THE CONCEPTS OF IMAGINATION, FANTASIES, DREAMS, AND HALLUCINATIONS IN MENTALLY HEALTHY PEOPLE

Imagination, fantasies, dreams, and hallucinations are contiguous mental processes that reflect various forms of image processing at the internal level. The ability to maintain boundaries between them, reflecting as they do either external or profoundly internal, subjective reality (reality testing), is considered to be one of the most widely accepted criteria of mental health. Nevertheless, traditionally these processes have been investigated independently by different authors adopting different approaches, and there is a discernible lack of studies dedicated to the comparative analysis of these phenomena, both in their theoretical and empirical aspects. At the same time, such data could be used to develop diagnostic methods of investigating mental processes in normal conditions as well as in cases of mental disorders. The aim of this study is to investigate people's common ideas about imagination, fantasies, dreams and hallucinations, as well as the subjective experience of them in comparison with each other. The study's group of participants consisted of 45 nominally mentally healthy people (32 women and 13 men) aged between 17 and 29 years old. The following methods were used during the study: a semistructured interview aimed at studying the respondents' ideas about imagination, fantasy, dreams and hallucinations, and visual drawings of the forms, which these processes took. According to the results of the study, in the case of 15% of the respondents, their ideas about imagination, fantasies, dreams and hallucinations differed from their scientific definitions. The drawings of the images of imagination, fantasies, dreams and hallucinations varied in terms of emotional experience. The more the mental process is voluntary and subjectively controlled, the more these images are associated with positive emotions. In particular, images of imagination are mainly associated with a positive emotional charge, images of fantasy more often evoke positive emotions, but also ambivalent experiences, and drawings of the images of dreams and hallucinations are most often associated with negative emotions.

When and for whom do psychodynamic therapists use guided imagery? Explicating practitioners’ tacit knowledge

Guided imagery psychotherapy (GIP) is an established therapeutic method using creative mental imagery within a psychodynamic frame of reference. Although there is evidence for the method’s general effectiveness, it is yet unclear under which conditions and for which patients it should be used. The aim of this study was therefore to empirically identify indication criteria for the use of guided affective imagery (GAI) as part of psychodynamic therapies. We conducted semi-structured interviews with N=15 psychodynamic therapists also qualified as GAI training therapists. We asked them to recollect cases in which they had decided either for or against the use of imagery. The therapists described a complex interplay of different factors. Using grounded theory coding supplemented by elements of Consensual Qualitative Research we reconstructed from their accounts a sequential model of their indicative decisions. First, there is a consideration of clear contraindications related to reality testing and destructiveness. Second, there are aspects requiring a modified application of GAI such as emotional instability and post-traumatic stress disorder symptoms. In a final step, there are a number of characteristics of the patient, the therapist, the therapeutic relationship, the patients’ initial imagery and different therapeutic goals and foci which are weighed relatively to each other in order for therapists to reach an indication decision. We end by discussing ways in which the indicative decision model may be used to improve GAI training as well as the method’s differential efficacy and effectiveness.

Contemporary Supportive Therapy: A Review of History, Theory, and Evidence

Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.

Training-Dependent Change in Content of Association in Appetitive Pavlovian Conditioning

In appetitive Pavlovian conditioning, experience with a conditional relationship between a cue [conditioned stimulus (CS)] and a reward [unconditioned stimulus (US)] bestows CS with the ability to promote adaptive behavior patterns. Different features of US (e.g., identity-specific sensory, general motivational) can be encoded by CS based on the nature of the CS-US relationship experienced (e.g., temporal factors such as training amount) and the content of association may determine the influence of CS over behavior (e.g., mediated learning, conditioned reinforcement). The content of association changed with varying conditioning factors, thereby altering behavioral consequences, however, has never been addressed in relevant brain signals evoked by CS. Our previous study found that phospholipase C β1-knockout (PLCβ1-KO) mice display persistent mediated learning over the extended course of odor-sugar conditioning, and that wild-type (WT) mice lose mediated learning sensitivity after extended training. In this study, in order to see whether this behavioral difference between these two genotypes comes from a difference in the course of association content, we examined whether odor CS can evoke the taste sensory representation of an absent sugar US after minimal- and extended training in these mice. In contrast to WT, which lost CS-evoked neural activation (c-Fos expression) in the gustatory cortex after extended training, KO mice displayed persistent association with the sensory feature of sugar, suggesting that sensory encoding is reliably linked to mediated learning sensitivity and there is a training-dependent change in the content of association in WT. PLCβ1 knockdown in the left medial prefrontal cortex (mPFC) resulted in mediated learning sensitivity and CS-evoked gustatory cortical activation after extended training, proposing a molecular component of the neural system underlying this Pavlovian conditioning process. We also discuss how disruption of this process is implicated for hallucination-like behaviors (impaired reality testing).

Insightful inference compensates for distorted perception

Introspective agents can recognize the extent to which their internal perceptual experiences deviate from the actual states of the external world. This ability, also known as insight, is critically required for reality testing and is impaired in psychosis, yet very little is known about its cognitive underpinnings. We developed a Bayesian modeling framework and a novel psychophysics paradigm to quantitatively characterize this type of insight while participants experienced a motion-aftereffect illusion. Participants could compensate for the illusion when judging the actual direction of a motion stimulus. Furthermore, confidence, reaction-time, and pupil-dilation data all showed signatures consistent with inferential adjustments in the Bayesian insight model. Our results suggest that people can question what they see and make insightful inferences that incorporate introspective knowledge about internal distortions.

