TO WHAT EXTENT HAVE NEW TECHNIQUES FOR

IMAGING BRAIN ACTIVITY PROVIDED USEFUL

INFORMATION IN RELATION TO ABNORMAL BRAIN
PROCESSES

Hemis Number: 106902

Words: 2572 (footnoes included)
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Advanced brain imaging techniques offer us a glimpse of the brain in action. Technological advances

have given cognitive neuroscientisits a unique and quite incredible tool with which to study the

physical material of our thoughts and processes. Some imaging techniques, such as computerised

tomography (CT) and magnetic resonance imaging (MRI) provide structural information, allowing us

to map out the various parts of the brain. Others, including positron emission tomography (PET),

single photon emission computerised tomography (SPECT), and functional magnetic imaging (fMRI)

offer functional information, and trace which parts of the brain are involved in various brain

processes. Such techniques are useful for the investigation of any psychological disorder to which

there is a neurological component. They have greatly added to the body of knowledge concerning

abnormal psychological processing as well as providing a powerful diagnostic tool (Eisenberg, 1992,

Oldendorf, 1980).

Although it is likely that neuroimaging techniques will increasingly become an essential tool for both

clinicians and researchers, three important and related issues must be born in mind by anyone wishing

to use them. Firstly, although cognitive neuroscience (the study of the brains of patients who display

abnormal psychological processing) is often taken to be a discipline in its own right, it also belongs to

the wider body of cognitive psychology. The relationship between cognitive neuroscience (and the

brain imaging techniques upon which they rely) and cognitive psychology is less than straightforward

because cognitive psychologists do not necessarily expect their theoretical models to reveal themselves

in the physical brain. Hence, if a model of, say, anxiety, has theoretical and therapeutic value in its

own right, then the role of brain imaging techniques is diminished because, in a sense, it does not

matter whether that model represents that brain process in a literal fashion,. Secondly, brain imaging

can only avail understanding of abnormal processes to the extent that there is a biological component

to those disorders. For those abnormal psychological processes for which there is no readily

identifiable physical cause or symptom, the use of brain imaging techniques will be limited only to a

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confirmation of the lack of physical disturbance displayed by those with the disorder. For those

disorders in which a biological components is more likely, such as depression (Barden

Barden et al 1995;

Nauta, 1971), caution should still be excised. If recent, and exciting reports of the intrinsic social

nature of depression (Brown 1996; Brown and Harris 1989) are to be believed, for example, then

cognitive neuroscientists must accept that they do not hold the monopoly on the understanding of

abnormal psychological processing; that they form just a part of the biopsychosocial model. A crucial

and related issue is that of causality. It is important to understand that neurological aspects of

abnormal psychological processing need not necessarily be the cause of the disorder, that they merely

be concomitant with it. Powerful though neuroimaging techniques may be, they do not posses the

authority to pronounce on whether a brain abnormality is the cause or symptom of that disorder with

which they are associated.

Brain imaging techniques can be classified into two distinct groups; those that provide information

about what the brain looks like (structural information), and those and that offer information about

what processes with which various parts of the brain are involved (functional information). Two of the

most widely used structural imaging techniques are computerised tomography (CT), and magnetic

resonance imaging (MRI). CT, developed in the 1970’s, is one of the oldest neuroimaging techniques

that remains in use. It rests on the observation that denser areas of tissue absorb more x-ray energy. X-

rays are passed through the brain, and are absorbed by the brain tissue. The amount of x-ray energy

not absorbed is measured as it emerges from the other side of the brain and provides the information

needed to reconstruct an image. X-rays are passed from all sides of the brain, with a typical image

requiring well over 20 000 transmission measurements (Hounsefield, 1973). MRI relies on the Nobel

prize (1952) winning observation that the structure of tissue can be observed by the changes that occur

in the tissue nuclei when placed in a magnetic field (Bloch 1946; Purcell et al 1946). When it was

discovered that the information provided from this procedure could be used to construct brain images

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(Pickett, 1982; Lauterbur, 1973) MRI was born. When patients are placed in a uniform magnetic field,

the nuclei in their brain tissue line up in a likewise uniform manner. The magnetic field is then

stopped suddenly, and the nuclei omit detectable radio signals as they return to their relaxed state.

These signals are measured, and when processed provide an image of the brain.

CT and MRI techniques provide useful ‘map-like’ information about what the brain looks like, but do

not provide information about what various parts of the brain do. Although the exact techniques differ,

functional techniques share a common principal. Levels are measured during a control task, which

establishes a base-level of activity. The particular area of the brain of interest is then stimulated.

