Therapist reactions to patient personality: A pilot study of clinicians' emotional and neural responses using three clinical vignettes from in treatment series.

Introduction: Therapists' responses to patients play a crucial role in psychotherapy and are considered a key component of the patient-clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants' high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients' faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists' responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists' event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists' late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Discussion: These results, albeit preliminary, shed light on the role played by therapists' memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

Two modes of being together: The levels of intersubjectivity and human relatedness in neuroscience and psychoanalytic thinking.

The notion of intersubjectivity has achieved a primary status in contemporary psychoanalytic debate, stimulating new theoretical proposals as well as controversies. This paper presents an overview of the main contributions on inter-subjectivity in the field of neurosciences. In humans as well as-probably-in other species, the ability for emotional resonance is guaranteed early in development. Based on this capacity, a primary sense of connectedness is established that can be defined inter-subjective in that it entails sharing affective states and intentions with caregivers. We propose to define such a form of inter-subjectivity as contingent, since the infant's early abilities for resonance do not imply the more generalized capacity to permanently conceive of the relationship outside the realm of current interactions and the infant-caregiver's mutual correspondence of internal states. This form of connection, hence, results in a self-referential, bodily, and affectively codified, context- and time dependent, like-me experience of interactions. The gradual maturation of brain structures and processes as well as interactive experiences allow proper intersubjectivity exchanges, grounded on new intentional and representational capacities, to evolve. In this more mature form of intersubjectivity, the individual is allowed to conceive of her own psychic space both as distinct and as possibly connected with the other's contents and experience, even in the absence of current behavioral indicators of such correspondence. This multi-layered model of intersubjectivity, which is embraced by current neuroscience research, seems to allow for new interpretations of psychoanalytic models of human relatedness based upon classic clinical observations.

Gender Differences in Empathy During Adolescence: Does Emotional Self-Awareness Matter?

Empathy refers to the capacity to experience emotions similar to those observed or imagined in another person, with the full knowledge that the other person is the source of these emotions. Awareness of one's own emotional states is a prerequisite for self-other differentiation to develop. This study investigated gender differences in empathy during adolescence and tested whether emotional self-awareness explained these differences. Two-hundred-eleven adolescents (108 girls and 103 boys) between 14 and 19 years completed the Interpersonal Reactivity Index (IRI) and the Toronto Alexithymia Scale (TAS-20) to assess empathy and emotional self-awareness, respectively. Overall, girls obtained higher scores than boys on IRI subscales like emotional concern, personal distress, and fantasy. Regarding emotional self-awareness, we found gender differences in TAS-20 scores, with girls reporting greater difficulty identifying feelings and less externally oriented thinking than boys. Difficulty identifying feelings explained the greatest personal distress experienced by girls. Lower externally oriented thinking accounted for girls' greater emotional concern and fantasy. These findings offer an insight into the role of emotional self-awareness-which is essential for self-other differentiation-as an account for gender differences in empathic abilities during adolescence. In girls, difficulty identifying feelings can impair the ability to differentiate between ones' and others' emotions, leading them to experience self-focused and aversive responses when confronted with others' suffering. Conversely, in boys, externally oriented thinking can mitigate personal distress when faced with others' discomfort.

Psychobiological Consequences of Childhood Sexual Abuse: Current Knowledge and Clinical Implications.

A large body of research has documented the long-term harms of childhood sexual abuse (CSA) on an individual's emotional-adaptive function and mental health. Recent studies have also provided evidence of the biological impact of CSA, implicating specific alterations in many systems, including the endocrine and immune systems, and in DNA and chromatin, in the pathogenesis of medical disorders. Although the effects of CSA are often examined with regard to the general impact of early-life traumatic experiences, the study of CSA per sè, as a trigger of specific pathogenic pathways, would be more appropriate to understand their long-term implications and develop tailored diagnostic and therapeutic strategies. Based on these premises, this narrative minireview summarizes the research on the short-term and long-term sequelae of CSA, focusing on dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the effects on the immune system, and the changes to DNA through altered methylation. Also, we discuss the literature that examines dysfunctional DNA telomere erosion and oxidative stress markers as a sign of CSA. Finally, recent evidence of the intergenerational transmission of the effects of CSA is reported. The impact of CSA on brain connectivity and functions is out of the scope of this review, thus brain imaging studies are not included. The results of this minireview are discussed, considering their implications for prevention and clinical practice.

