Depression and cortisol responses to psychological stress

Burke, H.M., Davis, M.C., Otte, C., & Mohr, D.C. (2005). Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology, 30, 846-856.

This meta-analysis pulled data from seven studies (196 participants with an average age of 40), each of which examined responses to psychological (non-pharmacological) stressors. Specifically, it examined the relationship between major depressive disorder (MDD) and levels of the stress hormone cortisol during three stages of experimentally-induced stress: (1) unstimulated 'baseline', (2) 'stress reactivity' in which cortisol increases from baseline, and (3) 'stress recovery' in which cortisol returns to baseline levels.

They concluded that at baseline MDD patients have lower cortisol levels than their non-depressed (ND) counterparts in morning studies and higher baseline cortisol levels than control groups in afternoon studies. This reveals somewhat opposite patterns of normal daily cortisol fluctuation (although some have described this as simply flattened diurnal activity). Therefore, it was critical to control for these baseline effects seen in the MDD group. After adjusting for these baseline effects, MDD individuals showed blunted stress reactivity and impaired stress recovery by comparison to controls.

Put simply, normal subjects show specific baseline patterns of cortisol release throughout the day and exhibit boosted cortisol levels and rapid recovery to baseline in response to stressors. These healthy cortisol activity curves are dynamic and responsive. MDD subjects, in contrast, show abnormal baseline patterns during the day and exhibit relatively flat and unresponsive patterns of cortisol secretion during and following stress. These effects were found to be most pronounced in older and more severely depressed patients. This altered hypothalamic-pituitary-adrenal (HPA) axis functioning appears somehow linked to depression.

Aversive learning enhances perceptual and cortical discrimination

Li, W, Howard, J.D., Parrish, T.B., & Gottfried, J.A. (March 28, 2008). Aversive learning enhances perceptual and cortical discrimination of indiscriminable odor cues. Science, Vol. 319, 1842-1844.

With this study, the authors explored the impact of aversive conditioning on olfactory discrimination. While most conditioning studies examine the acquisition of new behavioral responses (CR) to formerly benign stimuli presentations, this examined how associative learning can actually alter the perceptual processing of the conditioned stimulus (CS) itself. Following a conditioning regimen, behavioral accuracy for distinguishing by smell between a previously indistinguishable pair of molecules (CS+) rose by more than a factor of 2, exceeding both chance and preconditioning performance. Interestingly, following conditioning, no improvement in distinguishing between the unconditioned control pair (CS-) was witnessed, indicating that these effects are specific to the CS+. After conditioning, reorganization of neural coding was also observed in the posterior piriform cortex, where neural representations of odor identity are maintained. This may shed new light on anxiety disorders which are characterized by exaggerated sensory sensitivity and hypervigilance, potentially self-reinforcing patterns.

Prolongation of brainstem auditory-evoked responses in Autistic probands and their unaffected relatives

Maziade, M. et al. (2000). Prolongation of brainstem auditory-evoked responses in Autistic probands and their unaffected relatives. Arch Gen Psychiatry, 57, 1077-1083.

Genetic factors play a major role in autism, with heritability greater than 90%. As the search for biological markers of autism continues, electrophysiological markers have been considered more and more. Early EEG studies comparing autistic subjects to control subjects revealed differences in early brain auditory-evoked responses (BAER). Prolonged BAERs indicate a slowing in nerve conduction within the early auditory system. This study confirmed slow latencies between consecutive sequential waves in autistic individuals, and went further to show that first degree relatives also show significantly longer interpeak latencies (IPLs) than matched controls. Although no significant prolongation was found in second and third degree relatives, resemblance of the IPL trait was found within families. While autism is a complex disorder, perhaps a combination of many neurophysiological deficits, IPL prolongation could be a marker of one of these deficits.

Anterior prefrontal function

Koechlin, E. & Hyafil, A. (October 26, 2007). Anterior prefrontal function and the limits of human decision making. Science, Vol. 318, 594-598.

