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The post Neurobiology and its Applications to Psychotherapy – II appeared first on Confer.

Authored by Henry Strick van Linschoten

A difficult subject

Neurobiology, even more than biology in general, has become deeply rooted in a multidisciplinary background. As a result, a full insight and evaluation capability of neurobiological research requires a reasonable command of a number of sub-disciplines, including biology itself, chemistry, biochemistry, physics and computer science. Nevertheless, there are possibilities for an educated professional from a different discipline such as psychology to not only make sense of what is involved in neurobiological research findings, but to do this at a level substantially ahead of journalistic popularisation.

Character of the module’s study material

The neurobiology module contains videos / audios as well as a number of papers with bibliographies. The recorded material is unique and provided by contemporary experts in their field, who give their own point of view, usually about specific topics that they saw fit to highlight. They do not generally try to give systematic overviews of the whole field. For a fuller perspective it is essential to review the literature, guided by the overview and structure provided in the module’s papers.

Auxiliary materials

Other than formal study, going to lectures and viewing television or DVDs, the world-wide web is becoming a major source of knowledge, even at the academic level. Additional materials should be adapted to the optimum learning style of the student. In the field of neurobiology a range of high-quality sources in the form of books and articles is recommended in the bibliographies of the module papers. On the Web, wikipedia is especially good in the fields of biology, neurobiology, chemistry, genetics, evolution theory and computer science.

There is also a large number of videos available on the Web, starting with YouTube, of course of variable quality. A few videos have been recommended in the references of the papers. Out of a number of universities, MIT in Cambridge, MA are offering a substantial part of their courses in biology, neuroscience, neurobiology, cognitive science, anatomy and physiology via the Web for free. A particularly relevant course is Duke University’s online course in Medical Neuroscience. This is an important and valuable source of information that can supplement the module in aspects that are of special interest. A third option is the online neuroscience textbook of the University of Texas.

Studying method

The module papers assume that the reader will read with a computer alongside, ready to look up unexplained new words and concepts. Via search engines and wikipedia there is also a large number of images, important for most people for visualising the location of parts of the nervous system.

Helpful attitudes for study and evaluation

The following may be positions that will help in studying and processing new ideas in neurobiology:

• Assume that mind and body are always acting in parallel. Mind activity always has a counterpart in the body or mind; body or brain activity always has a counterpart in the mind. The mind here encompasses the conscious and the unconscious mind.
• In any relevant psychological or neurobiological manifestations, consider what happened to be part of a system, and try to imagine what the elements and the scope of the system may be. Even a system does not operate in isolation, but has an outside, environment or context. Complex explanations are inherently more likely than simple ones. Causality is almost always multiple. Environment and genes always interact and work together.
• Organisms and non-human or human animals always develop over time. The past influences the present. Always consider a developmental view.
• When the research you read or the conclusions you reach involve causality, consider how this could be used for intervention, prevention or change. An explanation of causality or aetiology rarely produces an automatic answer that can be used for cure or treatment.

The problem of controversies and contradiction

Popular presentations of neurobiological findings almost always overstate the degree of certainty, clarity, simplicity and originality of what they report – if not in the research article itself, then in the reporting of it in the media, in news items on the internet, and in secondary sources, including popular books.

Even top researchers and leading senior professionals, in order to take a topic forwards, may need to emphasise one side in a controversy, or focus on vocally stating a position or one aspect of a complex issue, in order to clarify what they have contributed or found. This also serves the scientific purpose of making it easier for reviewers and critics to know precisely what their position or claim is.

This represents a problem for all students of neurobiology, and especially for mental health professionals who aren’t neurobiology insiders themselves, but who want to apply neurobiological findings to their practice, or need clarity in order to engage constructively with the certainties and convictions of their clients.

Examples

A well-known example is the aetiology of schizophrenia. Setting aside the legitimate questions about its scope, definition, diagnosability, validity and unity or multiplicity as a ‘syndrome’, there are currently a number of aetiological explanations. One is the long-standing dopamine hypothesis, still quoted by some as an example of the achievements of biological psychiatry, This flies in the face of most textbooks now stating that it has been largely abandoned, in line with the conclusion of a recent review (Howes & Kapur, 2009) that the earlier versions of the dopamine hypothesis, especially what they call “Version I”, attributing schizophrenia to an excess of dopamine, has been overtaken by new research. A different view one hears expressed about schizophrenia is that it is most likely or always caused by childhood abuse, often held strongly as a monocausal explanation. The overview article by Howes & Kapur (2009) is an excellent example of moving from a monocausal simple explanation to the complex set of multiple causes that characterises modern neurobiology, pulling together genetic, environmental, dopamine and abuse interpretations, and repays a careful read.

Another good example is the development of thinking about autism. Autism has been recognised for half a century, possibly longer, and Asperger’s also for more than 50 years. Over that period there has been a long list of presumed causes, many of which were stated by reputable professionals as very definitely certainly established.

Suggested causes have been “refrigerator mothers”, genes, childhood abuse, family system dynamics, environmental toxins, neurotransmitter imbalance, vaccination, and pre- and perinatal events. For treatment, psychoanalysis, family therapy, behaviourist methods, diet, special forms of training have all been proposed. And there is also the suggestion that no treatment is necessary, but that “neurodiversity” should be accepted.

Mirror neurons are a third example; different views have been summarised and referenced in the paper ‘The neurobiological basis of human relationships’.

Some questions are how unusual the mirror neurons really are, what exactly their function is, the transferability of monkey research to humans, and, even if certain psychological capacities could be confidently linked with the mirror neurons, what could be done with that knowledge.

Dealing with contradiction

There is not much else that can be done than starting with acceptance. In this field some views are really beyond the pale, but a historical perspective shows that even ideas that were once completely abandoned have made a come-back. A realistic but far from easy approach is trying to hold the strongly expressed and supported single views simultaneously as a set of possible contributory causes. This may make it harder to move from understanding to action, but in the face of the actual certainty of almost all research evidence, of the likelihood of multiple causation, and of a review of the historical ups and downs of different explanations, it seems a well-founded position to take.

As regards the equally important question of responding to clients who have strong monocausal explanations that they believe apply to themselves or to people near to them, it usually is a good tactic anyway to try to advocate a shift from rigidity to flexibility, and to suggest that there is less certainty about their views than they think, and than they believe they can conclude from the reports they read about research “evidence”.

References

Howes, O.D. & Kapur, S. (2009). The dopamine hypothesis of schizophrenia: version III – the final common pathway. Schizophrenia Bulletin 35: 549-562.

The post Recommendations for psychotherapists studying neurobiology appeared first on Confer.

Authored by Henry Strick van Linschoten

The nervous system

The human nervous system works closely together with the endocrine system to channel, process and integrate information about the environment and about the body as a whole, and to take action or not, on a macroscopic or microscopic, external or internal scale, as a result.

All animals (with the exception of sponges) have at least a rudimentary nervous system. The modern view is that all vertebrates (i.e. including fish, amphibians, reptiles and birds) rely on a central nervous system (CNS) that includes the spinal cord, hindbrain, midbrain, forebrain and optical nerve. The brain and spinal cord together are called the central nervous system (CNS), and all other parts, mainly nerves leading to and coming from the CNS, are termed the peripheral nervous system (PNS).

¹The majority of specialised words used here designate locations in the nervous system. These are typically locations that are characterised by having a common function or functions. Where possible a short description of this function will be given, as well as an idea of which other parts of the nervous system the particular location is connected with. Some terms are different and do not specify a location, but by the use of the term make clear something about the type or shape of the group of (almost always) neurons or parts of neurons that they refer to. In particular cortex and neocortex are in the latter category, and refer to a type of sheet of cells which is present in various locations, although they are regularly used as shorthand for the cerebral cortex.

Focusing on the control and processing of information, the following major divisions of the nervous system can be distinguished:

• the sensory division of the peripheral nervous system that obtains information through the senses, which in general is passed to the central nervous system
• the central nervous system that processes information leading to “conclusions” or “decisions” and in turn sends signals to the motor division of the PNS, and/or to the endocrine system
• the motor division of the peripheral nervous system, that executes the “instructions” it is given by passing them on to muscles or glands

Neurons, synapses and neurotransmitters

A neuron (alternative spelling sometimes “neurone” – sometimes referred to as nerve cell or even brain cell) is a special kind of cell. There are many types and shapes of neurons; they have in common that they are part of the nervous system of animals. Neurons process and transmit information contained in incoming and outgoing signals through electrochemical means. A neuron typically consists of a cell body (soma), dendrites and an axon. A neuron often has many dendrites (dendrite tree), but usually it has only one axon, although that axon can branch many times. The dendrites receive inward signals, the axons send them out.

Sensory neurons typically receive their information through a number of dendrites, which then locally connect to an axon to take the information further in the direction of the neuron body.

When two neurons are connected an axon of one neuron is very close to a dendrite of the other. Where they (almost) touch is called a synapse.

When multiple neurons are connected, this is called a neural network. Axons and dendrites can touch each other or interface with other types of cells, e.g., muscle, skin or glandular cells, either for obtaining or sending information.

Neurons do not reproduce. The generation of human neurons – neurogenesis – starts in the womb and peaks around birth time. In adults far fewer new neurons are generated, though the process never ceases completely.

The distribution of neurons over the human brain seems somewhat skewed: a recent detailed update (Azevedo et al., 2009) concluded that the brain in total has about 86 billion neurons, of which the cerebellum has 69 billion, the cerebral cortex 16 billion, and the rest of the brain, including the whole brainstem, in the order of 1 billion. From different sources there is a global estimate of around 100 trillion synapses.

At the synapses, one neuron transfers information to another by passing special molecules called neurotransmitters. The main neurotransmitters are divided into groups:

• Smaller molecules – amino acids. Key examples: glutamate (the principal excitatory neurotransmitter); aspartate; GABA (the principal inhibitory neurotransmitter); glycine
• Smaller molecules – others. Key examples: acetylcholine; nitric oxide
• Biogenic amines – catecholamines. Key examples: (nor-)adrenaline; dopamine (reward motivation)
• Biogenic amines – others. Key examples: histamine; serotonin (usually inhibitory)
• Peptides. Key examples: substance P; endogenous opioids; encephalins, endorphins

A group of neurons in the body can be described as follows:

• grey matter, the most general term, only used for the central nervous system (CNS)
• nucleus, when the group is clearly distinguishable, usually deep in the brain
• cortex, when the collection of neurons forms a thin sheet
• ganglion, a group or collection outside the CNS (exception: the “basal ganglia” despite the name are part of the CNS; they would more appropriately be called basal nuclei)

A collection of axons can be described as follows:

• a nerve, when outside the CNS
• white matter, a general term for a collection inside the CNS
• a tract, a group in the CNS with a common origin and destination
• a bundle, axons running together with different origins and / or different destinations

The cerebrum – the cerebral cortex

The cerebrum is the name for a range of essential brain parts which in their size and functioning distinguish the human brain from those of mammals and even primates. It contains the two hemispheres of the cerebral cortex, the corpus callosum connecting them, the hippocampi and amygdalae, the basal ganglia, the olfactory bulbs and the optical nerve.

The human cerebral cortex is estimated to contain between 10 and 20 billion neurons. It has two hemispheres, which have small structural differences, and a degree of specialisation.

Cortex is not the name for a location, but for a kind of special (neural) tissue. In the human cerebrum most of it is composed of six layers and usually referred to as neocortex (sometimes isocortex). The neocortex is covered underneath (“ventrally”) by a cortex composed of three or four layers. The hippocampus is covered on the outside by a three-layered cortex, and there are a number of other cortex structures in the brain. The 2 to 4 mm thick sheet of the neocortex is folded in a characteristic structure of ridges (ridge = gyrus) and furrows (furrow = sulcus).

It covers the whole top and back parts below the human skull. To distinguish locations, it is divided into four main parts (“lobes”), which also largely have different special functions, the frontal, parietal, occipital and temporal lobes. In addition, inside these major lobes there are other parts with special names such as the cingular cortex, the insular cortex and the operculum. For smaller locations that are not cortex but groups of nuclei, a range of specialised terms are used.

The cerebral cortex is the seat of complex cognition. It plays a key role in perception (using all five external senses), conscious awareness, cognition and thought, memory, language and speech, and voluntary action. It is connected with almost every other part of the nervous system, directly or indirectly, but that does not mean that it is actively involved in every bit of human movement and activity. Substantial functions necessary for survival, including important homeostatic functions such as regulating heartbeat and breathing, upright balance, and the complete digestive system, operate with a great degree of independence from the cerebral cortex.

A different way of describing parts of the cortex is naming them by function. All these functional areas are present in both hemispheres, and are linked with the respective body parts they relate to in mirror form, left to right and vice versa (although for instance information from the eyes is sent to both sides in roughly a 60/40 proportion).

The functional parts of the cerebral cortex can be divided into three groups:

• The sensory cortices (primary cortices for all the senses, and the somatosensory cortex in the parietal lobes)
• The motor cortices, mainly in the frontal lobes
• The association areas in the parietal, occipital and temporal lobes

NOTE: The association areas constitute a clear majority of the cerebrum. It is believed that these link the sensory and motor components, and mediate the “higher order” functioning of the brain. Neuro-scientists usually summarise this with the word cognition which includes the ability to:-

(a) Pay attention to external stimuli and internal motivation

(b) Give these meaning and put them in context

(c) Initiate responses (planning and decision-making)

These three main capabilities are especially focused in (a) the parietal cortices, (b) the temporal lobes, and (c) the frontal lobes.

Almost no functions or brain parts operate in isolation. The challenge is in understanding how the parts work together, how action arises, how much of brain activity is unconscious, and what brain parts participate.

It is recommended that you listen to Dr Ruth Lanius’s audio presentation for further information on the connection between different modes of consciousness.

Other parts of the cerebrum

The corpus callosum connects the two cerebral hemispheres, a bundle of over 200 million axons running in both directions between the two halves of the cerebrum through which signals, chemical and / or electrical, are transmitted or communicated.

The hippocampi (used here in plural, as there are two of them on the left and right side) lie directly underneath the cortex of the medial part of the temporal lobes. They play a major role in the formation and retrieval of (long-term) memories about experienced events, and in spatial navigation. The hippocampi are the first to be damaged in the Alzheimer’s form of neurocognitive disorder. Damage to the hippocampus leads to anterograde amnesia, the inability to form new memories that last. It appears that the hippocampus is one of the few regions where, during adult life, new neurons can be created and incorporated. The hippocampi can be larger or smaller, and a considerable numbers of studies try to draw conclusions from the significance of their size.

