The Cardiac Rhythm of the Unconscious in a Case of Panic Disorder

Abstract

The field of psychodynamic psychotherapy would benefit from a comprehensive model that integrates its constructs with neurobiology. Research on the autonomic nervous system activity during the psychotherapeutic process is necessary because it is key in affective experiences and defensive behavior. The current case study reports physiological findings on heart rate dynamics in a patient suffering from panic disorder during two therapeutic sessions in which we used Davanloo's Intensive Short-term Dynamic Psychotherapy. We looked at various metrics of heart rate variability during the therapeutic process leading to breakthrough of unconscious feelings. The measurements included sympathetic and parasympathetic indices, vagal tone, and their responses. Our results suggest that the sympathetic system activates during defensive responses associated with anxiety and during the passage of unconscious-aggressive impulses. Following the experience of unconscious guilt, there is an increased vagal tone corresponding to the phase of reunification with the attachment figure. Findings are discussed integrating developmental neurobiology and clinical psychodynamics.

What the heart brings to therapy: A systematic review on heart rate variability contributions to psychotherapy research

“…Specifically, in one study with a PTSD case, improvements in cognitions and behaviors related to symptoms were observed from pre to post therapy, along with a 40.6% increase of baseline HRV activity (Norte et al, 2011). Another study adopted the psychophysiological approach to describe how emotions are embodied in therapy as an expression of underlying unconscious regulation defensive strategies (Fleury et al, 2016). Here, the pattern of psychophysiological activity related to therapy content (e.g., patient expresses unconscious guilt or anxiety) was explored across two therapy sessions, observing an overall increase in HRV activity within each session and a progressive symptom decrease across sessions.…”

Mechanisms of Change in Intensive Short-Term Dynamic Psychotherapy: Systematized Review

“…Abbass et al, 2017. Four of the 14 studies refer specifically to the concept of unlocking the unconscious as a key process underpinning change (18)(19)(20)(21). Abbass et al (18) explored instances of unlocking the unconscious during the initial assessment session, referred to as the "trial therapy."…”