LSD Increases Primary Process Thinking via Serotonin 2A Receptor Activation.

Rationale: Stimulation of serotonin 2A (5-HT2A) receptors by lysergic acid diethylamide (LSD) and related compounds such as psilocybin has previously been shown to increase primary process thinking - an ontologically and evolutionary early, implicit, associative, and automatic mode of thinking which is typically occurring during altered states of consciousness such as dreaming. However, it is still largely unknown whether LSD induces primary process thinking under placebo-controlled, standardized experimental conditions and whether these effects are related to subjective experience and 5-HT2A receptor activation. Therefore, this study aimed to test the hypotheses that LSD increases primary process thinking and that primary process thinking depends on 5-HT2A receptor activation and is related to subjective drug effects. Methods: Twenty-five healthy subjects performed an audio-recorded mental imagery task 7 h after drug administration during three drug conditions: placebo, LSD (100 mcg orally) and LSD together with the 5-HT2A receptor antagonist ketanserin (40 mg orally). The main outcome variable in this study was primary index (PI), a formal measure of primary process thinking in the imagery reports. State of consciousness was evaluated using the Altered State of Consciousness (5D-ASC) rating scale. Results: LSD, compared with placebo, significantly increased primary index (p < 0.001, Bonferroni-corrected). The LSD-induced increase in primary index was positively correlated with LSD-induced disembodiment (p < 0.05, Bonferroni-corrected), and blissful state (p < 0.05, Bonferroni-corrected) on the 5D-ASC. Both LSD-induced increases in primary index and changes in state of consciousness were fully blocked by ketanserin. Conclusion: LSD induces primary process thinking via activation of 5-HT2A receptors and in relation to disembodiment and blissful state. Primary process thinking appears to crucially organize inner experiences during both dreams and psychedelic states of consciousness.

Dreamlike effects of LSD on waking imagery in humans depend on serotonin 2A receptor activation.

RATIONALE: Accumulating evidence indicates that the mixed serotonin and dopamine receptor agonist lysergic acid diethylamide (LSD) induces an altered state of consciousness that resembles dreaming. OBJECTIVES: This study aimed to test the hypotheses that LSD produces dreamlike waking imagery and that this imagery depends on 5-HT2A receptor activation and is related to subjective drug effects. METHODS: Twenty-five healthy subjects performed an audiorecorded guided mental imagery task 7 h after drug administration during three drug conditions: placebo, LSD (100 mcg orally) and LSD together with the 5-HT2A receptor antagonist ketanserin (40 mg orally). Cognitive bizarreness of guided mental imagery reports was quantified as a standardised formal measure of dream mentation. State of consciousness was evaluated using the Altered State of Consciousness (5D-ASC) questionnaire. RESULTS: LSD, compared with placebo, significantly increased cognitive bizarreness (p < 0.001). The LSD-induced increase in cognitive bizarreness was positively correlated with the LSD-induced loss of self-boundaries and cognitive control (p < 0.05). Both LSD-induced increases in cognitive bizarreness and changes in state of consciousness were fully blocked by ketanserin. CONCLUSIONS: LSD produced mental imagery similar to dreaming, primarily via activation of the 5-HT2A receptor and in relation to loss of self-boundaries and cognitive control. Future psychopharmacological studies should assess the differential contribution of the D2/D1 and 5-HT1A receptors to cognitive bizarreness.

Assessing Attachment Representations in Adolescents: Discriminant Validation of the Adult Attachment Projective Picture System.

The contribution of attachment to human development and clinical risk is well established for children and adults, yet there is relatively limited knowledge about attachment in adolescence due to the poor availability of construct valid measures. The Adult Attachment Projective Picture System (AAP) is a reliable and valid instrument to assess adult attachment status. This study examines for the first time the discriminant validity of the AAP in adolescents. In our sample of 79 teenagers between 15 and 18 years, 42 % were classified as secure, 34 % as insecure-dismissing, 13 % as insecure-preoccupied and 11 % as unresolved. The results demonstrated discriminant validity for using the AAP in that age group, with no associations between attachment classifications and verbal intelligence, social desirability, story length or sociodemographic variables. These results poise the AAP to be used in clinical intervention and large-scale research investigating normative and atypical developmental correlates and sequelae of attachment, including psychopathology in adolescence.