Role of Parental Attachment Styles in Moderating Interaction Between Parenting Stress and Perceived Infant Characteristics.

By employing the transactional model of development and focusing on the multifactorial nature of parenting, this study aimed to (1) examine whether important risk factors, particularly mothers' insecure attachment styles and parenting stress contribute to the perception of their infants' characteristics and (2) explore whether maternal attachment styles moderate the relationship between parenting stress and perceived infants' characteristics. We recruited 357 mothers (age: 34.23; ± 5.38) who had 1-year-old infants (161 males and 196 females; age: 12.70; ± 1.60 months). All the mothers completed three self-report instruments: Parenting Stress Index-Short Form (PSI-SF), Attachment Style Questionnaire (ASQ), and 1st-Year Inventory (FYI). Although the latter was originally developed to determine the risk for autism in 1-year-olds, it was employed in this study to measure infant's characteristics within two domains: social communication and sensory regulatory functions. Multiple regression analyses revealed that one of the PSI-SF dimensions - specifically the Parent-Child Dysfunctional Interaction - contributed to mothers' perceptions of their children's social communication abilities, whereas the attachment style did not. Other multiple regression analyses showed that all the dimensions of parenting stress - that is, Parenting Distress (PD), Parent-Child Dysfunctional Interaction (PCDI), and Difficult Child (DC) - contributed to mothers' perceptions of their sensory regulatory abilities. The attachment styles, particularly anxious attachment, contributed significantly to a biased perception of these abilities controlled for parenting stress. Mothers reporting high levels of avoidance and high levels of PD viewed their children as less able in the social communicative domain (SC Dom) than if they had low levels of PD. By contrast, when levels of avoidance were low, mothers with high PD perceived their children as less difficult in the SC Dom than those with low levels of PD. Moreover, high avoidance levels influenced how mothers who considered the interaction with their children as difficult perceived them as having greater difficulties in relation to sensory regulatory domain (SR Dom). By contrast, mothers with high levels of anxiety high levels of PD view their children as less able in the SC Dom than if they had low levels of PD. When mothers' levels of anxiety were very low, those with high PD viewed their children as less difficult in the SC Dom in comparison to those with low levels of PD.

Predictive and Incremental Validity of Parental Representations During Pregnancy on Child Attachment.

Parental pre-natal representations predict the interactive patterns that parents will put in place after childbirth. Early interactions defined by high parental emotional availability (EA) influence the development of security in children. To date, research on the predictive role of parental pre-natal representations on child attachment is still poor. Moreover, investigations on pre-natal representations have mainly focused on mothers. This study aimed at: investigating the criterion validity of the Interview of Maternal Representations During Pregnancy-Revised (IRMAG-R) and of the Interview of Paternal Representations During Pregnancy (IRPAG), using EA, parental attachment, and child attachment toward both parents, as criteria; testing the incremental validity of the IRMAG-R and IRPAG in the prediction of child attachment, controlling for other covariates, such as depressive and anxious levels during pregnancy, EA, and parental attachment; evaluating the possible mediation role of EA on the relationship between parental representations during pregnancy and child attachment. Fifty couples of primiparous parents were recruited during pregnancy, when the IRMAG-R and IRPAG were administered to mothers and fathers. At 6-9 months after childbirth, the mother-child and father-child interactions were coded by means of the EA Scales (EAS). At 14-18 after childbirth, the Adult Attachment Interview (AAI) was administered to parents, and the Strange Situation Procedure (SSP) was carried out to assess children's attachment toward mothers and fathers, respectively. The results showed significant correlations between parental pre-natal representations and EA, parental attachment and child attachment. As regards the prediction of child attachment, the IRMAG-R/IRPAG categories showed: a significant and large unique contribution for maternal representations; a close to be significant contribution for paternal representations (with a higher effect size for mothers than fathers). Moreover, while the indirect effect of pre-natal representations in the prediction of child attachment was not significant for mothers, it was instead significant for fathers. The results of this study confirmed the criterion validity of the IRMAG-R and IRPAG, and supported the incremental validity of the IRMAG-R and IRPAG in the prediction of children's attachment categories. Finally, the mediation models revealed that EA did not mediate the relationship between maternal pre-natal representations and child attachment, while it totally mediated the relationship between paternal pre-natal representations and child attachment.

