Depression und Manie: Psychodynamik und Therapie affektiver Störungen (German Edition)

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Depression By Kwame Mckenzie

But we will continue to collect data to provide you with the insights next time. You can also contribute to the community by sending us your review on this products. Related Products. TWD Incredibles 2 [Dvd] []. Product Name. Product Id. Instead of exteroceptive-interoceptive and exteroceptive-cognitive connections, neuronal-interoceptive and interoceptive-cognitive connections are developed from now on. By this, the depressed attempts to compensate the loss of exteroceptive stimuli. In a psychodynamic perspective external objects, i.

The outstanding aim is to constitute objects and to develop object relations. Therefore, in a self-psychological perspective, this can be understood as a compensation of the loss of external or sensory self objects by internal or somatic and cognitive self objects. Regarding psychopathological symptoms, the constitution of internal or somatic and cognitive self objects contributes to the development of somatic symptoms.

The body is perceived in an altered way see Wiebking et al. If the constitution of cognitive self objects dominates, the depressed suffers from distinctly distorted, negative cognitive schemes and ruminations, which are experienced as painful and tormenting. How can we use the neuropsychodyamic model of depression for psychotherapeutic interventions in the treatment of depressed patients? Due to the multidimensionality and heterogeneity of depressive disorders, it is of essential importance to adapt the applicable somatotherapeutic and psychotherapeutic interventions to the specific conditions of each single case.


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Long-time course recidivism, double depression, loss of psychosocial functions, chronicity : psychotherapeutic maintenance strategies. A stepwise adapted therapeutic focus, which takes state-variables of depression as well as trait-variables into account, is necessary. Agitation and anxiety of the depressed patient require an appropriate containment, especially in the beginning of the treatment. In the long-time treatment course structural aspects of the personality of the patients move more and more into the center e.

The synergistic effects of pharmaco- and psychotherapy as an expression of top-down- and bottom-up-mechanisms are often the starting point for a combination therapy. Psychoanalytic psychotherapy focusses primarily on the conflictuous forms of self-worth regulation and relationship expectations, especially in the long-time course. This discontinuity may also contribute to difficult countertransference feelings e.

Zusammenfassung

The insight into the neuronal and neuropsychodynamic mechanisms of depression e. Finally, the neurobiological effects of psychotherapy, though one of the most interesting and important challenges of a multidimensional psychotherapy research for a methodological discussion, see Boeker et al.

Because of the importance of this issue, we shortly mention recent neurobiological literature concerning neural effects of psychotherapy. A recent meta-analysis on neuroimaging findings of neural change in brain networks associated to emotion regulation after psychotherapy of depression by Messina et al. A further meta-analysis by Kalsi et al.


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They found that patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area. They interpreted this finding as supporting the hypothesis that psychotherapy increases top-down emotional regulation through self-knowledge and meaning processing. In a recent neuroimaging study in depressed patients undergoing psychodynamic psychotherapy, Buchheim et al.

A neuropsychodynamic approach to depression may be summarized as follows: the self and the changes in self-experience are core dimensions in depression and of psychoanalytical theories of depression. The experience of self-related depression can be characterized as the experience of the loss of the self. A mechanism-based approach was developed, focussing on the psychodynamic, psychological and neuronal mechanisms in healthy and depressed persons. On the basis of empirical results concerning emotional-cognitive interaction in depression, neuropsychodynamic hypotheses of the self in depression were developed.

In particular, it may be assumed that the empirically validated increased resting state activity in depression is a pre-disposition for the reactivation of experiences of early loss. Further, it may be hypothesized that the resting state-stimulus-interaction in depression is reduced because of the increased resting state activity and that it corresponds with introjective processes of the self in the relationship with objects correlated with negative emotions. The increased resting state activity in depression is especially associated with an increased resting state activity in the DMN.

By means of this, changes in the complete spatial temporal structure of the intrinsic activity of the brain and the disbalance between DMN and executive network EN are induced. This disbalance causes an abnormal increase in the internal mental contents, whereas externally oriented actions are decreased. The increased inward focus with strong ruminations and a reduced outward focus with a reduced relationship to the outside world are core symptoms in depression.

Depression Und Manie Psychodynamik Und Therapie Affektiver Storungen

The depressed patient is no longer able to differentiate between external stimuli and his own self caused by the increased resting state activity in the DMN which cannot be modified by external stimuli. The question of why adaptive mechanisms are activated in the disturbed context of the increased resting state activity may be answered by mentioning the central aim of these neuropsychodynamic mechanisms: to maintain at all costs the subjective existence of the self in view of the experienced threat of loss of the self.

It is neither lesions nor disturbances of adaptive neuronal mechanisms which generate depressive symptoms, but rather increasingly dysfunctional mechanisms of compensation on the basis of the increased resting state activity. As has been shown, different kinds of cognitive symptoms in depression may be connected to different neuropsychological functions, which in turn can be attributed to different forms of processing in the prefrontal cortex. These different forms of processing in the prefrontal cortex can be characterized by spatiotemporal patterns of neuronal activity, which are altered in a specific way during depression.

In depression, there is hypofunction in the medial orbitofrontal cortex with consecutive changes in feedforward, feedback and re-entrant processing in the prefrontal cortex, anterior cingulate, DLPFC and VLPFC, respectively. The changes in prefrontal processing in depression are mostly related to an abnormal increase and synchronization in feedforward processing from the VMPFC, as well as to the resulting abnormal reduction of feedback and re-entrant processing.

Outcomes of Psychoanalytic Treatment (Whurr Series in Psychoanalysis)

Psychotherapeutic interventions in depression should focus on restoring these various forms of processing in the prefrontal cortex. In this context, emotional, cognitional and motor imagination, as well as working memory training, chronometrically oriented cognitive therapy and awareness of the time dimension play an important role in the psychotherapy of depression.

The role of attribution, i. However, neuropsychodynamic psychiatry see Boeker and Northoff, encompasses a novel approach to psychopathology and its psychodynamic dimensions. Neuropsychodynamic psychiatry aims to complement and extend phenomenological psychopathology beyond the phenomenal boundaries of experience and thus towards the brain. In the neuropsychodynamic approach to depression, therapeutic relationship empathy, countertransference, therapeutic alliance is of outstanding importance.

In fact, one of the authors, HB, underlined the importance of the therapeutic relationship in the psychotherapy of depressed patients in a recent publication Boeker, This is strongly supported by recent evidence from therapeutic outcome studies in major depression Blatt et al. Further studies are necessary to validate the increased resting state activity in depression. HB: main author, empirical studies on depression, development of hypotheses and concepts.

Immer wieder Achterbahn - Leben zwischen Manie und Depression

RK: co-author, neuroscientific research, critical discussion of literature and concepts. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MB and handling Editor declared their shared affiliation.