Pratiche di accettazione, mindfulness e terapia espositiva

Titolo Rivista QUADERNI DI PSICOTERAPIA COGNITIVA
Autori/Curatori Elio Carlo
Anno di pubblicazione 2024 Fascicolo 2024/54
Lingua Italiano Numero pagine 14 P. 131-144 Dimensione file 0 KB
DOI 10.3280/qpc54-2024oa18660
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Sebbene l’esposizione per abituazione, basata sul principio di cancellazione della memoria eccitatoria aversiva, sia ancora oggi largamente prevalente in ambito clinico, un modello differente, quello dell’apprendimento inibitorio, si propone di modificare radicalmente il trattamento delle fobie e dell’ansia, enfatizzando il ruolo delle procedure, diverse dall’abituazione, che elicitano, nel paziente, la creazione e il rafforzamento di una memoria rivale, la c.d. memoria inibitoria. L’articolo vuole essere una riflessione sul ruolo dell’esposizione nelle pratiche di accettazione in uso nella c.d. Terza Onda della Psicoterapia Cognitivo Comportamentale, in gran parte basate sull’utilizzo della mindfulness, e intende mostrare, basandosi sulle evidenze scientifiche più recenti, come tali pratiche possano essere inquadrate proprio all’interno del paradigma fissato dalla teoria dell’apprendimento inibitorio e come, per esse, conseguentemente, si apra un potenziale spazio di miglioramento procedurale, diretto all’ottimizzazione della forza, della durata e della recuperabilità della associazione inibitoria, al rafforzamento del processo di estinzione e al contrasto del ritorno della paura e dell’emozione negativa.

Parole chiave:; esposizione; estinzione; mindfulness; accettazione; terza onda CBT

  1. Alsubaie M., Abbott R., Dunn B., Dickens C., Keil T.F., Henley W. & Kuyken W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55: 74-91. DOI: 10.1016/j.cpr.2017.04.008
  2. Bishop S.R., Lau M., Shapiro S., Carlson L., Anderson N.D., Carmody J., Segal Z.V., Abbey S., Speca M., Velting D. & Devins G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3): 230-241. DOI: 10.1093/clipsy.bph077
  3. Baer R.A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2): 125-143. DOI: 10.1093/clipsy.bpg015
  4. Björkstrand J., Schiller D., Li J., Davidson P., Rosén J., Mårtensson J. & Kirk U. (2019). The effect of mindfulness training on extinction retention. Scientific Reports, 9, 19896.
  5. Hayes S.C., Strosahl K.D. & Wilson K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.
  6. Brewer J.A., Elwafi H.M. & Davis J.H. (2014). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Translational Issues in Psychological Science, 1(S): 70-90. DOI: 10.1037/2332-2136.1.S.70
  7. Bouton, ME (1993). Context, time and memory retriveval in the interference paradigms of Pavlovian learning. Psychological Bullettin, 114: 80-99.
  8. Brown K.W., Ryan R.M. & Creswell J.D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4): 211-237. DOI: 10.1080/10478400701598298
  9. Craske M.G. & Rachman S.J. (1987). Return of fear: perceived skill and heart rate responsivity. British Journal of Clinical Psychology, 26: 187-199.
  10. Craske M.G., Mystkowski J. (2006). Exposure therapy and extinction: Clinical studies. In Craske M.G., Hermans D. & Vansteenwegen D. (eds.), Fear and Learning: Basic Science to Clinical Application. Washington, DC: APA Books.
  11. Craske M.G., Treanor M., Conway C., Zbozinek T. & Vervliet B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58: 10-23. DOI: 10.1016/j.brat.2014.04.006
  12. Culver N.C., Vervliet B. & Craske M.G. (2015). Compound extinction: Using the Rescorla-Wagner model to maximize exposure therapy effects for anxiety disorders. Clinical Psychological Science, 3: 335-348. DOI: 10.1177/2167702614542103
  13. Denny B.T., Fan J., Liu X., Guerreri S., Mayson S.J., Rimsky L., New A.S., Siever L.J. & Koenigsberg H.W. (2014). Insula-amygdala functional connectivity is correlated with habituation to repeated negative images. Social Cognitive and Affective Neuroscience, 9(11): 1660-1667. DOI: 10.1093/scan/nst160
  14. Dibbets P. & Maes J.H.R. (2011). The effect of an extinction cue on ABA-renewal: does valence matter? Learning and Motivation, 42(2): 133-144. DOI: 10.1016/j.lmot.2010.12.003
  15. Dour H.J., Brown L.A. & Craske M.G. (2016). Positive valence reduces susceptibility to return of fear and enhances approach behavior. Journal of Behavioral Therapy Experimental Psychiatry, 50: 277-282. DOI: 10.1016/j.jbtep.2015.09.010
  16. Etkin A., Büchel C. & Gross J.J. (2015). The neural bases of emotion regulation. Nature Reviews Neuroscience, 16: 693-700. DOI: 10.1038/nrn4044
  17. Foa E.B. & Kozak M.J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99: 20-35.
  18. Foa E.B. & Cahill S.P. (2001). Emotional processing in psychological therapies. In Smelser N.J. & Bates P.B. (eds.), International encyclopedia of the social and behavioral science (pp. 12363-12369). New York: Elsevier.