The amygdalae (in plural as there are two on each side of the brain) are two complexes of grey matter on the left and right, buried in the front to middle portion of the temporal lobe just above and in front of one end of the hippocampi. They are groups of nuclei amongst which at least seven areas can be separately identified. The amygdalae play a major role in the processing and storage of memories with emotional associations – best studied in animals. It appears that the amygdalae have a major role in the consolidation of long-term memories, the emotional strength and valence of these memories, and in (longer-term) fear conditioning. There may be a relationship with anxiety disorders, and there may be some degree of specialisation between the left and right amygdalae. For a useful short review article about the amygdalae, with a focus on their role in emotions, see LeDoux (2008).

The basal ganglia (or nuclei) are a group of different nuclei located underneath the main cerebral cortex and more or less grouped around the thalamus and hypothalamus. Main components of the basal ganglia are the striatum (caudate nucleus and putamen), the globus pallidus, the substantia nigra, the nucleus accumbens, and the subthalamic nucleus. All these have a left and right-hand copy. The basal ganglia are involved in (the modulation of) voluntary motor control and the formation of procedural learning in the form of habits, and they probably co-operate with the prefrontal cortex in the selection of actions. The role of the basal nuclei in motor control is especially evident in the movement problems of people with Parkinson’s disease, where the basal nuclei are the brain area most affected.

The olfactory bulbs and the optical nerve are counted as part of the central nervous system. It is clear from evolutionary and embryological evidence that the cerebral cortex has evolved from what originally was an olfactory nerve system.

Hypothalamus and thalamus
Together often referred to as the diencephalon

The thalamus is a fundamental part of the brain. It is complex, and has about 50 subdivisions. The thalamus is in an evolutionary sense close to the cerebral cortex. Most of the information that reaches the cerebral cortex from the rest of the CNS reaches it via the thalamus. There is speculation about what difference the thalamus makes to all the signals passing through. Localisation of the thalamus, though less well developed than that of the cerebral cortex, tends to follow the cortical map, i.e. if there is a part for something in the cerebral cortex, there will also be a part in the thalamus that it passes through or is processed by. It may be that the thalamus plays a role in the regulation of consciousness, sleep and alertness, and possibly in epileptic seizures.

The hypothalamus is almond-size, but composed of a large number of well-described nuclei. It is strongly connected with the body’s endocrine system (see its role in different endocrine “axes”), controls a number of homeostatic functions (e.g. blood flow, blood glucose level, response to threat / stress, body temperature, hunger and thirst, circadian rhythms), is involved in the integration of emotions, and mainly controls the sexuality and reproductive system. It may play a role in social soothing and the attachment and caregiving systems (Coan, 2008). Although physically it clearly is a part of the cerebrum, functionally it plays a bridging role between the human nervous system and the endocrine system, partly through the pituitary gland (hypophysis).

The brainstem

The brainstem is positioned between the diencephalon and the spinal cord. It can be divided between midbrain (mesencephalon) and hindbrain (rhombencephalon), and sometimes (but not here) taken to include the cerebellum.

Parts of the brainstem have many specialised functions, but three overall general functions can be identified:

• The cranial nerves that deal with the sensory and motor function of the head and neck start and finish in the brainstem
• A number of tracts (bundles of axons with a common origin or destination) pass through the brainstem, especially sensory tracts ascending from the spinal cord, head and neck, and descending motor tracts from the forebrain and the optical nerve
• Regulation of the level of consciousness through connections from the reticular formation to the cerebrum

These functions are so generally critical for the functioning of the nervous system that substantial damage to the brainstem tends to be more completely life-threatening than damage to the cerebrum, the cerebellum or the spinal cord.

The midbrain includes the tectum, tegmentum, cerebral aqueduct and the cerebral peduncles. Inside the tegmentum, around the cerebral aqueduct, is found the periaqueductal grey (PAG), which plays a major role in pain regulation, and in emotions. The role of the PAG in emotions is strongly brought out by Panksepp (Panksepp, 1998; Panksepp & Biven, 2012).

The hindbrain mainly consists of medulla (oblongata) and pons. The medulla contains centres responsible for maintaining breathing, controlling the heart rate, and for digestion (note that the heart and the digestive system also have considerable local nerve centres steering their functioning, but the medulla commands the main brain input and involvement). The pons is involved with transferring information about the body’s movements between the cerebral hemispheres and the cerebellum.

The reticular formation is a distributed (sparse) neuronal network extending from the medulla to the thalamus, and is involved in arousal (being awake; it plays the key role in the “reticular activating system”), temperature regulation, the direction of eye movements and motor control.

The cerebellum

The cerebellum is a gigantic unit, evolutionarily old, that is estimated to contain almost 70 billion neurons (Azevedo et al., 2009). It does not occupy a commensurate amount of space, as many of its neurons are rather small granule cells. Much of the cerebellum is in the form of cortex. It has four nuclei, hidden deep inside the cortical hemispheres, and three peduncles. The cerebellum is not connected with the body in mirror image: the left hemisphere of the cerebellum is connected with the left side of the body. Most of its connections with the rest of the brain travel through the pons, which lies just in front.

The two hemispheres of the cerebellum have between them a formation called the vermis, which is strongly connected with all parts of the cerebellum. The cerebellar cortex is divided into lobes. Certain parts of it are designated with functional designations. The vermis is especially associated with body posture, while in general the cerebellum is associated with fine motor control.

In addition to its long-known involvement in fine motor control, the cerebellum is thought to be involved in language, attention, and probably associative learning, classical as well as operant, especially when this has a motor aspect.

Evolutionary understanding of the forebrain

In the 1930s an American neuroanatomist, James Papez, published an article about a pathway in the brain that he thought might be the main brain system involved with emotions. This was picked up by Paul MacLean (1913-2007), a doctor and professor in physiology whose presentation about the topic was published in 1949. MacLean devoted much of his life to developing his theory about the brain, and summarised much of his conclusions in a 1990 monograph (MacLean, 1990). He divided the parts of the forebrain (=telencephalon / cerebrum + diencephalon) in three groups, which he called the:

• Protoreptilian formation
• Limbic system
• Neomammalian formation

His theory has remained very popular and is much quoted but there are a number of problems with it and its use.

• The reptilian formation, commonly referred to as the “reptilian brain” is often assumed to refer to midbrain and or hindbrain (the brainstem). However, MacLean intended it to refer to a major part of the basal ganglia. The term reptilian brain is now hardly used, except in popular literature. The limbic brain refers to a collection of cortical and subcortical parts of the cerebrum. Although as a locational description it is still used, it is not seen as useful anymore as it encompasses too many different structures which do not share functions. Only parts of the limbic system are involved in emotional processing, and parts are not.
• MacLean’s supporting theories were, to a great extent, speculations. He suggested that because certain brain parts were evolutionarily older than others they were bound to function differently, and with a considerable degree of autonomy. There is no basis for that, and those types of reasoning have been largely abandoned (Striedter, 2005).

There is no doubt that MacLean was a very creative thinker who did much to encourage a positive kind of global functional thinking about the brain. In that respect he has been a positive influence on researchers. LeDoux (1998, chapter 4), who has studied MacLean in some detail, believes that MacLean’s conceptualisation of emotions and his evolutionary linkages remain fruitful, as do his ideas about somatising disorders, epilepsy and mental disorders and their neurobiological background. However, he also concludes that the grouping together of the parts of the limbic brain serves no purpose.

A broader critique of MacLean’s evolutionary speculations can be found in Striedter (2005), where he continues to set out the modern views that have superseded MacLean’s pioneering attempts. Kötter & Stephan (1997) engage in a helpful discussion specifically focused on the limbic system concept.

The spinal cord

The spinal cord receives and processes sensory information from all over the body. It has cervical, thoracic, lumbar and sacral regions, and reaches down from the medulla; it finishes in the lumbar region, and does not entirely extend down to the bottom of the spine. It is a substantial part of the nervous system. Many of the signals it receives are transmitted to the brain, and many signals are received back, but the spinal cord also has interneurons of its own, and takes care independently of a number of reflex actions, and it modulates a number of rhythmic patterns through “central pattern generators”, which are used in particular for locomotion, swimming and breathing.

The peripheral nervous system

The peripheral nervous system consists of spinal nerves, some of the cranial nerves, the lumbosacral nerves, and other nerve cell groups with a considerable degree of autonomy from the central nervous system, such as the enteric nervous system.

The autonomic nervous system

It should not be forgotten that the autonomic nervous system is really an autonomic motor system, i.e. it is composed of motor neurons, and its role is to let these motor neurons take action by passing instructions to a very wide range of muscles, glands and organs of the body. The word or idea of the “autonomic nervous system”, or “sympathetic autonomic system” might lead one to believe that it is one overall “system”, which at any one time has one “state”. This is not the case. It is a system with countless elements, composed of large numbers of nerves and neurons, which all at the same time are engaged in different activities in different parts of the body, and have different connections throughout the nervous system.

The autonomic nervous system (ANS) has three divisions, the sympathetic, parasympathetic and enteric divisions. Although it can be and often is influenced by the CNS, much of its activity is automatic, “autonomous”, and is not only unconscious but unaffected by the CNS. The sympathetic division is composed of spinal nerves including nerves from the lumbar section of the spinal cord. The parasympathetic division consists of most of the cranial nerves (some cranial nerves form part of the CNS), and of the spinal nerves coming from the sacral section of the spinal cord. Most body organs receive innervation from both the sympathetic and the parasympathetic branch, but not all. Those organs (for which in some circumstances both sympathetic and parasympathetic signals need to be given in a synchronised way) are clearly the most challenging to control.

The sympathetic nervous system orchestrates the fight of flight response (described in Confer’s Trauma and Dissociation module), which is an organised set of responses over a whole range of systems.

The parasympathetic division can be analysed via each of the cranial and sacral nerves that are part of it. It has an important role in regulating the heartbeat, which involves the dorsal motor nucleus of the vagus nerve (cranial nerve X), as discussed at length in Porges (2011).

The enteric (sometimes: “intrinsic”) nervous system is located mainly in the walls of the gastrointestinal section, from oesophagus to anus but especially the small intestine, in a special tissue layer. A very readable and useful book about the enteric system is Gershon (1998).

Resources

Neuroanatomy is essential for following and evaluating talks or writings about neurobiology. The descriptions given above are basic and concise but a lot of useful information is available by reading some of the references. To find one’s way it is well worth studying at least one major recent textbook about neuroscience, such as Breedlove & Watson (2013), Purves et al. (2012) or Bear et al. (2007), of which Breedlove and Watson is perhaps the closest to focusing on matters of interest to psychologists. Miller Miller (2010) offers a longer article on the interface between neurobiology and psychology. It is also highly recommended to read this paper with Wikipedia on the side, which provides good articles about almost every keyword.

References

Azevedo, F.A.C., Carvalho, L.R.B., Grinberg, L.T., Farfel, J.M., Ferretti, R.E.L., Leite, R.E.P., Filho, W.J., Lent, R. & Herculano-Houzel, S. (2009). Equal numbers of neuronal and non-neuronal cells make the human brain an isometrically scaled-up primate brain. The Journal of Comparative Neurology 513: 532-541.

Bear, M.F., Connors, B.W. & Paradiso, M.A. (2007). Neuroscience: Exploring the Brain (3rd edition).Philadelphia, PA: Lippincott, Williams & Wilkins.

Breedlove, S.M. & Watson, N.V. (2013). Biological Psychology: An Introduction to Behavioral, Cognitive, and Clinical Neuroscience (7th edition). Sunderland, MA: Sinauer.

Coan, J.A. (2008). Toward a neuroscience of attachment. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Application (2nd edition). New York: Guilford Press.

Gershon, M.D. (1998). The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine. New York: HarperCollins.

Kötter, R. & Stephan, K.E. (1997). Useless or helpful? The “limbic system” concept. Reviews in the Neurosciences, 8: 139-145.

LeDoux, J. (1998). The Emotional Brain: The Mysterious Underpinnings of Emotional Life. London: Phoenix.

LeDoux, J.E. (2008). Amygdala. Scholarpedia, 3(4): 2698. Available at www.scholarpedia.org (accessed 3 January 2014).

MacLean, P.D. (1990). The Triune Brain in Evolution: Role in Paleocerebral Functions. New York: Plenum.

Miller, G.A. (2010). Mistreating psychology in the decades of the brain. Perspectives on Psychological Science, 5: 716-743.

Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W W Norton.

Purves, D., Augustine, G.J., Fitzpatrick, D., Hall, W.C., LaMantia, A-S. & White, L.E. (Eds.) (2012). Neuroscience. (5th edition). Sunderland, MA: Sinauer.

Striedter, G.F. (2005). Principles of Brain Evolution. Sunderland, MA: Sinauer.

The post Neuroanatomical vocabulary and concepts appeared first on Confer.

Authored by Henry Strick van Linschoten

Quick navigation

• The cellular basis of life
• Evolution
• Genetics
• Embryology and the prenatal period
• Phylogeny and ontogeny
• Epidemiology
• Homeostasis
• The heart and cardiovascular system
• The immune system
• The endocrine system and hormones
• Sexuality and reproduction
• Nutrition and the digestive system
• Complex behavior
• Ageing

While the human mind cannot be reduced to physiological properties, psychology is grounded in biology. Psychological understanding and psychotherapeutic practice are thus significantly enriched by a good knowledge of biology.

Modern biology, the “science of life”, is informed by a number of principles that give a strong unity to the subject:

• Life has a cellular basis
• The diversity of life forms can be explained by evolution
• Living organisms preserve homeostasis, i.e. relatively constant internal conditions that are different from the environment
• Life is best understood by a systems view at many levels of complexity, e.g., the molecular level, elements that jointly have one function, organ systems, ecosystems.
• Living organisms respond to their environment and need energy and raw materials to continue living
• For a type of organism (species) to survive over time, it needs adaptive processes of growth, development, reproduction and evolution
• In order to adapt to its environment, an organism needs to obtain information about its environment, process and integrate all the information it has and take actions in response, acting on the environment in turn

Living things are complex, and can be described and studied at many levels:

• molecular
• cell
• tissue
• organ
• organ system
• organism
• population and community (ecology)
• ecosystem
• the biosphere

Living organisms are also characterised as containing substantial numbers of organic molecules (molecules containing carbon and using covalent bonds). Some of the most used and essential molecules are:

• fats and sugars for energy storage
• phospholipids for cell membranes
• nucleic acids (RNA and DNA) for instructions about growth processes in cells
• proteins for transport, catalysis and a range of other functions

Proteins are long and complex chains of smaller building blocks called amino acids. Relatively short chains of amino acids are called polypeptides.

