond the Pleasure Principle” (1920)

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