Based on recent empirical findings and predictions from a neurocomputational model, the authors of this review propose a role for the not-yet-well-understood frontopolar cortex (FPC), also known as the anterior prefrontal cortex or Brodmann's area 10. They argue that processing of 'cognitive branching' is the core function of the FPC. Cognitive branching enables a previously running task to be maintained in a pending state for subsequent retrieval and execution upon completion of the ongoing one. Many of our complex behaviors and mental activities require simultaneous engagement of multiple tasks, and the FPC may perform a domain-general function in these scheduling operations.

Empowering Techniques of Play Therapy

Griffith, M. (1997). Empowering Techniques of Play Therapy: A Method for Working with Sexually Abused Children. Journal of Mental Health Counseling. 19 (2), 130-42.

This article, like many others, begins with a brief survey of play therapy theory. It is remarked that play is the natural medium of expression for children and that sexual abuse seems to block many basic developmental needs. Treatment goals are outlined and plotted along a pattern which the process of therapy follows. A case study is provided to articulate these points and exemplify the "five stages" of play therapy. These stages are the establishment of the therapeutic relationship, the later exploratory stage (in which regressive and repetitive behaviors often appear), the limit-setting stage (in which the child tests the boundaries and safety of the therapeutic setting), the growth stage (see below), and the termination stage. Treatment goals in the growth stage involve confronting the "four characteristics of sexual trauma" which are sexual traumatization, stigmatization, betrayal, and powerlessness. Sexual traumatization can lead to confusion between sexuality and affection, confusion about sexual norms, age-inappropriate sexual knowledge, and sexual behavior. It is believed that through the use of empowering techniques of play therapy (expressive/imaginative play and non-direction), the emotional distress of sexual abuse can be relieved and normal psychological development can resume.

The gateway hypothesis of rostral prefrontal cortex function

Burgess, P.W., Dumontheil, I., & Gilbert, S.J. (2007). The gateway hypothesis of rostral prefrontal cortex (area 10) function. Trends in Cognitive Science, Vol. 11, No. 7.

The rostral prefrontal cortex, area 10, is a particularly large brain region in humans, but its function is still poorly understood, to which this paper provides a nascent hypothesis. Their 'gateway hypothesis' suggests that the rostral PFC serves as a gateway between the internal mental life that exists in the absence of sensory influence (i.e. pure, imaginative cognition) and stimulus-oriented cognition. They maintain that lateral and medial subregions are differentially sensitive to changes in demands for stimulus-oriented or stimulus-independent attending, and together their coordination enables us to attend to either environmental stimuli or to self-generated representations. They highlight initial supporting evidence and discuss goals for future experimentation.

(A more general role is proffered by Koechlin & Hyafil.)

Neural substrates of musical creativity

Limb, C.J. & Braun, A.R. (February 2008). Neural substrates of spontaneous musical performance: an fMRI study of jazz improvisation. Public Library of Science ONE, 3, 2, e1679.

This study imaged jazz musicians with fMRI during low and high complexity improvisational sessions to look for correlations in brain activation/deactivation patterns. They found widespread deactivation in the dorsolateral prefrontal cortex (dlPFC), where goal-directed behaviors are thought to be consciously monitored, evaluated, and corrected. Deactivation was also observed in limbic structures. They also found consistent activation in sensorimotor areas, as expected, as well as focal activation in the medial prefrontal cortex (MPFC), a currently poorly understood structure. An emerging view sees this region, Brodmann Area 10, as playing an important role in "the neural instantiation of the self, organizing internally motivated, self-generated, and stimulus-independent behaviors".

Play therapy with sexually abused children

Hill, A. (2006). Play therapy with sexually abused children: Including parents in therapeutic play. CHILD AND FAMILY SOCIAL WORK. 11 (4), 316-324.

According to this article, situations in which sexual abuse has increased a child's separation anxiety can often be improved by including parents in play therapy. This allows the child to feel more secure in his/her primary attachment relationships, while presenting the often confused and uncomfortable parents with a positive model of interaction to emulate. It may also be beneficial for the therapist to witness and interact in the parent-child relationship which, if strained, can often exacerbate the trauma. It is noted that parents benefit from participating in the therapy by eliminating feelings of exclusion and jealousy they may have developed in response to the new therapist-child relationship, by countering feelings of guilt and failure in the role of parent/protector common to situations of child abuse, and by rebuilding confidence in their parenting abilities.