Organ systems are groups of organs which are classified together on the basis of the broad functions they serve, ultimately either for survival of the organism or the species. This paper will describe several organ systems, but not give much detail about the skin, skeletal, muscular, respiratory and urinary systems, important as they all are.

The cellular basis of life

The smallest unit of life, seen as perhaps the most characteristic property of life, is the cell. In the modern view of biology all life is seen as consisting of cells. The human body is estimated to have between 10 and 100 trillion cells. There are many specialised types of cells – the human body has around 210 types (Raven et al., 2008).

This complexity is typical for animals, even small ones. A thoroughly studied roundworm (nematode), the about 1 mm long C. elegans, has 959 somatic cells in the adult hermaphrodite form, and 302 neurons in its nervous system. These have been completely mapped, as has been its genome, which has six chromosomes and a mitochondrial genome. It is an example of one of a few “model organisms” that have been exhaustively studied and which help in the understanding of larger and more complicated animals.

Cells are the smallest units of life that can replicate (reproduce) independently. Two fundamental distinctions about organisms are whether they are unicellular or multicellular, and whether they are prokaryotes or eukaryotes. All eukaryote cells have a nucleus. In a eukaryote cell most of the DNA is contained in the nucleus. All animals, plants, fungi and algae are eukaryotes. The first (prokaryote) cells emerged on earth at least 3.5 billion years ago; eukaryote cells at least 1.5 billion years ago.

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Evolution

Evolution offers an explanation for the phenomena of differences and change amongst living organisms, especially diversity amongst members of a species at one time, and variation through the generations. Differences and change are ubiquitous, between species, amongst members of a species, over time, over shorter, longer and very long time periods. The widest concept of evolution can be defined as any heritable changes in the frequency or distribution of traits in a population, no matter what mechanism makes those traits heritable. (Pigliucci & Kaplan, 2006) This is wider than the traditional gene-centred reference to changes in the allele (alternative version or state of a gene) frequencies of a population. Change may be smaller or larger, quick or slow. Evolution is a matter of historical results, the observable outcome over time of many processes. One of those processes can be natural selection. Even when natural selection takes place, it can only have an evolutionary impact if the traits selected are heritable, genetically (via its impact on DNA sequences transmitted from parent(s) to child) or otherwise.

Evolution assumes by definition that there are mechanisms of heredity, but does not depend on knowing what they are. Indeed, in the 19th century most concepts of heredity were wrong – Lamarck was wrong (the theory that traits or behaviours acquired during adult life could be passed to one’s children via heredity); Darwin’s pangenesis theory (the whole of the parental organism would participate in heredity, through tiny heredity particles called gemmules) was similarly flawed. Only Mendel developed a better concept (mid 19th century) proposing that traits are inherited, resulting in fixed proportions in the next generation, but he was unread for 50 years.

In the course of the 20th century much progress has been made in understanding the properties of genetic inheritance (the rediscovery of Mendel), and the material of genes – DNA, its structure, function and potential modification. However, there remains a barrier in understanding how proteins influence disease processes or behaviour, in contrast to the very detailed understanding of how DNA instructions lead to the manufacture of the proteins (Rutter, 2006).

The most studied and probably most generally operative process leading to evolutionary change is natural selection. It works as follows:

• There is a population consisting of organisms which differ from one another in a particular trait
• The trait can be inherited from one generation to the next (the way in which it is inherited does not matter); inherited means that offspring are more like one or both of their parents in the trait than the average of the population
• The differences in the trait make organisms with certain traits more likely to (survive and) reproduce than others
• Natural selection takes place: over a number of generations the presence (frequency) in the population of the variant of the trait that is more successful, and their genetic or otherwise heritable basis, will increase

Of these different aspects of the process the origin of the first step, the cause for variation or innovation, is the most controversial (e.g. Müller, 2010). Once there are differences, especially when these are significant differences that materially affect the probability of survival and reproduction, the other steps will tend to work as expected. But a number of the major controversies in thinking about evolution are linked to the question how the initial difference in DNA has come about; whether the difference is big or small (satltationism, punctuated equilibrium or phyletic gradualism); and whether the more important changes are likely to be or have been random mutations in genetic material (DNA), were initiated by environmental events, or by the developmental processes in which the genes interacted with the environment in producing proteins. It may be useful to regard this overall question unsettled scientifically, and be open to at least some of the different possibilities.

In any real-life population, it is highly unlikely that the frequency of traits will remain stable over the generations. Reasons for change in frequency other than natural selection may be:

• Mutations
• Non-random mating (e.g., phenotypically similar individuals may be more likely to mate with each other)
• Migration in and out of the population (gene flow)
• Genetic drift, an effect occurring by chance, especially in smaller populations
• Artificial selection, e.g. selective breeding

Even when natural selection is the main engine behind a particular case of evolutionary change, it may be in response to environmental change, e.g., the need to avoid newly introduced predators, the introduction of toxic substances, or to deal with climate change.

There is a lot of unsettled controversy about evolution, and the major mechanisms that lead especially to long-term evolutionary significant change – which is of course the question evolution theory is supposed to answer. As these questions keep coming back with practical consequences about the inheritance of characteristics and behaviour of human beings, it may be useful for psychotherapists to take an interest. The following are a number of high-level books that describe some of the main controversies that are important at the moment: Pigliucci & Kaplan (2006), Oyama et al. (2001), Neumann-Held & Rehmann-Sutter (2006), Jablonka & Lamb (1995), Jablonka & Raz (2009).

To summarise some major conclusions:

• There are no scientists who deny the influence of the environment on the nature and characteristics of organisms. The questions are how and how much, not if.
• Preformationism, the old idea that organisms grow from miniature versions of their fully grown state, is not supported (but see Oyama, 2000).
• There are very few serious defenders of an absolute determinism, genetic, environmental, “biological” or otherwise. Any currently existing theory accepts that outcomes will be probabilistic, that there are random elements in whatever processes are described as explanations, and that new scientific knowledge about processes usually leads to ways of influencing those processes.
• Excluding supernatural factors as explanation is a question of choice. The general biological discourse excludes these. But if someone wants to subordinate or incorporate science (in)to a religious or spiritual system, they have the right to do so.
• There are very few scientists who would disagree with a central role for DNA in inheritance and genetics, and a central role for natural selection as the explanation of a great deal of evolutionary phenomena. There continue to be arguments about alternatives, about relative importance, about the most useful ways of defining key concepts, etc., but they all tend to leave this major place to natural selection in evolution, and to DNA in inheritance systems.
• Evolution can be studied at all biological levels, at those of genes, organisms, species, and groups.

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Genetics

Please also refer to our module paper Controversies: Genetics

Genetics is the science of heredity. It studies the variation in the traits (characteristics) of living organisms, and how variation relates to the reproduction of organisms (with changes) from one generation to the next. A gene is the smallest physical unit of heredity. It is generally identified with a sequence of DNA that is enough to code for a single polypeptide or protein.

The words genotype and phenotype are much used in genetics. The genotype is the genetic constitution of an organism or the allelic composition of one or a few genes under investigation relative to a trait. The phenotype is the observable properties (physical appearance or functional expression) of an organism or a trait. It is important to note that a phenotype undergoes development – always has its own ontogeny; any phenotype has its own developmental history.

Trait is used for the characteristics of an organism, either (physical) structures or behaviours. Many traits are not inherited, e.g. dyed hair, a surgically removed kidney or a scar.

Genetics is about the mechanism for change passing down through generations of reproducing organisms, not at the species-level, which is studied by evolution theory, but at the level of the individual organism. If a phenotype changes through mutilation, or through learning something, this is not in general of interest to geneticists, as these are not changes that will be passed on. This is the question that Lamarckism tried to address, as well described in Jablonka & Lamb (1995).

Classical (“Mendelian”) genetics believed that heredity could only be transmitted by nuclear genes located on the chromosomes of both parents (meiosis) or one parent (mitosis). This belief was already held by some geneticists before the mechanism or even the identity of DNA had been discovered. It is now well-known that there are many other methods (“developmental systems” or “developmental mechanisms”) through which traits can be passed on through the generations. One other ingenious possibility is that the balance between DNA-genetic and “other” processes may have been different at earlier stages of evolution than it is now, as in Newman & Müller (2006). The epigenetic details which widen the purely DNA-centred position are now described in complete textbooks (e.g. Allis et al., 2007), and take a major place in up to date general textbooks about genetics (e.g. Klug et al., 2013). An article discussing non-DNA-based epigenetic inheritance is Jablonka & Raz (2009).

Genetics is often seen as controversial. Few people would doubt the clear role that heredity plays in the inheritance of traits of plants, bacteria, fruit flies and other insects. Without the increase in yield of major cereals and rice during the Green Revolution between 1960 and 1980, hundreds of millions of people would have died. This was the result of selective breeding and crossing, and preceded the current capabilities of genetic engineering. Equally most people recognise the long record of horses, dogs and cats being bred artificially to achieve a special appearance or qualities such as speed or endurance, but also temperament. Dogs have been bred for a long time specifically for certain kinds of behaviour (Plomin et al., 2013). For all these activities genetics, and the enormous progress achieved by genetics between 1900 and the present day, has increased their effectiveness. The non-biologist reader is urged to read Bürglin (2006), which gives an introduction to how genes function in a tiny animal, the nematode or roundworm C. elegans, which has about 20,500 protein-coding genes (Bürglin, 2006), and of which the cell structure and the nervous system are known in great detail. Whilst this animal has about the same number of genes as humans (Pennisi, 2012), it has far fewer base pairs of DNA (about 100 million vs 3 billion for humans).

Turning now to human beings, many people accept that eye colour, blood type and height of humans have a large heritable component. For a number of diseases there is a good deal of knowledge about their genetic origin, e.g., phenylketonuria; Huntington’s disease; Down’s syndrome; type-1 diabetes; sickle cell anaemia. There are specific less common forms of early onset Alzheimer’s disease and of breast cancer which are strongly heritable. For all these the cause lies in genetical defects or abnormalities, but for standard trisomy 21 Down’s syndrome the abnormality in the DNA of the child is not found in that of the parents. A rare variant of Down’s syndrome is however heritable. There are also diseases such as leukaemia, which is rarely considered as heritable.

Some of the above diseases involve a single gene, others several or many. There are far more heritable traits that are polygenic (i.e., involve multiple genes) than are monogenic, although that still leaves many thousands of human diseases that are held to be monogenic.

Information similar to the one given in the above examples exists about a number of mental disorders. The special field within genetics studying these is called behavioural genetics. Two source books about this are Plomin et al. (2013) and Rutter (2006).

There is considerable controversy about behavioural genetics. Some critical assertions made by its opponents are as follows:

• Behavioural traits, including mental disorders, can never be inherited
• Even if there would be some heritability, it is bound to be very small
• It is not possible to determine whether behavioural traits can be inherited or not, and certainly the degree or strength of heritability cannot be measured, as the methods used are incoherent
• Even if heritability could be determined, this is it not useful
• It is impossible to distinguish between genetic and environmental influences
• Mental disorders do not exist, or cannot be coherently defined, or at least so far it is not known how to do so

In practice, a majority of biologists, medical practitioners and of course geneticists, and probably many psychiatrists, agree that there are considerable practical and methodological problems, but that they are not sufficiently different from those for any genetic research. In addition, it is widely believed that over the years the genetics field will make substantial progress in what it can do. There is a particular interest in research that has been done and that continues in genetic influences on autism spectrum disorder, drug and alcohol abuse, bipolar disorder and schizophrenia, which, partly based on twin and adoption studies, are widely held to have a substantial (but very complex, polygenic and mixed with environmental and epigenetic influences) degrees of heritability.

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Embryology and the prenatal period

Animal embryology is a fascinating discipline, which, starting on modern principles in the first half of the 19th century, studies the early development where one zygote (a fertilised ovum or egg cell) develops up to its fetal stage. As part of the multiplication of the cells, they also become differentiated, allowing the formation of patterns that include positioning of the multicellular embryo so that specialised cells continue growing in specific locations.

There is a sequence of significant stages in the prenatal development of mammals, with the new animal referred to first as embryo, then as fetus (weeks are from fertilisation):

• the blastula (blastocyst for mammals) stage (characteristic of and limited to animals)
• the gastrulation period
• organogenesis, for vertebrates starting with neurulation (for humans starts around days 18-20, and shows a clear separation between forebrain, midbrain, hindbrain and spinal cord at the end of week 4)
• the embryonic stage (until 8 weeks for humans)
• the fetal stage (for humans from 8 weeks until birth)

The period of gestation (counted from the last menstruation) varies for mammals from about 20 days in mice to 21-23 months for elephants.

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Phylogeny and ontogeny

These words were coined by Ernst Haeckel in 1866 and continue to be much used by biologists. Ontogeny (sometimes ontogenesis) is somewhat equivalent to the more general word development, but is intended to start at conception, and is used to emphasise that it includes the development as influenced by all conceivable biological, cultural and social factors. It is only applied to living beings. Although less often stated, it only ends with the death of the organism.

Phylogeny (sometimes phylogenetics) is the development, studied in all its aspects, of a whole species, through generations, – including the major element that genetics plays in development, together with environmental influences and events.

The contrast is important; for both there are elements of genetic and environmental influence, but they interact and combine very differently whether the species is studied long-term, or a single individual over its lifetime.

Haeckel is known for the idea that “ontogeny recapitulates phylogeny”, also known as recapitulation theory. He thought that it would be possible by studying the development, especially the early embryonic development, of organisms to derive valid conclusions as to how the species had developed. As a general theory this has been thoroughly disproven, but studying early development of embryonic development remains worth while, as it brings out species similarities (homology and homoplasy) and their place in evolution. Sigmund Freud was fond of these ideas, and used them repeatedly in his writings.

Gould (1977) describes the development of ideas about ontogeny and phylogeny.

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Epidemiology

Epidemiology is a fundamental discipline for public health, prevention, and the understanding of society-wide causes and wider connections about mental health. This field has enormously grown in the last 30 years, and is of importance for psychotherapists, as it gives answers and approaches for a number of issues of direct relevance, including the usage of drugs, views of causation, ideas about what evidence means and where it can be found. It would be a good complement to these papers to read at least one short introduction to epidemiology such as Rothman (2012).

