前额叶皮质损伤患者的情绪异常

人类前额叶皮质与情绪之间有着密切的关系,文章在相关的临床和神经成像研究结果基础上,分析了前额叶皮质损伤对情绪行为造成的影响,分别概述了精神分裂症、重性抑郁和焦虑患者的情绪变化、前额叶切除对情绪的影响以及左右前额叶皮质与情绪的关系,重点阐述了前额叶功能异常的神经生理学特点,认为情绪的改变会随着前额叶皮质不同部位的结构缺损或功能变化而有所不同,此有利于对前额叶皮质损伤患者情绪异常的评价与防治。     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

心理预期与认知方式对负面情绪的交互调节

近年来, 研究发现对负性事件发生之前预先的心理准备, 即心理预期, 能有效降低负性事件发生后的情绪影响, 但预期过程本身却导致情绪相关神经环路的激活与主观焦虑体验。因此, 采用适应性认知调节方式克服预期过程本身的负面情绪效应, 以充分发挥事先预期的情绪调控优势, 成为情绪调节领域亟待解决的问题。另一方面, 过度负性预期--对潜在负性事件不仅作负面心理预期同时以情绪化的认知方式应对该事件, 是焦虑障碍的核心特征。因此, 对焦虑症患者进行适应性认知方式的训练以消除其情绪化应对方式, 最终减弱该人群对未知事件的过度负面预期, 可能是焦虑障碍干预的重要途径。因此, 有必要综合行为学, 多导外周生理记录与神经成像手段以揭示认知方式与心理预期对负面情绪的交互调节效应; 旨在探求发挥心理预期情绪调节优势, 减弱其情绪代价的方法; 并为焦虑症的临床治疗提供新的思路。     

抑郁症情绪加工与认知控制的脑机制

抑郁症患者负性认知加工偏向是导致抑郁的一个主要认知因素, 是抑郁症的一个稳定特质。这种偏向与对负性情绪刺激自下而上的情绪加工增强有关, 表现为杏仁核和梭状回等脑区过度激活; 也与自上而下的认知控制功能不足有关, 表现为背外侧前额皮质、前扣带回等脑区活性不足。文章在前人研究基础上, 提出了关于抑郁症情绪加工与认知控制脑机制的一个理论假说, 即抑郁症的产生是由于抑郁症患者情绪加工脑区过度激活与认知控制脑区功能降低之间的相互作用而形成的恶性循环所介导。目前证明此理论假说在研究内容、研究材料、研究技术等方面还存在一些问题, 这些可能是未来研究的方向。     

自伤行为的神经生理机制及共病障碍比较

非自杀性自伤行为（Non-Suicidal Self-Injury, NSSI）,简称自伤行为,意为个体在没有明确的自杀意图的情况下,故意、重复地改变或伤害自己的身体组织,是一种不具致死性或致死性较低的、以自身为伤害目标的破坏性行为。本文主要基于近十年的研究文献,从神经生理层面对自伤行为相关脑区、神经递质以及与共病障碍的异同展开述评,并尝试建立一个整合性的自伤行为认知神经机制模型。 关于自伤行为的神经生理机制,综合以往研究发现,自伤患者边缘系统中情绪脑区的异常（如杏仁核的过度激活等）使患者可能产生情绪调节障碍进而导致自伤;控制脑区如前额叶皮层的异常导致其抑制控制能力受损;奖赏脑区如眶额皮层等的过度激活或许会成为自伤复发的维持因素;自伤患者疼痛感知区域如HPA轴的反应水平的减弱使其疼痛敏感性较低并主动追寻疼痛感。除此之外,相关的神经递质和基因的异常也是自伤研究领域关注的重点。比如5-羟色胺转运体其基因连锁多态区的短等位基因会减弱该递质的调节功能,诱使个体出现情绪调节障碍;又比如内源性阿片肽参与了疼痛和情绪调节的过程,且其水平会因个体早期挫折经历和遗传因素而降低,而自伤行为可以促进该递质的释放;同样的,在阿片受体被刺激之后,自伤者体内的多巴胺水平将会升高,个体对自伤行为产生愉悦感。 此外,还将其与自杀、成瘾、进食障碍和抑郁障碍进行了比较。自伤和自杀尝试者在脑电指标上有某些不同的表现,但二者从行为研究和功能成像的角度也呈现出相似性。个体的自伤行为与物质成瘾显著相关,且二者都伴随着抑制控制能力的损伤、阿片类和多巴胺系统异常引发的对某种物质或行为的渴望等。进食障碍患者和自伤行为存在较高的共病率,前者可能就是一种间接的自伤,且二者的脑电和功能成像的指标部分相似。最后,抑郁障碍也是和自伤行为有着较高共病率的一种障碍,部分抑郁障碍患者会通过自伤来调节情绪,且二者有共同的风险因素以及部分重叠的神经机制。研究以上障碍与自伤行为的异同有助于我们从不同角度认识自伤,并多方位实施预警和干预。 在此基础上,本文尝试构建了自伤行为的认知神经机制假设模型,将自伤的认知过程与各阶段起主要作用的神经生理机制相联系。未来的研究可以关注于自伤行为的性别差异、发展特点、干预以及与注意脑区异常的联系等。     

