心智化的方法與技術(shù)：第6講課件

NeurobiologicalPerspectives神經(jīng)生理學(xué)觀點JonG.Allen,Ph.D.Outline

提綱DevelopmentalImpactofAttachmentTrauma依戀創(chuàng)傷對發(fā)展影響AttachmentandBrainRewardSystems依戀和大腦獎勵系統(tǒng)BrainRegionsAssociatedwithMentalizing與心智化有關(guān)的腦區(qū)Implicitvs.ExplicitMentalizingandtheNeurochemicalSwitch內(nèi)隱vs.外顯的心智化與神經(jīng)化學(xué)開關(guān)TreatmentImplications:MindfulnessandConsciousRegulation治療啟示：正念和意識調(diào)節(jié)Caution:Biomania警惕：生理學(xué)狂熱AttachmentTrauma依戀創(chuàng)傷Childhoodattachmenttrauma(neglectandabuse)hasadverseeffectsonthedevelopmentofneurobiologicalsubstratesofemotionregulationthatareevidentintoadulthood.兒童期的依戀創(chuàng)傷（忽略和虐待）對負(fù)責(zé)情緒調(diào)節(jié)的神經(jīng)生理學(xué)基質(zhì)的發(fā)展具有不利影響，這在成年期也很明顯。Attachmenttraumasensitizesthenervoussystemsuchthatlowerlevelsofstressleadtohighlevelsofdistressthatareinterpretedas“over-reactions”(“makingmountainsoutofmolehills”).依戀創(chuàng)傷使神經(jīng)系統(tǒng)敏感，使得較低水平的壓力導(dǎo)致高水平的痛苦，這被解釋為“過度反應(yīng)”（“小題大做”）。Primateresearchshowshigherlevelsofstressreactivityandimpulsivity,alongwithdecreasedexplorationandintergenerationaltransmissionofimpairedcaregiving.靈長類動物的研究表明，應(yīng)激反應(yīng)性和沖動性水平較高，同時探索性下降，受損的養(yǎng)育會在代際間傳遞。Traumalowersthethresholdfora“neurochemicalswitch”fromreflectivementalizingtodefensivefight-flight-freezeresponse.創(chuàng)傷降低了從反思性的心智化到防御性的戰(zhàn)斗-逃跑-木僵反應(yīng)的“神經(jīng)化學(xué)開關(guān)”的閾值。Conclusions:(a)Neurobiologicalresearchisconsistentwiththedualliabilityofattachmenttrauma:increaseddistress+impaireddevelopmentofemotionregulation.(b)Wemostneedtomentalizewhenweareleastcapableofdoingit.結(jié)論：（a）神經(jīng)生理學(xué)研究成果與依戀創(chuàng)傷的雙重不利因素一致：痛苦增加+情緒調(diào)節(jié)發(fā)展受損。（b）當(dāng)我們最不能做到心智化時，我們最需要心智化。AttachmentandBrainRewardSystems依戀和大腦獎勵系統(tǒng)DOPAMINEBrainrewardcircuitsarewellestablished,associatedwithgoal-directedactivity,includingmaternalinterestininfantsandcaregiving(alsoprominentinaddiction-relatedbehavior,e.g.,cocaine)多巴胺大腦有健全的獎勵回路，與目標(biāo)導(dǎo)向的活動相關(guān)，包括母親對嬰兒和養(yǎng)育的興趣（在成癮相關(guān)行為中也很突出，例如可卡因）OPIOIDDecreaseseparationdistress(playaroleinaddictionrelatedtosocialdeprivation,e.g.,heroin)Addiction(e.g.,cocaine,heroin)“highjacks”rewardsystemsthatevolvedforattachment.類鴉片物質(zhì)減少分離痛苦（在與社會剝奪有關(guān)的成癮現(xiàn)象中發(fā)揮作用，例如海洛因）成癮（例如，可卡因，海洛因）會“劫持”為依戀進(jìn)化出來的獎勵系統(tǒng)。AttachmentandBrainRewardSystems依戀和大腦獎勵系統(tǒng)OXYTOCINHormoneassociatedwithmaternalbehavioraswellasbrainrewardsystems;playsaroleindecreasingdistress.Associatedwithsocialengagement:approach,trust,cooperation,bonding.Associatedinmothersandfatherswith(a)bondingtotheirparents,(b)bondingwitheachother,and(c)bondingwiththeirchildren.Securemothersfindinteractingwithdistressedinfantsrewarding(approach);avoidantmothersmorelikelytoshowsignsofdistress(avoidance).