心智化的方法与技术：第6讲课件

NeurobiologicalPerspectives神经生理学观点JonG.Allen,Ph.D.Outline

提纲DevelopmentalImpactofAttachmentTrauma依恋创伤对发展影响AttachmentandBrainRewardSystems依恋和大脑奖励系统BrainRegionsAssociatedwithMentalizing与心智化有关的脑区Implicitvs.ExplicitMentalizingandtheNeurochemicalSwitch内隐vs.外显的心智化与神经化学开关TreatmentImplications:MindfulnessandConsciousRegulation治疗启示：正念和意识调节Caution:Biomania警惕：生理学狂热AttachmentTrauma依恋创伤Childhoodattachmenttrauma(neglectandabuse)hasadverseeffectsonthedevelopmentofneurobiologicalsubstratesofemotionregulationthatareevidentintoadulthood.儿童期的依恋创伤（忽略和虐待）对负责情绪调节的神经生理学基质的发展具有不利影响，这在成年期也很明显。Attachmenttraumasensitizesthenervoussystemsuchthatlowerlevelsofstressleadtohighlevelsofdistressthatareinterpretedas“over-reactions”(“makingmountainsoutofmolehills”).依恋创伤使神经系统敏感，使得较低水平的压力导致高水平的痛苦，这被解释为“过度反应”（“小题大做”）。Primateresearchshowshigherlevelsofstressreactivityandimpulsivity,alongwithdecreasedexplorationandintergenerationaltransmissionofimpairedcaregiving.灵长类动物的研究表明，应激反应性和冲动性水平较高，同时探索性下降，受损的养育会在代际间传递。Traumalowersthethresholdfora“neurochemicalswitch”fromreflectivementalizingtodefensivefight-flight-freezeresponse.创伤降低了从反思性的心智化到防御性的战斗-逃跑-木僵反应的“神经化学开关”的阈值。Conclusions:(a)Neurobiologicalresearchisconsistentwiththedualliabilityofattachmenttrauma:increaseddistress+impaireddevelopmentofemotionregulation.(b)Wemostneedtomentalizewhenweareleastcapableofdoingit.结论：（a）神经生理学研究成果与依恋创伤的双重不利因素一致：痛苦增加+情绪调节发展受损。（b）当我们最不能做到心智化时，我们最需要心智化。AttachmentandBrainRewardSystems依恋和大脑奖励系统DOPAMINEBrainrewardcircuitsarewellestablished,associatedwithgoal-directedactivity,includingmaternalinterestininfantsandcaregiving(alsoprominentinaddiction-relatedbehavior,e.g.,cocaine)多巴胺大脑有健全的奖励回路，与目标导向的活动相关，包括母亲对婴儿和养育的兴趣（在成瘾相关行为中也很突出，例如可卡因）OPIOIDDecreaseseparationdistress(playaroleinaddictionrelatedtosocialdeprivation,e.g.,heroin)Addiction(e.g.,cocaine,heroin)“highjacks”rewardsystemsthatevolvedforattachment.类鸦片物质减少分离痛苦（在与社会剥夺有关的成瘾现象中发挥作用，例如海洛因）成瘾（例如，可卡因，海洛因）会“劫持”为依恋进化出来的奖励系统。AttachmentandBrainRewardSystems依恋和大脑奖励系统OXYTOCINHormoneassociatedwithmaternalbehavioraswellasbrainrewardsystems;playsaroleindecreasingdistress.Associatedwithsocialengagement:approach,trust,cooperation,bonding.Associatedinmothersandfatherswith(a)bondingtotheirparents,(b)bondingwitheachother,and(c)bondingwiththeirchildren.Securemothersfindinteractingwithdistressedinfantsrewarding(approach);avoidantmothersmorelikelytoshowsignsofdistress(avoidance).催产素与母性行为以及大脑奖励系统相关的激素;在减少痛苦中发挥作用。与社会参与相关：亲近，信任，合作，连接。令母亲和父亲（a）与他们的父母连接，（b）彼此连接，以及（c）与其子女连接。安全型的母亲发现与有痛苦的婴儿互动（亲近）会带来奖励；回避型的母亲更有可能表现出痛苦的迹象（回避）。TheSocialBrain社交大脑Socialintelligence(nottoolmaking)drovetheevolutionofthehumanbrain.社交智力（不是制造工具）推动了人类大脑的进化。Mirrorneurons:mediateimplicitawarenessofothers’emotionalstates镜像神经元：中介对他人情绪状态的内隐觉察Amygdala:respondstothreatandemotionalsignificanceofsocialstimuli杏仁核：回应社会刺激中的威胁和情感意义Anteriorinsula:senseofselfandawarenessofemotionsconjoinedtobodilyarousal前岛叶：自体感受和情绪觉察与身体唤起相结合Temporallobe:identificationofindividualfaces;perceptionofbiologicalmotionandintentionality;interpretationofbehaviorincontext(socialscripts)颞叶：辨认个体面孔；生理运动和意向性的感知；结合背景解释行为（社交脚本）TheSocialBrain社交大脑Temporo-parietaljunction:attributingthoughtsandmentalstatesinothers颞顶联合区：对他人思想和心理状态的归因Medialprefrontalandanteriorcingulate:“mentalizingregion”involvedincomplexsocialcognitionincludingreflectiononmentalstatesinself,others,andothers’perceptionofself.Forexample,activatedwhenparticipantsinteractingwithcomputergamebelievetheyareplayinganotherpersonversusplayingagainstthecomputer(computermakesthesamemoveinbothcases)内侧前额叶和前扣带回：“心智化区域”涉及复杂的社会认知，包括对自我、他人和他人对自己感知的心理状态的反思。例如，当参与者玩计算机游戏时，认为他们正在与另一个人而不是与计算机玩时才会被激活（计算机在两种情况下都有着相同的行动）ImplicitandExplicitSocialCognition内隐和外显的社会认知Implicit:automatic,intuitive,non-verbal,emotional(e.g.,frowningface)内隐的：自动的，直觉的，非语言的，情绪化的（例如，皱眉的脸）Explicit:slow,deliberate,reflective,verbal(interpretationoffrown)外显的：缓慢的，有意的，反思的，言语的（对皱眉的解释）Implicitfeelslikereality(psychicequivalencemode)内隐感受如同现实（精神等同模式）Explicitfeelsself-generated(mentalstatesasrepresentational,mentalized)外显感受为自我生成出来的（作为表征性的，心智化了的心理状态）ImplicitandExplicitSocialCognition内隐和外显的社会认知Implicitprocessingbrainregions:amygdala,basalganglia,ventromedialprefrontalcortex,dorsalanteriorcingulate,lateraltemporalcortex内隐处理脑区：杏仁核，基底神经节，腹内侧前额叶皮层，背侧前扣带回，外侧颞叶皮层Explicitprocessingbrainregions:lateralprefrontalcortex,medialprefrontalcortex(“mentalizingregion”)lateralandmedialposteriorparietalcortex,rostralanteriorcingulate,medialtemporallobe外显处理脑区：外侧前额叶皮层，内侧前额叶皮层（“心智化区域”），外侧和内侧后顶叶皮层，前内侧扣带，内侧颞叶Ideally,implicitandexplicit(fastandslow)worktogether,withmentalizingprovidingmoreflexiblebutslowerresponding(“pausebutton”)理想情况下，内隐和外显（快速和慢速）协同工作，心智化提供更灵活但更慢的响应（“暂停按钮”）TreatmentImplications治疗意义Neuroimagingresearchshowsthatimplicitandexplicitprocessesarereciprocal:consistentwiththe“neurochemicalswitch,”activationofeitherdiminishesactivationoftheother.神经影像学研究表明，内隐和外显过程是相互的：与“神经化学开关”一致，激活一个会减少另一个的激活。Strongemotionalreactionsdiminishreflection;conversely,reflection,suchasverballylabelingandemotion,diminishesemotionalarousal.强烈的情绪反应会减少反思；相反，反思，如用言语命名情绪，会减少情绪唤起。Mindfulnesspracticehelpsprovidesomeemotionaldetachmentfromexperience,diminishesarousal,andisconducivetoflexibleattentionandawarenessoftheouterandinnerworlds.正念练习有助于提供一些从经验中脱离情感的能力，减少唤起，并有助于灵活地注意和觉察外在和内在世界。TreatmentImplications治疗意义Reflectivementalizingexemplifiesthemoregeneraladaptivefunctionsofconsciousness,whichincludeflexiblerespondingtonovelty,ambiguity,andcomplexity—allofwhicharecharacteristicofinterpersonalrelationshipsdependingonsocialcognition.反思性的心智化体现了意识的更加普遍的适应功能，包括对新颖性，模糊性和复杂性的灵活回应–所有这些都是人际关系的特点，并且依赖于社会认知。Atherapeuticrelationshipisconducivetosecureattachment,whichregulatesemotionalarousalandisthereforeconducivetomindfulattentionandmentalizing(includingpatient-therapistinteractions).治疗关系有利于安全依恋，其调节情绪唤起，因此有助于带着思考的注意力和心智化（包括病人–治疗师的互动）。EnthusiasmforBiologicalPsychiatry对生理精神病学的热情 neurologyandpsychiatrywillmergeintoacommonclinicaldiscipline…abiologicallyinspired,personalizedmedicine…understandingthebiologyofbraindisordersispartofthecontinuousattemptofeachgenerationofscholarstounderstandhumanthoughtandhumanactioninnewterms…anewhumanismthatdrawsonourbiologicalindividuality.—EricKandel(2018).Thedisorderedmind.

