Cristina Trentini

Neural Basis of Maternal Communication and Emotional Expression Processing during Infant Preverbal Stage

During the first year of life, exchanges and communication between a mother and her infant are exclusively preverbal and are based on the mothers ability to understand her infants needs and feelings (i.e., empathy) and on imitation of the infants facial expressions; this promotes a social dialog that influences the development of the infant self. Sixteen mothers underwent functional magnetic resonance imaging while observing and imitating faces of their own child and those of someone elses child. We found that the mirror neuron system, the insula and amygdala were more active during emotional expressions, that this circuit is engaged to a greater extent when interacting with ones own child, and that it is correlated with maternal reflective function (a measure of empathy). We also found, by comparing single emotions with each other, that joy expressions evoked a response mainly in right limbic and paralimbic areas; by contrast, ambiguous expressions elicited a response in left high order cognitive and motor areas, which might reflect cognitive effort.

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. Hum Brain Mapp, 2013.

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.

How New Knowledge About Parenting Reveals the Neurobiological Implications of Intersubjectivity: A Conceptual Synthesis of Recent Research

Observations of early mother–infant interactions have shown that intersubjectivity is a primary motivation and have underscored the importance of maternal competencies in this development. In our paper we propose a conceptual overview of the different perspectives according to which parental caregiving has been formulated. Psychoanalytical theory has fundamentally promoted the exploration of maternal and paternal intrapsychic constellation, by stressing the role of unconscious processes in parental attitude as well as in infant development. In contrast with psychoanalytical theory, the conceptual framework of attachment has mostly considered real interactions between parents and infant, underlining parental abilities in providing the infant with a secure base. Finally, infant research has explored the complexity of communicative system between parents and infants, which appears already active from the birth of the baby. Recently, these different viewpoints have been broadened by neurobiological research, which has begun to explore maternal brain functioning and structure, by means of new scientific instruments such as fMRI techniques. From these perspectives, we provide an overview of motherhood, underlining both neurobiological and psychological transformations, which begin from pregnancy and run through the first year of the infant, when the mother–infant intersubjective matrix is built. This matrix influences the construction of the infants Self and support the development of the sense of “we,” a sort of connective net, which ties the baby to parents, letting him feel as a part of the familiar world.

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.

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.

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 infants 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 mothers ability to understand her infants 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 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.

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.

Rappresentazioni mentali materne e qualità degli scambi diadici in un gruppo di bambini a rischio di maltrattamento

Maternal representations and quality of dyadic interactions in children at risk of maltreatment - Problem: maltreatment impacts on the quality of interactive exchanges, precociously putting the infant at risk for maladaptive outcomes. Method: research involved 37 mother-infant dyads at risk for maltreatment and 37 non-referred dyads. AAI has been administered to the mothers; furthermore, dyadic interactive exchanges were observed and video-recorded. Results: in comparison with the control group, the at-risk group shows a prevalence of disorganized models (X2= 12,2; p < 0,01). Additionally, in the at-risk group an influence of maternal mental state on the interactive quality has been evidenced: dismissing mothers present lower sensitivity (F = 4,87; p < 0,01), whereas disorganized mothers express more negative affective states (F = 5,65; p < 0,01). Conclusions: early traumatic relational experiences influence maternal state of mind with respect to attachment, thus compromising the process of dyadic affective regulation. Key words: child maltreatment, traumatic experiences, attachment, dyadic interaction. Parole chiave: maltrattamento infantile, esperienze traumatiche, attaccamento, interazione diadica.