Brain

Question 1

Which parts of the brain are linked with emotions?

Answer 1

Anterior cingulate cortex→ deal with emotion
Amygdala→ threat and positive emotions
—>frontal lobes part are those that evolves later and are more unique to human

Question 2

What is the difference between top-down and bottom-up processing ?

Answer 2

Top down processing→ Slow, deliberate explicit, and strategic processing that uses rule-based knowledge
- Mediated by prefrontal cortex
- Main target in CBT

Bottom-up processing→ Automatic, effortless, implicit, and pre-conscious processing based on salient features or stimulus and situational cues
- Mediated by lower-order brain structures→ amygdala
- Also changes with CBT, though not targeted as explicitly
—>Cognitive restructuring is thought to increase top-down cognitive control over negative emotion
—>medication is thought to decrease bottom-up reactivity to emotional stimuli

Question 3

How does psychotherapy alter the brain in depressed patients?

Answer 3

Depression
- CBT alters activity in dorsolateral, ventrolateral, and medial prefrontal cortices as well as anterior and posterior cingulate cortices
- Mostly higher-order areas
- Modulation of top-down processes involved in encoding and retrieval of negative associative memories, rumination, and over-processing or irrelevant information

Question 4

How does psychotherapy alter the brain for anxiety, PTSD, Social anxiety and OCD?

Answer 4

Anxiety
- CBT alters activity in the same higher-order regions as well as the amygdala, hippocampus, and anterior and medial temporal cortices
- More modulation of bottom-up structures in CBT for anxiety

PTSD
- Increased activity in anterior cingulate cortex
- decreased activity in amygdala after exposure plus restructuring

Social anxiety
- Decreased activity in amygdala-hippocampal region after either CBT or medication treatment

OCD
- Behavior therapy and medication treatment decrease activation in orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior cingulate cortex

Question 5

What are the basic mechanisms responsible for cognitive control of emotion?

Answer 5

Basic mechanisms→ cognitive control of emotion
- involved higher-order cortical regions
- Cognitive reappraisal involves increased activation of dorsolateral and ventrolateral prefrontal cortex and anterior cingulate cortex, as well as decreased activity of amygdala
- Using strategies to regulate emotions in experimental studies activates top-down processes in a manner consistent with CBT

Question 6

What did the recent research on connectivity found for psychotherapy?

Answer 6

More recently→ look at changes in connectivity of relevant brain regions after therapy
- Shou et al. 2017→ CBT increased resting state connectivity between amygdala and fronto-parietal network in patients with MDD and PTSD
- Young et al. 2017→ Symptom improvement in either CBT or Acceptance and Commitment Therapy for SAD was correlated with increased connectivity between the amygdala and the vm/vl-PFC during an emotion regulation task
- Mason et al., 2016→ CBT for psychosis associated with greater connectivity between amygdala and dorsolateral PFC in a social threat task

Question 7

What is the link between mindfulness and the brain?

Answer 7

Positive and negative info not located at the same spot in brain
- joy→ higher activity in left PFC
- anxiety, sadness→ higher activity in right PFC
- left to right ratio was greater for the Buddhist monk
—>means that could change happiness midpoint from inside
- cortical thickening in regions dedicated to attention, learning…

Gotnik et al 2016
- systematic review of 11 studies examining brain changes after 8week MBSR program
- Increase in volume, activity, and connectivity of prefrontal cortex, cingulate cortex, insula, and hippocampus
- Decrease in amygdala activity and increased connectivity with prefrontal cortex

Question 8

What are the effects of psychopharmacology?

Answer 8

Psychopharmacology
- Selective serotonin reuptake inhibitors (SSRIs) recommended as first-line pharmacological treatment for depression
- Compared to previous medication generations (tricyclics and monoamine inhibitors)
- Side effect profile more mild
- Less fatal in case of overdose
- No evidence that they are more effective
- Benefit most pronounced for severe depression (otherwise, possible placebo effect)→ sometimes give it for very severed depression in order to be able to start behavioural activation
- Most people discontinue use within 3 months, but course of average major depressive episode is 9 months

Question 9

What are the effects of deep brain stimulation?

Answer 9

Deep brain stimulation
- Neurostimulator implanted in brain sends electrical impulses to specific subcortical regions of the brain
- Good for research because control is built in→ sham VS active stimulation
Helen Mayberg, 2005→ targeted subgenual cingulate in six patients with treatment-resistant depression
- 4/6 patients achieved sustained clinical response or remission at 6 months
- Being applied to other treatment-refractory conditions like OCD and anorexia nervosa
—>not first line treatment

Question 10

What are the effects of psychedelic drugs when linked with psychotherapy?

Answer 10

Reiff et al, 2020→ psychedelic drugs
- Scoping review of 161 studies on clinical application of psychedelic drugs for psychiatric disorders
- Psychedelics→ psilocybin (serotonin agonist); lysergic acid diethylamide (LSD; serotonin agonist); ayahuasca (harmine and DMT); 3,4-Methylenedioxymethamphetamine (MDMA)
- Psychedelic-assisted therapy: preparatory therapy, psychedelic session high-dose of drug, processed in integrative therapy

Dworkin, 2023→ have to combine psychedelics with psychotherapy
- Psychological and physical safety
- May enhance magnitude and duration of benefit
- is it better than both separately→ need to use a factorial design to answer that question
- BUT how to create a drug placebo of strong drugs like that?

Question 11

How does knowledge about psychotherapy affect beliefs about its efficacy?

Answer 11

Perricone et al, 2024
- Intervention to change belief that psychotherapy affects the mind, but
not the brain
- Participants with elevated depression, from general population, and mental health clinicians
- Pre-test (case description), biological explanation of depression (focused on serotonin)
- followed by randomization to one of three conditions: brain-level psychotherapy description, mind-level psychotherapy description (active control), or inactive control

Results
- Biological explanation + inactive control → found psychotherapy less effective
- Biological explanation + brain-level psychotherapy description → psychotherapy more effective
- Biological explanation + mind-level psychotherapy condition → no change in beliefs