Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

COMPRENDERE L'EMPATIA NELLE DIMENSIONI INTRAPERSONALE E INTERPERSONALE DA UNA PROSPETTIVA INCARNATA: UNA RACCOLTA DI STUDI

The present doctoral project aims, across five empirical studies, two systematic reviews, and one theoretical and methodological proposal, at deepening the intraindividual and interindividual dimensions of empathy within the construct of embodiment. Intraindividual empathy has been studied, in the first empirical study, from the perspective of one of its hormonal correlates, i.e., testosterone, in 18 patients affected by Kennedy’s disease. In such an EEG study, results revealed a significant increase in neural reactivity (pcorr = 0.019) in terms of experience sharing (construct close to affective empathy) 0–350 ms post-stimulus, with respect to 18 non-clinical male healthy subjects. The first PRISMA systematic review, on the main neurodegenerative diseases (of 528 screened studies, 39 fulfilled inclusion and exclusion criteria), confirmed that each facet of empathy probably has a morpho-functional peculiar layout thus confirming the somatic perspective as a potentially unifying framework to outline the plethora of constructs that are comprehended under the term “empathy.” In the second empirical study, empathy, in its self- and other-oriented components, has been studied in a psychiatric sample of 59 consecutively recruited inpatients. Comparison of multinomial models revealed how self-oriented empathy was the best predictor of the levels of personality organization, as evaluated by the PDM-2, explaining data 25 times better than the null model. Contrary to the hypothesis, no association with somatizations aspects has been found. The other five investigations were devoted to the interpersonal perspective of empathy. Specifically, the second PRISMA systematic review aimed at identifying the constructs and the definition of such perspective on empathy and its associations with somatic components. From a total of 127 screened articles, the 17 included reports allowed us to infer that the best term to use, and that has been used throughout my thesis, is the one of “interpersonal empathy.” Unfortunately, none of the screened records investigated its somatic counterparts. 2 Therefore, in the third empirical study, we started validating a self-report questionnaire measuring interpersonal empathy based on the three empathy components by Zaki and Ochsner (2012): the affective, cognitive, and prosocial ones. Ninety-two interacting dyads participated, and their interactions were audio and video recorded. The questionnaire, in its state and trait versions, seems to have good psychometric proprieties although its validation isn’t concluded yet. We then conducted three more empirical studies, (Study 6A, 6B, and 7) in which 17 sessions of different therapies and a whole therapy of 16 sessions have been video registered and both members of the therapeutic dyad had their physiological signals acquired. In these studies, we hypothesised higher dyadic physiological synchronization (PS) would correspond to moment of high interpersonal affective empathy. Physiological acquisition was done through BIOPAC wireless acquisition device; therapist’s interventions were categorized with the Psychodynamic Intervention Rating Scale (PIRS; Cooper et al., 2002) and patient’s responses with the Therapeutic Collaboration Coding System (TCCS; E. Ribeiro et al., 2013). Briefly, results have essentially confirmed our hypothesis by indicating higher levels of PS when therapists’ interventions were of Reflections or Associations PIRS categories, and when patient’s responses were of Safety TCCS category. PS has therefore been confirmed as a possible somatic marker of interpersonal affective empathy and, for the first time in literature, also through the use of coding systems on the verbatim transcripts of therapeutic sessions. Finally, in a proposal, we outlined a neural model engaging both the central and the peripheral nervous system, by considering mirror mechanisms and assigning a crucial role to oxytocin.The present doctoral project aims, across five empirical studies, two systematic reviews, and one theoretical and methodological proposal, at deepening the intraindividual and interindividual dimensions of empathy within the construct of embodiment. Intraindividual empathy has been studied, in the first empirical study, from the perspective of one of its hormonal correlates, i.e., testosterone, in 18 patients affected by Kennedy’s disease. In such an EEG study, results revealed a significant increase in neural reactivity (pcorr = 0.019) in terms of experience sharing (construct close to affective empathy) 0–350 ms post-stimulus, with respect to 18 non-clinical male healthy subjects. The first PRISMA systematic review, on the main neurodegenerative diseases (of 528 screened studies, 39 fulfilled inclusion and exclusion criteria), confirmed that each facet of empathy probably has a morpho-functional peculiar layout thus confirming the somatic perspective as a potentially unifying framework to outline the plethora of constructs that are comprehended under the term “empathy.” In the second empirical study, empathy, in its self- and other-oriented components, has been studied in a psychiatric sample of 59 consecutively recruited inpatients. Comparison of multinomial models revealed how self-oriented empathy was the best predictor of the levels of personality organization, as evaluated by the PDM-2, explaining data 25 times better than the null model. Contrary to the hypothesis, no association with somatizations aspects has been found. The other five investigations were devoted to the interpersonal perspective of empathy. Specifically, the second PRISMA systematic review aimed at identifying the constructs and the definition of such perspective on empathy and its associations with somatic components. From a total of 127 screened articles, the 17 included reports allowed us to infer that the best term to use, and that has been used throughout my thesis, is the one of “interpersonal empathy.” Unfortunately, none of the screened records investigated its somatic counterparts. 2 Therefore, in the third empirical study, we started validating a self-report questionnaire measuring interpersonal empathy based on the three empathy components by Zaki and Ochsner (2012): the affective, cognitive, and prosocial ones. Ninety-two interacting dyads participated, and their interactions were audio and video recorded. The questionnaire, in its state and trait versions, seems to have good psychometric proprieties although its validation isn’t concluded yet. We then conducted three more empirical studies, (Study 6A, 6B, and 7) in which 17 sessions of different therapies and a whole therapy of 16 sessions have been video registered and both members of the therapeutic dyad had their physiological signals acquired. In these studies, we hypothesised higher dyadic physiological synchronization (PS) would correspond to moment of high interpersonal affective empathy. Physiological acquisition was done through BIOPAC wireless acquisition device; therapist’s interventions were categorized with the Psychodynamic Intervention Rating Scale (PIRS; Cooper et al., 2002) and patient’s responses with the Therapeutic Collaboration Coding System (TCCS; E. Ribeiro et al., 2013). Briefly, results have essentially confirmed our hypothesis by indicating higher levels of PS when therapists’ interventions were of Reflections or Associations PIRS categories, and when patient’s responses were of Safety TCCS category. PS has therefore been confirmed as a possible somatic marker of interpersonal affective empathy and, for the first time in literature, also through the use of coding systems on the verbatim transcripts of therapeutic sessions. Finally, in a proposal, we outlined a neural model engaging both the central and the peripheral nervous system, by considering mirror mechanisms and assigning a crucial role to oxytocin