  19. Garland E.L. & Froeliger B. (2014). Mindfulness training targets addiction at the attention-emotion interface: A neurocognitive framework. In Ie A., Ngnoumen C.T. & Langer E.J. (eds.), The Wiley Blackwell handbook of mindfulness (pp. 794-817). Wiley Blackwell.
  20. Grabovac A.D., Lau M.A. & Willett B.R. (2011). Mechanisms of mindfulness: a Buddhist psychological model. Mindfulness, 2: 154-66. DOI: 10.1007/s12671-011-0054-5
  21. Gu J., Strauss C., Bond R. & Cavanagh K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37: 1-12. DOI: 10.1016/j.cpr.2015.01.006
  22. Guendelman S., Medeiros S. & Rampes H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, Article 220. DOI: 10.3389/fpsyg.2017.00220
  23. Hayes S.C. (2004). Acceptance and Commitment Therapy and the New Behavior Therapies: Mindfulness, Acceptance, and Relationship. In Hayes S.C., Follette V.M. & Linehan M.M. (eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 1-29). New York: Guilford Press.
  24. Hofmann S.G., Grossman P. & Hinton D.E. (2011). Loving-kindness and compassion meditation: potential for psychological interventions. Clinical Psychology Review, 31: 1126-32.
  25. Hofmann S.G., Sawyer A.T., Witt A.A. & Oh D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2): 169-183. DOI: 10.1037/a0018555
  26. Hölzel B.K., Ott U., Hempel H., Hackl A., Wolf K., Stark R. & Vaitl D. (2007). Differential engagement of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators. Neuroscience Letters, 42: 116-21. DOI: 10.1016/j.neulet.2007.04.074
  27. Hölzel B.K., Lazar S.W., Gard T., Schuman-Olivier Z., Vago D.R. & Ott U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6: 537-559. DOI: 10.1177/1745691611419671
  28. Jha A.P., Krompinger J. & Baime M.J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective & Behavioral Neuroscience, 7(2): 109-119. DOI: 10.3758/cabn.7.2.109
  29. Kabat-Zinn J., Massion A.O., Kristeller J., Peterson L.G., Fletcher K.E., Pbert L., Lenderking W.R. & Santorelli S.F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149(7): 936-943. DOI: 10.1176/ajp.149.7.936
  30. Kabat-Zinn J. (2005). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (15th anniversary ed.). Delta Trade Paperback/Bantam Dell.
  31. Kabat-Zinn J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2): 144-156. DOI: 10.1093/clipsy.bpg016
  32. Kandel R.L. (2012). The molecular biology of memory: aAMP, PKA, CRE, CREB -1, CREB -2, and CPEB. Molecular Brain, 5, 14. DOI: 10.1186/1756-6606-5-14
  33. Kircanski K., Lieberman M.D. & Craske M.G. (2012). Feelings Into Words: Contributions of Language to Exposure Therapy. Psychological Science, 23(10): 1086-1091. DOI: 10.1177/0956797612443830
  34. Kleim B., Wilhelm F., Temp L., Margraf J., Wiederhold B. K & Rasch B. (2014). Sleep enhances exposure therapy. Psychological Medicine, 44(7): 1511-1519. DOI: 10.1017/s0033291713001748
  35. Kral T.R.A., Schuyler B.S., Mumford J.A., Rosenkranz M.A., Lutz A. & Davidson R.J. (2018). Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli. Neuroimage, 181: 301-313. DOI: 10.1016/j.neuroimage.2018.07.013
  36. LeDoux J.E. (1999). Emotional circuits in the brain. In Encyclopedia of Neuroscience (II ed., pp. 644-646). Elsevier.
  37. LeDoux J.E. (2016). Ansia. Come il cervello ci aiuta a capirla. Milano: Raffaello Cortina Editore.
  38. Likierman H. & Rachman S. (1980). Spontaneous decay of compulsive urges: cumulative effects. Behaviour Research and Therapy, 18: 387-394. DOI: 10.1016/0005-7967(80)90003-0
  39. Lutz A., Slagter H.A., Dunne J.D. & Davidson R.J. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Sciences, 12(4): 163-169. DOI: 10.1016/j.tics.2008.01.005
  40. McMain S., Sayrs J.H.R., Dimeff L.A. & Linehan M.M. (2007). Dialectical behavior therapy for individuals with borderline personality disorder and substance dependence. In Dimeff L.A. & Koerner K. (eds.), Dialectical behavior therapy in clinical practice: Applications across disorders and settings (pp. 145-173). New York: Guilford Press.
