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The capacities for cross-modal processing, integration, and expression, in the context of Meltzoff and Moore's (1977, 1994) concept of a “supramodal” representational framework, Damasio's (2008) concept of “convergence-divergence zones”, and Iacoboni's (2008a,b) “super mirror neurons,” present from infancy onward, provide a mechanism for understanding this wide-ranging variability. The neuroanatomical locations of the representational space where this ongoing reprocessing and integration spread out into the complex associative networks within the brain, including the prefrontal cortex, that are linked to the mirror neuron system and which serve to integrate internal and external stimuli. Investigation into the neural bases underlying an individual's ability to differentiate self and other in the presence of shared representations mediated by the mirror neuron system and to inhibit the automatic imitative response tendencies associated with these shared representations is ongoing (Bien, Roebroeck, Goebel, & Sack 2009; Brass, Ruby, & Spengler 2009). VI. Dc. Representational-Symbolic Systems in Panic and Anxiety Disorders Neuroimaging studies of patients with panic disorder, as well as other disorders of emotional regulation, indicate that subcortical activation is heightened relative to cortical activation ( Busch, Oquendo, Sullivan, & Sandberg 2010 ). On a neurophysiological level somatic and affective elements can be thought of as being generated on a limbic level and becoming more predominantly cortical as they are represented verbally or symbolically. The increased awareness and identification of affects and body states allow the patient to better recruit control mechanisms in the prefrontal cortex to regulate limbic system and affective states. Effective psychotherapeutic treatments of panic have been associated with a reduction in subcortical relative to prefrontal and cortical activity. Recently, Samberg and Busch (2014) developed a dynamic therapeutic approach- Focused-Psychodynamic Psychotherapy (PFPP) with panic patients who are typically unable to identify bodily experiences and symptoms as representations or symbols of affective states. The threat is experienced as if it is occurring in the body rather than the mind, and as if it is a catastrophic danger to the body. This subjective experience indicates a deficit in symbolizing, a sub-symbolic state that has not been represented. The therapist and the patient work to translate somatic symptoms into mentalized symbolic and verbal content. This can occur partly through working with associations to bodily states and somatic symptoms, or through linking traumatic dissociated states that have been incorporated as somatic body memories, to identify specific meaning. VI. Dd. Integration of Symbolic Level of Psychic Functioning and Neurobiology In Otto Kernberg ’s (2012, 2015) integration, the libido and aggression represent a complex organization, at a symbolic level of experiential motivational behavior, which is manifest clinically in the expression of positively and negatively invested focused motivations
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