Neuroimagem e mediunidade: uma promissora linha de pesquisa / Neuroimaging and mediumship: a promising research line

A relação mente-corpo tem despertado perguntas e debates desde os tempos das milenares tradições religiosas e dos antigos gregos até a neurociência contemporânea e, apesar de essas questões ainda não terem sido decisivamente respondidas, atualmente intervenções terapêuticas são orientadas por suposições a esse respeito. As investigações sobre os correlatos neurais da consciência e expressões mentais progrediram ao longo dos últimos 15 anos por meio do desenvolvimento de métodos de imagiologia funcional do cérebro. Essa abordagem pode abrir novas perspectivas para investigação da expressão de consciências supostamente espirituais com importantes implicações éticas, sociais e filosóficas. Propomos uma promissora nova linha de pesquisa em neurociências e discussão de algumas questões pertinentes à efetiva utilização da neuroimagem como potencial método de investigação da mediunidade para avançar a compreensão consensual a respeito da consciência, da suposta comunicação espiritual e suas relações com o cérebro. Destacamos certos aprendizados e desafios metodológicos adquiridos em nossa pesquisa neurofuncional sobre mediunidade a serem considerados em novos estudos nesse campo para formulação de hipóteses a respeito de tais fenômenos e discutimos orientações úteis para estudos de neuroimagem envolvendo experiências espirituais em geral.

The mind-body relationship has prompted debate from the times of millennial religious traditions and the ancient Greeks through to contemporary neuroscience, and although these questions have yet to be decisively answered, therapeutic interventions today are guided by assumptions made in this respect. Research on the neural correlates of consciousness and mental expressions has made progress over the last 15 years by developing functional brain imaging methods. This approach may open up new perspectives for studies of the expression of presumed instances of spiritual consciousness, which would have major ethical, social and philosophical implications. We pose a promising new line of research in the neurosciences and discuss certain issues pertaining to the effective use of neuroimaging to investigate mediumship and advance the consensus comprehension of consciousness, alleged spiritual communication and its relations with the brain. We highlight methodological challenges and lessons gleaned from our neurofunctional study of mediumship to be considered for further research in this field when formulating hypotheses to address these phenomena, and discuss useful guidelines for neuroimaging studies of spiritual experiences in general.

Should psychotherapy consider reincarnation?

There is increasing recognition of the need to take into account the cultural environment and belief systems of psychotherapy patients because these values reflect basic assumptions about man's nature and the cognitive references used to cope with psychological difficulties. Currently accepted psychotherapeutic approaches take no account of the belief in life after death held by most of the world's population. The World Values Survey (http://www.worldvaluessurvey.org) showed that there are large numbers of reincarnationists around the world, and whatever the reasons for believing in reincarnation, psychotherapeutic approaches should not ignore this significant group of people. Respect for patient opinions and subjective realities is a therapeutic need and an ethical duty, even though therapists may not share the same beliefs. Guidelines are suggested for professionals to develop collaborative models that help patients mobilize their intrinsic intelligence to find solutions to their complaints.

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: what do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.

Police officers under attack: resilience implications of an fMRI study.

OBJECTIVE: Crime is now a top-priority public-health issue in many urban areas. Sao Paulo's state police force was the target of gunfire attack on an unprecedented scale. Several officers were killed or wounded, and many more were affected by psychological trauma. We investigated the brain activity underlying trauma, the coping effect of psychotherapy, and resilience in a highly homogenous sample that experienced the same traumatic event. The design applied was a between-group comparison of cerebral blood-oxygenation-level-dependent signals and symptom scores of police officers with and without partial Posttraumatic Stress Disorder (pPTSD). METHOD: We used functional magnetic resonance imaging (fMRI) to investigate the retrieval of traumatic memories of 36 volunteers divided in three groups: (1) pPTSD policemen submitted to psychotherapy; (2) pPTSD policemen on the wait list; and (3) symptom-free (resilient) policemen. All participants were given a baseline fMRI scan and a follow-up scan some 40 days later. Not given psychotherapy, groups 2 and 3 were controls. RESULTS: Group 1 showed 37% fewer PTSD symptoms post-psychotherapy and their scores and neural expressions were comparable to Group 3 resilient policemen. A marked increased in medial prefrontal cortex (mPFC) activity was concomitant with decreased amygdala activity during traumatic memory retrieval in both resilient and pPTSD participants (after psychotherapy) and these findings were associated with symptom attenuation. CONCLUSIONS: Our results provide neurophysiological evidence of resilience in a high-risk group for PTSD. Psychotherapy may help to build narratives and resilient integrated translations of fragmented traumatic memories via mPFC, and thus weaken their sensory content while strengthening them cognitively.