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Homeostasis

A system or organism is in homeostasis when certain variables of its internal environment are maintained at a stable and relatively constant level. It is a fundamental quality of living organisms. Typically an iron atom will not be structurally effected, even under extreme physical circumstances: it may react with and form molecules with other atoms, it may vaporise, but it does not cease to exist. Only under extreme conditions of radiation could it be split. But any living organism, even simple unicellular ones, needs to maintain certain internal parameters, usually at least connected with its fluid balance, to maintain its integrity. If the homeostasis breaks down, the organism dies.

For multicellular organisms especially, and even more for the large multicellular organisms represented by animals, homeostasis of a range of internal properties within narrow limits is essential for survival. Mammals have a long list of variables that need to be regulated and stay in homeostasis, such as body temperature, the concentration of a long list of substances in the blood and in other body fluids, blood pressure and the number of hours slept per day. For humans one of many examples is that of body temperature. A human person can survive in a range of external temperatures, but the internal temperature that is an indication of health lies in a range of less than 1°C around perhaps 36.8°C, and internal temperature must be within a range of less than 15°C perhaps for the human body to survive. Human regulation depends on a number of well-understood detailed mechanisms that will not be described here.

This example and most other examples depend on there being a “no action” range of a variable, inside of which no attempt will be made to adjust, with a maximum and a minimum which are trigger points outside of which considerable changes will be made inside the organism in order to move the variable back inside the “proper” range. Many psychotherapists are familiar with the picture of general arousal, above which there is hyperarousal and below which there is hypo-arousal, both of which are considered to be states of dysregulation (Rothschild, 2000; Porges, 2011). This picture follows the general form of a homeostatic system.

Another example of regulation is that of emotions and affects, which are often described as requiring regulation so much that this can be a major target of psychotherapy (Schore, 2012). As it is not possible in general therapy conditions to measure affect and emotion in quantitative terms, this usage of homeostasis and regulation is more metaphorical, but that does not take away its importance or effectiveness.

Many diseases and disorders can be understood, at least partly, as disturbances in homeostasis, or as unsuccessful attempts to restore homeostasis. Homeostasis is not always positive, however. A behaviour pattern, an interpersonal exploitative dynamic or an immovable set of roles in a family system, can all maintain their stability and lack of change through homeostatic mechanisms: homeostasis can also be the maintenance of rigidity.

The technical term for the mechanism whereby moving beyond a particular level of a variable leads to activity to bring the variable back to where it came from is “negative feedback”. Despite homeostasis being a very typical mark of living organisms, the concepts of homeostasis and negative feedback are used of systems in general, including mechanical and non-living physical systems, and can help to understand the dynamic “behaviour” of the system.

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The heart and cardiovascular system

The heart and the circulatory system are vital for the life of most animals with a coelom, a body cavity, to the extent that death follows rapidly when the circulatory system ceases to function. Larger animals – most reptiles, mammals and birds – have two circulatory systems, one for the lungs and one for the whole body, The circulatory system is key for distributing blood and other substances throughout the body, regulating the body by transporting hormones, and protecting the body through the blood clotting mechanism and its part in fighting viruses and bacteria.

Blood is regulated by a number of homeostatic mechanisms:

• Blood pressure must be kept within a narrow range, avoiding hypotension as well as hypertension
• The blood’s acidity must be regulated in narrow boundaries
• The blood glucose level must be regulated
• If oxygen and carbon dioxide levels are not right, the heart beat will be adjusted, and signals go to the respiratory system for correction
• Water and ion concentration must be kept at the right level – if there is too much, this will be secreted by the kidneys – if too little, thirst feeling will suggest intake of fluids

Anything that threatens the functioning and regularity of the circulatory system tends to have a survival meaning, as it could so easily develop into a life-or-death problem. Regulating the heart rhythm is a vital function. The heart rate is controlled by the autonomic nervous system, coordinated by the medulla in the brainstem. Inhibitory signals come from the parasympathetic fibres in the vagus nerve. The heart can malfunction in a number of ways, gradually or suddenly, with a whole range of causes. Heart problems increase as a part of normal ageing, but heart problems can also be congenital and become apparent in the womb, during or shortly after birth. Peripheral arterial disease can be problematic. An important class of problems is cerebrovascular disease, involving the blood vessels supplying the brain. The latter includes stroke, but there are also less easily detectable and slower-developing problems that lead to or exacerbate the neurocognitive disorders (dementias).

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The immune system

The immune system has the function of protecting the body against disease and the consequences of accidents, in particular against the invasion of the body by foreign elements usually called pathogens. These can be bacteria, viruses, prions (infectious proteins) and others. To play this role effectively, the immune system must have the capacity to distinguish disease and health, and to determine the status of cells and substances.

The immune system needs to work when other primary defences (e.g. the skin, or the respiratory or digestive systems) have failed. The human immune system is complex and advanced, and apart from its different protective functions has the ability to learn about diseases, i.e., to acquire immunity based on its experience of disease (e.g., vaccination, whether artificial or naturally achieved through having suffered a disease). Many of the cells produced by the immune system need to be transported to the place needed, via the blood, or the lymph – the fluid that gives its name to the lymphatic system, which is a circulatory system linked to the blood circulation but accessing every part of the body. Specific organs supporting the immune system are the bone marrow, the thymus, the spleen and the mucosal-associated lymphoid tissue.

Because of its sensitivity and complexity, there are a number of things that can go wrong with the immune system:

• It can fail, and not function as intended
• There are diseases such as cancer, which are body cells that multiply out of control; as they are cells of the own body, they will not normally be detected as “foreign” bodies by the immune system
• There are in the order of 40 known or suspected autoimmune diseases, jointly affecting about 5-7% of the human population. They are based on the body’s immune system somehow treating parts of human tissue as the antigens of a foreign invader, thus triggering a specific immune response against them, which causes damage. This can only be corrected by suppressing some of the action of the immune system, which of course has the downside that it is then also less available to fight other real diseases or invasions.
• Hypersensitivity means an overreaction by the immune system, which overproduces antibodies against what is not really a dangerous substance. The reaction can be so strong as to completely overpower the body in what is called systemic anaphylaxis or anaphylactic shock.

When the body is threatened, in many cases there will be an “inflammatory response”, mobilising the immune system. The immune system has a number of mechanisms, including:

• The use of leukocytes (white blood cells), of which macrophages, neutrophils, and NK (natural killer) cells are three major examples
• A number of proteins can help deal with foreign attackers, including about 30 proteins belonging to the “complement system” and interferons, another class of proteins.
• The specific immune system organises a tailor-made defence against attacking pathogens. This uses specialised cell types to identify antigen molecules which are part of the invading pathogen, which are a special kind of leukocyte called lymphocyte, developing into B cells and T cells. These cells further play a major role in putting together the antibodies that will grapple with specific antigens. The antibodies are immunoglobulins, of which there are five classes with specific characteristics.
• When a particular attack has triggered the specific immune system, a “memory” will be left in the form of (lymphocyte) “memory” cells that are able to “recognize” the attacking cells if they return, so that a secondary immunity builds up which will act more quickly and effectively.
• The same types of molecules that could be attacked as invaders are also part of the human body. It is essential that the lymphocytes recognise what are “friendly” or self cells, and differentiate them from foreign bodies. The self cells become marked by the immune system as part of the major histocompatibility complex (MHC)

It is not only the human immune system that is complex, versatile, and has ways of developing defences and learning from each one of them. The attacking pathogens have ways to circumvent or “outwit” the immune system. This includes making changes to their identifying antigens, and in the case of bacteria their ways of changing can be analysed as forms of evolution. Viruses keep changing and evolving, too. A more sophisticated way of successfully attacking is not to attack the body directly, but undermine the immune system, as is done by human immunodeficiency virus (HIV) infection. AIDS is a disease of the human immune system.

There is a major overlap between the endocrine system and the immune system in that changes in one influence the other.

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The endocrine system and hormones

One of the main challenges for multicellular organisms is ensuring internal integration, especially when the cells have differentiated and specialised into organ systems. This requires a means of internal communication, where coherence is maintained through ways of passing “signals” throughout the body. In this internal communication system the nervous system and endocrine system play key roles. Nerve cells (neurons) receive information from the sensory organs, communicate with each other, and send output to the motor (muscle) system; it passes this information via synapses. The endocrine system moves chemicals through the body, mainly by using the circulatory system, i.e. the blood, and the lymphatic system. Some chemicals move locally from cell to cell, bypassing the blood, and are called paracrine regulators.

The chemicals used to send signals throughout the body via the blood are called hormones. The chemicals called hormones are mainly classified in three groups:

• Peptides and proteins. These are shorter (peptides) and longer (protein) chains of amino acids. Examples are insulin, oxytocin, growth hormone and corticotrophin (ACTH).
• Biogenic amines, derived from amino acids. Examples are the catecholamines noradrenaline and dopamine, and other amines such as serotonin and melatonin.
• Steroid hormones and eicosanoids. These are all derived from cholesterol. Examples of steroids are cortisol and testosterone, as are the sex hormones or sex steroids in general (oestrogens; other androgens; progesterone). Prostaglandins are a main class of eicosanoids.

Hormones are produced in many parts of the body, by the hypothalamus (part of the brain), the pineal, pituitary (in two parts), (para-) thyroid and adrenal (in two layers) glands, by the thymus, pancreas, testes or ovaries, and also in substantial quantities by the kidneys, and by the whole gastrointestinal system. Hormones are usually distributed throughout the body (only not reaching the brain, as this is protected by the blood-brain barrier), but they only affect specific types of cells, called “target cells”.

There is no space to enumerate all the different glands and organs and the hormones they produce. In making sense of the multitude of hormones, a number of systems have been identified which link several hormones and activities under one functional heading. Some of the major systems are:

• The hypothalamic-pituitary-adrenal axis
• The hypothalamic-pituitary-thyroid axis, regulating metabolism, using various thyroid hormones
• The renin-angiotensin system regulating blood pressure and the body’s fluid balance
• The hypothalamic-pituitary-gonadal axis, controlling growth / development, the sexuality-reproduction system and (part of) ageing.

The overlap between the nervous system and the endocrine system is substantial. Though the hypothalamus is part of the brain, its function is central for the endocrine system. Many of the chemicals identified as hormones are called neurotransmitters when functioning in the nervous system. The secretory activity of many glands is controlled by the nervous system – though they are also self-regulating through feedback loops. A number of the major systems described as endocrine are better called neuroendocrine, as they mobilise activity in the nervous system as well as in the rest of the body. A major difference is that endocrine action tends to be slower and longer lasting, compared with the rapid action associated with control by the nervous system.

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Sexuality and reproduction

This system has a dual name. Especially for human beings, sexuality, although closely linked to reproduction, needs to be regarded as a separate (behavioural) system. Amongst the non-egg-bearing placental mammals, humans and apes are unusual in having a menstrual cycle. Most other mammals have an oestrous cycle, in which periods of fertility alternate with non-fertility, and the animals mostly mate only during the fertile period. Another system is that of cats and rabbits, who are induced ovulators, which means that the females only ovulate immediately after copulation, in a reflex behaviour. Humans and apes mate throughout the menstrual cycle.

It is relatively difficult to study the human sexual and reproductive system as there is great variety amongst animal, vertebrate, mammalian and even primate species in this system. This means that it is less possible than usual to use the conclusions from animal research for the functioning of sexuality and reproduction.

The menstrual cycle, ovulation, the changes during pregnancy, the initiation and process of childbirth, sexual arousal and sexual intercourse are all regulated by (sex) hormones. The important ones that have been identified are:

• Follicle-stimulating hormone, a glycoprotein
• Luteinising hormone, a glycoprotein
• Oxytocin, a peptide
• Vasopressin, a peptide
• Prolactin, a protein
• Testosterone and its variants; in general, the group of androgens; these are precursors to

oestrogens and mostly steroid hormones

• The oestrogens (not one, but several), steroid hormones
• Progesterone, one of the progestogens, steroid hormones

The regulation of the sexual / reproductive system is referred to as the hypothalamic-pituitary-gonadal axis.

The complete physiological cycle of what takes place in humans during sexual intercourse has been studied to a considerable extent. It can be reasonably well described, and at least largely explained in terms of the mechanisms regulating the process. The complete process is particularly complex, as at various stages both the sympathetic and the parasympathetic branches of the autonomic nervous system need to be activated and deactivated. To co-ordinate these both simultaneously is more complex than when only one of the autonomic divisions is involved.

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Nutrition and the digestive system

Nutrition plays an essential role in well-being and health; unlike some other simple organisms, animals are not self-sufficient, but are dependent on taking in other organisms to survive. In aetiological research or in client assessment, in addition to the many other factors that need to be considered (e.g. early family environment, attachment, infections, genes, trauma) recent past and current nutrition should never be ignored as another possible influence, risk factor or protection factor (Rutter, 2006).

Nutrition includes a balanced diet, the presence of certain essential nutrients, toxicity of substances consumed, allergies, toxic factors in the environment (radiation; air pollution).

The digestive system is composed of the mouth, oesophagus, stomach, small intestine and large intestine, supported by accessory organs and glands, and the endocrine and nervous system. The digestive system has a substantial part of the nervous system built into its walls, the enteric nervous system. Although the enteric nervous system and the gastrointestinal muscles are linked with other parts of the nervous system, too, they continue to function when these links are interrupted, or when parts of the rest of the body have ceased functioning.

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Complex behaviour

More complex forms of animal and human behaviour, when they can clearly grouped together because of functional commonality and because they engage a similar well-defined network of parts of the brain, a brain system, are studied by a number of disciplines. Apart from neuroscience, this is in ethology (the science of animal behaviour), neuroethology, comparative psychology, evolutionary biology, developmental biology and attachment theory. Bowlby (1982) had coined the term “behavioural system”, but this has not been significantly adopted outside attachment theory.

As regards the behaviours central to the attachment behavioural system, a good summary of to what is known, and how important it is to study attachment in a developmental context, can be found in Marvin & Britner (2008). Coan (2008) gives a good summary of findings about the neurobiological basis of attachment.

There are other groupings of complex behaviour into systems which would benefit from a similar systematic treatment and research programmes, such as sexual behaviour, caregiving behaviour, social behaviour and exploration behaviour, but they have not had as much attention or systematic treatment as attachment behaviour using the combined strengths of systems theory, developmental theory, learning theory, ethology and neuroscience.