Possible complications of introducing parents into child therapy are discussed. Issues of the child's privacy and confidentiality are naturally raised, as well as the possibility that some parents might be unwilling to participate or counter-productive in the process. Suggestions or interventions by the therapist may be viewed as criticism by the parent.

Two case studies are provided to exemplify these points and to illustrate the situation of a child expressing anger towards his/her parents in response to sexual abuse (by someone else). While this is a common occurrence in play therapy, it becomes complicated when that parent is present. Lastly, it is noted that including parents in play therapy can counteract the "dynamic of secrecy" often imposed on the sexually abused child by the abuser.

Plasticity underlying fear conditioning occurs in the BLA

Fanselow, M.S. & LeDoux, J.E. (June 1999). Why we think plasticity underlying Pavlovian fear conditioning occurs in the basolateral amygdala. Neuron, Vol. 23, 229-232.

A debate over the role of the neural plasticity in the amygdala has been ongoing. The 'encoding view' believes that neural plasticity in the basolateral complex of the amygdala (BLA) encodes the emotional component of memories formed during fear conditioning. The 'modulatory view' sees the amygdala as modulating memories stored in other brain regions, not unlike current theories of the hippocampus. This paper believes that the two views are not mutually exclusive, and argues for a synthesized model in which the amygdala is both the site of fear memory encoding and storage and a modulator of memory functions in other structures.

Play Therapy with Sexually Traumatized Children

Kelly, M. M. (1995). Play Therapy with Sexually Traumatized Children: Factors That Promote Healing. Journal of Child Sexual Abuse. 4 (3), 1-11.

This article begins with a survey of play therapy theory, with special attention given to various writer's takes on the merits of directive vs. non-directive approaches. It is argued that the treatment of sexually abused children often involves a series of "resolution cycles" characterized by the alternation of active work and periods of respite. Each of these cycles comprises three phases: testing the therapeutic relationship, readdressing the trauma, and protective distancing and denial. Another cycle will then be initiated only if there is trust and respect between the child and the therapist. Cycles can take as long as four or more sessions to complete, or may play out in the course of a single session (as is common in the beginning stages of therapy).

Two case studies (one with a 7 year old girl and another with an 8 year old boy) are provided to illustrate the progression of such cycles and to show that the denial phase usually occurs when the child's personal resources are exhausted. It is argued that a clear understanding of these cycles can furnish a therapist with more realistic expectations when working with sexually abused children.

A case study using child-centered play therapy approach to treat enuresis and encopresis

Cuddy-Casey, M. (1997). A case study using child-centered play therapy approach to treat enuresis and encopresis. ELEMENTARY SCHOOL GUIDANCE AND COUNSELLING. 31 (3), 220-225.

Enuresis (bedwetting) and encopresis (bed-defecation) may come from one or more of the following causes: medical-genetic disorders, emotional disturbances, and failure to learn. Depending on the main cause, different treatments are used. Physicians are usually called to deal with the organic problems underlying medical-genetic disorders, while behavioral techniques are used to treat problems stemming from a failure to learn. However, problems rooted in emotional disturbances are commonly lumped into the "failure to learn" category and treated thusly. This article argues for an alternative treatment (i.e. non-directive play therapy) to be used in response enuresis and encopresis rooted in emotional disturbances.

A case example is provided in which an 8-year old male with enuresis and encopresis is treated with play therapy after medical-genetic disorders and failure-to-learn are ruled out. In these sessions, the child began to exhibit aggressive behavior and admitted to wanting to destroy the playroom's pictures and wall clock, which he believed to have cameras hidden behind them. After this admission was received with the permissiveness and acceptance that are the hallmarks of non-directive therapy, the child also admitted that he did not use public restrooms because of this fear of hidden cameras. He spent the next few sessions searching the playroom for cameras and, upon not finding any, began to have less and less problems with enuresis/encopresis.

Parallel incentive processing: an integrated view of amygdala function

Balleine, B.W. & Killcross, S. (May 2006). Parallel incentive processing: an integrated view of amygdala function. Trends in Neuroscience, Vol. 29, 272-279.

