大脑神经可塑性与情绪障碍的治疗课件

Treatingemotionaldisorderswithneuroplasticityinmind大脑神经可塑性与情绪障碍的治疗Prof.FreedomLeung梁耀坚教授DepartmentofPsychologyChineseUniversityofHongKongPartI:Basicsaboutneuron

第1部分：神经元基础知识Dendrite,Axon,andSynapse

树突,轴突和突触树突形成的突触细胞体体细胞的突触轴突终末扣髓鞘Receptorsalongdendrite:geneticpotentialvsactualexpression受体数量：遗传可能数量对实际数量

轴突终末端再摄取突触受体神经递质囊泡Factorsthataffectdendriticlength,spinesdensity,andactualnumbersofreceptors

影响树突长度,树突刺密度,

和实际受体数量的因素Genes

基因Learningexperience

学习经验Emotionalexperience

情感经验PartII:Basicsaboutneuroplasticity第2部分：神经可塑性基础知识“Cellsthatfiretogether,wiretogether.”(Hebb,1949)NobelLaureateof2000(Kandel,2001)Conceptsofneuroplasticityandlongtermpotentiation:fromHebb’sideastoKandel’sNobelprize(2)

Experience-inducedchangesinspinesdensity

(Kolbetal.,2003)

经验诱导的树突刺密度改变刺激前树突刺激后30分钟的树突(4)Experience-inducedcorticalreorganization

(Merzenichetal.,1984)经验引起的皮层重组特异性刺激之前特异性刺激之后(6)Learningandpracticesalsocreateangiogenesis

(Holloway,2003)学习和实践还可以引起血管生成(7)Emotionalexperienceinduceschangesinthepeptilesystems

(Pert,1997)情感性经验引起生物肽系统的改变

PartIII:Howdoesemotionaldysregulationleadtodysregulatedbrain?第3部分：情绪失调怎样导致大脑失调Dual-processmodelofemotionregulation(LeDoux,1996)

情绪调节的双轨模式丘腦杏仁核下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)丘腦下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)杏仁核Hippocampus

海馬abImmediatethreatandtheANS

直接威胁与自主神经系统Negativeemotionsandsomaticsymptoms负性情感与躯体化症状Whathappenifthreatspersist?

如果威胁持续会怎样？丘腦杏仁核下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)丘腦下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)杏仁核Hippocampus

海馬abThelong-termstrugglealarm

长期战斗警报Endocrinesystemreleasescortisol

内分泌系统释放皮质醇Cortisolbreakdownsaminoacids,bodyfatandproteinsintoglucose(gluconeogenesis糖异生)toguaranteesufficientlongtermsupplyofenergyinourbodytodealwithlongtermstruggle皮质醇将氨基酸,身体脂肪和蛋白质分解成葡萄糖以确保对身体充分长期的能量供给以应付长期战斗Cortisolsuppressespeptidesandproteinssynthesisinourbody.Neurotransmitters,neurons,enzymes,bodycellsandantibodiesarealleitheraminoacids,peptidesorproteins.Longtermsuppressionofpeptidesorproteinssynthesiscanleadtotheirdeficienciesandtheassociatedmentalandphysicalproblems

皮质醇抑制体内生物肽和蛋白质的合成。神经递质，神经元，酶，体细胞和抗体都是氨基酸，多肽或蛋白质的合成物。长期抑制多肽和蛋白质合成会导致这些物质的缺乏和相关的精神与生理问题Chronicelevationofcortisolresultsinprolongedmultiplesomaticsymptoms,damagesneuronsinourbrain,impairsmemory,learningandmoodregulationability

皮质醇长期增加引起多种躯体症状，损害脑内的神经元，损害记忆，学习和情绪调节能力Achronicallydysregulatedbrain

(Drevets,2001)

一个长期失调的大脑杏仁核前扣带回

(IV)Howdoestherapyworkinneuroscienceterms?心理治疗用神经科学术语来看是怎样发挥作用的？Dual-processmodelofemotionregulation(LeDoux,1996)

情绪调节的双轨模式丘腦杏仁核下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)丘腦下丘腦內分泌系統(長期抗爭)自主神經系統(緊急應變)杏仁核Hippocampus

海馬abTherapyisjustanotherwayofcreatingsynapticpotentiationinbrainpathwaysthatcontroltheamygdala.……..Andthewaywedothisisbygettingthecortextocontroltheamygdala.心理治疗是在大脑通路中制造用以控制杏仁核的突触潜能……而我们通过用皮层控制杏仁核的方式达到这一目的。