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Ageing

Ageing is a natural process, as opposed to the deterioration of the major neurocognitive disorders, which are caused by defined disease processes. As the whole organism changes throughout the life-span it is difficult to define a real difference between ageing and development. There is no completed and fully convincing understanding of why ageing takes place or what is causing it. It may well be the result of a combination of three phenomena:

• Most known cells in nature stop reproducing after a certain number of times. It is not understood how or why this happens. It is possible that some part of the cell system is programmed to stop after a certain number, and this may also apply to some or all of human cells.
• Although a lot of the body gets replaced and regenerated over time, it is possible that replacing and repairing cells leads to deterioration over time and ultimately to accumulated small changes and defects that are beyond renewed repair – sometimes called the accumulation of misrepair.
• Different body systems and body parts age (change) at different rates. It is possible that every time that a specific part of the whole organism fails or deteriorates, all the other parts and organ systems also suffer and are damaged as a consequence. This would emphasise that in order to survive much longer than humans in general do, it would be necessary to keep all body parts and systems at a top level of health, which can be seen to be a difficult result to achieve. This would be even more plausible if it would be caused by certain forms of tissue damage, say, being caused by protein damage that when it took place would affect most other tissues too.

It is well documented and observable that the major organ systems usually age at different rates. This is in itself a problem to manage. The muscle, bone and skin systems all age, and start ageing early in life. The heart muscle over time becomes slowly stiffer. Some glands needed for the immune system decrease in size. Neurons die, and few if any are replaced (however, the remaining neurons often create more synaptic connections). Finally, the reproductive system functions optimally earlier in life, and with advanced age fertility almost always declines for men, and always for women.

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Resources

Biology is a huge topic and this paper only brings out highlights, mainly referring to issues that may concern psychotherapeutic practice and mental health issues. The great majority of information in this particular paper is standard and can be found in any biology textbook.

As biology is the basis of Interpersonal Neurobiology, and the latter offers a significant elaboration of psychotherapy, the reader may want to review the W.W. Norton series on this subject. Module owners have an automatic 30% discount on these books (apply the discount code WNPRO )

It may be useful to read parts of a biology university textbook or to review online courses in biology and / or videos. Some of the many books worth considering are: Raven et al. (2013) and Johnson (2013).

An additional possibility is to take up one of the online biology courses that are available. The Biology I course of the CK-12 Foundation (2010) is free and comes with a considerable amount of online support. It covers cell biology, genetics, evolution, ecology, and physiology.

It is recommended to look up some of the unexplained terms in this paper in Wikipedia, which in the field of biology has a number of excellent write-ups which can help to deepen one’s understanding of the subject.

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References

Allis, C.D., Jenuwein, T., Reinberg, D. & Caparros, M-L. (Eds.) (2007). Epigenetics. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press.

Bowlby, J. (1982). Attachment (2nd edition). London: The Hogarth Press.

Bürglin, T.R. (2006). Genome analysis in developmental biology: the nematode caenorhabditis elegans as a model system. In E.M. Neumann-Held & C. Rehmann-Sutter (Eds.), Genes in Development: Re-Reading the Molecular Paradigm. Durham, NC: Duke University Press.

CK-12 Foundation (2010). Biology I Honors. Available from www.ck12.org (accessed 15 December 2013).

Coan, J.A. (2008). Toward a neuroscience of attachment. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Gould, S.J. (1977). Ontogeny and phylogeny. Cambridge, MA: Belknap Press.

Jablonka, E. & Lamb, M.J. (1995). Epigenetic Inheritance and Evolution: The Lamarckian Dimension.Oxford: Oxford University Press.

Jablonka, E. & Raz, G. (2009). Transgenerational epigenetic inheritance: prevalence, mechanisms, and implications for the study of heredity and evolution. Quarterly Review of Biology, 84: 131-176.

Johnson, M.D. (2013). Human biology: Concepts and Current Issues (7th edition). San Francisco, CA: Pearson Education.

Klug, W.S., Cummings, M.R., Spencer, C.A. & Palladino, M.A. (2013). Concepts of Genetics (10th edition).San Francisco, CA: Pearson.

Lewis, R. (2011). Human Genetics: Concepts and Applications (10th edition). New York: McGraw-Hill.

Marvin, R.S. & Britner, P.A. (2008). Normative development: the ontogeny of attachment. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition).New York: The Guilford Press.

Müller, G.B. (2010). Epigenetic innovation. In M. Pigliucci & G.B. Müller (Eds.), Evolution: The Extended Synthesis. Cambridge, MA: The MIT Press.

Neumann-Held, E.M. & Rehmann-Sutter, C. (Eds.) (2006). Genes in Development: Re-Reading the Molecular Paradigm. Durham, NC: Duke University Press.

Newman, S.A. & Müller, G.B. (2006). Genes and form: inherency in the evolution of developmental systems. In E.M. Neumann-Held & C. Rehmann-Sutter (Eds.), Genes in Development: Re-Reading the Molecular Paradigm. Durham, NC: Duke University Press.

Oyama, S. (2000). The Ontogeny of Information: Developmental Systems and Evolution (2nd edition).Durham, NC: Duke University Press.

Oyama, S., Griffiths, P.E. & Gray, R.D. (Eds.) (2001). Cycles of Contingency: Developmental Systems and Evolution. Cambridge, MA: MIT Press.

Pennisi, (2012). ENCODE project writes eulogy for junk DNA. Science, 337: 1159-1161.

Pigliucci, M. & Kaplan, J. (2006). Making Sense of Evolution: The Conceptual Foundations of Evolutionary Biology. Chicago, IL: University of Chicago Press.

Plomin, R., DeFries, J.C., Knopik, V.S. & Neiderhiser, J.M. (2013). Behavioral Genetics (6th edition). New York: Worth Publishers.

Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W W Norton.

Raven, P.H., Johnson, G.B., Mason, K.A., Losos, J.B. & Singer, S.R. (2013). Biology (10th edition). New York: McGraw-Hill Education.

Rothman, K.J. (2012). Epidemiology: An Introduction (2nd edition). Oxford: Oxford University Press.

Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment.New York: W W Norton.

Rutter, M. (2006). Genes and Behavior: Nature-Nurture Interplay Explained. Malden, MA: Blackwell Publishing.

Schore, A.N. (2012). The Science and Art of Psychotherapy. New York: W W Norton.

The post Some basics of human biology appeared first on Confer.

Authored by Henry Strick van Linschoten

Understanding of emotions

Emotions are widely held to involve a subjective element, sometimes distinguished as a feeling. However, if emotions are also identified with observable bodily phenomena the question then arises as to how we can be sure that the subjective, emotional state corresponds to, let alone matches, the physiological dimension of that state – whether the emotion is definable as a facial expression, as substances in the blood, or as activity in certain parts of the brain.

While there is some controversy over whether emotions originate in the cerebral cortex, in evolutionarily older parts of the brain such as the midbrain or in multiple and connected parts of the body-mind, Panksepp (1998) and Panksepp & Biven (2012) are major proponents of the view that seven basic emotions can be identified in all mammals, and that they have a basis in the brainstem. Panksepp has studied emotions throughout his career, and is an influential voice. Panksepp’s research and theory strongly suggests that all mammals share these emotional systems.

Some of the problems of understanding emotions through neuroscience are set out in Miller (2010).

Following are some sources about the contribution of neurobiology to understanding emotions:

• Larsen et al. (2008) describes in systematic detail the psychophysiology of emotions. It reviews the research evidence for the different theories of parts of the nervous system involved in emotions. It also deals with the question of lateralization, and discusses differences between the left and right hemispheres as regards specialization on positive vs negative emotions, as well as specialization between approach and avoidance motivation. This chapter follows the more classical theorization about emotions, and does not even refer to Panksepp.
• LeDoux (1998) is an important monograph about emotional neuroscience. Based in part on original research, LeDoux reviews historical views about how emotions originate in the nervous system. He has an enlightening discussion of MacLean’s brain theories. He discusses localization of emotions, emotional mechanisms, and emotional memories. LeDoux & Phelps (2008) is a more recent and much shorter summary, with similar views, and references to the literature. It has an extensive discussion of fear.
• Panksepp & Biven (2012) is the latest book in which Panksepp sets out his views about the neurobiological basis of emotions. Panksepp’s views are based on a lifetime of original research, mostly with animals. While they are deeply anchored in research evidence, the overall vision and a number of accents he puts have not been accepted by the great majority of neurobiology researchers, especially his views that emotions at a primary level must be understood sub-cortically, and that non-human animals have substantially the same emotional systems and emotions as humans.
• Damasio (1994, especially Ch. 7) has an especially good chapter on emotions in a complete book devoted to discussing the mind-body problem, and advocating non-dualistic views of mind and body.
• Lindquist et al. (2012) is a meta-analytic review of the latest research evidence about the brain basis of emotions that allows a more refined view of the different ideas about emotions as represented by classical researchers, Panksepp and Damasio.
• Tooby & Cosmides (2008) is a review by two of the most respected evolutionary psychologists of the evolutionary backgrounds to different emotions. This view does not directly contradict, but is additional to the more purely neurobiological views of emotions, as it provides explanations at a different level and in a different, evolutionary, time frame.

Affect regulation

Affect regulation plays a key role in psychotherapy, and is seen by many as a major element in a range of mental disorders, as described in Greenberg (2002), Schore (2003a, 2003b, 2012), Linehan (1993) and Rothschild (2000). Schore (2012) explains how interpersonal neurobiological findings contribute to understanding the mechanisms of affect regulation, and offers promise of how this may influence psychotherapeutic practice. Gross (2007) is an extensive and very complete review volume, with a strong emphasis on neurobiology, but also its developmental underpinnings.

A number of brain parts contribute to emotional regulation: locations in the prefrontal cortex, the anterior cingulate cortex and the amygdala. In Panksepp’s view the brainstem contributes significantly – which fits in well with other brainstem functions. The autonomic nervous system is usually engaged, and most emotions include facial expressions, which are generated by parts of the motor system. It has been reported that different parts of the brain are active for different emotions. (On all these points see Larsen et al. (2008)). As regards the lateral hemispheres, there is an often-stated view that the right hemisphere of the cerebral cortex is more active in processing emotion. Coan & Allen (2004) summarise the difficulties with doing appropriately conclusive brain studies on this point.

Please view Dr Ruth Lanius’s video in this module for an exploration of the function and anatomy of the intrinsic brain networks (central executive, salience and default-modes) and the importance of being able to move flexibly between these in maintaining affect regulation.

Localisation of brain functions and brain modularity

Much cognitive neuroscience reports the outcome of research into locations or parts of the nervous system that are involved in particular experiences, cognitions, emotions, behaviours or functions. This is not new. Franz (1901) offers an overview of all the research that was done in the 1890s in this regard. Whilst the research, especially that supported by the increasingly sophisticated brain imaging techniques, provides real evidence of association and statistical correlation of brain activity with certain other activities, stimuli or phenomena, there are severe limitations on the conclusions one can draw (even in the most-researched areas such as fear) as there is no access to what the activity consists of and what it means.

The highest level meaningfulness of ‘localisation’ research is also modified by the main two conflicting theories about brain functioning: modularity and distributed processing. Modularity is the idea that the human mind, at least in part, and for at least a number of significant functions, is composed of innate modules which have been evolutionarily selected and have a substantial degree of independent functioning. Massive modularity at its most radical represents the view that the mind only has independent modules and very many – maybe thousands. Distributed processing (or connectionism) differs in suggesting that the human mind is characterised by a general problem-solving capability. In this view, the cerebral-cortical regions function as a single connected network, with different activities occurring in parallel but all of these with the potential to influence each other. This view may go back to William James and Hughlings Jackson.

The concept of modularity mainly originates in the work of Fodor (1983; 2000), and is now supported by most evolutionary psychologists in the more extreme form of massive modularity. Confer et al. (2010)reviews some of the general background. The discussion about modularity becomes at times very technical and difficult to follow but touches on issues of substance that continue to be controversial. Distributed processing is less of a “school” than modularity, but may be seen as a partly-owned designation for those scientists who are not convinced by the stronger views of modularity. Shallice & Cooper (2011) provide a nuanced but somewhat advanced view of the issues, especially in Chapters 2 and 3.

The lateralisation of the brain

Questioning the differences between the two brain hemispheres began in the second half of the 19th century with the work of Broca and Wernicke, who studied aphasia (a neurologically caused inability or impaired ability in language comprehension or ability to speak – whilst the physical capability seems to be present – vocal chords, etc.) This area of investigation developed following research done in the 1960s by Roger Sperry and Gazzaniga with human patients whose corpus callosum had been severed as a treatment for severe epilepsy.

There is little doubt that there are small differences in the exact size and shape of left and right hemispheres in most people. There also appears to be a degree of specialisation between the two sides, although there are also nuclei and locations where the two sides simply seem to function as a back-up, so that when one side is damaged or destroyed, the other one will take over the functions. The specialisation between the hemispheres is most pronounced for language function, with the left hemisphere being primary for explicitly semantic processing, and the right hemisphere for the emotional (affective) content of speech and perhaps qualitative aspects designated as “prosody”. This does mean, however, that in listening to speech both hemispheres are activated and co-operate.

As regards emotional lateralisation, rather than the often-quoted view that the right brain is primary for processing emotions, there is considerable evidence suggesting that the right hemisphere is primary for negative, and the left hemisphere for positive emotions (e.g. Larsen et al., 2008). It may also be that anger leads to a higher activity level in the left than in the right hemisphere (Coan et al., 2001). To the extent that it is possible in psychotherapy to primarily address one side preferentially, it seems to make a real difference which of these views is correct. Schore (2003a, 2003b, 2012) is amongst those who are very convinced of the great theoretical and practical therapeutic importance of hemispheric lateralisation. Coan & Allen (2004) set out a number of conceptual problems with much of the research conducted. The (relative) skeptics about lateralisation do not dispute that there are small differences and a degree of specialisation in the brain; they believe that the cortical left-right specialisation as far as known is more complementary than absolute, and that there is more plasticity in the brain than often assumed.

Please view Dr Iain McGilchrist’s videos in this module for an elaboration of the different functions of the right and left-brain hemispheres and clinical examples showing the functions of lateralisation.

Some major disorders with a clear biological origin

There are some “mental disorders” in DSM-5 for which a major genetic causality is established: Huntington’s disease, Down’s syndrome and some other neurodevelopmental disorders. There is a shift towards considering autism spectrum disorder as substantially genetically caused. And, as opposed to most other mental disorders, the neurocognitive disorders (dementias) all are linked with clearly visible and diagnosable changes in the brain. Beyond that there is much speculation around genetic causes, observable changes in the brain either of the size or the activity of particular brain locations and hypotheses about links with neurotransmitters, but little certainty. For autism spectrum and the potential genetic influences on other disorders, the multiple genes with small influences have not been determined, though some are speculated about (Plomin et al., 2013).

