MY THERAPY JOURNEY – Page 5 – Critical Research Journal

The neuropathology of delusional thinking

Delusional thinking is a complex phenomenon often associated with various neuropsychiatric disorders, including schizophrenia, Alzheimer’s disease, and substance-induced psychoses. Understanding the neurobiological underpinnings of delusions involves examining specific brain regions, neurotransmitter systems, and cognitive processes that contribute to the formation and maintenance of these fixed false beliefs.

Research indicates that delusions may arise from aberrant salience attributed to stimuli, which is often linked to dysregulation in dopaminergic pathways, particularly in the mesolimbic system. The aberrant salience hypothesis posits that chaotic disinhibition of dopamine release leads to the misattribution of significance to otherwise neutral stimuli, fostering delusional beliefs (Hayashi et al., 2021; Mishara & Fusar‐Poli, 2013). This is supported by findings that show increased activation in the ventral striatum during delusional experiences, suggesting that motivational and reward-related processes are involved in the reinforcement of these beliefs (Raij et al., 2018; Arjmand et al., 2020). Furthermore, neuroimaging studies have demonstrated that individuals with persecutory delusions exhibit heightened activation in the medial temporal lobe when processing negatively valenced stimuli, indicating a potential neural basis for the emotional and cognitive aspects of delusions (Perez et al., 2015).

In the context of Alzheimer’s disease, delusions are often linked to cognitive deficits, particularly memory impairments. Studies have shown that patients with Alzheimer’s frequently exhibit delusions alongside memory deficits, which may stem from a failure to accurately recall information, leading to the formation of erroneous beliefs (Sultzer et al., 2014; Ismail et al., 2011). Neurobiological correlates such as decreased blood flow and metabolic activity in the frontal and temporal lobes have been associated with the prevalence of delusions in this population (Lai et al., 2017; Nomura et al., 2012). Moreover, the presence of neurovascular dysfunction and blood-brain barrier permeability issues has been proposed as contributing factors to the neurobiology of delusions in various psychiatric conditions, including schizophrenia and Alzheimer’s (Najjar et al., 2017; Prasad, 2019).

The right hemisphere of the brain has also been implicated in the manifestation of delusions. Research suggests that lesions or dysfunctions in the right hemisphere may disrupt the processes involved in reality testing and belief updating, leading to the persistence of delusional beliefs despite contradictory evidence (Gurin & Blum, 2017). This aligns with the two-factor theory of delusions, which posits that the initial neuropsychological impairment that prompts a delusion is compounded by a second impairment that hinders belief evaluation processes (Coltheart, 2010).

In summary, delusional thinking is associated with a variety of neurobiological factors, including dopaminergic dysregulation, temporal lobe dysfunction, and right hemisphere involvement. These factors interact with cognitive processes, such as memory and belief evaluation, to contribute to the persistence of delusions across different psychiatric disorders. Further research is needed to elucidate the complex interplay between these neurobiological and cognitive mechanisms, which could inform more effective treatment strategies for individuals experiencing delusions.

References

Arjmand, S., Kohlmeier, K., Behzadi, M., Ilaghi, M., Mazhari, S., & Shabani, M. (2020). Looking into a deluded brain through a neuroimaging lens. The Neuroscientist, 27(1), 73-87. https://doi.org/10.1177/1073858420936172

Coltheart, M. (2010). The neuropsychology of delusions. Annals of the New York Academy of Sciences, 1191(1), 16-26. https://doi.org/10.1111/j.1749-6632.2010.05496.x

Gurin, L. and Blum, S. (2017). Delusions and the right hemisphere: a review of the case for the right hemisphere as a mediator of reality-based belief. Journal of Neuropsychiatry, 29(3), 225-235. https://doi.org/10.1176/appi.neuropsych.16060118

Hayashi, N., Igarashi, Y., & Harima, H. (2021). Delusion progression process from the perspective of patients with psychoses: a descriptive study based on the primary delusion concept of karl jaspers. Plos One, 16(4), e0250766. https://doi.org/10.1371/journal.pone.0250766

Ismail, Z., Nguyen, M., Fischer, C., Schweizer, T., Mulsant, B., & Mamo, D. (2011). Neurobiology of delusions in alzheimer’s disease. Current Psychiatry Reports, 13(3), 211-218. https://doi.org/10.1007/s11920-011-0195-1

Lai, L., Lee, P., Chan, P., Fok, M., Hsiung, G., & Sepehry, A. (2017). Prevalence of delusions in drug‐naïve alzheimer disease patients: a meta‐analysis. International Journal of Geriatric Psychiatry, 34(9), 1287-1293. https://doi.org/10.1002/gps.4812

Mishara, A. and Fusar‐Poli, P. (2013). The phenomenology and neurobiology of delusion formation during psychosis onset: jaspers, truman symptoms, and aberrant salience. Schizophrenia Bulletin, 39(2), 278-286. https://doi.org/10.1093/schbul/sbs155

Najjar, S., Pahlajani, S., Sanctis, V., Stern, J., Najjar, A., & Chong, D. (2017). Neurovascular unit dysfunction and blood–brain barrier hyperpermeability contribute to schizophrenia neurobiology: a theoretical integration of clinical and experimental evidence. Frontiers in Psychiatry, 8. https://doi.org/10.3389/fpsyt.2017.00083