  41. Myers K.M. & Davis M. (2007). Mechanisms of fear extinction. Molecular Psychiatry, 12: 120-150. DOI: 10.1038/sj.mp.4001939
  42. Neff K.D. & Germer C.K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69: 28-44. DOI: 10.1002/jclp.21923
  43. Pace-Schott E.F., Germain A. & Milad M.R. (2016). Effects of sleep on memory for conditioned fear and fear extinction. Psychological Bulletin, 14(4): 835-857. DOI: 10.1037/2Fbul0000014
  44. Pavlov I.P. (1927). Conditioned reflexes. An Investigation of the physiological activity of the cerebral cortex. London: Oxford University Press.
  45. Phelps E.A. & Hofmann S.G. (2019). Memory editing from science fiction to clinical practice. Nature, 572(7767): 43-50. DOI: 10.1038/s41586-019-1433-7
  46. Plendl,W. & Wotjak C.T. (2010). Dissociation of within and between session extinction of conditioned fear. The Journal of Neuroscience, 30(14): 4990-4998. DOI: 10.1523/JNEUROSCI.6038-09.2010
  47. Prenoveau J.M., Craske M.G., Liao B. & Ornitz E.M. (2013). Human fear conditioning and extinction: Timing is everything…or is it? Biological Psychology, 92(1): 59-68. DOI: 10.1016/j.biopsycho.2012.02.005
  48. Rachman S., Craske M., Tallman K. & Solyom C. (1986). Does escape behaviour strengthen agoraphobic avoidance? Behavior Therapy, 17: 366-384.
  49. Rescorla R.A. (2006). Deepened extinction from compound stimulus presentation. Journal of Experimental Psychology: Animal Behavior Processes, 32(2): 135-144. DOI: 10.1037/0097-7403.32.2.135
  50. Rescorla R.A. & Wagner A.R. (1972). A theory of pavlovian conditioning: variations in the effectiveness of reinforcement and nonreinforcement. In Black A.A., Prokasy W.F. (eds.), Classical conditioning. II: current research and theory (pp. 64-99). New York: Appleton Century crofts.
  51. Rowe M.K. & Craske M.G. (1998). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36(7): 719-734. DOI: 10.1016/s0005-7967(97)10017-1
  52. Salkovskis P. & Mills I. (1994). Induced mood, phobic responding and the return of fear. Behaviour research and therapy, 32: 439-445. DOI: 10.1016/0005-7967(94)90007-8
  53. Schuman-Olivier Z., Trombka M., Lovas D.A., Brewer J.A., Vago D.R., Gawande R., Dunne J.P., Lazar S.W., Loucks E.B. & Fulwiler C. (2020). Mindfulness and behavior change. Harvard Review of Psychiatry, 28(6): 371-394. DOI: 10.1097/HRP.0000000000000277
  54. Shapiro S.L., Carlson L.E., Astin J.A. & Freedman B. (2006) Mechanisms of Mindfulness. Journal of Clinical Psychology, 62: 373-386. DOI: 10.1002/jclp.20237
  55. Shoham A., Goldstein P., Oren R., Spivak D. & Bernstein A. (2017). Decentering in the process of cultivating mindfulness: An experience-sampling study in time and context. Journal of Consulting and Clinical Psychology, 85(2): 123-134. DOI: 10.1037/ccp0000154
  56. Tang Y.Y., Ma Y.H. & Fan Y.X. (2009). Central and Autonomic Nervous System Interaction Is Altered by Short-Term Meditation. Proceedings of the National Academy of Sciences of the United States of America, 106: 8865-8870. DOI: 10.1073/pnas.0904031106
  57. Tang Y.Y., Hölzel B.K. & Posner M.I. (2015). The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16(4): 213-225. DOI: 10.1038/nrn3916
  58. Taylor V.A., Grant J., Daneault V., Scavone G., Breton E. & Roffe-Vidal S. (2011). Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators. NeuroImage, 57: 1524-1533. DOI: 10.1016/j.neuroimage.2011.06.001
  59. Torre J.B. & Lieberman M.D. (2018). Putting feelings into words: Affect labeling as implicit emotion regulation. Emotion Review, 10(2): 116-124. DOI: 10.1177/1754073917742706
  60. Toso E., Vicentini M., Carlo E. & Agnoletti M. (2023). Una nuova realtà virtuale per una nuova terapia di esposizione. pionieristiche considerazioni. Psicoterapia Cognitiva e Comportamentale, 29(3): 289-322.
  61. Tsao J.C.I. & Craske M.G. (2000). Timing of treatment and return of fear: effects of massed, uniform, and expanding spaced exposure schedules. Behavioral Therapy, 31(3): 479-497. DOI: 10.1016/S0005-7894(00)80026-X
  62. Vago D.R. & Silbersweig D.A. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, Article 296. DOI: 10.3389/fnhum.2012.00296
  63. Wells A. (2011). Metacognitive therapy for Anxiety and Depression. London: Guilford Press.

Elio Carlo, Pratiche di accettazione, mindfulness e terapia espositiva in "QUADERNI DI PSICOTERAPIA COGNITIVA" 54/2024, pp 131-144, DOI: 10.3280/qpc54-2024oa18660