Neurocognitive disorders

The neurocognitive disorders (thus renamed in DSM-5; the old and still much-used name is dementias) are bound to have a steadily increasing degree of attention, as they affect more and more people all over the world. Neurocognitive disorders are not normal forms of ageing, but are identified forms of disease with observable biological signs. It used to be that an accurate diagnosis often had to await autopsy, but with the new brain-imaging techniques (often using MRI followed by PET) the differentiation between the major types of neurocognitive disorder is rapidly improving.

The neurocognitive disorders are a clear example of the time delay between fully knowing what a disease consists of and being able to find ways of curing or even substantially slowing down the disease progression.

Metaphors – utility and pitfalls

Using metaphors in psychotherapy has a long and distinguished history. Hypnosis uses metaphor to a great extent, and Freud made much use of the words of energy and force taken from physics. Probably the biggest metaphoric use of language in neuroscience is the words used for body components that are personified, or are used as homunculi. This happens for human parts as much as for animals and even cells; it may be more common for living organisms, but is not completely absent for purely material substances either (“the acid ate up the paper in no time”). A lighthearted set of ideas about metaphors for psychoanalysts is available in Friedman (2009).

There is nothing wrong with using words metaphorically, as long as the awareness of their metaphorical status is strong enough to avoid using them as links in real causal arguments. Interestingly enough, the effectiveness of using metaphor for communication, for rhetorical purposes, to explain or to influence or even to hypnotise does not seem to depend on a quality of truthfulness or appropriateness of correspondence it might or might not have. Visualisations of being in a special place, of growing to large proportions or becoming invisible, of being on fire or on the surface of a star do not have less potential power than ones that would stay closer to the laws of nature. The same is of course true for the very basic but powerful placebo effect.

Accordingly, it is difficult to put limits on the metaphorical use of neuroscientific words or narratives in a psychotherapeutic context according to whether something is proven or there is research evidence for it. One restraint may be the issue of misrepresentation to a client; when using official serious-sounding scientific language, it would seem that in certain contexts a client would consider that what you are saying is intended to be factual, truthful, and based on some form of objective evidence. The therapist must be guided here by their conscience and their ethical standards. More easily, when writing books or articles, or speaking in a professional forum, one would usually expect a psychotherapist to clarify it when they use words and ideas metaphorically rather than in their surface meaning. Similarly, if one uses ideas in order to reach conclusions for work or treatment which are based on causal reasoning, it remains of the utmost importance not to be confused, and to be sure that the reasoning continues to be based for every part of it on evidence, facts, and the supported ideas of other professionals. Anything else would be a risk of betraying one’s professional standards.

An interesting article about the use of “evidence” by psychotherapists is Milton (2002). Some books about metaphors in psychotherapy are Combs & Freedman (1990) and Stott et al. (2010). Lakoff & Johnson (1980) is one of the standard works on metaphor.

References

Coan, J.A. & Allen, J.J.B. (2004). Frontal EEG asymmetry as a moderator and mediator of emotion. Biological Psychology 67: 7-49.

Coan, J.A., Allen, J.J.B. & Harmon-Jones, E. (2001). Voluntary facial expression and hemispheric asymmetry over the frontal cortex. Psychophysiology 38: 912-925.

Combs, G. & Freedman, J. (1990). Symbol, Story and Ceremony: Using Metaphor in Individual and Family Therapy. New York: W W Norton.

Confer, J.C., Easton, J.A., Fleischman, D.S., Goetz, C.D., Lewis, D.M.G., Perilloux, C. & Buss, D.M. (2010). Evolutionary psychology: controversies, questions, prospects, and limitations. American Psychologist 65: 110-126.

Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain (2nd edition). New York: W W Norton.

Damasio, A. (1994). Descartes’ Error: Emotion, Reason, and the Human Brain. New York: Penguin.

Fodor, J. A. (1983). The Modularity of Mind: An Essay on Faculty Psychology. Cambridge, MA: MIT Press.

Fodor, J.A. (2000). The Mind Doesn’t Work That Way: The Scope and Limits of Computational Psychology.Cambridge, MA: MIT Press.

Frank, J.D. & Frank, J.B. (1991). Persuasion and Healing: A Comparative Study of Psychotherapy (3rd edition). Baltimore, MD: The Johns Hopkins University Press.

Franz, S.I. (1901). Localization of brain function. Psychological Review 8: 418-425.

Friedman, L. (2009). Tractatus metaphorico-psychoanalyticus (with apologies to L.W.). Psychoanalytic Inquiry 29: 12-17.

Greenberg, L.S. (2002). Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings.Washington, DC: American Psychological Association.

Gross, J.J. (Ed.) (2007). Handbook of Emotion Regulation. New York: The Guilford Press.

Gross, J.J. (2008). Emotion regulation. In M. Lewis, J.M. Haviland-Jones & L. Feldman Barrett (Eds.) (2008). Handbook of Emotions (3rd edition). New York: Guilford Press.

Lakoff, G. & Johnson, M. (1980). Metaphors We Live By. Chicago, IL: Chicago University Press.

Larsen, J.T., Berntson, G.G., Poehlmann, K.M., Ito, T.A. & Cacioppo, J.T. (2008). The psychophysiology of emotion. In M. Lewis, J.M. Haviland-Jones & L. Feldman Barrett (Eds.) (2008). Handbook of Emotions (3rd edition). New York: Guilford Press.

LeDoux, J. (1998). The Emotional Brain: The Mysterious Underpinnings of Emotional Life. London: Phoenix.

LeDoux, J.E. & Phelps, E.A. (2008). Emotional networks in the brain. In M. Lewis, J.M. Haviland-Jones & L. Feldman Barrett (Eds.) (2008). Handbook of Emotions (3rd edition). New York: Guilford Press.

Lindquist, K.A., Wager, T.D., Kober, H., Bliss-Moreau, E. & Barrett, L.F. (2012). The brain basis of emotion: a meta-analytic review. Behavioral and Brain Sciences, 35: 121-202.

Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.

Miller, G.A. (2010). Mistreating psychology in the decades of the brain. Perspectives on Psychological Science, 5: 716-743.

Milton, M. (2002). Evidence-based practice: issues for psychotherapy. Psychoanalytic Psychotherapy 16:160-172.

Panksepp, J. (1998). Affective Neuroscience: The Foundations of Human and Animal Emotions. Oxford: Oxford University Press.

Panksepp, J. (2008). The affective brain and core consciousness: how does neural activity generate emotional feelings? In M. Lewis, J.M. Haviland-Jones & L. Feldman Barrett (Eds.) (2008). Handbook of Emotions (3rd edition). New York: Guilford Press.

Panksepp, J. & Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions.New York: W W Norton.

Plomin, R., DeFries, J.C., Knopik, V.S. & Neiderhiser, J.M. (2013). Behavioral Genetics (6th edition). New York: Worth Publishers.

Rose, S., Lewontin, R.C. & Kamin, L.J. (1984). Not in Our Genes: Biology, Ideology and Human Nature.London: Penguin Books.

Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment.New York: W W Norton.

Rutter, M. (2006). Genes and Behavior: Nature-Nurture Interplay Explained. Malden, MA: Blackwell Publishing.

Schore, A.N. (2003a). Affect Dysregulation and Disorders of the Self. New York: W W Norton.

Schore, A.N. (2003b). Affect Regulation and the Repair of the Self. New York: W W Norton.

Schore, A.N. (2012). The Science of the Art of Psychotherapy. New York: W W Norton.

Shallice, T. & Cooper, R.P. (2011). The Organisation of Mind. Oxford: Oxford University Press.

Siegel, D.J. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W W Norton.

Siegel, D.J. (2012). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind.New York: W W Norton.

Stott, R., Mansell, W., Salkovskis, P., Lavender, A. & Cartwright-Hatton, S. (2010). Oxford Guide to Metaphors in CBT: Building Cognitive Bridges. Oxford: Oxford University Press.

Tooby, J. & Cosmides, L. (2008). The evolutionary psychology of the emotions and their relationship to internal regulatory variables. In M. Lewis, J.M. Haviland-Jones & L. Feldman Barrett (Eds.) (2008). Handbook of Emotions (3rd edition). New York: Guilford Press.

The post The neurobiological contribution to psychotherapy appeared first on Confer.

Authored by Henry Strick van Linschoten

All biologists recognise that under no circumstances can genes and the environment function or exist without each other: all life consists of cells and all cells contain DNA. The DNA molecule itself is inert and cannot be connected with any activity or influence unless it is embedded in a living cell, while a cell cannot live on its own, but needs an environment in which to live. Genetic influences are traditionally contrasted with environmental effects. Biologists define environment in to cover everything that is not inherited from the DNA of the parents. “Environment” here includes the following (Plomin et al., 2013):

• the biophysical environment surrounding the organism, including its chemical and physical aspects / components, both living and non-living and that may interact with the organism by the exchange of mass, energy or information
• developmental influences such as parenting, family, local community, education, groups, culture
• prenatal events, between conception and birth, including the environment over that period
• pre- and post-birth events such as illness, nutrition, toxicity, environmental load through noise, pollution, radiation
• changes in the DNA that are not inherited because they occur in cells other than testes and ovaries (including environmentally induced changes in DNA)
• when taking a systems view, its components and its interactions seen as one whole environmental system

Gene expression

The consequences of this wider view of environment are considerable. In particular, the interchangeable use of the terms innate and inherited is questionnable. What is innate at birth (e.g., instincts, functioning senses, reflexes, certain behavioural systems) is not present when the first cell of the organism was conceived. It must therefore have come about during embryological development. Hence it is just as likely to have been influenced by the environmental period in the womb as have been “programmed” genetically.

More terminology is needed to describe the factors behind a completed phenotype. Biologists define epigenetic as referring to the interaction between inherited DNA-genetic factors and developmental processes, of whatever type, through which the genotype is expressed in the phenotype. Epigenetic factors and processes are again under the influence of both the available genes and the environment (as it changes over time).

Any expressed phenotype of an organism (or one of its traits) is always the result of a combination of genes and environment from conception until the time that the phenotype is under observation. There are several groups of factors that can influence the gene expression and the development (ontogeny) of a particular phenotype. A gene is being expressed by a stretch of DNA being copied into an mRNA molecule (messenger RNA), which is then used in another process for the synthesis of a protein. Epigenetic factors are a generic name for all the different processes over time that can influence how the genes are used to express themselves into phenotype. At every step of the way environmental factors can intervene, join or overrule. Although at times geneticists have described the process as deterministically proceeding (and have used expressions such as “programming”) it has long been clear that that is an incorrect description. At times genes dominate a particular process; at others the environment.

Single-cause theories offer explanations for certain traits that are found exclusively in genes, “the environment”, child abuse, poverty, toxins or radiation, events happening in early childhood, prenatally, or parenting style. These theories are countered by the objection that multiple causes are the most common basis for human (and mammalian) symptoms and disorders. The principal reason that researchers attempt to establish causation is to use it to find pointers to cure, alleviate or prevent, disorders, symptoms or problems from occurring. In that respect it is useful to review and think through some examples that show that moving from known causation to remedy is often difficult:

• Phenylketonuria (PKU) is an example of a 100% genetic cause that can be matched by a wholly environmental (nutritional) means of prevention.
• After decades of comparing, there is no way of knowing whether the best remedy for mental disorders is psychoactive drugs, talking therapy or a combination of both.
• In established cases of clearly physical diseases such as terminal cancer or the neurocognitive disorders (dementias) there may be good evidence that forms of talking therapy would benefit the patients.
• For two of the most studied disorders with a suspected causal mixture of strong (polygenic) genetic causation combined with environmental influences, schizophrenia and autism spectrum disorder, there is no clear indication what the most effective treatment or combination of treatments should be, or how prevention or early diagnosis could be used.

Major battles have been fought about the question to what extent genetic and environmental (from conception) influences play the bigger role. Asserting that both always play some role is easy, but does not solve the problem of which role is stronger, nor address the complication of multiple causes including environmental, epigenetic and genetic causes. In addition, the influences are almost always probabilistic and don’t determine a particular outcome with certainty, and there is the difficulty of assessing indirect factors. Finally, there are influences early in life, whether genetic or environmental, that only impact in later life. This is true of genetic influences as much as of negative environmental experiences such as child abuse or disorganised attachment.

Rutter (2006) gives an overview of the main controversies. He writes especially about the shortcomings, hype and overpromises of geneticists in exaggerating what the breakthroughs in DNA and genome knowledge and in technology were going to allow. But it must be said that it is as possible to exaggerate the importance and dominance of epigenetic effects and of environmental influences as it is to exaggerate the role of genes. It is as extreme to believe in child sexual abuse as a single-cause explanation of mental disorder as it is to believe mental disorders are caused completely by genetic anomalies. An overview book about behavioural genetics is Plomin et al. (2013).

The most likely explanation for most severe problems and disorders is that there are contributions, not all of them equal, from the whole range of causes:

• genes, in the form of small contributions from multiple genes leading to an increased vulnerability
• environmental influences between conception and birth
• environmental influences around and shortly after birth
• attachment security in the first 1.5 years of life
• attachment issues during development
• lifelong influences of a person’s relational experiences and personal development, including natural or human-made trauma
• child abuse
• parenting
• group, community, social and cultural influences
• use of drugs and substances
• influences from nutrition, nutritional deficiencies and toxicity
• psychotherapy
• more generally ecological influences
• learning in the sense of learning theory, including behaviourism

Further resources

For further reading on genes and the environment in the context of human behaviour see Rutter (2006). Plomin et al. (2013) offers similar information but is more purely focused on behavioural genetics and research results than Rutter (2006), who gives a wider overview. For an understanding of the more detailed issues of genetic influence and its role in evolution, two modern texts are Jablonka & Lamb (1995)and Pigliucci & Kaplan (2006). They complement each other in that the former gives a more detailed picture of mechanisms and history, whereas the latter is up to date, modern, and deals with a wider range of the scientific issues surrounding the topic. Francis (2011) is a shorter and perhaps more readable book that illustrates the issues with examples.

Oyama et al. (2001) and Oyama (2000) (the latter being an updated version of a seminal text published in 1985) offer the most fully organised and compelling vision for what could replace the current neo-Darwinian and genetic mainline view but is so ambitious that the project has not been progressed much so far.

