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 60% 5% Schizophrenia 40% 10% Bipolar disorder 40% 10% Coronary artery disease 40% 10% Depression 50% 15% Breast cancer 30% 10% N.Andreasen: Brave New Brain,2001

Techniques that used for the neuropsychological model 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 re- experience 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 fear-related stimuli. B. The Hippocampal system Reaction to more specific fear- provoking 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:

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