Italians now more fragile, tms a valuable aid against neuro-covid and insomnia

“The pandemic situation has created a huge clinical problematic on the one hand by dislodging dysfunctional pictures already present, and on the other hand by creating protracted conditions of suffering that have defined new clinical pictures. In this context, recent assessments recounting the impact of the pandemic on the quality of life of the general population, a specific issue has emerged given the effects of Covid infection on the central nervous system and, in particular, on the so-called ‘Brain Fog’ from Long Covid, that is, an altered cognitive and emotional state given by the viral effect.”. Drawing the picture is Cristina Abbiate, psychologist and president of Brain&Care Group. “But there are also non-direct effects-continues Abbiate-think, for example, of the generation of preadolescents and teenagers who during lockdowns have seen themselves ‘dispossessed’ of an important piece of social and relational life, or-continues the psychologist-the vulnerability of the elderly in relation to contagion. All of this has triggered a problematic framework such that we can verify post-traumatic stress disorder in whole sections of the population and offered a stressful condition such that we can verify in many of us sleep disturbances, concentration disorders and a kind of increased surrender.

All elements that have made us more fragile and vulnerable”.

The picture in front of us today

The picture we face today “is an increase in the number of individuals with difficulties with a possible clinical relevance, and in this sense being able to offer a system of early diagnosis, a targeted and easily accessible intervention, with long-term monitoring, allows not only the containment of the phenomenon but also the reduction of the impact on the individual and the family group,” stresses Gabriele Zanardi, psychotherapist and neuropsychologist, head of the psychological area of Brain & Care Group and professor at the Department of Experimental and Forensic Medicine, University of Pavia.

Brain & Care Group together with LetscomE3 organized for April 2, in Rimini, the Ecm course (residential and live streaming) ‘The integrated clinical approach and rTMS in neurology and psychiatry’ with the aim, among others, to increase the knowledge of studies on the role of transcranial magnetic stimulation in the treatment of neuropsychiatric disorders and to foster an integrated interdisciplinary clinical approach for the treatment of these conditions. TMS is a method of noninvasive brain neuromodulation that allows, through the generation of electromagnetic pulses, to modulate the activity of the cerebral cortex and bring about a modification of the individual’s behavioral responses.

The need for an integrated therapeutic approach

“The one-sided approach no longer works-continues Zanardi-because what we observe in evidence-based medicine is a polydysfunctional system. We can no longer have a simplistic and categorical approach in the difficulties our patients bring to us but there must be an integrated multidisciplinary approach because what we observe may be a response to an attempt to compensate for very deep and heterogeneous difficulties”. The head of Brain’s psychological area & Care Group recalls how a theory was recently developed “that has been the basis of our clinical approach model,” he says-this theory argues that some pathological pictures are not true simple organ pathologies but become an alteration of behavioral allocation. It is like saying that the subject tends to produce a behavior in an attempt to protect himself from suffering and problems and this behavior initially gives a positive and conservative response, but then in the long run it is the behavior itself that becomes the problematic. The example that can be given-continues Zanardi-is the feeling of pleasantness that the adolescent who drinks a spritz with friends may feel, too bad, however, that in the long term alcohol becomes a depressive.

Over time, the individual’s subjective perception of drinking changes and processes are triggered whereby it seems that one can no longer have fun without the support given by alcohol.”.

This theory “which defines a framework of addiction as a behavior allocation disorder-stresses the psychotherapist again-says that we sediment in memory certain behavioral responses that seem adaptive to us but actually become dysfunctional and unfortunately imprison the subject in automatic behaviors. Fortunately, this model also gives us the solution, which is to be able to replace old memories with new ones. That is, the possibility of accompanying the patient in building a recognition of the dysfunctionality of those more or less automated behaviors, defusing them and replacing them with much more adaptive behaviors. This represents the backbone of our approach: the course of treatment should not be exclusively related to symptom reduction, but also in the construction of ‘new functional memories’ that can replace the old pathological ones.

Herein lies the novelty and methodology of our approach, namely accompanying the patient to the reconstruction of a new ‘personal and emotional identity’ by riding the process of continuous and progressive improvement. In this sense, the integrated approach serves precisely to go and modify all those individual factors that constitute the pathological picture.”.

So in this context, Transcranial Magnetic Stimulation, “an absolutely valid and internationally recognized tool,” says Zanardi, “must be accompanied by a psychotherapeutic approach that involves not only the subject but the family group for accompaniment to a modification of lifestyle. The more this type of modification is deposited in the subject as a very strong amnesic trace, the more the subject will have useful procedures for the preservation of a more effective quality of life”.

Vulnerability and levels of fragility

Psychological processes “make reference to our system’s need to adapt to the environment and to build relationships that are functional to the quality of life in emotional and cognitive terms- continues Abbiate- In the course of our existence, from birth to adulthood, psychological experiences define who we are and what we do, our habits, part of our identity and also the relational model we learned during childhood with the attachment figure. Obviously, stressful events, depending on one’s psychological framework, can predispose an already fertile ground to develop personal difficulties within a rigid framework, for example, they can take on a dysfunctional psychological framework and this can then become a pathology over time that needs multidisciplinary intervention. Knowing how to read these signs and welcome them into a broader process of care allows us a greater level of therapeutic effectiveness.”.

Over the past decade, “the concept of vulnerability has interested research in an attempt to understand the causes and effects of genetic predispositions, environmental and/or behavioral alterations- Zanardi points out- The most effective definition remains expressed in the concept of the esposome: our biological structure (defined by a narrow genetic inheritance) leads us to apply engrams (automatic decoded processes) that change in relation to environmental responses, such interaction allows us to develop new skills or strengthen already automated systems. This concept has been used to understand clinical phenomena such as addictions. One of the questions that has always been asked is: is there a possibility of predicting whether a person exposed to certain behaviors may more or less become addicted to them?

It is a question that is still unanswered-continues Zanardi-in the sense that there is no one element that defines a pathological problem a priori, it is the set of certain elements that can foster a pathological type of picture. Our vulnerability is an integral part of our adaptive system, our task is to preserve it in a physiological mode to prevent it from becoming a true pathological conformation,” he concludes.