Nomura, K., Kazui, H., Wada, T., Sugiyama, H., Yamamoto, D., Yoshiyama, K., … & Takeda, M. (2012). Classification of delusions in alzheimer’s disease and their neural correlates. Psychogeriatrics, 12(3), 200-210. https://doi.org/10.1111/j.1479-8301.2012.00427.x

Perez, D., Pan, H., Weisholtz, D., Root, J., Tuescher, O., Fischer, D., … & Stern, E. (2015). Altered threat and safety neural processing linked to persecutory delusions in schizophrenia: a two-task fmri study. Psychiatry Research Neuroimaging, 233(3), 352-366. https://doi.org/10.1016/j.pscychresns.2015.06.002

Prasad, K. (2019). Delusions in alzheimer disease: what researchers should not forget. American Journal of Geriatric Psychiatry, 27(5), 499-501. https://doi.org/10.1016/j.jagp.2018.12.034

Raij, T., Riekki, T., Rikandi, E., Mäntylä, T., Kieseppä, T., & Suvisaari, J. (2018). Activation of the motivation-related ventral striatum during delusional experience. Translational Psychiatry, 8(1). https://doi.org/10.1038/s41398-018-0347-8

Sultzer, D., Leskin, L., Melrose, R., Harwood, D., Narvaez, T., Ando, T., … & Mandelkern, M. (2014). Neurobiology of delusions, memory, and insight in alzheimer disease. American Journal of Geriatric Psychiatry, 22(11), 1346-1355. https://doi.org/10.1016/j.jagp.2013.06.005

You may have seen this post: Things coaches and counsellors notice… – Critical Research Journal | Graham Wilson (tobelikethis.org)

As part of our training, we tend to use a lot of ‘triad’ sessions. One person is the client, a second is the helper and the third is the observer. The roles are rotated during a session so that each person takes part in the three roles.

Initially, observation can be quite hard, but progressively more and more details come to attention. Here are some key aspects an observer might look for during such a session:

Application of Coaching Techniques: The observer assesses how well the trainee applies coaching techniques such as active listening, powerful questioning, and goal-setting. It’s important to see how these techniques are integrated into the session to facilitate the client’s self-awareness and growth (Stober & Grant, 2006).
Adherence to a Coaching Structure: Observing whether the trainee follows a structured approach to the session, which includes setting an agenda, maintaining focus on the client’s goals, and ensuring a clear closure, is crucial. This structure is vital for effective coaching outcomes (Rogers, 2012).
Handling of Feedback: The observer looks at how the trainee gives and receives feedback. Effective feedback is crucial for helping clients progress towards their goals and for the trainee’s own improvement (Williams & Davis, 2007).
Emotional Intelligence: The observer evaluates the trainee’s emotional intelligence, particularly their ability to manage personal emotions and understand the emotions of others. This capability is fundamental in creating a safe, supportive, and empathetic coaching environment (Green, Oades, & Grant, 2006).
Ethical Conduct: Ensuring that the trainee adheres to ethical guidelines set by relevant coaching bodies is essential. This includes maintaining confidentiality, avoiding conflicts of interest, and respecting the client’s autonomy (Passmore & Fillery-Travis, 2011).
Use of Self-Awareness in Coaching: Observers should look for evidence of self-awareness in trainees. This includes how well trainees understand their own biases and how these might affect their coaching practice. A good coach should be aware of their own limitations and how their experiences influence their coaching style (Kauffman & Scoular, 2004).
Client Engagement: Observing the client’s engagement can provide indirect feedback on the trainee’s effectiveness. A client who is actively participating and demonstrating positive changes is often a sign of effective coaching (Whitworth, Kimsey-House, & Sandahl, 2007).
Flexibility and Adaptability: The ability to adapt coaching techniques to suit different clients and situations is a valuable skill for a coach. Observers should note how well trainees adjust their approach based on the client’s reactions and feedback during the session (Prochaska & DiClemente, 1983).

These observations help in providing constructive feedback to the trainee, aiding in their development as effective coaches.

References

Green, S., Oades, L. G., & Grant, A. M. (2006). Coaching psychology manual. Philadelphia, PA: Lippincott Williams & Wilkins.
Kauffman, C., & Scoular, A. (2004). Toward a positive psychology of executive coaching. In P. A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp. 287-302). Hoboken, NJ: John Wiley & Sons.
Passmore, J., & Fillery-Travis, A. (2011). A critical review of executive coaching research: a decade of progress and what’s to come. Coaching: An International Journal of Theory, Research and Practice, 4(2), 70-88.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.
Rogers, J. (2012). Coaching skills: A handbook. Maidenhead, UK: Open University Press.
Stober, D. R., & Grant, A. M. (Eds.). (2006). Evidence based coaching handbook: Putting best practices to work for your clients. Hoboken, NJ: John Wiley & Sons.
Whitworth, L., Kimsey-House, H., & Sandahl, P. (2007). Co-active coaching: New skills for coaching people toward success in work and life. Palo Alto, CA: Davies-Black Publishing.
Williams, P., & Davis, D. C. (2007). Therapist as life coach: Transforming your practice. New York, NY: W. W. Norton & Company.

[Written and illustrated with the help of Scholar GPT and Dall-E.]