An interpersonal neurobiology perspective on the mind and mental health: personal, public, and planetary well-being.

This article outlines an Interpersonal Neurobiology (IPNB) perspective on the fundamental components that comprise mental health and promote well-being. The central aim of this paper is to answer essential but often overlooked questions related to the field of mental health, such as: What is the mind? What is the basis of well-being? What is the self and how does it develop? We will offer scientific support for the IPNB position that the mind is relational and embodied and that integration is the basis of mental health. It will also describe how the self extends beyond the individual, arising from and inextricably connected to the social, cultural and planetary systems in which we exist. IPNB is not a form of therapy; rather, it is a framework that focuses on deepening our understanding of the mind and human development across the lifespan. Drawing from interdisciplinary principles from a range of fields including physics, mathematics, neuroscience, and psychology, we will provide a practical view of the underlying basis of mental suffering and the scientific mechanisms of change to improve mental well-being. These core principles are building blocks of clinical evaluation and treatment that can be applied across multiple theoretical orientations and client populations. The special emphasis in this article is on the issue of psychache as an underlying cause of suicide and its relationship to personal, public and planetary health.

A longitudinal study of personality traits, anxiety, and depressive disorders in young adults.

BACKGROUND: How personality traits, anxiety, and depressive disorders relate longitudinally has implications for etiologic research and prevention. We sought to determine how neuroticism and extraversion relate to first-onset anxiety and depressive disorders in young adults. DESIGN: An inception cohort of 489 university freshmen was followed for 6 years. METHOD: Participants self-reported personality traits using the Eysenck Personality Questionnaire. Anxiety and depressive disorders were assessed using the Diagnostic Interview Schedule. RESULTS: Baseline neuroticism predicted first-onset panic disorder, agoraphobia, generalized anxiety disorder (GAD), and major depressive disorder (MDD), while introversion predicted first-onset agoraphobia (moderate-large effects). Participants who developed panic disorder, agoraphobia, GAD, or MDD had increases in neuroticism if the disorder was current at follow-up (moderate-large effects). Participants who developed MDD but were in remission by follow-up had a moderate increase in neuroticism. CONCLUSIONS: High neuroticism in young adulthood is either a true risk factor, or marker of risk, for first-onset anxiety and depressive disorders, as is low extraversion for agoraphobia. The current data suggest large neuroticism "state" effects for panic disorder, agoraphobia, and MDD, and moderate "scar" effects from MDD. Though many clinicians and researchers regard personality traits simply as "vulnerability" factors, longitudinal analyses suggest additional complexity.

The mind in psychotherapy: An interpersonal neurobiology framework for understanding and cultivating mental health.

In this brief overview, I offer a conceptual approach to the mind that can support whatever clinical, research, public policy, or other approach you may be involved with. It seeks to help both the understanding and cultivating of mental health and well-being in our world, and may be especially important in encouraging future psychotherapists to be systems-oriented and multidisciplinary in their work. As the ideas of this framework have been published in a number of texts, I will simply have a brief listing of those and other selected publications at the end of this article and outline the main ideas and factual points as we move along. PRACTITIONER POINTS: Consilience across wide range of disciplines leads to an integrated framework defining the mind, mental health, and the strategies of intervention to cultivate well-being.

Disorganized attachment and defense: exploring John Bowlby's unpublished reflections.

Main and Solomon were the first to create a formal infant Strange Situation classification of attachment disorganization. Bowlby's reflections on the underlying psychological processes of such behaviors, however, began early in his career, including the term "disorganization." Most of these remained unpublished but are available through the John Bowlby Archive. Bowlby saw affective experiences as the source of the attachment behavioral system's organization and regulation, and he introduced the term "effector equipment" to describe the emergent organization of attention, expectation, affect, and behavior to orchestrate responses to the environment. In his thinking, disorganization results from threat conflict, safe haven ambiguity, and/or activation without assuagement, which interfere with coordination and integration across a behavioral system. Bowlby's unpublished writings also amplify his published work on segregated systems and defensive exclusion. Bowlby's insights are relevant today and can provide greater background and clarity to current work, as researchers and clinicians consider the origins, manifestations, and meaning of disorganization.

Self-monitoring in clinical practice: a challenge for medical educators.

Recent literature has described how the capacity for concurrent self-assessment-ongoing moment-to-moment self-monitoring-is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those observations to improve behavior and thinking in the future. Self-monitoring allows for the early recognition of cognitive biases, technical errors, and emotional reactions and may facilitate self-correction and development of therapeutic relationships. Cognitive neuroscience has begun to explore the brain functions associated with self-monitoring, and the structural and functional changes that occur during mental training to improve attentiveness, curiosity, and presence. This training involves cultivating habits of mind such as experiencing information as novel, thinking of "facts" as conditional, seeing situations from multiple perspectives, suspending categorization and judgment, and engaging in self-questioning. The resulting awareness is referred to as mindfulness and the associated moment-to-moment self-monitoring as mindful practice-in contrast to being on "automatic pilot" or "mindless" in one's behavior. This article is a preliminary exploration into the intersection of educational assessment, cognitive neuroscience, and mindful practice, with the hope of promoting ways of improving clinicians' capacity to self-monitor during clinical practice, and, by extension, improve the quality of care that they deliver.