催產(chǎn)素與母性行為以及大腦獎勵系統(tǒng)相關(guān)的激素;在減少痛苦中發(fā)揮作用。與社會參與相關(guān)：親近，信任，合作，連接。令母親和父親（a）與他們的父母連接，（b）彼此連接，以及（c）與其子女連接。安全型的母親發(fā)現(xiàn)與有痛苦的嬰兒互動（親近）會帶來獎勵；回避型的母親更有可能表現(xiàn)出痛苦的跡象（回避）。TheSocialBrain社交大腦Socialintelligence(nottoolmaking)drovetheevolutionofthehumanbrain.社交智力（不是制造工具）推動了人類大腦的進(jìn)化。Mirrorneurons:mediateimplicitawarenessofothers’emotionalstates鏡像神經(jīng)元：中介對他人情緒狀態(tài)的內(nèi)隱覺察Amygdala:respondstothreatandemotionalsignificanceofsocialstimuli杏仁核：回應(yīng)社會刺激中的威脅和情感意義Anteriorinsula:senseofselfandawarenessofemotionsconjoinedtobodilyarousal前島葉：自體感受和情緒覺察與身體喚起相結(jié)合Temporallobe:identificationofindividualfaces;perceptionofbiologicalmotionandintentionality;interpretationofbehaviorincontext(socialscripts)顳葉：辨認(rèn)個體面孔；生理運動和意向性的感知；結(jié)合背景解釋行為（社交腳本）TheSocialBrain社交大腦Temporo-parietaljunction:attributingthoughtsandmentalstatesinothers顳頂聯(lián)合區(qū)：對他人思想和心理狀態(tài)的歸因Medialprefrontalandanteriorcingulate:“mentalizingregion”involvedincomplexsocialcognitionincludingreflectiononmentalstatesinself,others,andothers’perceptionofself.Forexample,activatedwhenparticipantsinteractingwithcomputergamebelievetheyareplayinganotherpersonversusplayingagainstthecomputer(computermakesthesamemoveinbothcases)內(nèi)側(cè)前額葉和前扣帶回：“心智化區(qū)域”涉及復(fù)雜的社會認(rèn)知，包括對自我、他人和他人對自己感知的心理狀態(tài)的反思。例如，當(dāng)參與者玩計算機游戲時，認(rèn)為他們正在與另一個人而不是與計算機玩時才會被激活（計算機在兩種情況下都有著相同的行動）ImplicitandExplicitSocialCognition內(nèi)隱和外顯的社會認(rèn)知Implicit:automatic,intuitive,non-verbal,emotional(e.g.,frowningface)內(nèi)隱的：自動的，直覺的，非語言的，情緒化的（例如，皺眉的臉）Explicit:slow,deliberate,reflective,verbal(interpretationoffrown)外顯的：緩慢的，有意的，反思的，言語的（對皺眉的解釋）Implicitfeelslikereality(psychicequivalencemode)內(nèi)隱感受如同現(xiàn)實（精神等同模式）Explicitfeelsself-generated(mentalstatesasrepresentational,mentalized)外顯感受為自我生成出來的（作為表征性的，心智化了的心理狀態(tài)）ImplicitandExplicitSocialCognition內(nèi)隱和外顯的社會認(rèn)知Implicitprocessingbrainregions:amygdala,basalganglia,ventromedialprefrontalcortex,dorsalanteriorcingulate,lateraltemporalcortex內(nèi)隱處理腦區(qū)：杏仁核，基底神經(jīng)節(jié)，腹內(nèi)側(cè)前額葉皮層，背側(cè)前扣帶回，外側(cè)顳葉皮層Explicitprocessingbrainregions:lateralprefrontalcortex,medialprefrontalcortex(“mentalizingregion”)lateralandmedialposteriorparietalcortex,rostralanteriorcingulate,medialtemporallobe外顯處理腦區(qū)：外側(cè)前額葉皮層，內(nèi)側(cè)前額葉皮層（“心智化區(qū)域”），外側(cè)和內(nèi)側(cè)后頂葉皮層，前內(nèi)側(cè)扣帶，內(nèi)側(cè)顳葉Ideally,implicitandexplicit(fastandslow)worktogether,withmentalizingprovidingmoreflexiblebutslowerresponding(“pausebutton”)理想情況下，內(nèi)隱和外顯（快速和慢速）協(xié)同工作，心智化提供更靈活但更慢的響應(yīng)（“暫停按鈕”）TreatmentImplications治療意義Neuroimagingresearchshowsthatimplicitandexplicitprocessesarereciprocal:consistentwiththe“neurochemicalswitch,”activationofeitherdiminishesactivationoftheother.