Early-Life Interpersonal and Affective Risk Factors for Pathological Gaming.

Internet gaming is among the most popular entertainment options, worldwide; however, a considerable proportion of gamers show symptoms of pathological gaming. Internet gaming disorder (IGD) has been proposed to describe a behavioral addiction, which shares many similarities, both physical and psychological, with substance use disorder. Environmental factors, such as interpersonal and relationship dynamics during childhood and adolescence, have been suggested to modulate the onset and trajectories of IGD. However, studies exploring the contributions of dysfunctional family environments to the development of IGD remain limited. This minireview aims to offer an overview of the current knowledge regarding the impacts of early-life interpersonal and relationship dynamics on the development of IGD and to provide a snapshot of the current state of the literature in this field. Specifically, it underlines the modulatory role of early-life relational factors such as a) family function, b) parent-child relationships, c) childhood maltreatment, and d) bullying and cyberbullying on the development of IGD. Consistent with this evidence, therapeutic interventions that aim to "restructure" the emotional ties and familiar dynamics that are known to be associated with dysfunctional behaviors and feelings, and likely promote pathological gaming, are recognized as the most successful clinical therapeutic approaches for IGD.

Neural Responses to Infant Emotions and Emotional Self-Awareness in Mothers and Fathers during Pregnancy.

Neuroscientific research has largely investigated the neurobiological correlates of maternal and (to a much lesser extent) paternal responsiveness in the post-partum period. In contrast, much less is known about the neural processing of infant emotions during pregnancy. Twenty mothers and 19 fathers were recruited independently during the third trimester of pregnancy. High-density electroencephalography (hdEEG) was recorded while expectant parents passively viewed images representing distressed, ambiguous, happy, and neutral faces of unknown infants. Correlational analyses were performed to detect a link between neural responses to infant facial expressions and emotional self-awareness. In response to infant emotions, mothers and fathers showed similar cerebral activity in regions involved in high-order socio-affective processes. Mothers and fathers also showed different brain activity in premotor regions implicated in high-order motor control, in occipital regions involved in visuo-spatial information processing and visual mental imagery, as well as in inferior parietal regions involved in attention allocation. Low emotional self-awareness negatively correlated with activity in parietal regions subserving empathy in mothers, while it positively correlated with activity in temporal and occipital areas implicated in mentalizing and visual mental imagery in fathers. This study may enlarge knowledge on the neural response to infant emotions during pregnancy.

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy.

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.

El propósito del presente estudio fue investigar el papel de varios factores sicosociales de riesgo para predecir la sintomatología depresiva durante el embarazo en mamás y papás, respectivamente. Un total de 146 madres primerizas y 105 papás primerizos que habían reportado una condición de riesgo sicosocial fueron reclutados independientemente de los servicios de salud de maternidad e infantil, durante el segundo trimestre del embarazo. Todos los padres fueron evaluados con relación a la sintomatología depresiva, la ansiedad y el percibido apoyo social. Se llevaron a cabo dos análisis de regresión múltiple jerárquicos para determinar el papel de los factores sicosociales para predecir la sintomatología depresiva durante el embarazo, en mamás y papás. Se identificó la insatisfacción marital, la historia personal de depresión y el rasgo personal de ansiedad como factores significativos de predicción de la sintomatología depresiva durante el embarazo, tanto en mamás como en papás. Se identificó la historia familiar de abuso de sustancias, la conflictiva relación con los padres en el pasado año, así como el duelo en el pasado año como factores significativos que contribuyen a un nivel elevado de síntomas depresivos durante el embarazo en las mamás, pero no así en los papás. En este estudio, varios factores sicosociales de riesgo fueron consistentemente relacionados con un aumento en los síntomas depresivos maternos y paternos durante el embarazo: algunos de estos factores parecen estar específicamente relacionados con el estado depresivo materno.

