Possibili correlati neurobiologici di quattro specifici fattori comuni della relazione terapeutica

Abstract

Introduction

Four specific therapeutic factors (previously considered non-specific) that are common to all care activities seem to be correlated with treatment outcomes. Our hypothesis is that each factor has specific neurobiological underpinnings. Using an operationalized definition of each of the four factors, we conducted a search of the Medline database for neuroimaging and neurobiological studies conducted during the past decade.

Results and conclusions

On the basis of our review, we argue that the clinician's communication style could affect activity in the mirror neuron system and in theory of mind brain areas of both the patient and therapist, based on mutual comprehension. Attention to patient history could activate the patient's episodic memory. Transformation of memories to working memory could 1) allow the patient to become aware of them; 2) render mnestic traces usually stored in a long-term memory labile and therefore available for modification; and 3) facilitate calibration of emotions by cognitive conflict-induced activation of the anterior-dorsal cingulate cortex with inhibition of the ventral one. Calibration of expectations could activate in advance the neural networks on which the expected response depends and “reward circuits,” thereby avoiding the so-called nocebo effect. The therapeutic alliance includes two interacting components: 1) cooperation, which depends on prefrontal cortex inhibition of behavior aimed at immediate reward, and 2) attachment, which might involve modulation of the anxiety and “theory of mind” networks. The neurobiological hypotheses presented above seem to support the view that each factor plays a partly specific role in the therapeutic process.