伤害性躯体感觉的中枢网络动态编码过程

痛觉是感受躯体所受伤害性刺激的保护性感觉;慢性痛则是耗费巨额医疗费用的顽固性疾病。近年来的研究表明,疼痛感知觉的形成是一个大规模的中枢网络编码过程,包括了感觉、情绪、认知等若干不同的维度,牵涉到脊髓、脑干、边缘系统、皮层等多个相关结构。慢性痛则是一种由神经网络编码异常所导致的中枢性疾患。上述编码过程的任何异常都可能导致慢性痛。认识痛觉的中枢网络编码机制,将促进人们对感觉与情绪形成过程的深入理解,并有助于寻求新的临床疼痛治疗措施     

情绪预测偏差的成因及干预

情绪预测偏差是一种对未来事件发生时情绪反应的预测和实际体验之间的分离现象。梳理该领域最近10年(2009~2019年)研究文献可知, 热点研究主题涉及偏差的现象、成因和干预, 相应呈现为三点主要发现: 情绪预测偏差十分普遍, 情绪预测偏差成因多源, 情绪预测偏差可以干预。未来研究应着力关注情绪预测偏差的发生模式和心理机制, 着力揭示具体偏差的神经心理机制, 并从进化和文化视角综合考察偏差的发生机制。     

抑郁症患者工作记忆内情绪刺激加工的特点及其机制

抑郁症患者在工作记忆内情绪刺激加工的特点为倾向于加工与负性心境一致的材料, 被认为是抑郁症认知易感性的核心特征。目前研究者们围绕抑郁症工作记忆中央执行系统三个子功能的情绪刺激加工特点及其作用机制进行了大量研究, 发现在更新功能上, 患者难以移除负性情绪信息, 且在正性信息的加工上存在缺损; 在抑制功能上, 患者难以抑制无关负性情绪信息进入工作记忆; 在转换功能上, 患者情绪材料转换困难的研究证据尚不充分。神经生理与脑成像的研究初步表明, 工作记忆中的情绪刺激加工与抑郁症患者背外侧前额叶和前扣带回的功能激活水平异常有关。未来研究需评估工作记忆三个子功能对抑郁症状的差异性贡献及在情绪刺激加工上的统一性, 并探究其随疾病发生发展变化的轨迹, 谨慎选取并评估不同情绪刺激材料指标的诱发效应及其对工作记忆功能的独特影响。在此基础上, 深入探究工作记忆内情绪刺激加工的神经机制, 为工作记忆偏向矫正干预的临床应用及其预期效果提供理论依据和方向。     

狭义情绪的神经—心理机制

在新近人们对情绪神经机制的探索中,很多研究成果都在表明,在通常概念下的人的情绪感受中,不仅有那种含有喜厌态度的更严格意义上的情绪成分,还有直接来自各种内外感官上的认知性感知觉成分。本文的目的是运用新近的情绪心理学研究成果,仅以情绪内在体验中的含有喜厌态度的心理成分作为情绪的心理实体,对其的神经—心理机制进行一些尝试性的解释,以期使通常概念情绪感受中的情绪成分和感觉成分更具可辨性。     

自我意识情绪：人类高级情绪

自我意识情绪是个体在具有一定自我评价的基础上,通过自我反思而产生的情绪。自我意识情绪与基本情绪既有区别又有联系。自我表征、自我觉察、自我评价过程的卷入是自我意识情绪产生的重要条件。对个体行为进行自我调节、服务于人际交流、人际互惠和个体心理内部需要是自我意识情绪具有的主要功能。自我意识情绪是随着认知的发展而逐渐形成和发展的,并会受到文化的影响。自我报告、非言语行为编码技术、言语报告和行为编码、神经成像技术是自我意识情绪的主要研究方法。自我意识情绪的普遍性和特殊性需要进一步跨文化研究的验证     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.