Effects of the Adult Attachment Projective Picture System on Oxytocin and Cortisol Blood Levels in Mothers.

Oxytocin, a small neuropeptide of nine amino acids, has been characterized as the "hormone of affiliation" and is stimulated, for instance, in mothers when interacting with their offspring. Variations in maternal oxytocin levels were reported to predict differences in the quality of care provided by mothers. In this study, the Adult Attachment Projective Picture System (AAP) as a valid measure to assess attachment representations was used as an activating attachment-related stimulus. We investigated whether the AAP induces a release of oxytocin in mothers with a secure attachment representation and a stress-related cortisol response in mothers with an insecure attachment representation. Therefore, pre-post effects of AAP administration on plasma oxytocin and serum cortisol levels were investigated in n = 44 mothers 3 months after parturition. Oxytocin levels increased from pre to post in the significant majority of 73% participants (p = 0.004) and cortisol decreased in the significant majority of 73% participants (p = 0.004). Interestingly, no association between alterations in oxytocin and cortisol were found; this suggests taking a model of two independent processes into considerations. These results show that the AAP test procedure induces an oxytocin response. Concerning the results within the four AAP representation subgroups, our hypothesis of a particularly strong increase in oxytocin in secure mothers was not confirmed; however, in secure mothers we observed a particularly strong decrease in cortisol. Effect sizes are reported, allowing the replication of results in a larger study with sufficient sample size to draw final conclusions with respect to differences in OT and cortisol alterations depending on attachment representation. When interpreting the results, one should keep in mind that this study investigated lactating mothers. Thus, the generalizability of results is limited and future studies should investigate non-lactating healthy females as well as males and include a control stimulus condition.

A Reaction Time Experiment on Adult Attachment: The Development of a Measure for Neurophysiological Settings.

In the last few decades, there has been an increase of experimental research on automatic unconscious processes concerning the evaluation of the self and others. Previous research investigated implicit aspects of romantic attachment using self-report measures as explicit instruments for assessing attachment style. There is a lack of experimental procedures feasible for neurobiological settings. We developed a reaction time (RT) experiment using a narrative attachment measure with an implicit nature and were interested to capture automatic processes, when the individuals' attachment system is activated. We aimed to combine attachment methodology with knowledge from implicit measures by using a decision RT paradigm. This should serve as a means to capture implicit aspects of attachment. This experiment evaluated participants' response to prototypic attachment sentences in association with their own attachment classification, measured with the Adult Attachment Projective Picture System (AAP). First the AAP was administered as the standardized interview procedure to 30 healthy participants, which were classified into a secure or insecure group. In the following experimental session, both experimenter and participants were blind with respect to classifications. One hundred twenty eight prototypically secure or insecure sentences related to the eight pictures of the AAP were presented to the participants. Their response and RTs were recorded. Based on the response (accept, reject) a continuous security scale was defined. Both the AAP classification and security scale were related to the RTs. Differentiated study hypotheses were confirmed for insecure sentences, which were accepted faster by participants from the insecure attachment group (or with lower security scale), and rejected faster by participants from secure attachment group (or with higher security scale). The elaborating unconscious processes were more activated by insecure sentences with potential attachment conflicts. The introduced paradigm is able to contribute to an experimental approach in attachment research. The RT analysis with the narrative procedure might be of interest for a broader variety of questions in experimental and neurophysiological settings to capture unconscious processes in association with internal working models of attachment. An electrophysiological model based on preliminary research is proposed for assessing the preconscious neuronal network related to secure or insecure attachment representations.