Le but de cette étude était de rechercher le rôle de plusieurs facteurs psychosociaux dans la prédiction de symptopathologie dépressive durant la grossesse chez les mères et les pères. Un total de 146 mères primipares et de 105 pères primipares faisant état d'une condition de risque psychosocial ont été recrutés indépendamment des services de maternité et de soin de santé de l'enfant, durant le second trimestre de la grossesse. Tous les parents ont été évalués pour une symptomatologie dépressive, l'anxiété et le soutien social perçu. Deux analyses de régression multiples hiérarchiques ont été faites afin de déterminer le rôle de facteurs psychosociaux dans la prédiction de symptomatologie dépressive durant la grossesse, chez les mères et les pères. Le mécontentement conjugal, l'histoire personnelle de dépression et l'anxiété comme trait personnel ont été identifiés comme étant des prédicteurs importants de symptomatologie durant la grossesse, à la fois chez les mères et chez les pères. L'antécédent familial de toxicomanie, une relation conflictuelle avec les parents dans l'année précédente et un deuil durant l'année précédente ont tous été identifiés comme des facteurs importants contribuant à des symptômes dépressifs élevés durant la grossesse chez les mères mais pas chez les pères. Dans cette étude plusieurs facteurs de risque psychosocial étaient systématiquement liés à une augmentation des symptômes dépressifs maternels et paternels durant la grossesse : certains de ces facteurs semblaient liés plus spécifiquement à l'humeur dépressive maternelle.

Neurophysiological correlate of emotional regulation in cognitive and motor deficits in Tourette's syndrome.

Objectives: The present study investigated the role of different emotions in the expression of cognitive and motor control abilities of children having Tourette's syndrome (TS) compared to healthy controls.Methods: The electroencephalography activity of 33 children (mean age in final sample: TS (n = 10) = 10.5 ± 2.3; control (n = 10) = 10.1 ± 2.9) was recorded during a visual task consisting of four emotional face cues (anger, happiness, neutral and sadness) followed by a target in congruent or incongruent position with emotional cue. The participants were asked to indicate the target location.Results: The TS patients showed a shorter latency of the P1 and N170 only for anger cues compared to controls. In addition, sLORETA results showed an increased activation in the left occipital area and a decreased activation in the left amygdala, temporal and cingulate for anger cues in TS patients. Coherently, TS patients showed a lower accuracy of response only with anger cue and severity of tics resulted correlated with the event-related potentials data and behavioural responses linked to anger cue.Conclusions: These results suggest that children with TS process emotions (in particular the anger) differently from the controls, and that its regulation seems to have an important role in the cognitive and motor deficits in TS.

Dealing With the Aftermath of Mass Disasters: A Field Study on the Application of EMDR Integrative Group Treatment Protocol With Child Survivors of the 2016 Italy Earthquakes.

This study explored the effects of the EMDR Integrative Group Treatment Protocol (EMDR-IGTP) on child survivors of the earthquakes that struck Umbria, a region of central Italy, on August 24th and on October 26th 2016. Three hundred and thirty-two children from the town of Norcia and nearby severely disrupted villages received 3 cycles of EMDR-IGTP. The Emotion Thermometers (ET-5) and the Children's Revised Impact of Event Scale (CRIES-13) were administered before (T0) and about 1 week after the conclusion of the third cycle (T3) of EMDR-IGTP. At T3, older children showed a reduction of distress and anger, whereas younger children reported an increase on these domains; moreover, older children reported a greater reduction of anxiety than younger ones. A greater reduction of distress, anxiety, and need for help was evidenced in females, whereas a greater improvement in depressive symptoms was evidenced in males. The effects of the EMDR-IGTP treatment on post-traumatic symptoms were particularly evident in older children, compared to younger ones, and marginally greater in females than in males; moreover, a greater improvement was found in children who had received a timelier intervention, than in those who received delayed treatment. These results provide further evidence for the utility of EMDR-IGTP in dealing with the extensive need for mental health services in mass disaster contexts. Also, these data highlight the importance of providing EMDR-IGTP in the immediate aftermath of a natural disaster, to contribute significantly in restoring adaptive psychological functioning in children, especially in older ones.