Researchers who are, for example, interested those parts of the brain areas involved with certain types

of vision (e.g. Anderson et al, 1996) might typically get their subjects to involve themselves with

some visual task to promote physical activity in that area. The image from the control-state is then

subtracted from the task-state image to leave an image showing only the area of interest.

Functional information of this kind is available from at least three techniques. Functional magnetic

resonance imaging (fMRI) is similar in nature to MRI accept that it adopts the additional principal that

the magnetic properties of the nuclei undergo changes during neural activity. When a part of the brain

is undergoing activity, it is over-supplied with oxygen. This excess oxygen changes the magnetic

properties in a way that is detectable, and varies according to brain activity. Positron emission

tomography (PET; and single photon emission computerised tomography (SPECT, which provides

three dimensional information) requires patients to be injected with radioactive water (e.g. fluorine –

18, oxygen –15, that contain more photons than neutrons) which very rapidly accumulated in the

blood vessels of the brain. Changes in the cerebral blood flow required by the task reflect changes in

neural activity. Those parts of the brain requiring more blood (required by the task) omit more

positrons, and this is reflected in the resultant image.

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There are a number of reasons why neuroimaging techniques are attractive to those who seek to

identify physical abnormalities associated with psychological problems. Firstly, they are extremely

accurate and are capable of detecting even very small brain changes. Changes that are associated with

abnormal psychological processing are often minute, especially when the abnormality is in its early

stages. Both CT and MRI techniques have led to the early detection of brain tumours, for example, in

a way that was not previously possible (Jaekle, 1991). The critical importance of the early detection in

such disorders is all but self-evident, and in some cases life saving. Furthermore, the accuracy of

neuroimaging techniques maintains its value throughout the course of the problem. They are

frequently relied upon for successful management and grading of tumours, as well as the

determination of prognosis (DiChiro, 1986; Wilson, 1989).

Because such techniques are so exquisitely accurate, they can be used for diagnostic purposes. SPECT

can detect perfusion changes in the early changes of AIDS dementia even in patients who have normal

CT and MR images (Schielke et al 1990; Tatsch et al 1990; Masdeu et al 1991). The use of CT scans

in the diagnosis of head trauma is also well established (Kelly et al 1988; Sklaret al, 1992). To the

extent that the prognosis of such disorders is improved by early detection and intervention, the

contribution that brain imaging makes to the understanding of abnormal psychological processing.

Secondly, they allow examination of patients in a conscious state. This carries a number of advantages

over the post-mortem examinations that were used before neuroimaging techniques were developed.

Information from patients of all ages can be gathered whereas previously it was more common to

examine the brains of older people. Because the ageing process itself is responsible for some quite

significant brain changes (eg Craig and Jennings, 1982; Kuhl et al 1982; Samirajski and Rolsten,

1973), it was sometimes difficult to determine whether changes in the brain had been caused by an

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abnormality or by the ageing process. An additional drawback post-mortem investigation comes from

the possibility that the cause of death had caused changes in the brain that would not otherwise have

occurred. Additionally, because patients are conscious, it is possible to get them to perform a task as

they are being scanned, and to observe that part of the brain with which it is associated. This is

particularly important for psychologists who are interested in the function of various brain regions.

However, their power is limited by at least three important issues. The first issue is philosophical in

nature. In the hands of psychologists, brain imaging tools fall broadly under the auspices of

neurocognitive scientists, which in turn is a branch of cognitive psychology. The philosophical roots

of cognitive psychology stem from attempts to model human psychological processes. The list of such

models is ever growing. Although by no means limited to abnormal psychological processing,

cognitive models have been applied to, amongst others, depression (e.g. Beck et al, 1979), problem

gambling (e.g. Sharpe and Tarrier, 1993), and coping with illness (e.g. Leventhal, in Pimm and

Weinman, 1998). However, some consider these models to be merely convenient fictions that are not

necessarily meant to reflect accurately the structure of the brain. It is perfectly legitimate to subscribe

to some particular model or other and not to be disappointed when the physical structure of that model

is not confirmed by imaging techniques. Arguably, one of the central goals of cognitive psychology (a

discipline which walks a parallel road with cognitive science,) is to develop computers according to

the models that are constructed so that they might mimic human behaviour. The achievement of this

goal does not rely upon the recreation of the biological systems that are associated with human

psychological processes- computers are constructed in a fundamentally different wa.y. Therefore, a

one to one correspondence between psychological models and the organic nature of the brain is not

necessary. The position in which cognitive neuroscience is left is not entirely clear. What is certain

though, is that when brain imaging techniques suggest one thing, whereas a cognitive models suggests

another, it is erroneous to reject, by default, the theoretical model in favour of the physiological

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evidence.