High Prevalence of Insecure Attachment in Patients with Primary Hypertension.

Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension, which implies the need for further investigations to evaluate attachment insecurity as a possible risk factor for hypertension.

Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study.

Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients' inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.

Caloric vestibular stimulation as a treatment for conversion disorder: a case report and medical hypothesis.

Conversion disorder is a medical condition in which a person has paralysis, blindness, or other neurological symptoms that cannot be clearly explained physiologically. To date, there is neither specific nor conclusive treatment. In this paper, we draw together a number of disparate pieces of knowledge to propose a novel intervention to provide transient alleviation for this condition. As caloric vestibular stimulation has been demonstrated to modulate a variety of cognitive functions associated with brain activations, especially in the temporal-parietal cortex, anterior cingulate cortex, and insular cortex, there is evidence to assume an effect in specific mental disorders. Therefore, we go on to hypothesize that lateralized cold vestibular caloric stimulation will be effective in treating conversion disorder and we present provisional evidence from one patient that supports this conclusion. If our hypothesis is correct, this will be the first time in psychiatry and neurology that a clinically well-known mental disorder, long considered difficult to understand and to treat, is relieved by a simple or common, non-invasive medical procedure.

The therapist's attachment representation and the patient's attachment to the therapist.

This study examines the relationship between the therapist's own attachment representation (Adult Attachment Interview, AAI) and the patient's attachment relationship to the therapist (client's attachment to the therapist, CATS). The attachment representations of n=22 psychotherapists who treated n=429 patients were assessed. A general effect of the secure/insecure therapist attachment status on the attachment of the patient to the therapist was not found whereas the more specific effects expected could be confirmed: The more preoccupied the therapist's attachment status was, the more the patient experienced a preoccupied-merger attachment to the therapist. The more dismissing the therapist's attachment status was, the more the patient experienced an avoidant-fearful attachment to the therapist. In summary, not the general security/insecurity of the therapist's attachment representation but rather the type of the insecurity is associated with the subjective patient's attachment-related experience of the therapeutic dyad.

The subject, its biology, and the chronic recurrent cystitis.

Functional disorders in urology are troubling for both patients and physicians. Moreover, advances in recent research promise to provide biological insights into psycho-neuro-endocrino-immunological pathways that are one important facet of chronic urogenital inflammations. We present a case of a middle-aged woman with long-lasting recurrent cystitis for which especially a psychosomatic approach helped to understand and cure the disorder. Altogether, as practitioners treat subjects, not illnesses, a biopsychosocial understanding of human disease should be taken into account in cases of chronic recurrent cystitis.

Matching the patient to the therapist: the roles of the attachment status and the helping alliance.

The helping alliance between patient and therapist is essential in the psychotherapeutic relationship. Recently, the links between patients' attachment and therapeutic alliance were examined. So far, there has been no published study that matched the patients and the patients' attachment representation to examine its role on the therapeutic relationship. Working along Bowlby's assumptions, a dissimilar matching of the attachment status to both was assumed to positively effect the helping alliance. In our study, the attachment representations of 19 psychotherapists and 59 anxiety patients (Structured Clinical Interview for DSM Axis I Disorders) were measured using the Adult Attachment Interview, using the dimensional scales by Waters et al. (Scoring secure versus insecure and dismissing versus preoccupied attachment as continuous variables: Discriminant analysis using AAI state of mind scales; unpublished manuscript). The helping alliance was assessed using the Helping Alliance Questionnaire. As expected, anxiety patients with a more insecure attachment with highly preoccupied and disorganized features evaluated the relationship with a more dismissing therapist as more helpful than that with a more preoccupied therapist. The results indicate the importance of a matching attachment status to a fruitful helping alliance in psychotherapy.

Oxytocin enhances the experience of attachment security.

