How psychotherapy changes the brain – the contribution of functional neuroimaging

Abstract

A thorough investigation of the neural effects of psychotherapy is needed in order to provide a neurobiological foundation for widely used treatment protocols. This paper reviews functional neuroimaging studies on psychotherapy effects and their methodological background, including the development of symptom provocation techniques. Studies of cognitive behavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistent in showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similar effects were observed after successful intervention with selective serotonin reuptake inhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms of psycho-and pharmacotherapy. These findings are discussed in the context of current neurobiological models of anxiety disorders. Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects. Further studies with larger patient numbers, use of standardised imaging protocols across studies, and ideally integration with molecular imaging are needed to clarify the remaining contradictions. This effort is worthwhile because functional imaging can then be potentially used to monitor treatment effects and aid in the choice of the optimal therapy. Finally, recent advances in the functional imaging of hypnosis and the application of neurofeedback are evaluated for their potential use in the development of psychotherapy protocols that use the direct modulation of brain activity as a way of improving symptoms.

Long-term Cognitive and Behavioral Therapies, Combined with Augmentative Communication, are Related to Uncinate Fasciculus Integrity in Autism

“…More recently, Spironelli and collegues suggested that phonological training might reorganize cortical areas in dyslexic children (Spironelli et al 2010). Furthermore, cognitive behavioral therapy (CBT) techniques have been correlated with neuroplastic changes in different pathological conditions using neuroimaging techniques (Linden 2006;de Lange et al 2008). The potential of MRI techniques to measure CBT impact on brain architecture has been shown also in a recent study on chronic fatigue syndrome patients, in which CBT has been correlated with prefrontal cortex gray matter modulation (de Lange et al 2008).…”

ADHD and criminality: A primer on the genetic, neurobiological, evolutionary, and treatment literature for criminologists

“…The definitive version has been published in Criminal Justice, Volume 39, Issue 1, 2011, DOI: 10.1016/j.jcrimjus.2010 CBT is currently the preferred psychosocial intervention in most correctional settings (Sharp, 2006). Linden (2006) reviewed a number of neuroimaging studies that assessed the effects on the human brain of CBT compared with the effects of pharmacological treatment for such maladies as depression and obsessive compulsive disorder. Both types of treatment are found to decrease activity in areas of the brain associated with these problems to the same extent -indicating commonalities in the biological mechanisms of psycho-and pharmacotherapy‖ (Linden 2006:528).…”

Evidências de alterações neurais na Terapia Cognitivo-Comportamental: uma revisão da literatura

“…Assim, está sendo reconhecido que intervenções psicoterápicas acarretam expressiva modificação nas crenças, nos pensamentos, nas emoções e nos comportamentos dos pacientes (Linden, 2006) e que mudanças nesses níveis estão ligadas a modificações do funcionamento neural (Linden, 2008).…”