Kendler & Prescott (2006) reports on one very large project to look at combined genetic and environmental causes for mental disorders in a systematic way, using modern methods for deriving causality from observations. It is impressive in its scope and methodology. Kendler (2006) is a short article in which he sets out a number of his conclusions about genetic causes for psychiatric disorders.

Lewis (2011) is an introductory textbook about human genetics for those who want to have a full overview and follow the details of the technical arguments for themselves.

Parens et al. (2006) deals with the public, political and ethical issues around behavioural genetics. Rose et al. (1984) is a classic that warns vigorously for the dangers of an overly gene-centred biology profession, psychiatry profession and society.

References

Francis, R.C. (2011). Epigenetics: How Environment Shapes Our Genes. New York: W W Norton.

Jablonka, E. & Lamb, M.J. (1995). Epigenetic Inheritance and Evolution: The Lamarckian Dimension.Oxford: Oxford University Press.

Kendler, K.S. (2006). “A gene for…”: the nature of gene action in psychiatric disorders. FOCUS, 4: 391-400.

Kendler, K.S. & Prescott, C.A. (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Abuse Disorders. New York: Guilford Press.

Lewis, R. (2011). Human Genetics: Concepts and Applications (10th edition). New York: McGraw-Hill.

Parens, E., Chapman, A.R. & Press, N. (Eds.) (2006). Wrestling with Behavioral Genetics: Science, Ethics and Public Conversation. Baltimore, MD: Johns Hopkins University Press.

Pigliucci, M. & Kaplan, J. (2006). Making Sense of Evolution: The Conceptual Foundations of Evolutionary Biology. Chicago, IL: University of Chicago Press.

Plomin, R., DeFries, J.C., Knopik, V.S. & Neiderhiser, J.M. (2013). Behavioral Genetics (6th edition). New York: Worth Publishers.

Rose, S., Lewontin, R.C. & Kamin, L.J. (1984). Not in Our Genes: Biology, Ideology and Human Nature.London: Penguin Books.

Rutter, M. (2006). Genes and Behavior: Nature-Nurture Interplay Explained. Malden, MA: Blackwell Publishing.

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Authored by Henry Strick van Linschoten

Ingesting psychoactive, “mind-altering” or “mood-changing” drugs or substances has been a human option for millennia: there are records of the use of alcohol, opium and marijuana many thousands of years BC. Psychoactive drugs are substances, whether solid, liquid or gas and however introduced into the body, that change the way a person thinks, feels or behaves by changing (something in) the functioning of the brain. For the biological effect of substances it makes no difference whether they are prescription medicines, recreational drugs, legal or illegal, over-the-counter medication, alternative remedies, or not regarded as “drugs” at all, e.g. alcohol, smoking tobacco, coffee, tea, soft drinks or refined sugar.

All psychoactive drugs have effects that can be divided between the main desired effect(s) and “side-effects”. As drug use in the widest sense is so common as to be almost inevitable amongst clients, it can be expected that psychotherapists have a reasonable understanding of the range of the possible effects of drugs.

Substance Use

DSM-5 has made some small but important changes in their preferred terminology by putting (much) less focus on the terms “substance abuse” and “dependence”, and putting all substance disorders on a dimensional scale of severity. The main classes of problems about drug use focused on in DSM-5 are:

• Impaired control by the user over their drug-related behaviour, including craving
• Social impairment
• Riskiness of use, i.e. the difficulty the user has to respond to the problems caused by the drug use
• Tolerance and withdrawal symptoms

DSM-5 states that apart from the disordered drug use, there can also be mental disorders caused directly by using certain drugs: “substance-induced disorders” as opposed to “substance use disorders”. This is an important distinction: if drug use does not lead to separate (drug-induced) disorders, that still leaves the classes of physically determined tolerance and withdrawal symptoms, and the other criteria related to the harm done by the drug use. The classification also leaves open the possibility that drug use might not lead to symptoms of tolerance and withdrawal, and it is emphasised that only tolerance and withdrawal symptoms without harm are not sufficient for a drug use disorder.

Recreational drugs are obviously used for their effects: to stimulate (e.g. cocaine, amphetamines, caffeine); to produce hallucinations (e.g. LSD) or to sedate (e.g. barbiturates and alcohol). The effects of cannabis and of opioids are similar or identical to those caused by endogenous cannabinoids and opioids that the body itself produces. The effects of alcohol are relatively complex and imperfectly understood in terms of their mechanisms; it is known to influence a number of neurotransmitter systems.

Drug use has by now been well studied from a neurobiological perspective. This research makes it plausible that psychoactive drug use and the effect of drugs depend on an understanding of a wide range of factors: the user’s experience with the drug; physiological sensitivity to the drug, probably with an inherited component; the situational and relational context of drug use; and the user’s expectations.

An increasing problem is the use of prescription drugs, whether or not they were originally prescribed for good reasons. Benzodiazepines are a good example of this; they are effective, their effect is understood, they may be prescribed for very “normal” reasons, and they replace other anxiolytics, sedatives or hypnotics that may be much more dangerous or harmful. Until recently a number of major countries appeared to be overprescribing them, leading to what was considered to be such an undesirable degree of dependence that by now the great majority of doctors is cautious about prescribing them for any sustained time periods. There are by now a range of prescription drugs which people like using for reasons other than basic medically justifiable needs, and for which expert opinion differs greatly as to whether the use of these drugs constitutes a disorder or not, especially on a longer-term basis. This includes learning-enhancing and attention-focusing drugs. It is clear that this is not a new problem.

The effect of drugs can clearly overlap with the effects of psychotherapy. Affect regulation, and improving a client’s experience of mood and anxiety “disorders” are standard goals for therapy, and it is clear that affects and mood can be influenced by taking drugs. It would seem useful for a psychotherapist to have a good understanding of the intended effects, side-effects, complications and potential physical impact of drugs, whether legal, illegal, recreational, normally prescribed or freely available.

A few up-to-date sources about drugs are: Healy (2009), exclusively about psychiatric drugs; Erickson (2007), excluding psychiatric drugs; and three books with more of an emphasis on recreational drugs but also summarising psychiatric drugs: McKim & Hancock (2012); Meyer & Quenzer (2013); Brick & Erickson (2013).

The evidence for the effectiveness of medically prescribed psychoactive drugs is mainly in the form of randomised controlled trials (RCTs), as the regulatory agencies of major western countries make this a condition of approving the drugs for general prescription to the public. Over the past few decades these RCTs, especially the main ones for older and more recent antidepressants and antipsychotic drugs, have been heavily scrutinised and much criticised (Goldacre, 2012; Healy, 2009).

It may be true that the profit-based pharmaceutical companies have biased and at times manipulated their reporting of research, that some of the effectiveness of pharmaceutical drugs is not that impressive, that a significant part of the effectiveness is a placebo effect, and that the drugs usually have at least some negative side-effects. Nevertheless, there are many people for whom these drugs have delivered benefits or at least relief, and the fact that there are significant numbers of drugs screened out, i.e. rejected by the approval process, suggests that the screening via RCTs is not completely a wasted effort. Another key example worth analysing is the fact that drugs inspired by the neurobiology of PTSD have not done as well in trials as was hoped for, and certainly have not done as well as antidepressants for depression and anxiety.

A considerable amount of research has been devoted to comparing the effectiveness of psychoactive drugs and psychotherapy. It would be desirable to conduct more research in this area. Whilst for specific problems or disorders it has been found that either (forms of) psychotherapy or (certain) drugs are clearly superior to the other, it seems possible to make a broad generalisation, on current evidence, that there are many people and many disorders for whom a good choice of psychotherapy or a good choice of prescription drugs can produce about equivalent results – as it were a broadening of the “equal effectiveness” conclusion that most research into comparing different types of psychotherapy has led to. As these statistical results always hide a wide range of individual differences, this means that a psychotherapist should be as open to the possibility that drugs might be better for a particular client than therapy, as doctors and psychiatrists should be open to the option of psychotherapy. In practice this rarely means a one-off choice between drugs and therapy, but a sequencing over time in which first one and then the other is tried – just as for somewhat more difficult problems people often end up being in psychotherapy repeatedly and with more than one psychotherapist.

Much research has taken place into comparing drugs and therapy alone with a combination of the two. Here too, a reasonable generalisation can probably be made that, with exceptions, there is no clear pattern that usually the combination is more effective, or usually one or the other mono-therapy is better. All combinations of effectiveness are possible, and may need to be investigated, if sufficient resources to do careful research are available. In practice this means that in a case about which no research is known, there should be a presumption that all the options are open. Given that there is firm evidence that the client’s “theory of what is effective” can have a considerable impact, this means that being sensitive to what the client’s perceptions or suggestions are must be a significant part of good practice. The usage of sequencing of intervention options should be actively considered (Forand et al., 2013).

Two overview chapters about the comparison of drugs and psychotherapy are Forand et al. (2013) and Sparks et al. (2010). For individual disorders the chapters of Lambert (2013) contain summaries and references to research about the relative effectiveness.

The last few paragraphs most directly related to drugs prescribed by doctors. When a psychotherapist works with a client who uses prescription drugs but has obtained them otherwise than through a regular medically authorised prescription, or uses over-the-counter drugs, or drugs from the world of alternative or complementary medicine, the situation is different. It appears important in any case to be aware of what clients are using, to ask them why they are using it, and what is the source of the client’s conviction that the usage would be effective and safe at an acceptable level. Depending on the answers it may be appropriate to link this with issues about self-care. It becomes more difficult for the psychotherapist to form a view about the effectiveness and riskiness dimensions, but from a holistic point of view it seems difficult to ignore drugs that a client is taking.

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: Text Revision (4th edition): DSM-IV-TR. Arlington, VA: American Psychiatric Association.

Brick, J. & Erickson, C.K. (2013). Drugs, the Brain, and Behavior: The Pharmacology of Drug Use Disorders (2nd edition). New York: Routledge.

Erickson, C.K. (2007). The Science of Addiction: From Neurobiology to Treatment. New York: W W Norton.

Forand, N.R., DeRubeis, R.J. & Amsterdam, J.D. (2013). Combining medication and psychotherapy in the treatment of major mental disorders. In M.J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th edition). Hoboken, NJ: John Wiley.

Goldacre, B. (2012). Bad Pharma: How Medicine is Broken, and How We Can Fix It. London: Fourth Estate.

Healy, D. (2009). Psychiatric Drugs Explained (5th edition). Edinburgh: Churchill Livingstone.

Kendler, K.S. (2006). “A gene for…”: the nature of gene action in psychiatric disorders. FOCUS, 4: 391-400.

Kendler, K.S. & Prescott, C.A. (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Abuse Disorders. New York: Guilford Press.

Lambert, M.J. (Ed.) (2013). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th edition). Hoboken, NJ: John Wiley.

Lewis, R. (2011). Human Genetics: Concepts and Applications (10th edition). New York: McGraw-Hill.

McKim, W.A. & Hancock, S.D. (2012). Drugs and Behavior: An Introduction to Behavioral Pharmacology (7th edition). Upper Saddle River, NJ: Pearson Education.

Meyer, J.S. & Quenzer, L.F. (2013). Psychopharmacology: Drugs, The Brain and Behavior (2nd edition). Sunderland, MA: Sinauer.

Sparks, J.A., Duncan, B.L., Cohen, D. & Antonuccio, D.O. (2010). Psychiatric drugs and common factors: an evaluation of risks and benefits for clinical practice. In B.L. Duncan, S.D. Miller, B.E. Wampold & M.A. Hubble (Eds.), The Heart and Soul of Change: Delivering What Works in Therapy (2nd edition). Washington, DC: American Psychological Association.

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Authored by Henry Strick van Linschoten

Attunement

When we speak of attunement in psychotherapy, it is possible to recognise and describe significant physical, bodily elements in what is going on in line with the non-dualist ideas about mind and body. Apart from what is perceived to happen psychologically, body systems, organ systems, parts of the body are in tune, are running synchronously and this is directly connected or perhaps even partly identified with the psychological sense of the attunement. Attunement has to a limited extent been studied in biology and medicine, but it has a large component that is seen to belong to psychology. Amongst many other aspects, this is a prime example of the unity of body and mind, going beyond the mutual influencing of somehow independent systems to a fully integrated single bodymind reality.

The prime example and source of information about attunement can be found in babies and infants with their primary caregivers. Stern (1977, 1985, 1995), Tronick (2008, passim but especially Parts III and V and chapters 15, 16, 17, 20,29 and 32) and Beebe & Lachmann (2002, especially chapters 2, 5 and 6) are key sources. The attachment behavioural system can only function on the basis of attunement: basic attachment security is formed in the first year to year and a half of life, and that period is largely pre-verbal.

As with many underlying concepts, there are a number of synonyms or overlapping ideas such as intersubjectivity, resonance, shared states, dyadic states, mutual regulation, co-constructed interaction, rapport, or even dialogue, conversation and I-Thou relationship.

The following are a number of important milestones in the development of the wider attunement concept since the 1970s:

• Intersubjectivity can be defined as the processes involved in a mind obtaining knowledge of the mental activity of another mind. This includes the ability to distinguish between minds and things. Colwyn Trevarthen did a great deal of pioneering work to establish that this ability is already present in infants so young that it must be called innate, and was able to describe its observable features in detail. One of his own summaries of his work from the early 1960s onwards is Trevarthen (1980). He himself describes the history of his work in this field in Trevarthen (1998)
• The psychologist Dr Daniel Stern did a great deal of pioneering work painstakingly observing infants and their interactions with caregivers. The first published book in a series of publications was Stern (1977), in which he reported on the infant’s recognising other human beings, on structure and timing of the behaviour repertoires, and how interaction developed into relationship. He lay the groundwork for his work of the next few decades, in particular by taking the idea of mutual regulation as basic to human intersubjectivity and relationship.
• Harris (1998) is based in the rather different psychoanalytic tradition, but from a modern relational perspective, and sites the body firmly at the centre of psychotherapeutic theory and clinical practice. She bases herself firmly on a complete mind-body integration, emphasises the body and the person as only understandable in its relationality, and in addition draws attention to the importance of the overall social context. In addition she refers to the importance of general systems theory and to the metaphoric meaning and power of the terminology and processes she describes.
• Fonagy et al. (2008) come from a slightly different trajectory of research projects started in the early 1990s. In this chapter they summarise the latest state of their thinking, and pull together and connect relational psychoanalytic theory and practice with attachment theory, systems theory and (neuro-)biological ideas to show that it is not too early for a rich synthesis of relational and attachment thinking that can be one very helpful basis for clinical practice for the substantial group of practitioners who are part of all these traditions. They also demonstrate here the good fit between this synthesis and the new ideas developed by their group around the concept of mentalisation.
• Surrey &smp; Kramer (2013) show how relational psychotherapy and intersubjectivity can be anchored and linked with the ancient traditions of Buddhism and mindfulness in a way that strengthens and deepens the understanding of what is really happening in relationality and how this powerful understanding further develops the acquisitions of other traditions. They use practical examples of methods and therapeutic moments to illustrate their statements.
• Schore (2012) is perhaps currently the most complete, detailed and systematic example of how attunement as the basis for intersubjectivity can be used clinically to develop the therapeutic relationship in safe and effective ways towards a firmly-held, relational and attachment-based holistic conceptualisation that is enriched by an understanding of and integration with the latest ideas of neurobiology.
• Siegel (2012, Ch. 23) is a chapter from one of Siegel’s several summaries and integrations of most of the above strands into one seamless whole called Interpersonal Neurobiology. In this chapter he emphasises how many strands come together in the concept of attunement. Short as it is, he stresses that attunement is an essential element in the movement towards integration, one of the fundamental organising principles of Siegel’s formulation of Interpersonal Neurobiology.