The Intolerance of Uncertainty Inventory: Validity and Comparison of Scoring Methods to Assess Individuals Screening Positive for Anxiety and Depression.

Intolerance of Uncertainty is a fundamental transdiagnostic personality construct hierarchically organized with a core general factor underlying diverse clinical manifestations. The current study evaluated the construct validity of the Intolerance of Uncertainty Inventory, a two-part scale separately assessing a unitary Intolerance of Uncertainty disposition to consider uncertainties to be unacceptable and threatening (Part A) and the consequences of such disposition, regarding experiential avoidance, chronic doubt, overestimation of threat, worrying, control of uncertain situations, and seeking reassurance (Part B). Community members (N = 1046; Mean age = 36.69 ± 12.31 years; 61% females) completed the Intolerance of Uncertainty Inventory with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory. Part A demonstrated a robust unidimensional structure and an excellent convergent validity with Part B. A bifactor model was the best fitting model for Part B. Based on these results, we compared the hierarchical factor scores with summated ratings clinical proxy groups reporting anxiety and depression symptoms. Summated rating scores were associated with both depression and anxiety and proportionally increased with the co-occurrence of depressive and anxious symptoms. By contrast, hierarchical scores were useful to detect which facets mostly separated between for depression and anxiety groups. In sum, Part A was a reliable and valid transdiagnostic measure of Intolerance of Uncertainty. The Part B was arguably more useful for assessing clinical manifestations of Intolerance of Uncertainty for specific disorders, provided that hierarchical scores are used. Overall, our study suggest that clinical assessments might need to shift toward hierarchical factor scores.

Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis.

The most prevalent mental disorders, anxiety and depression, are commonly associated with structural and functional changes in the fronto-limbic brain areas. The clinical trials investigating patients with affective disorders showed different outcome to different treatments such as psychotherapy or pharmacotherapy. It is, however, still unexplored how these interventions approach affect the functional brain. This meta-analysis aims to compare the effects of psychotherapy compared to antidepressant therapy on functional brain activity in anxiety and depression disorders. Twenty-one samples with psychotherapy and seventeen samples with antidepressant therapy were included. The main finding showed an inverse effect of the two treatments on the right paracingulate activity. The patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area. This finding seems to support the recent studies that hypothesize how psychotherapy, through the self-knowledge and the meaning processing, involves a top-down emotional regulation.

Mothers with depressive symptoms display differential brain activations when empathizing with infant faces.

Maternal care during the first year of life provides the foundation for the infant's emotional and cognitive development. Depressive symptoms in mothers can undermine their early dyadic interaction, which may lead to various psychopathological disorders with long-term consequences. During this period, the mother-child interaction is exclusively preverbal and is based on the mother's ability to understand her infant's needs and feelings (i.e., empathy) and on reciprocal imitation of facial expressions that promote a social dialog that influences the development of the infant self. To study the effects of maternal depressive symptoms on neural circuits underlying these processes, we studied 16 healthy mothers (H) and 14 mothers with depressive symptoms (D), as assessed by the Center for Epidemiologic Studies Depression Scale. Subjects underwent functional magnetic resonance during observation/empathizing (OE) and imitation (IM) of the faces of both their own child and of that of an unknown child aged between 6 and 12 months. During OE, D deactivated the orbital and medial prefrontal cortex to a greater extent (compared with H), thus pointing to an increased internally focused cognitive style during rest. Moreover, D, in respect to H, displayed a greater reactivity of the right amygdala, which may be an expression of emotional dysregulation.

Neural processing of emotions in traumatized children treated with Eye Movement Desensitization and Reprocessing therapy: a hdEEG study.