Repeated interactions between infant and caregiver result in either secure or insecure relationship attachment patterns, and insecure attachment may affect individual emotion-regulation and health. Given that oxytocin enhances social approach behavior in animals and humans, we hypothesized that oxytocin might also promote the subjective experience of attachment security in humans. Within a 3-week interval, 26 healthy male students classified with an insecure attachment pattern were invited twice to an experimental session. At the beginning of each experiment, a single dose of oxytocin or placebo was administered intranasally, using a double-blind, placebo-controlled within-subject design. In both conditions, subjects completed an attachment task based on the Adult Attachment Projective Picture System (AAP). Thirty-two AAP picture system presentations depicted attachment-related events (e.g. illness, solitude, separation, and loss), and were each accompanied by four prototypical phrases representing one secure and three insecure attachment categories. In the oxytocin condition, a significant proportion of these insecure subjects (N=18; 69%) increased in their rankings of the AAP prototypical "secure attachment" phrases and decreased in overall ranking of the "insecure attachment" phrases. In particular, there was a significant decrease in the number of subjects ranking the pictures with "insecure-preoccupied" phrases from the placebo to the oxytocin condition. We find that a single dose of intranasally administered oxytocin is sufficient to induce a significant increase in the experience of attachment security in insecurely attached adults.

Do you see what I see? A study about the interrater reliability in art therapy.

There are many clinical reports on art therapy, but there are few data from experimental research. The main goal of this study was to investigate the interrater agreement of 86 raters who evaluated a picture created during an art therapy session. This rating was based on formal (color, lines, shapes) and contextual criteria. The resulting interrater agreement was not satisfying (intraclass correlation coefficient = 0.18-0.52). The authors also address the question of whether raters are able to determine which picture was created at the beginning of the art therapy and which was created at the end. On the basis of the examination of five sets of pictures, it became apparent that they were not able to do so.

Tumor patients in psychodynamic psychotherapy including daydreaming: can imagery enhance primary process and positive emotions?

This therapy process study investigates the use of guided affective imagery for tumor patients. The therapeutic access to tumor patients is generally described as complex and challenging because of a disturbed emotion regulation and a defensive focus on reality. After autologous blood stem cell transplantation, 29 patients were treated with psychotherapy, including two daydreaming imagery sessions. Three text-analytical measures--Affective Dictionary Ulm, Regressive Imagery Dictionary, and Computerized Referential Activity for verbatim session transcripts--as well as the Quality of Life Questionnaire and the Karnofsky Performance Status were administered. Results show that guided affective imagery was able to enhance the psychotherapeutic process in tumor patients by activating the primary process, decreasing anxiety, and increasing referential activity. The positive emotional shift during imagery was achieved by the patients irrespective of their oncological severity status. Study limitations and future directions for research are discussed.

Neural correlates of attachment trauma in borderline personality disorder: a functional magnetic resonance imaging study.

Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first time the functional neuroanatomy of attachment trauma in BPD patients using functional magnetic resonance imaging (fMRI) during the telling of individual stories. A group of 11 female BPD patients and 17 healthy female controls, matched for age and education, told stories in response to a validated set of seven attachment pictures while being scanned. Group differences in narrative and neural responses to "monadic" pictures (characters facing attachment threats alone) and "dyadic" pictures (interaction between characters in an attachment context) were analyzed. Behavioral narrative data showed that monadic pictures were significantly more traumatic for BPD patients than for controls. As hypothesized BPD patients showed significantly more anterior midcingulate cortex activation in response to monadic pictures than controls. In response to dyadic pictures patients showed more activation of the right superior temporal sulcus and less activation of the right parahippocampal gyrus compared to controls. Our results suggest evidence for potential neural mechanisms of attachment trauma underlying interpersonal symptoms of BPD, i.e. fearful and painful intolerance of aloneness, hypersensitivity to social environment, and reduced positive memories of dyadic interactions.