Attachment theory

At its origin, attachment theory was very much rooted in biology, including ethology and evolution theory, as is evident from the foundational book, Bowlby (1982), that was originally written in the late 1960s. Attachment theory has continued to be open to and influenced by interpersonal neurobiology.

A summary of attachment-related work that has been done in areas of neurobiology can be found in the chapters in Part II of Cassidy & Shaver (2008), and especially in Coan (2008). However, the focus of ongoing research in attachment theory has been primarily on the diagnostic / categorical model of different qualities of attachment security, measurement and diagnosis of these in infants, adults and at other ages, and correlations between these categories over time, between closely related people, and with other categories of interest such as the classifications of mental disorder.

Attachment theory has been a significant influence on the development of psychotherapy, and has been understandably integrated in many of its new conceptualisations (Schore, 2012; Fonagy et al., 2008; Siegel, 2010, 2012; Cozolino, 2010), that are based on an interdisciplinary synthesis of research findings.

Mirror neurons

Mirror neuron theory is listed by Siegel (2012, Ch. 19) as an aspect of interpersonal neurobiology and there is great interest in this phenomenon among those studying the unconscious and involuntary impact of the other upon the self at an embodied and affective level, a core concern in relational approaches to psychotherapy.

Mirror neurons are a special group of motor neurons in the cerebral cortex. They were first identified in the ventrolateral part of the premotor cortex of monkeys. They are activated not just as part of preparation for some kind of (muscle) action, but also when behaviours of other animals are being observed. A minimal response to this discovery would be to assume that they play a role in procedural imitation learning. In general the premotor cortex appears to play a major role in the initiation of motor action, of which the voluntary execution would be driven from the primary motor cortex. The premotor cortex also contains Broca’s area, the location that since the 19th century is known to play a role in producing speech. A key question is the meaning and implications of the special role being played by the mirror motor neurons compared with other neurons in the premotor area.

They were first observed in experiments conducted in Italy with macaque monkeys, as described in Gallese et al. (1996). This article reports the observation of two monkeys; it reported that there was a strong correspondence between observation and prepared action in about 30% of the neurons. In interpreting the results it compared the neurons with the neurons in Broca’s area. The paper was combined with an article with more interpretation of the same results, Rizzolatti et al. (1996). Some of the conclusions reached have been:

• Primate experimenters have been able to study action potentials of individual neurons. In humans this is almost never possible for ethical reasons; as a result the research is almost exclusively based on non-human animals, mainly animals, and to some extent birds. The few studies that suggest that mirror neurons exist in humans only show activity in particular areas, and show that in a number of different areas. Dinstein et al. (2008) review and critique the human protocols that have been used.
• It appears that neurons with similar properties to the ones whose properties were described by Gallese et al. (1996) and Rizzolatti et al. (1996) may be more common than initially thought. Similar responses have been found in the supplementary motor area, in the primary somatosensory cortex and in the inferior parietal lobe.

A number of readable books have been written expanding the mirror neuron narrative, such as Rizzolatti & Sinigaglia (2008), Stamenov & Gallese (2002) and Ramachandran (2010). Mirror neurons have now been described as explaining empathy (either the Rogerian version or the simulation theory of Goldman and Gordon), supplying the neurological basis for human self-awareness, explaining the origins of human language skills and have been implicated in the causes of autism.

Some reviews and perspectives are given by Hickok (2009), Dinstein et al. (2008), Catmur et al. (2007)and Gallese et al. (2011). Gallese et al. (2011) was a discussion forum during which supporters and skeptics of mirror neuron theory jointly looked at research evidence and tried to evaluate the support for conclusions in a number of areas. Hamilton (2013) reviews the evidence for a mirror neuron influence on autism, and concludes that the research evidence is very limited.

References

Beebe, B. & Lachmann, F.M. (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Hillsdale, NJ: The Analytic Press.

Bowlby, J. (1982). Attachment (2nd edition). London: The Hogarth Press.

Cassidy, J. & Shaver, P.R. (Eds.) (2008). Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Catmur, C., Walsh, V. & Heyes, C. (2007). Sensorimotor learning configures the human mirror system. Current Biology 17: 1527-1531.

Coan, J.A. (2008). Toward a neuroscience of attachment. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain (2nd edition). New York: W W Norton.

Dinstein, I., Thomas, C., Behrmann, M. & Heeger, D.J. (2008). A mirror up to nature. Current Biology 18:233; R13-R18.

Fonagy, P., Gergely, G. & Target, M. (2008). Psychoanalytic Constructs and Attachment Theory and Research. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Gallese, V., Fadiga, L., Fogassi, L. & Rizzolatti, G. (1996). Action recognition in the premotor cortex. Brain 119: 593-609.

Gallese, V., Gernsbacher, M.A., Heyes, C., Hickok, G. & Iacoboni, M. (2011). Mirror neuron forum. Perspectives on Psychological Science 6: 369-407.

Hamilton, A. F. de C. (2013). Reflecting on the mirror neuron system in autism: a systematic review of current theories. Developmental Cognitive Neuroscience 3: 91-105.

Harris, A. (1998). Psychic envelopes and sonorous baths: siting the body in relational theory and clinical practice. In L. Aron & F.S. Anderson (Eds.), Relational Perspectives on the Body. Hillsdale, NJ: Analytic Press.

Hickok, G. (2009). Eight problems for the mirror neuron theory of action understanding in monkeys and humans. Journal of Cognitive Neuroscience 21: 1229-1243.

Ramachandran, V.S. (2010). The Tell-Tale Brain: Unlocking the Mystery of Human Nature. London: William Heinemann.

Rizzolatti, G., Fadiga, L., Gallese, V. & Fogassi, L. (1996). Premotor cortex and the recognition of motor actions. Cognitive Brain Research 3: 131-141.

Rizzolatti, G. & Sinigaglia, C. (2008). Mirrors in the Brain: How Our Minds Share Actions and Emotions.Oxford: Oxford University Press.

Schore, A.N. (2012). The Science of the Art of Psychotherapy. New York: W W Norton.

Siegel, D.J. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W W Norton.

Siegel, D.J. (2012). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind.New York: W W Norton.

Stamenov, M.I. & Gallese, V. (Eds.) (2002). Mirror Neurons and the Evolution of Brain and Language.Amsterdam: John Benjamins Publishing.

Stern, D.N. (1977). The First Relationship: Infant and Mother. Cambridge, MA: Harvard University Press.

Stern, D.N. (1985). The Interpersonal World of the Infant: A View From Psychoanalysis and Developmental Psychology. London: Karnac.

Stern, D.N. (1995). The Motherhood Constellation: A Unified View of Parent-Infant Psychotherapy.

Surrey, J.L. & Kramer, G. (2013). Relational mindfulness. In C.K. Germer, R.D. Siegel & P.R. Fulton (Eds.), Mindfulness and Psychotherapy (2nd edition). New York: Guilford Press.

Trevarthen, C. (1980). The foundations of intersubjectivity: development of interpersonal and cooperative understanding in infants. In D.R. Olson (Ed.) The Social Foundations of Language and Thought. New York: W W Norton.

Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In S. Bråten (Ed.), Intersubjective Communication and Emotion in Early Ontogeny. Cambridge: Cambridge University Press.

Tronick, E. (2007). The Neurobehavioral and Social-Emotional Development of Infants and Children. New York: W. W. Norton.

The post The neurobiological basis of human relationships: a summary of concepts and underlying studies appeared first on Confer.

Authored by Henry Strick van Linschoten

There have always been considerable limitations on ways of acquiring knowledge about the nervous system, and especially about the human nervous system. As a result, a great deal of what is considered to be research relevant to human neurobiology in fact relies on experiments with animals. As the human nervous system in a number of ways has more similarity with the nervous system of animals than other organ systems this has been widely regarded as legitimate. However, it cannot be proven that an animal and a human will respond identically to any particular circumstance or set of events.

For a long time the main information about the brain depended on three sources:

• autopsies
• damage to part of the brain which enabled observation of subsequent changes in behaviour
• electrical stimulation of brain locations

Remarkable results were gained from undertaking autopsies, and many pictures of the brain at the end of the 19th century look the same as they do now. Even more incredibly, a charting by Brodmann of the areas of the cerebral cortex based on careful microscopic study of the cortex tissue was published in 1909 and is still quoted today. The work based on both brain damage and brain stimulation established associations (correlations) and could lead to speculation, but could not produce a complete picture.

The main focus of brain research takes one of the following forms:

• The location of a particular function of activity is determined. This requires both adequate mapping of the nervous system, as well as locating in the available structural maps where activities or functions take place.
• It can be mapped which parts (locations) of the nervous system are connected with which other parts, and how many axons appear to connect them. Whilst this gives a rough quantitative idea of which groups of parts might work together in some systematic way, as long as it is not known what is being communicated over the connections the results have limited value.
• Making comparisons between the left and right hand side of parts of the brain, and between the brain locations of different people, or even of the same person at different developmental stages.
• Making size comparisons of parts of the brain, which one can then try to relate to a person’s history and genotype, i.e. genetic and environmental influences. However, “size” does not have a natural meaning.
• For all brain processes, the dynamic over time (how and how quickly it changes) and what this might be related to, can be studied.

An overview article discussing and evaluating the relationship between psychology and biology is Miller (2010).

The new brain imaging techniques

To the old techniques already available in the 19th century, have now been added a range of imaging techniques (the first three are older than the others):

• X-rays, but with the major limitation of the poor contrast, and the damage done by the considerable amount of radiation.
• Angiography – an improvement on X-rays by injecting dye to give better contrast. The technique was useful for picturing blood vessels.
• Electroencephalography (EEG), a recording of the global electrical activity (potentials) of the brain, showing up brain waves from a number of measuring positions on the skull. It is useful for investigating sleep stages and types, and for distinguishing types of seizures and seizure-like activity. It is a main source of ideas about left to right hemisphere differences.
• Computerised tomography (CT; sometimes also CAT, with A for axial), using narrow X-ray beams, specialised detectors, and movement between the detectors and the body, thus allowing much more detailed pictures, albeit still with a resolution of several millimetres, i.e. insufficient to distinguish individual (neuron) cells.
• Magnetic Resonance Imaging (MRI), which allows more versatility and for images to be made with a better resolution than CT, at less than a millimetre. It requires contrast agent to be used, and while it is generally regarded as much safer than CT, it is not completely safe. It has a number of variants. The basic method for making images helps to clarify physical structure, and is sometimes designated as sMRI – structural MRI.
• Functional MRI (fMRI) does not measure neurons or neuronal function directly, but blood flow or the state of haemoglobin in the blood, which is taken as a proxy for the local activity level. It probably mainly reflects synaptic input and local processing, not neuronal impulses. As the name says, it tries to establish function and activity levels throughout the brain. The spatial resolution is a few mm, and the time resolution a few seconds, which is better than PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computerised Tomography).
• Dyadic functional MRI (dfMRI), where recently experimentally two people have been scanned with fMRI in the same machine, and lying in the machine in parallel, with the possibility of visual contact. This is bound to develop further, and is important for developing ideas in social neuroscience.
• Diffusion MRI (dMRI) or Diffusion Tensor Imaging (DTI) is another variant of MRI. It is especially effective for images of axon pathways.
• Positron Emission Tomography (PET) measures brain activity (rather than structure) by injecting radioactive chemicals in the blood and measuring the positron emission. Apart from the radioactive load on the subject, the measurements produced usually need large amounts of computer processing.
• Single Photon Emission Computerised Tomography (SPECT) is simpler and lower-cost than PET, and gives images of poorer quality. It measures emitted gamma-ray radiation of the radioactive substance with a gamma camera.
• Magnetoencephalography (MEG) measures brain activity though special ultra sensitive detectors measuring minute amounts of magnetic activity. Its time resolution is especially good, so it can measure rapidly shifting cortical activity.
• Magnetic Source Imaging (MSI) is a combination of MEG and MRI.

When considering these techniques it is important also to be aware of their major limitations:

• They either measure structure, which is a refined technique of making static images, or activity.
• Measuring activity remains indirect, mostly via measuring blood flow.
• There is a trade-off between the spatial and the temporal resolution: if the images are more precise as regards location, they cannot detect quick changes, and vice versa.
• Many of the techniques are used in conjunction with substantial amounts of computer processing of the raw data. Some of this processing is probabilistic, smoothes out, and averages, and there is controversy as to whether what it presents as output is still in any way close enough to what one would have wished to observe directly.
• Apart from the computer processing, many images used more widely as “results” are in fact the average of a number of subjects, the average of one person scanned repeatedly, or represent the difference between measurements taken during stimulation or at rest. Furthermore, since the brain is never inactive this also introduces an element of fuzziness.
• The colours usually shown in pictures do not correspond to what is observed; they have been added by the computer as part of the photo-processing.
• None of the techniques can measure activity at an individual neuronal, synaptic or molecular level, or can measure the totality of the neurotransmitter activity crossing a particular synapse.

A summary of the state of neuroimaging techniques can be found in Miller et al. (2007).

References

Miller, G.A. (2010). Mistreating psychology in the decades of the brain. Perspectives on Psychological Science, 5: 716-743.

Miller, G.A., Elbert, T., Sutton, B.P. & Heller, W. (2007). Innovative clinical assessment technologies: Challenges and opportunities in neuroimaging. Psychological Assessment, 19: 58-73.

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