Eye Movement Desensitization and Reprocessing (EMDR) therapy has been proven efficacious in restoring affective regulation in post-traumatic stress disorder (PTSD) patients. However, its effectiveness on emotion processing in children with complex trauma has yet to be explored. High density electroencephalography (hdEEG) was used to investigate the effects of EMDR on brain responses to adults' emotions on children with histories of early maltreatment. Ten school-aged children were examined before (T0) and within one month after the conclusion of EMDR (T1). hdEEGs were recorded while children passively viewed angry, afraid, happy, and neutral faces. Clinical scales were administered at the same time. Correlation analyses were performed to detect brain regions whose activity was linked to children's traumatic symptom-related and emotional-adaptive problem scores. In all four conditions, hdEEG showed similar significantly higher activity on the right medial prefrontal and fronto-temporal limbic regions at T0, shifting toward the left medial and superior temporal regions at T1. Moreover, significant correlations were found between clinical scales and the same regions whose activity significantly differed between pre- and post-treatment. These preliminary results demonstrate that, after EMDR, children suffering from complex trauma show increased activity in areas implicated in high-order cognitive processing when passively viewing pictures of emotional expressions. These changes are associated with the decrease of depressive and traumatic symptoms, and with the improvement of emotional-adaptive functioning over time.

Neural basis of attachment-caregiving systems interaction: insights from neuroimaging studies.

The attachment and the caregiving system are complementary systems which are active simultaneously in infant and mother interactions. This ensures the infant survival and optimal social, emotional, and cognitive development. In this brief review we first define the characteristics of these two behavioral systems and the theory that links them, according to what Bowlby called the "attachment-caregiving social bond" (Bowlby, 1969). We then follow with those neuroimaging studies that have focused on this particular issue, i.e., those which have studied the activation of the careging system in women (using infant stimuli) and have explored how the individual attachment model (through the Adult Attachment Interview) modulates its activity. Studies report altered activation in limbic and prefrontal areas and in basal ganglia and hypothalamus/pituitary regions. These altered activations are thought to be the neural substrate of the attachment-caregiving systems interaction.

Memories of attachment hamper EEG cortical connectivity in dissociative patients.

In this study, we evaluated cortical connectivity modifications by electroencephalography (EEG) lagged coherence analysis, in subjects with dissociative disorders and in controls, after retrieval of attachment memories. We asked thirteen patients with dissociative disorders and thirteen age- and sex-matched healthy controls to retrieve personal attachment-related autobiographical memories through adult attachment interviews (AAI). EEG was recorded in the closed eyes resting state before and after the AAI. EEG lagged coherence before and after AAI was compared in all subjects. In the control group, memories of attachment promoted a widespread increase in EEG connectivity, in particular in the high-frequency EEG bands. Compared to controls, dissociative patients did not show an increase in EEG connectivity after the AAI. Conclusions: These results shed light on the neurophysiology of the disintegrative effect of retrieval of traumatic attachment memories in dissociative patients.

Attachment models affect brain responses in areas related to emotions and empathy in nulliparous women.

BACKGROUND: The attachment model, as assessed by means of the Adult Attachment Interview (AAI), is crucial for understanding emotion regulation and feelings of security in human interactions as well as for the construction of the caregiving system. The caregiving system is a set of representations about affiliative behaviors, guided by sensitivity and empathy, and is fully mature in young-adulthood. Here, we examine how different attachment models influence brain responses in areas related to empathy and emotions in young-adult subjects with secure and dismissing attachment models. METHODS: By means of AAI, we selected 11 nulliparous young-adult females with a secure model and 12 with a dismissing model. Subjects underwent functional magnetic resonance, whereas imitating or observing and empathizing with infant facial expressions. Subjects were tested for alexithymia and reflective functioning. RESULTS: Dismissing subjects activated motor, mirror, and limbic brain areas to a significantly greater extent, but deactivated the medial orbitofrontal cortex (mOFC) and the perigenual anterior cingulated cortex (pACC). During emotional faces, increased activity in dismissing women was seen in the right temporal pole. Furthermore, greater alexithymia was correlated with greater activity in the entorhinal cortex and greater deactivation in the pACC/mOFC. CONCLUSIONS: These findings provide evidence of how the attachment model influences brain responses during a task eliciting attachment. In particular, hyperactivation of limbic and mirror areas may reflect emotional dysregulation of infantile experiences of rejection and lack of protection, whereas increased deactivation of fronto-medial areas may be the expression of the inhibition of attachment behaviors, which is a typical aspect of dismissing attachment.