Psychological trauma in chronic pain: implications of PTSD for fibromyalgia and headache disorders.

The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.

Traumatic memories: bridging the gap between functional neuroimaging and psychotherapy.

OBJECTIVE: Neuroimaging studies have highlighted important issues related to structural and functional brain changes found in sufferers of psychological trauma that may influence their ability to synthesize, categorize, and integrate traumatic memories. METHODS: Literature review and critical analysis and synthesis. RESULTS: Traumatic memories are diagnostic symptoms of post-traumatic stress disorder (PTSD), and the dual representation theory posits separate memory systems subserving vivid re-experiencing (non-hippocampally dependent) versus declarative autobiographical memories of trauma (hippocampally dependent). But the psychopathological signs of trauma are not static over time, nor is the expression of traumatic memories. Multiple memory systems are activated simultaneously and in parallel on various occasions. Neural circuitry interaction is a crucial aspect in the development of a psychotherapeutic approach that may favour an integrative translation of the sensory fragments of the traumatic memory into a declarative memory system. CONCLUSION: The relationship between neuroimaging findings and psychological approaches is discussed for greater efficacy in the treatment of psychologically traumatized patients.

Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study.

BACKGROUND: Traumatic memory is a key symptom in psychological trauma victims and may remain vivid for several years. Psychotherapy has shown that neither the psychopathological signs of trauma nor the expression of traumatic memories are static over time. However, few studies have investigated the neural substrates of psychotherapy-related symptom changes. METHOD: We studied 16 subthreshold post-traumatic stress disorder (PTSD) subjects by using a script-driven symptom provocation paradigm adapted for single photon emission computed tomography (SPECT) that was read aloud during traumatic memory retrieval both before and after exposure-based and cognitive restructuring therapy. Their neural activity levels were compared with a control group comprising 11 waiting-list subthreshold PTSD patients, who were age- and profile-matched with the psychotherapy group. RESULTS: Significantly higher activity was observed in the parietal lobes, left hippocampus, thalamus and left prefrontal cortex during memory retrieval after psychotherapy. Positive correlations were found between activity changes in the left prefrontal cortex and left thalamus, and also between the left prefrontal cortex and left parietal lobe. CONCLUSIONS: Neural mechanisms involved in subthreshold PTSD may share neural similarities with those underlying the fragmented and non-verbal nature of traumatic memories in full PTSD. Moreover, psychotherapy may influence the development of a narrative pattern overlaying the declarative memory neural substrates.

Promovendo resiliência em vítimas de trauma psicológico / Fostering resilience in psychological trauma victims

A exposição a eventos estressores e violentos ocorre com relativa freqüência em grande parte da população. A busca pela compreensão das respostas ao trauma está voltada também para a contribuição dos fatores da personalidade. A maneira como os indivíduos processam o evento estressor é crítica para a determinação ou não do trauma. O encéfalo não armazena propriamente registros factuais, mas traços de informações que serão usados para recriar memórias, as quais nem sempre expressam um retrato completamente fidedigno da experiência passada. Sempre que um evento traumático é recordado, este pode submeter-se a mudanças cognitivas e emocionais. Postulamos que os psicoterapeutas devem trabalhar, além do evento traumático em si, os diálogos internos que mantêm a relação patológica com o episódio passado. A exposição imaginária e a reestruturação cognitiva podem auxiliar as vítimas de experiências traumáticas a evoluir a partir de suas experiências negativas, com o desenvolvimento de diálogos internos saudáveis e resilientes.