Neural correlates of self-reflection in post-traumatic stress disorder.

OBJECTIVE: Disturbances in self-referential processing (SRP) are increasingly recognized in post-traumatic stress disorder (PTSD). In healthy adults, SRP tasks engage the medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) brain regions that have shown altered function in PTSD. We hypothesized that individuals with PTSD would differ from controls in functional activation of the MPFC and PCC during SRP. METHOD: We compared neural activation in healthy controls (n = 15) and participants with PTSD (n = 20) during a SRP task, using fMRI at 4.0T. RESULTS: Controls made faster responses to the self-relevance of personal characteristics than to the accuracy of general facts, whereas response times did not differ between these conditions in PTSD. Controls also demonstrated greater MPFC (dorsal and ventral) and PCC response when considering the self-relevance of personal characteristics in comparison with the accuracy of general facts. Individuals with PTSD demonstrated less MPFC response than did healthy controls for the contrast of self-relevance of personal characteristics relative to general facts. CONCLUSIONS: These results implicate MPFC in SRP disturbances associated with PTSD. These findings are relevant to current proposals for including symptoms of negative self-referential cognition and identity-existential disturbance as diagnostically relevant to PTSD.

Attachment and the regulation of the right brain.

It has been three decades since John Bowlby first presented an over-arching model of early human development in his groundbreaking volume, Attachment. In the present paper I refer back to Bowlby's original charting of the attachment landscape in order to suggest that current research and clinical models need to return to the integration of the psychological and biological underpinnings of the theory. Towards that end, recent contributions from neuroscience are offered to support Bowlby's assertions that attachment is instinctive behavior with a biological function, that emotional processes lie at the foundation of a model of instinctive behavior, and that a biological control system in the brain regulates affectively driven instinctive behavior. This control system can now be identified as the orbitofrontal system and its cortical and subcortical connections. This 'senior executive of the emotional brain' acts as a regulatory system, and is expanded in the right hemisphere, which is dominant in human infancy and centrally involved in inhibitory control. Attachment theory is essentially a regulatory theory, and attachment can be defined as the interactive regulation of biological synchronicity between organisms. This model suggests that future directions of attachment research should focus upon the early-forming psychoneurobiological mechanisms that mediate both adaptive and maladaptive regulatory processes. Such studies will have direct applications to the creation of more effective preventive and treatment methodologies.

A century after Freud's project: is a rapprochement between psychoanalysis and neurobiology at hand?

In his 1895 "Project for a Scientific Psychology" Freud attempted to construct a model of the human mind in terms of its underlying neurobiological mechanisms. In this endeavor "to furnish a psychology which shall be a natural science," Freud introduced the concepts that to this day serve as the theoretical foundation and scaffolding of psychoanalysis. As a result, however, of his ensuing disavowal of the Project, these speculations about the fundamental mechanisms that regulate affect, motivation, attention, and consciousness were relegated to the shadowy realm of "metapsychology." Nonetheless, Freud subsequently predicted that at some future date "we shall have to find a contact point with biology." It is argued that recent advances in the interdisciplinary study of emotion show that the central role played by regulatory structures and functions represents such a contact point, and that the time is right for a rapprochement between psychoanalysis and neuroscience. Current knowledge of the psychobiological mechanisms by which the right hemisphere processes social and emotional information at levels beneath conscious awareness, and by which the orbital prefrontal areas regulate affect, motivation, and bodily state, allows for a deeper understanding of the "psychic structure" described by psychoanalytic metapsychology. The dynamic properties and ontogenetic characteristics of this neurobiological system have important implications for both theoretical and clinical psychoanalysis.

Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders.

The concepts of self-organization, state changes, and energy flow are central to dynamic systems theory. In this work 1 suggest that to apply these general principles to the study of normal and abnormal development, these constructs must be specifically defined in reference to current knowledge of brain development. Toward that end, I present an overview of the properties of self-organizing developmental systems, and then propose a model of attachment dynamics as synchronized energy exchanges that cocreate nonlinear changes of state, discuss the roles of bioamines and energy-generating brain mitochondria in state regulation, and describe the energy-dependent imprinting of synaptic connectivity and neural circuitry in the infant brain. In this application of nonlinear concepts to developmental models of both resistance against and vulnerability to mental disorders, particular emphasis is placed upon the experience-dependent maturation of a system in the orbital prefrontal cortex that regulates psychobiological state and organismic energy balance. This frontolimbic system is expanded in the nonlinear right hemisphere that generates stress-regulating coping strategies, and it serves as the hierarchical apex of the limbic and autonomic nervous systems. Early forming microstructural alterations and energetic limitations of this regulatory system are suggested to be associated with a predisposition to psychiatric disorders.