Duquette Patrice, Ainley Vivien
Private Practice, Birmingham, MI, United States.
Lab of Action and Body, Royal Holloway, University of London, Egham, United Kingdom.
Front Psychol. 2019 Sep 26;10:2173. doi: 10.3389/fpsyg.2019.02173. eCollection 2019.
To understand our patients and optimize their treatment, psychotherapists of all theoretical orientations may benefit from considering current scientific evidence alongside psychodynamic constructs. There is recent neuroscientific evidence that subjective awareness, feelings and emotions depend upon "interoception," defined as the neural signaling to the brain from all tissues of the body. Interoception is the obvious basis of homeostasis (in the brainstem) but some interoceptive signals rise above this level and contribute to inferential processes that substantiate intrapersonal and interpersonal experience. The focus of this paper is on the essential role that their "interoception" plays in our patients' emotional experience and subjective awareness, and how the process referred to as "mentalizing interoception" may be harnessed in therapy. This can best be understood in terms of "predictive processing," which describes how subjective states, and particularly emotion, are inferred from sensory inputs - both interoceptive and exteroceptive. Predictive processing assumes that the brain infers (probabilistically) the likely cause of sensation experienced through the sense organs, by testing this sensory data against its innate and learned "priors." This implies that any effort at changing heavily over-learned prior beliefs will require action upon the system that has generated that set of prior beliefs. This involves, quite literally, acting upon the world to alter inferential processes, or in the case of interoceptive priors, acting on the patient's body to alter habitual autonomic nervous system (ANS) reflexes. Focused attention to bodily sensations/reactions, in the safety of the therapeutic relationship, provides a route to "mentalizing interoception," by means of the bodily cues that may be the only conscious element of deeply hidden priors and thus the clearest way to access them. This can: update patients' characteristic, dysfunctional responses to emotion and feelings; increase emotional insight; decrease cognitive distortions; and engender a more acute awareness of the present moment. These important ideas are outlined below from the perspective of psychodynamic psychotherapeutic practice, in order to discuss how relevant information from neuroscientific theory and current research can best be applied in clinical treatment. A clinical case will be presented to illustrate how this argument or treatment relates directly to clinical practice.
为了了解我们的患者并优化他们的治疗，所有理论取向的心理治疗师都可能从结合当前科学证据和心理动力学结构中受益。最近有神经科学证据表明，主观意识、感觉和情感取决于“内感受”，内感受被定义为身体所有组织向大脑发送的神经信号。内感受显然是（脑干中的）内稳态的基础，但一些内感受信号超越了这个水平，并有助于证实人际和人际间体验的推理过程。本文的重点是“内感受”在我们患者的情感体验和主观意识中所起的重要作用，以及如何在治疗中利用被称为“内感受心智化”的过程。这可以从“预测加工”的角度得到最好的理解，预测加工描述了如何从感觉输入（包括内感受和外感受）中推断主观状态，特别是情感。预测加工假设大脑通过将这种感觉数据与其先天和习得的“先验知识”进行比较，（概率性地）推断通过感觉器官体验到的感觉的可能原因。这意味着，任何改变过度习得的先验信念的努力都需要对产生那组先验信念的系统采取行动。这实际上涉及对世界采取行动以改变推理过程，或者就内感受先验而言，对患者的身体采取行动以改变习惯性的自主神经系统（ANS）反射。在治疗关系的安全环境中，专注于身体感觉/反应，通过身体线索提供了一条通往“内感受心智化”的途径，这些身体线索可能是深藏的先验知识中唯一的意识元素，因此是获取它们的最清晰方式。这可以：更新患者对情感和感觉的特征性、功能失调的反应；增加情感洞察力；减少认知扭曲；并产生对当下更敏锐的意识。下面从心理动力心理治疗实践的角度概述这些重要观点，以便讨论神经科学理论和当前研究的相关信息如何最好地应用于临床治疗。将呈现一个临床案例来说明这种论点或治疗方法如何直接与临床实践相关。