Although the amygdala has been long studied for its involvement in emotional learning and memory, the exact nature of its involvement is still disputed. Historically, a serial model has predominated, with the lateral nucleus detecting threatening stimuli and the central nucleus initiating expression of defensive behaviors and other bodily responses associated with fear reactivity. However, in this paper Balleine and Killcross opine perhaps it's time to consider alternative models, and propose a model which, based on appetitive conditioning studies, has the basolateral and central nuclei operating independently and in parallel to mediate incentive processes in both appetitive and aversive situations. They suggest the basolateral nucleus encodes emotional events with reference to their particular sensory features, while the central nucleus provides affective significance to processing, motivating or inciting responses and actions.

Jungian Play Therapy in Elementary Schools

Allan, J., & Brown, K. (1993). Jungian Play Therapy in Elementary Schools. Elementary School Guidance and Counseling. 28 (1), 30-41.

This article discusses the Jungian approach to play therapy and provides a case study to exemplify its methods. As a (or perhaps the) proto-humanistic psychologist, Jung believed that growth and transformation are the main drives in the psyche. Thus, counseling involves mainly providing a safe and protective setting in which these internal processes can propel a child into change. This so-called self-healing archetype requires a healthy connection between the child's conscious and unconscious worlds. Therapy is thus also aimed at creating such a connection.

Jungian play therapy identifies three major themes or stages through which a child's play evolves: chaos, struggle, and resolution. It is through the progression of this resolution that the ego develops a sense of control and mastery as it learns to mediate the "struggle of opposites." Towards the end of therapy, common themes become construction, reparation, and healing.

Jungian play therapy is directive in its counseling style and makes use of interpretation interventions to "deepen affective expression." This is received much more positively by the child if it is initiated after a strong therapeutic relationship of rapport is established. This point and others are illustrated in the case study of a third grader with aggressive behavior problems. His sand play had a recurrent theme of "good guys" struggling against "bad guys." When, later in therapy, this theme was interpreted as analogous to his own feelings of isolation and confliction, he accepted it and showed remarkable change in the next session. In the next sand world he made, there was a fenced off area where kids could go and nothing could happen to them. It is argued that this opportunity to release his feelings allowed the child's positive, integrating mechanisms to guide him to growth, and that the direct interpretations expedited this process.

The Masterson Approach with Play Therapy

Mulherin, M. A. (2001). The Masterson Approach with Play Therapy: A Parallel Process between Mother and Child. AMERICAN JOURNAL OF PSYCHOTHERAPY. 55, 251-272.

This article illustrates the principles of the Masterson Approach with a long-term case study involving a child and his mother in adjunct therapy. The Masterson Approach (with which I am not very familiar) is a psychodynamic developmental self and object relations approach. It involves providing opportunities for diagnostic assessment, developing a working relationship within therapy, assisting in the breakdown of defenses, facilitating verbalization, providing cathartic release, and preparing the child for future life events. As will be seen, the diagnosis has a large effect on which treatment strategies are deemed appropriate.

The initial diagnosis for both the mother and son was distancing borderline disorder. As a result, the technique of confrontation was used as intervention. However, as confrontation led to increased anxiety in both patients, the diagnosis was changed to schizoid disorder of the self and interpretation of the schizoid dilemma became the primary therapeutic technique. This seemed to have drastic effect, as both patients responded positively. The new diagnosis was thus confirmed.

An interesting aspect of this case study was the enmeshment, or parallel progression of the mother and son. Often the son would act out (in his sand trays) the very same conflicts his mother struggled with in her verbal therapy. They both exhibited signs of the splitting defense mechanism, with the son accepting his mother while rejecting his father, and the mother having panic attacks as she fantasized about reuniting with her separated husband.

Two interesting events in the play therapy are also worth noting. First was when the son explicitly acknowledged the symbolic nature of his play by remarking (after destroying one of his sand worlds) that he was glad those "bad feelings [were] gone". And second was when the creation of a loss/death-themed sand world in his fifth year of treatment seemed to usher in a much more integrated child. After this cathartic experience, his regressive defenses completely disappeared.

Play therapy; the troubled child's self-encounter

Hyde ND. (1971). Play therapy; the troubled child's self-encounter. The American Journal of Nursing. 71 (7), 1366-70.

