Open Door Review III

a0B%2_!V$Y$2*$_!5>_!I066<0%_!H>_!IJ7#0<0_!H>_!8$0%1M2_!@>_!5)(#_!S>_!S0)%D0_!8>_!I0%*30%D_!N>L>_!F%B*6_!S>_! "2B3*0%_!Q>![+,-+^>!8#2*D06!$*!1%0:%)*(2 &'5"6&402&bpkm^&%kkblJC& &)$?!-,>-Pd-uj)B%*2<>1)*0>,,PPd].! FB7##0$9_!=>_!G!S0)%D0_!8>![+,-+^>!R6$*D!(#0!==/!$*!*0B%)3$)<)D4!%0602%7#>!;*?!8>!S0)%D0!G!@>!K06(_!@>!['&6>^_! 1-%&/*>B,&/,,@?-$%+,&'#"_%?,)<%&')?,>#%&6A(,%$& [11 C& +.PE+d]^>!a0Z!e)%M?!SB$<:)%&!/%066>>!! FB7##0$9_!=>_!A230M_!I>_!"2B3*0%_!Q>_!I066<0%>!H>_!IJ7#0<0_!H>_!8$0%1M2_!@>_!5)(#_!S>_!/)D2%0<<_!N>_!I2%7#_!Q>![+,-]^>! a0B%2!"#0!-.(#!;*(0%*2($)*2E+g>!iB<4!+,-]! We investigated recurrently depressed ( DSM-IV ) unmedicated outpatients ( N =16) and healthy control participants matched for sex, age, and education ( N =17) before and after 15 months of psychoanalytic therapy. The stimulus materials were attachment-related pictures from the Adult Attachment Projective Picture System (AAP), an interview measure for assessing attachment representations that has been shown to be feasible for using in an fMRI environment (Buchheim & George 2012). These pictures are designed to elicit mental engagement with attachment-related experiences such as separation, illness, danger, and loss. To increase the capacity of the signal to elicit a response related to the emotional processes of each individual, material was here prepared using personalized content derived from AAP interviews with each participant. In the personally relevant condition the AAP attachment scenes were accompanied by individually tailored descriptions containing core sentences from the patient’s own narrative previously elicited by each picture. The same series of attachment scenes accompanied by a standard factual, non-emotional description for all participants was used as control condition. Participants were scanned at two time points (at the beginning of therapy and after 15 months). Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. ;&2-5.2! In the fMRI study signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. The pattern of changes in prefrontal areas found in the present study may be associated with mechanisms of emotional appraisal and control, suggesting reduced recourse to styles characterized by suppression and avoidance after long-term therapy. This interpretation outlines a possible mechanism for the understanding of emotional appraisal and regulation in the psychodynamic psychotherapy of depression. The same sample was also examined in an EEG setting. At the beginning of treatment, patients confronted with the attachment paradigm showed a sustained gamma-band activity and a significant higher late positive potential (LPP) at fronto-central sites compared to the healthy controls. After 15 months of treatment, gamma band responses to personalized stimuli were significantly decreased in patients. This effect was not observed in the control group. In addition, the LPP amplitudes of the patients decreased and equalized to the amplitudes of the healthy controls. A smaller LPP as well as

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