Research Department of Clinical, Educational & Health Psychology, University College London, Gower Street, London WC1E6BT, England.
Psychol Rev. 2010 Jan;117(1):210-32. doi: 10.1037/a0018113.
Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy.
在许多类型的精神病理学中，非自愿的意象和视觉记忆都很突出。创伤后应激障碍、其他焦虑障碍、抑郁症、饮食障碍和精神病患者经常报告重复的视觉侵入，对应于少数真实或想象的事件，通常非常生动、详细，并且内容令人深感痛苦。记忆和意象似乎都依赖于涉及内侧前额叶区域、内侧和外侧顶叶皮质的后区域、外侧颞叶和内侧颞叶的共同网络。认知心理学和神经科学的证据表明，抽象、灵活、上下文化的表示（C-reps）和不灵活、感官受限的表示（S-reps）有不同的神经基础。我们修改了以前关于创伤后应激障碍的双重表示理论，将其置于健康记忆和意象的神经系统模型中。根据支持 S-reps 和 C-reps 的神经系统通过视空间工作记忆正确交互的需要，使用修订后的模型来解释与临床障碍相关的不同类型的令人痛苦的视觉侵入是如何产生的。最后，我们讨论了新模型的治疗意义，并将其与现有的心理治疗形式联系起来。