Bridging the Gap? Altered Thalamocortical Connectivity in Psychotic and Psychedelic States

Psychiatry has a well-established tradition of comparing drug-induced experiences to psychotic symptoms, based on shared phenomena such as altered perceptions. The present review focuses on experiences induced by classic psychedelics, which are substances capable of eliciting powerful psychoactive effects, characterized by distortions/alterations of several neurocognitive processes (e.g., hallucinations). Herein we refer to such experiences as psychedelic states. Psychosis is a clinical syndrome defined by impaired reality testing, also characterized by impaired neurocognitive processes (e.g., hallucinations and delusions). In this review we refer to acute phases of psychotic disorders as psychotic states. Neuropharmacological investigations have begun to characterize the neurobiological mechanisms underpinning the shared and distinct neurophysiological changes observed in psychedelic and psychotic states. Mounting evidence indicates changes in thalamic filtering, along with disturbances in cortico-striato-pallido-thalamo-cortical (CSPTC)-circuitry, in both altered states. Notably, alterations in thalamocortical functional connectivity were reported by functional magnetic resonance imaging (fMRI) studies. Thalamocortical dysconnectivity and its clinical relevance are well-characterized in psychotic states, particularly in schizophrenia research. Specifically, studies report hyperconnectivity between the thalamus and sensorimotor cortices and hypoconnectivity between the thalamus and prefrontal cortices, associated with patients' psychotic symptoms and cognitive disturbances, respectively. Intriguingly, studies also report hyperconnectivity between the thalamus and sensorimotor cortices in psychedelic states, correlating with altered visual and auditory perceptions. Taken together, the two altered states appear to share clinically and functionally relevant dysconnectivity patterns. In this review we discuss recent findings of thalamocortical dysconnectivity, its putative extension to CSPTC circuitry, along with its clinical implications and future directions.

De-realization and Infra-humanization

In this chapter, we suggest that our enforced interactions with digital technologies impose a series of adjustments that (a) induce a de-realization of our experience of everyday life, and (b) facilitate the infra-humanization of those with whom we interact through those technologies. De-realization is induced by temporal disorganization, ephemerality, spatial detachment, sensory incongruity, impairment in our capacity for information-processing and reality-testing, and personalization. Infra-humanization is prompted by the unique aspects of digital interactions, the condition of permanent surveillance, and increasing interactions with non-human agents. De-realization and infra-humanization mutually influence each other, produce significant transformations in the human experience, and present severe risks.

Thinking Style and Paranormal Belief: The Role of Cognitive Biases

This study investigated the degree to which cognitive bias mediated the relationship between thinking style and belief in the paranormal. A sample of 496 participants completed the Revised Paranormal Belief Scale (RPBS), the Belief in Science Scale (BISS), the Cognitive Biases Questionnaire for Psychosis, and the reality testing subscale of the Inventory of Personality Organization (IPO-RT). The BISS and IPO-RT served as proxy indices of preferred thinking style; the BISS assessed rational-analytical (objective) processing, and the IPO-RT intuitive-experiential (subjective) processing. Cognitive biases (Jumping to Conclusions, Intentionalising, Catastrophising, Emotional Reasoning, and dichotomous thinking) correlated positively with belief in the paranormal. Mediation using path analysis indicated that Emotional Reasoning and Catastrophising exerted indirect effects in relation to BISS, IPO-RT and RPBS. Direct relationships existed between IPO-RT and RPBS, and BISS and RPBS. Of the biases, only Emotional Reasoning and Catastrophising predicted RPBS. The contribution of Emotional Reasoning and Catastrophising to belief in the paranormal were consistent with previous research and the cognitive model of psychosis, which asserts that there are strong relationships between defective reality testing, emotional reasoning and delusional beliefs.

Paranormal Belief, Thinking Style and Delusion Formation: A Latent Profile Analysis of Within-Individual Variations in Experience-Based Paranormal Facets

This study examined the degree to which within-individual variations in paranormal experience were related to belief in the paranormal, preferential thinking style, and delusion formation. A sample of 956 non-clinical adults completed measures assessing experience-based paranormal indices (i.e., paranormal experience, paranormal practitioner visiting, and paranormal ability), paranormal belief, belief in science, proneness to reality testing deficits, and emotion-based reasoning. Latent profile analysis (LPA) combined the experience-based indices to produce six underlying groups. Inter-class comparison via multivariate analysis of variance (MANOVA) indicated that both breadth and intensity of experiential factors were associated with higher belief in in the paranormal, increased proneness to reality testing deficits, and greater emotion-based reasoning. Belief in science, however, was less susceptible to experiential variations. Further analysis of reality testing subscales revealed that experiential profiles influenced levels of intrapsychic activity in subtle and intricate ways, especially those indexing Auditory and Visual Hallucinations and Delusional Thinking. Collectively, identification of profiles and inter-class comparisons provided a sophisticated understanding of the relative contribution of experiential factors to differences in paranormal belief, belief in science, proneness to reality testing deficits, and emotion-based reasoning.