A general overview with anecdotal examples of non-directive play therapy from a psychiatric nurse. The article quotes largely and effectively from the major players (Axline, Moustakas, etc.). There is not much here that you can't get from the primary texts themselves, but it is not bad either. It outlines the theoretical framework of non-direction, permissiveness, and attentiveness on the part of the therapist. It also acknowledges the projection, darkness, and struggle for integration evident in children's play.

An experiment with play therapy

Smith LF. (1977). An experiment with play therapy. The American Journal of Nursing. 77 (12), 1963-5.

A summarized and anecdotal account of an amateur play therapist (nursing student) working with a withdrawn child. Only very limited dialogue is provided, more often utilizing descriptions of what actions and conversations took place. This article is another case study to read, but without dialogue and given the inexperience of the therapist, it leaves much to be desired as a learning tool. The child in this case study expressed his anxiety in an obsession with cleanliness, spending much of the time cleaning the windows and walls of the playroom. He also played extensively with a customizable doll house, deconstructing and reconstructing it, and had the therapist act out his own daily routines.

Using play therapy in outpatient settings

Meer PA. (1985). Using play therapy in outpatient settings. MCN. The American Journal of Maternal Child Nursing. 10 (6).

This article demonstrates the ambiguity existing in terms such as "play therapy" in research contemporary to it. What is described here is toys being used by nurses in calming children and preparing them for medical procedures, which is very different from the play therapies used by professional therapists in building permissive and accepting relationships with "troubled" children.

Aside from this rather frustrating catachresis, the article describes the interesting application of play-related concepts to children in health care settings. Specifically, puppets and dolls can be used to familiarize children with the equipment and procedures they will later be exposed to. Allowing children to participate in this play-acting can make them feel more control over the situation, assuaging some of their anxiety and leading to an overall feeling of independence.

Play Therapy With Abused Children: A Review of the Literature

White, J., & Allers, C. T. (1994). Play Therapy With Abused Children: A Review of the Literature. JOURNAL OF COUNSELING AND DEVELOPMENT. 72 (4), 390.

This article gives an overview of play therapy, identifies and explores seven characteristic behaviors exhibited by abused children, identifies and explores two general themes of play in abused children, and critiques play therapy research. The characteristic behaviors are developmental immaturity, opposition and aggression, withdrawal and passivity, self-deprecating and self-destructive behavior, hypervigilance, sexual behavior, and dissociation. The recurrent themes of play behavior are unimaginative/literal play and repetition/compulsion. Each of these behaviors and themes are elaborated on and special attention is paid to the differences between the behaviors exhibited by sexually abused, physically abused, and neglected children. Lastly, contemporary research is critiqued for its inconsistent definitions, nonstandardized methodologies, and flawed statistical designs.

Use of the telephone in child play therapy

Spero MH. (1980). Use of the telephone in child play therapy. Social Work. 25 (1), 57-60.

A brief exposition of the use and benefits of supplying a toy telephone in child play therapy settings. Spero begins by remarking that a toy is only as useful in a therapeutic context as the child's willingness to play with it. Thus, despite the potential goldmine of communication in a toy telephone, this is wasted unless the child decides to use it. Having said this, he continues on to highlight the potential uses the toy telephone might be to. A child may hold a conversation with an imaginary party, fantasize a connection with the deceased or unavailable, or even exercise projection by assuming the role of both parties. Four brief case studies are provided to illustrate these potential uses. It is remarked that children will often pretend to phone their therapist (early in therapy) in an attempt to form a connection with them, and that the act of forcibly hanging-up can be a powerful way for reserved children to learn to express their desires and frustrations.

Play therapy: the children's views

Carroll, J. (2002). Play therapy: the children's views. CHILD AND FAMILY SOCIAL WORK. 7, 177-188.

A qualitative study on children's reactions to non-directive play therapy. Interview questions pertained to how the children felt about their introduction to play therapy, their relationship with the therapist, the therapeutic processes, their likes and dislikes in therapy, and the termination of their therapy. Children's responses varied greatly, but several basic themes emerged. Notably, while children universally enjoyed their relationship with the therapist greatly, they were largely unable to pinpoint what aspects of the therapist's behavior were most helpful. The children appreciated the provisions of food at the beginning of therapy and described their sessions as being importantly "fun". Many seemed to dislike explicit "talking about their feelings". This is a truly fascinating project, but unfortunately only a small sample size was acquired. More research on this is needed.