Desenvolvimento da versão em português do Brasil do questionário sobre padrão de relacionamentos Beziehungs-Muster Fragebogen / Development of a Brazilian Portuguese version of the questionnaire on relationships pattern Beziehungs-Muster Fragebogen

INTRODUÇÃO: O desenvolvimento da versão em português do Brasil do Beziehungs-Muster Fragebogen, conhecido na literatura internacional como Relationship Patterns Questionnaire, questionário que avalia o padrão central de relação, visa à introdução, em nosso meio, de uma medida auto-aplicável para implementação de projetos de pesquisa cuja questão envolva o construto transferência. METODOLOGIA: As etapas para o desenvolvimento da versão foram: obtenção da licença dos autores; tradução do instrumento original para o português do Brasil; julgamento e ajuste do material traduzido por profissionais da área da psiquiatria e psicologia; retrotradução; julgamento da equivalência semântica; consenso de profissionais da área da psiquiatria e psicologia sobre a adequação do instrumento à nossa cultura; interlocução com a população-alvo. CONCLUSÃO: O Beziehungs-Muster Fragebogen é uma medida auto-aplicável, para avaliação da transferência ou padrão central da relação, que poderá facilitar a implementação de projetos para investigar os aspectos da relação terapêutica adjuntos à transferência. É um método de fácil aplicação e análise, baixo custo e que dispensa o uso de vídeos ou gravadores na sessão. Estudos investigatórios acerca do padrão de relação poderão fornecer mais resultados sobre a adaptabilidade desse instrumento à nossa cultura.

INTRODUCTION: The Beziehungs-Muster Fragebogen (BeMus-3), known in the international literature as the Relationship Patterns Questionnaire (RPQ), is a questionnaire that evaluates the central pattern of relationship. The development of its Brazilian Portuguese version aims at introducing, in our country, a self-report measurement to implement research projects involving the construct of transference. METHODOLOGY: The development stages of this version were: obtaining permission from the authors; translation of the original instrument into Brazilian Portuguese; evaluation and adjustment of the translated material by psychiatry and psychology professionals; back-translation; evaluation of semantic equivalence; consensus of psychiatry and psychology professionals on the adequacy of the instrument to our culture; interchange with the target population. CONCLUSION: BeMus-3 is a self-report measurement to assess the transference or central pattern of relationship that can facilitate the implementation of projects to investigate the transference-related aspects of therapeutic relationship. This method is easy to apply and analyze, has a low cost and does not require the use of video or voice recorders during the session. Investigative studies on the pattern of relationship may provide further results on the adaptability of this instrument to our culture.

The German specimen case, Amalia X: empirical studies.

The authors provide a perspective on how psychoanalytic process research can be implemented. This is based on a process research model described elsewhere and summarizes the kinds of studies that can be situated on the four levels of the model. The authors summarize multiple empirical studies that were performed in a completely tape-recorded psychoanalytic therapy and have been published. These studies demonstrate the many modalities empirical process research has available to objectively study psychoanalytic process phenomena and their implication for outcome.

[The Relationship Patterns Questionnaire (RPQ): a validation using a clinical sample]. / Der Beziehungs-Muster-Fragebogen (BeMus): Validierung anhand einer klinischen Stichprobe.

The Relationship Patterns Questionnaire RPQ was designed to assess the relationship patterns concerning the individual's own behavior as well as the anticipated behavior of an important reference person. In this study, the questionnaire is examined psychometrically by using a sample of psychosomatic inpatients (N = 160). The underlying circumplex structure could be confirmed by means of factorial analyses as well as by the correlations between IIP and RPQ. There were no significant correlations between physical complaints (GBB) and relationship patterns; however, a less affectionate relation was associated with greater psychosocial strains (SCL-90-R) both on the self and on the object level. The pre-post analysis revealed a tendency to a greater ability to assert oneself as well as to be open opposite the reference person, but the effect size was small. Possibilities and limits of the present RPQ version are discussed and conclusions are drawn concerning the further development.