(LeDoux,1996,p.265)心理治疗用神经科学术语来看是怎样发挥作用的？杏仁核(1)Cooldownamygdalaactivities

使杏仁核活动平复杏仁核(2)FreeACCfromemotionallock

将扣带回的情绪锁定状态解除杏仁核前扣带回(3)FreeVmPFCfromemotionalbias

将VmPFC脱离情绪性偏见杏仁核将VmPFC脱离情绪性偏见1)

Amygdala:registeremotionalsignificanceofastimulus;2)

Hippocampus:createsandretrievesmemoriesassociatedwiththestimulus;3)

ACC:focusonthesituationeffectively;4)

Orbito-frontal:inhibitsinappropriateactionsinfavoroflong-termadvantage;5)

Ventromedial:emotionsareexperiencedandsituationisevaluated;6)

Dorsolateral:toformplansandconceptsandchooseactions(Davidson,2002)眶后前额叶皮质腹正中前额叶皮质背外侧前额叶皮质杏仁核海马扣带回(4)TrainOPFCtoinhibitinappropriatereactions

训练OPFC抑制不适当反应1)

Amygdala:registeremotionalsignificanceofastimulus;2)

Hippocampus:createsandretrievesmemoriesassociatedwiththestimulus;3)

ACC:focusonthesituationeffectively;4)

Orbito-frontal:inhibitsinappropriateactionsinfavoroflong-termadvantage;5)

Ventromedial:emotionsareexperiencedandsituationisevaluated;6)

Dorsolateral:toformplansandconceptsandchooseactions(Davidson,2002)眶后前额叶皮质(5)ActivatesleftDLPFCandenhancesself-directedmentalactivities(Schwartz,2002)

激活左背外侧前额叶皮质眶后前额叶皮质腹正中前额叶皮质背外侧前额叶皮质杏仁核海马扣带回Therapymodifiesbraincondition

(Baxteretal.,1992)心理治疗改变大脑状态运动皮层扣带回胼胝体尾状核小脑枕部皮质壳核丘脑海马治疗环路OCD环路杏仁核眶部额叶皮质前额叶皮质Experience-inducedchangesinsynapticefficiency

(Kandel,2001)

经验诱导的突触功效改变Pre-之前Post-之后B:LTP后的突触，突触前神经元释放更多的神经递质；突触后神经元包含了更多的神经递质受体；这些受体的开放时间也延长（以星号表示）A:LTP前的单一突触Aparadigmshiftinclinicalinterventions

一个临床干预范式的转变Mostemotionaldisordersoriginatefrommaladaptivelywiredbraincircuits,notbraindiseases.

多数情绪障碍起源于非适应性的大脑环路形成，而不是大脑疾病Braincanberewiredthroughexperientialchangesnotjustinchildhood,butthroughoutlife.

大脑不仅能通过童年期的经验性改变得以再建，终生都可以被重建Modernneuroscienceresearchindicatesthatpsycho-behavioralinterventionscanmodifybraincircuits(Kandel,1998).现代神经科学研究提示心理－行为干预能够改变大脑环路Therapy,inmodernneuroscienceterms,aimsatrewiringbraincircuitsthroughintroducingenduringchangesinlifeexperiencesandbehaviors.心理治疗，用现代神经科学术语来说，目的在于通过引入持久的生活经验和行为改变，来重建大脑环路References参考文献Baxter,L.R.etal.(1992).Caudateglucosemetabolicratechangeswithbothdrugandbehaviortherapyforobsessive-compulsivedisorder.ArchivesofGeneralpsychiatry,49,681-689.Davidson,etal.(2003).Alterationsinbrainandimmunefunctionproducedbymindfulnessmeditation.PsychosomaticMedicine,65,564-570.Drevets,W.C.(2001).Neuroimagingandneuropathologicalstudiesofdepression:Implicationsforthecognitive-emotionalfeaturesofmooddisorders.CurrentOpinioninNeurobiology,11,240-249.Fuchs,T.(2004).Neurobiologyandpsychotherapy:anemergingdialogue.CurrentOpinioninPsychiatry,17,479-485.Gabbard,G.O.(2000).Aneurobiologicallyinformedperspectiveonpsychotherapy.BritishJournalofPsychiatry,177,117-122.Gould,E.,etal.(1999).Neurogenesisinadulthood:apossibleinlearning.TrendsinCognitiveSciences,3,186-192.

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