Classical fear conditioning in functional neuroimaging

Buchel, C. & Dolan, R.J. (2000). Classical fear conditioning in functional neuroimaging. Current Opinion in Neurobiology, 10, 219-223.

A brief overview of the brief history of the examination of classical conditioning with functional neuroimaging. Early PET studies showed a striking absence of expected amygdala activation, but later demonstrated the expected amygdala involvement. More recently, 'backward masking' designs indicate a hemispheric difference when the CS+ was presented out of awareness, with greater activation observed in the right amygdala. fMRI studies showed amygdala participation during initial acquisition and early phases of extinction, and also demonstrated the characteristic decreases in amygdala activation over time. Interestingly, blocked fMRI designs revealed that social phobics do not show the 'physiological' decrease of amygdala activation over time. Finally, the paper points out the controversy about the role of the amygdala. One camp regards the amygdala as a rapid subcortical information processing unit that is continuously involved in the processing of CSs in aversive classical conditioning, producing deliberately high "false alarm" rates and being kept under the supervision of cortical controllers. The other camp sees the amygdala as enabling or permitting associative plasticity that encodes acquired sensory contingencies which are later expressed at a cortical level; once the association has been learned, the systems mediating the modulation of plasticity disengage and hence we see the decline in amygdala activation. More on this debate here.

Neural mechanisms of extinction learning and retrieval

Quirk, G.J. & Mueller, D. (2008). Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology, 33, 56-72.

Early in the study of classical conditioning, Pavlov observed spontaneous recovery of responding to an extinguished conditioned stimulus. This witnessed 'uncovering phenomena', brought on by a change in context or stimulus presentation, led to the belief that extinction is not erasure of a previous fear memory but rather the learning of an additional inhibitory memory. This paper reviews what has been learned about extinction learning ever since. Like other types of learning, extinction occurs in three phases: acquisition, consolidation, and retrieval. Acquisition seems to depend on the basolateral amygdala (BLA) and the ventrolateral periaqueductal gray (vlPAG) structures. Consolidation seems to be most dependent on the BLA, where the learning of new memories (requiring protein synthesis) appears to take place. It also seems to rely on the involvement of the prefrontal cortex and the hippocampus. Retrieval requires expression of an inhibitory memory, and as such, during retrieval we see activation of inhibitory networks in the amygdala, cortical control of amygdala inhibition by the IL mPFC, and contextual regulation provided by the hippocampus and mPFC. Thus, like classical conditioning, extinction seems to be distributed across a network of structures, rather than centered in any one particular area.

The paper also raises many fascinating special issues. One challenges the Pavlovian idea that extinction is purely an additional inhibitory memory: recent evidence seems to indicate that extinction leads to reversal of conditioning-induced phosphorylation of CREB, indicating some erasure of the original BLA fear memory!

It also discusses anxiety disorders and PTSD which may be caused by a failure to retrieve an extinction memory generated in extinction-based treatment. Subjects with PTSD show reduced volume and activity in the vmPFC and hippocampus areas, along with increased activity in the amygdala, suggesting inhibitory control and contextual modulation of extinction may be compromised. It also mentions that chronic stress can impede extinction-based therapies, decreasing dendritic branching and spine count in the vmPFC and hippocampus, and increasing dendritic branching and spine count in the BLA, thereby enhancing conditioning effects and impairing extinction. Recently, deficits in fear extinction observed in these human disorders have been combated with pharmacological agents, facilitating extinction of the fear memory with the help of D-cycloserine and impairing fear memory reconsolidation with the B-adrenergic receptor blocker propranolol.

Human amygdala activation during conditioned fear acquisition and extinction

LaBar, K.S., Gatenby, J.C., Gore, J.C., LeDoux, J.E., & Phelps, E.A. (May 1998). Human amygdala activation during conditioned fear acquisition and extinction: a mixed-trial fMRI study. Neuron, Vol. 20, 937-945.

