clinical and research implications

clinical and research implications

1. AM

   • is understood as a central aspect of healthy function throughout the human life expectancy
     • Be able to recover personal data Memories allow people to form representations of themselves as unique beings that exist with significant continuity over time
       • Such processes seem interrupted in people suffering from forms of psychopathology.
         • For example
           • instead of turning to key events from the past as a prototype for action predictions and meaning making, patients may resort to overgeneralization memories or intellectualizations
             • Los pacientes con TP narcisista podría responder a un conflicto interpersonal no recordando recuerdos específicos de su vida en los que
               • memories can focus around threat and fight/flight responses and end up without any resolution or a irreversible resolution
                 • Research has suggested that many patients with avoidant, dependent, and obsessive-compulsive PDs present with reduced AM specificity
                   • Many with schizophrenia are less able to spontaneously recall memories involving discrete events what happened at a specific time and place
   • Patients diagnosed with psychosis could respond to the same dilemma with no clear recollection of the past
     • AM in people with these conditions often lacks clear space and time
       • when memories are retrieved, they often make sense through the use of intellectualization and moral rules, without a nuanced sense of what actually happened between the specific people involved in the memory
         • For example
           • certain people were ungrateful or demanding without there being enough detail to determine what might have led to that event
             • within narrative episode the dialogue that takes place between characters are often repetitive and stereotyped
               • Exchanges between people can be remembered but tend to follow more than one formula that reflect memories of a unique conversation
                 • The Memories may lack details related to visual, auditory, olfactory or gustatory cues, elements that would provide an opportunity to understand the memory as something unique experiencia
                   • The narratives produced by patients with borderline PD portray life events as imbued with dysregulated affect and lacking any sense of agency
                     • the specific AM of patients with schizophrenia are less consistent with the general self-image they support and the self lacks agency
                       • a deficit not only in retrieving memories, but also in integrating different aspects of identity into a coherent whole

2. NEUROSCIENCE AND THE LINK OF AUTOBIOGRAPHICAL MEMORY WITH METACOGNITION

   • neuroscientists have also offered evidence of a close relationship between AM and metacognition
     • FOR EXAMPLE
       • imaging studies have suggested that AM is compatible with areas of the brain that partially overlap with those devoted to attributions to mental states.
   • the ability to engage in pretend play is combined with activations in cortical areas involved in both ToM and narrative processes

3. METACOGNITIVE/MENTALIZING DYSFUNCTIONS IN PERSONALITY DISORDERS AND SCHIZOPHRENIA

   • that patients with PD and schizophrenia suffer from a wide array of dysfunctions in thinking about themselves and others
   • Referred to as dysfunction in metacognition or mentalizing
   • this includes difficulties recognizing mental states, correctly naming them and using them in a flexible way and as a reliable source of information.
   • experience difficulties describing their own emotions. persons with PD appear to have limited abilities to use mentalization in order to respond to psychological problems (Carcione et al., 2011)

4. THE INTERPLAY OF IMPAIRMENTS IN AM AND METACOGNITION IN PSYCHOTHERAPY

   • While much psychopathology research has considered impairment in AM and metacognition separately, recent work in psychotherapy has begun to urge that successful treatment requires a consideration of the relationship of the two.
     • treatments
       • Among those are mentalization-basedtreatment (Bateman and Fonagy, 2004),
       • metacognitive interpersonal therapy for PD (Dimaggio et al., 2007, 2012),
       • metacognition-oriented psychotherapy for psychosis (Lysaker et al., 2007, 2011a; Buck and Lysaker, 2009; Salvatore et al., 2009,2012)
       • therapy is to help patients to narrate specific AM—instead of resorting to overgeneralized memories or intellectualizations—as specific AM are the most fertile soil to think about for mental states (Dimaggio et al., 2010, 2012; Lysaker et al., 2011a).
         • The rationale for seeking and thinking about specific episodes is based on the assumption that metacognitive reflection is at its heart a consideration of real life events, and as such impoverished AM offer little fertile ground for metacognitive activity

5. Clinicians in the mental health fields, neuroscientists, and social psychologists have become increasingly interested in how people with psychiatric conditions experience a variety of difficulties related to how they think about themselves and others. These difficulties include problems in forming and retrieving the specific autobiographical memories (AMs) that underlie a sense of personal identity

   • Research in psychopathology has tended to explore one or the other, thus neglecting the broader issue of how metacognition and MA are produced by systems that are likely to be closely related and likely to feed and support each other ( Markowitsch & Staniloiu, 2011 ).
   • Psychotherapy research and general neuroscience have begun to examine how these functions support each other and how disruptions in MA or metacognition can lead to decrements in the other.
   • . Luego discutimos los avances de la investigación en psicoterapia y neurociencia para comprender cómo se relacionan estos dos fenómenos y comentamos las oportunidades que ofrecen estos conocimientos para el trabajo científico y clínico.

6. IMPLICATIONS FOR TREATMENT AND RESEARCH IN PSYCHOPATHOLOGY

   • While difficulties in MA and metacognition have been treated separately as factors that are present and influential, psychotherapy and neuroscience suggest the need to study these phenomena together. Further efforts would seem to have the potential to answer several questions, even if one form of deficit emerges before the other.