神經(jīng)影像學(xué)研究表明，內(nèi)隱和外顯過程是相互的：與“神經(jīng)化學(xué)開關(guān)”一致，激活一個會減少另一個的激活。Strongemotionalreactionsdiminishreflection;conversely,reflection,suchasverballylabelingandemotion,diminishesemotionalarousal.強烈的情緒反應(yīng)會減少反思；相反，反思，如用言語命名情緒，會減少情緒喚起。Mindfulnesspracticehelpsprovidesomeemotionaldetachmentfromexperience,diminishesarousal,andisconducivetoflexibleattentionandawarenessoftheouterandinnerworlds.正念練習(xí)有助于提供一些從經(jīng)驗中脫離情感的能力，減少喚起，并有助于靈活地注意和覺察外在和內(nèi)在世界。TreatmentImplications治療意義Reflectivementalizingexemplifiesthemoregeneraladaptivefunctionsofconsciousness,whichincludeflexiblerespondingtonovelty,ambiguity,andcomplexity—allofwhicharecharacteristicofinterpersonalrelationshipsdependingonsocialcognition.反思性的心智化體現(xiàn)了意識的更加普遍的適應(yīng)功能，包括對新穎性，模糊性和復(fù)雜性的靈活回應(yīng)–所有這些都是人際關(guān)系的特點，并且依賴于社會認(rèn)知。Atherapeuticrelationshipisconducivetosecureattachment,whichregulatesemotionalarousalandisthereforeconducivetomindfulattentionandmentalizing(includingpatient-therapistinteractions).治療關(guān)系有利于安全依戀，其調(diào)節(jié)情緒喚起，因此有助于帶著思考的注意力和心智化（包括病人–治療師的互動）。EnthusiasmforBiologicalPsychiatry對生理精神病學(xué)的熱情 neurologyandpsychiatrywillmergeintoacommonclinicaldiscipline…abiologicallyinspired,personalizedmedicine…understandingthebiologyofbraindisordersispartofthecontinuousattemptofeachgenerationofscholarstounderstandhumanthoughtandhumanactioninnewterms…anewhumanismthatdrawsonourbiologicalindividuality.—EricKandel(2018).Thedisorderedmind.

神經(jīng)學(xué)和精神病學(xué)將融入一個共同的臨床學(xué)科……一個由生理學(xué)啟發(fā)的，個性化的醫(yī)學(xué)……理解大腦疾病的生理學(xué)是每一代學(xué)者不斷嘗試以新的方式理解人類思想和人類行為的一部分……一種新的人文主義，著眼于我們的生理個體性?！＠锟恕た驳聽枺?018）《紊亂的心靈》Caution:“Biomania”警惕：“生理學(xué)狂熱”Biomania:excessiveenthusiasmforexclusivefocusonneurobiologyastheultimatebasisforunderstandingpsychologicalprocessesandtreatingpsychiatricdisorders.生理學(xué)：過度熱衷于專注神經(jīng)生理學(xué)，將其作為理解心理過程和治療精神疾病的終極基礎(chǔ)。Psychiatricdisordersare“braindisorders.”精神疾病是“大腦疾病”。Caution:thelabel“braindisorders”doesnotreducestigma.警惕：“大腦疾病”的標(biāo)簽不會減少恥辱感。Asresearchontraumaattests,thebrainbecomesdisorderedinthecontextofdisorderedattachmentrelationships.對創(chuàng)傷的研究證明，在出問題的依戀關(guān)系的背景下，大腦會變得混亂有問題。Caution:“Biomania”警惕：“生理學(xué)狂熱”Healingthebrainrequireshealingtheperson’slife(relationships),analogoustotheneedforlifestylechangesinheartdisease.治愈大腦需要治愈人的生活（關(guān)系），類似于心臟病患者需要改變生活方式。Patientscanbedemoralizedwhentoldtheyare“treatment-resistant”becausetheyhavenotrespondedtomedication;medicationcanbemoreeffectiveinconjunctionwithpsychotherapy(includinggroupandfamilywork).當(dāng)病人被告知他們由于對藥物沒有響應(yīng)，因而“對治療有抵抗力”時，病人可能會感到沮喪低落；藥物治療與心理治療（包括團體和家庭工作）相結(jié)合，可以發(fā)揮出更大效果。References參考文獻(xiàn)AllenJG