The amygdala is believed to be a key component in a network mediating survival functions by coordinating behavioral plans of action based on the integration of exteroceptive and interoceptive information. The amygdala, in particular, has been thought to be the structure responsible for detecting and reacting to potentially threatening environmental stimuli through classical conditioning learning.

However, attempts to investigate amygdala function in humans has produced inconsistent results, with failures to notice increased amygdala blood flow in PET being most surprising. Difficulties may stem from the small size and troublesome subcortical placement of the structure, and that amygdalar responses are relatively transient to discrete cues, have low spontaneous neuronal firing rates, and exhibit marked habituation (gradual signal intensity reduction). This study attempted to overcome these difficulties by using a mixed-trial fMRI design. This time, results successfully showed amygdala/periamygdaloid cortex involvement during both conditioned fear acquisition and extinction, biased towards the right hemisphere in both cases.

Previous lesion studies have shown the integrity of the amygdala is required for expression of learned conditioned fear associations. However, the temporal pattern of amygdala activity (greatest during early acquisition and early extinction, and degrading over time) suggests that this activity may only partially underlie expression. The paper offers a hypothesis that the observed activation may be related to encoding the emotional meaning of the conditioned stimulus. This is consistent with with the amygdala activity witnessed during the initial stages of learning (when stimulus is novel) and during early extinction (when the meaning of the stimulus has changed).

The Emotionally Engaged Analyst

Miller, M.L. (2008). The Emotionally Engaged Analyst: Theories of affect and their influence on therapeutic action. Psychoanalytic Psychology, Vol. 25, No. 1, 3-25.

The article provides a review of affect theories and how they relate to therapy. As Dahl mentions, "the absence of a coherent psychoanalytic theory of emotions is truly remarkable, given clinician's nearly universal belief in the centrality of emotions in every patient's life and treatment".

Two broad categories have predominated thus far. One is the cognitive appraisal theory of emotion which holds that emotions are the conscious or unconscious cognitive appraisal of an arousing stimulus. These cognitive evaluations are formed by assimilating the current event into a stored schema that represents earlier experiences in similar circumstances. Schemas may be processed in subsymbolic, nonverbal symbolic, and verbal symbolic modes. If we are to represent and understand emotional experiences, subsymbolic processes must be integrated with symbolic processes. This idea forms the basis for therapy: enable the patient to metabolize unformulated subsymbolic experiences of emotion into meaningful feelings.

The second category encompasses so-called functional and discrete theories of emotion. These theories hold that the brain is more an emotional organ than a cognitive one, and emotions are seen as a hierarchy of embedded regulatory functions necessary for the automatic adaptive survival of the organism. Emotions are orchestrated in response to significant changes perceived in the internal or external milieu, and responses are executed subcortically. Cortical involvement occurs after subcortical emotional processes have begun; this may later influence the execution of the underlying emotional processes by providing the informational context of the body, the self, and the environment. Feelings, the mental representations of ongoing regulatory processes, do not initiate these emotional processes but are instead the product of them. These theories view the essence of change in psychoanalytic treatment as the remodeling of the nonconscious procedures through which the person adapts to his or her environment.

The dynamic systems theory of emotion, a recent theoretical addition, can be viewed as a combination of the cognitive appraisal schema of emotion and the discrete/functional models of emotion with an emphasis on social interaction. In this model, emotions should be seen not as discrete states of being or constructed interpretive programs but as ongoing, continuous processes influencing and being influenced by the complex context in which they occur. Emotions emerge as three critical component systems (the subcortical arousal system, the cortical interpretive system, and the motor system) dance together. In so doing, emotions, meanings, and actions are continuously modified and negotiated. Viewed in the context of social interaction, another three-way interaction can be seen to take place between each person's own emotional processes, those of the person he or she in interacting with, and the emotional character of the interaction itself. Although all of these components within the individual and without can interact with one another in an infinite number of ways, they have a tendency to self-organize into a finite number of stable patterns which tend to repeat under particular conditions and ultimately define the different emotional states and state transitions a system can take. The goal of therapy is then to engender systemic change, to perturb the system appropriately into allowing transformations in the emotional experience of the client. In a truly interactive system, with multiple internal and external factors contributing to the individual's emotional experience, as one component within the system changes, all other components adjust to that change. As such, the analyst's emotional participation is viewed as an essential component.