To this philosophical argument, there is a practical and logical partner. Just as any psychological

model cannot be required necessarily to reveal itself as a physical reality before it is of use, the

abnormal psychological processes themselves need not be detectable to such techniques before they

are considered meaningful. Brain scanning techniques can only lead to information about

psychological abnormalities if there are physiological changes in the brain associated with that

disorder. For example, some studies have demonstrated quite convincingly that there may be a genetic

vulnerability alcoholism (Cloninger, Bohaman and Sigvardsson, 1981; Goodwin, 1979) and that it is

therefore, to an extent, an organic disorder. However, to date, the use of brain imaging techniques has

been limited to an observation of the actual damage caused by the alcohol itself (e.g. Gilman et al,

1988; Sachs et al, 1987) It has not been possible to detect differences associated with the addictive

process itself (which is presumably that aspect of the disorder which is of most interest to

psychologists). Despite the fact that brain imaging techniques have provided convincing evidence of

the damage that alcoholism does to the brain, they have (so far) not been useful in identifying the

processes involved with the the psychology of addiction. When brain imaging techniques detect

differences that are caused by the disorder, rather than those physiological changes that are involved in

the aetiology of the disorder, the information that they provide is less useful to psychologists.

Finally, there is the issue of causality. This extremely important issue confronts science as a whole.

What brain imaging techniques do extremely well is identity relationships between types of abnormal

psychological processing and physiological changes in the brain, and it is becoming increasingly likely

that different parts of the brain are associated more with some psychological processes than with

others. In the same way, disruption of certain parts of the brain is associated with different types of

abnormal processing. However, this is not to say that organic changes in the brain cause disruptions in

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psychological processing (or that changes in psychological processing causes a disruption of the

brain). It has, for example, become reasonably clear that depression is associated with changes in

frontal lobe volume (MRI; Coffey et al, 1993; Nasrallah et al, 1989), frontal cerebral width (MRI;

Krishnan et al, 1992), blood flow to the brain (SPECT, Kuhl, 1983) and major, depression, as well as

temporal (MRI; Altshuler et al, 1991; Hauser and Altschuler, 1989), and frontal (PET; Baxter et al

1985, 1989) lobe volume deficits in bipolar disorder. However, what these observations fail to show,

is whether such brain changes are the cause of the depression, or whether they are merely the

symptoms of depression. Substantial theories exist which attempt to account for the aetiology of

depression without recourse to biological factors (e.g. Beck, 1979), and it is becoming increasingly

recongised that biological factors represent just one of a number of vulnerability factors which

increase the likelyhood thaty a person will experience depression1. The issue of causality is

particularly troublesome for psychologists working in the clinical field because the types of

experiments that are required to tease apart causality are often difficult and expensive to conduct. To

identify formally the causes of depression, for example, it would be necessary to first gather together a

group of subjects who had never before been depressed, and barrage them with all manner of

demographic questions (to ensure that factors such as gender or age were not responsible for any

changes which might occur). Subjects would then have to undergo that particular brain scan capable of

measuring that particular brain state hypothesised to be responsible for depression. After a sufficiently

long period had elapsed (measured in terms of years rather than months), subjects would be assessed

for depression. Only then would it be possible to suggest confidently that some organic factor (that

was observable pre-onset) was responsible for the cause of the depression. Prospective studies such as

this are all too rare in psychology, and those that involve the use of brain images (which are

themselves costly), are scarcer still although it is possible that further advances in technology will

make brain imaging a less costly affair in the future, and that prospective studies will become easier to
1
It is likely that some forms of depression are more biologically based than others (Schatzberg et al, 1983; Torgesern,
1986), with endogenous factors playing a particularly strong role in the onset of bipolar depression (Baron et al, 1987;
Depue and Iocono). 1989; Goodwin and Jamison 1990).

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conduct.

The problem of causality is one which plagues those who seek to understand abnormal psychological

processing whether or not they decide to use brain imaging techniques to help them do so. Poweful

modern imaging techniques are no more equipt to solve this problem than their more traditional

counterparts. But this is not where their benefits lie. What they provide is a chance to see the living

brain, and to note accurately those changes which are associated with a variety of abnormal

psychological processing.

Those wishing to understand neurological disorders such as brain tumours, Alzheimers disease, AIDS

dementia, and cocaine abuse, as well as psychiatric disorders including schizophrenia, depression,

obsessive-compulsive disorder (OCD) will find the newer brain imaging tools an increasingly

indispensable tool in their pursuit. Cognitive neuroscience, as defined by the technological equipment

that it employs, will continue to play an increasingly significant part in the understanding of abnormal

psychological processes; it represents state-of-the-art psychology,

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