神经学和精神病学将融入一个共同的临床学科……一个由生理学启发的，个性化的医学……理解大脑疾病的生理学是每一代学者不断尝试以新的方式理解人类思想和人类行为的一部分……一种新的人文主义，着眼于我们的生理个体性。—埃里克·坎德尔（2018）《紊乱的心灵》Caution:“Biomania”警惕：“生理学狂热”Biomania:excessiveenthusiasmforexclusivefocusonneurobiologyastheultimatebasisforunderstandingpsychologicalprocessesandtreatingpsychiatricdisorders.生理学：过度热衷于专注神经生理学，将其作为理解心理过程和治疗精神疾病的终极基础。Psychiatricdisordersare“braindisorders.”精神疾病是“大脑疾病”。Caution:thelabel“braindisorders”doesnotreducestigma.警惕：“大脑疾病”的标签不会减少耻辱感。Asresearchontraumaattests,thebrainbecomesdisorderedinthecontextofdisorderedattachmentrelationships.对创伤的研究证明，在出问题的依恋关系的背景下，大脑会变得混乱有问题。Caution:“Biomania”警惕：“生理学狂热”Healingthebrainrequireshealingtheperson’slife(relationships),analogoustotheneedforlifestylechangesinheartdisease.治愈大脑需要治愈人的生活（关系），类似于心脏病患者需要改变生活方式。Patientscanbedemoralizedwhentoldtheyare“treatment-resistant”becausetheyhavenotrespondedtomedication;medicationcanbemoreeffectiveinconjunctionwithpsychotherapy(includinggroupandfamilywork).当病人被告知他们由于对药物没有响应，因而“对治疗有抵抗力”时，病人可能会感到沮丧低落；药物治疗与心理治疗（包括团体和家庭工作）相结合，可以发挥出更大效果。References参考文献AllenJG