Boeker Heinz, Kraehenmann Rainer
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland.
Center for Psychiatry, Psychotherapy, and Psychoanalysis, Psychiatric University Hospital Zurich, Zürich, Switzerland.
Front Hum Neurosci. 2018 Jun 27;12:247. doi: 10.3389/fnhum.2018.00247. eCollection 2018.
A mechanism-based approach was developed focusing on the psychodynamic, psychological and neuronal mechanisms in healthy and depressed persons. In this integrative concept of depression, the self is a core dimension in depression. It is attributed to negative emotions (e.g., failure, guilt). The in depression is connected with a . The development of neuropsychodynamic hypotheses of the altered self-reference is based on the investigation of the emotional-cognitive interaction in depressed patients. It may be hypothesized that the increased negative self-attributions-as typical characteristics of an increased self-focus in depression-may result from altered neuronal activity in subcortical-cortical midline structures in the brain, especially from hyperactivity in the cortical-subcortical midline regions and hypoactivity in the lateral regions. The increased resting state activity in depression is especially associated with an increased resting state activity in the default mode network (DMN) and a dysbalance between DMN and executive network (EN) activity. Possible therapeutic consequences of the neuropsychodynamic approach to depression involve the necessary emotional attunement in psychotherapy of depressed patients and the adequate timing of therapeutic interventions. The hypotheses which have been developed in the context of the neuropsychodynamic model of depression may be used for more specific psychotherapeutic interventions, aiming at specific mechanisms of compensation and defence, which are related to the increased resting state activity and the disturbed resting state-stimulus-interaction.
一种基于机制的方法得以发展，其聚焦于健康人群和抑郁症患者的心理动力学、心理学及神经机制。在这种抑郁症的综合概念中，自我是抑郁症的一个核心维度。它与负面情绪（如失败、内疚）相关。抑郁症中的自我与一种[此处原文缺失相关内容]相联系。自我参照改变的神经心理动力学假设的发展基于对抑郁症患者情绪 - 认知相互作用的研究。可以假设，增加的负面自我归因——作为抑郁症中自我关注增加的典型特征——可能源于大脑皮层下 - 皮层中线结构中神经元活动的改变，特别是皮层 - 皮层下中线区域的活动亢进和外侧区域的活动减退。抑郁症中静息态活动的增加尤其与默认模式网络（DMN）中静息态活动的增加以及DMN和执行网络（EN）活动之间的失衡相关。神经心理动力学抑郁症治疗方法可能产生的治疗后果包括抑郁症患者心理治疗中必要的情绪协调以及治疗干预的适当时间安排。在抑郁症神经心理动力学模型背景下提出的假设可用于更具体的心理治疗干预，旨在针对与静息态活动增加和静息态 - 刺激相互作用紊乱相关的特定补偿和防御机制。