SELF-ORIENTED EMPATHY AND PERSONALITY ORGANISATION LEVEL: INSIGHTS FROM A PSYCHIATRIC SAMPLE

Objective Empathy functioning is among the criteria to delineate psychiatric diagnosis. However, the self-oriented empathy dimension is almost neglected in the existing literature. On the basis of previous fragmented contributions, we hypothesised that an individual’s level of personality organisation is explained by this facet of empathy more than the other components of empathy, both transversally and independently from the specific psychiatric diagnosis. Method Fifty-nine psychiatric inpatients were evaluated with clinical interviews inspired by the Structured Clinical Interview for DSM-5, completed the Symptom Checklist-90-Revised, and Interpersonal Reactivity Index (IRI). A panel of experts established each patient’s psychiatric diagnosis and the level of personality organisation according to DSM-5 and PDM-2. Thirty-two patients were considered functioning at a psychotic level, 27 at a borderline level, and none at a neurotic level. Multinomial models were compared with the corrected AIC to determine if self-oriented empathy, among all IRI subscales, was the best-fitting model for explaining the levels of personality organisation. A further analogue series of models was used to investigate the best IRI subscale to explain each patient’s psychiatric diagnosis. Results The first series of models revealed self-oriented empathy (IRI personal distress subscale) as the best empathic dimension to explain levels of personality organisation. The second series revealed that none of the four IRI subscales explained psychiatric diagnoses. Conclusions The consistency of our findings with evolutionary concepts pertaining to both traditional psychodynamic models and contemporary models of psychopathology, such as the p factor theory, was illustrated. Despite the many limitations of our consecutive sampling jeopardising the findings’ generalisability, the insight of self-oriented empathy as the best predictor of the level of personality organisation, irrespective of psychiatric diagnosis, has several implications from both research and clinical/diagnostic perspectives

pRb suppresses camptothecin-induced apoptosis in human osteosarcoma Saos-2 cells by inhibiting c-Jun N-terminal kinase.

This paper studies the cytotoxic effect induced by the topoisomerase I inhibitor camptothecin in human osteosarcoma Saos-2 cells, which lack p53 and contain a non-functional form of the product of the retinoblastoma gene, pRb. Cytotoxicity induced by camptothecin was dose- and time-dependent; the treatment with 100 nM camptothecin reduced cell viability by 50% at 32 h and by 75% at 72 h of exposure. The cytotoxic effect was caused by apoptosis, as ascertained by morphological evidence, acridine orange-ethidium bromide staining and flow cytometric analysis. Apoptosis was accompanied by both the activation of caspase-3 and the fragmentation of poly(ADP-ribose) polymerase. Treatment with camptothecin caused a threefold increase in the activity of c-Jun N-terminal kinase (JNK) and an eightfold increase in the level of phosphorylated c-Jun. The introduction of the RB gene into Saos-2 cells reduced the rate of cell growth. Moreover, stable clones of transfected cells were resistant to camptothecin. Exposure to 100 nM camptothecin for 72 h reduced the viability of transfected cells by only 10%; moreover, very modest effects were observed on the activity of JNK as well as on the level of phosphorylated c-Jun. The results reported in this paper support the conclusion that the expression of wild-type pRb in Saos-2 cells exerts an anti-apoptotic influence through the control of JNK activity