Neural Correlates of Psychotherapy in Anxiety and Depression: A Meta-Analysis

Abstract

Several studies have used neuroimaging methods to identify neural change in brain networks associated to emotion regulation after psychotherapy of depression and anxiety. In the present work we adopted a meta-analytic technique specific to neuroimaging data to evaluate the consistence of empirical findings and assess models of therapy that have been proposed in the literature. Meta-analyses were conducted with the Activation Likelihood Estimation technique, which evaluates the overlap between foci of activation across studies. The analysis included 16 studies found in Pubmed (200 foci of activation and 193 patients). Separate meta-analyses were conducted on studies of 1) depression, post-traumatic stress disorder and panic disorder investigated with rest state metabolism (6 studies, 70 patients); 2) depression, post-traumatic stress disorder and panic disorder investigated with task-related activation studies (5 studies, 65 patients); 3) the previous studies considered jointly; and 4) phobias investigated with studies on exposure-related activation (5 studies, 57 patients). Studies on anxiety and depression gave partially consistent results for changes in the dorsomedial prefrontal cortex and in the posterior cingulated gyrus/precuneus. Several areas of change in the temporal lobes were also observed. Studies on the therapy of phobia were consistent with a reduction of activity in medial temporal areas. The cluster of change in the prefrontal cortex may refer to increased recruitment of control processes, as hypothesized by influential models of emotion regulation changes due to psychotherapy. However, not all areas associated with controlled emotion regulation were detected in the meta-analysis, while involvement of midline structures suggested changes in self-related information processing. Changes in phobia were consistent with reduced reactivity to phobic stimuli.

Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy

“…The key prediction of this hypothesis concerns the involvement of dorsal prefrontal areas associated with executive function. This hypothesis is supported by several studies on the effects of psychotherapy in which the involvement of prefrontal areas has been reported (for reviews, see Frewen et al, 2008;Messina et al, 2013; see also Fig. 3).…”

“…Meta-analyses of neuroimaging studies of the effect of psychotherapy show that significant changes may occur in the temporal cortex, a key node of the semantic system (Messina et al, 2013;see Fig. 3).…”

“…3 Neural effects of psychotherapy. Clusters of brain activity changes after psychotherapy in executive areas (in green) and semantic areas (in blue), based on a meta-analysis of functional neuroimaging studies of the effects of psychotherapy (Messina et al, 2013). (Color figure online) formulated without reference to emotion processing.…”

“…However, the exact mechanisms through which psychotherapy acts are not well understood. An influential model of the mechanism of action of psychotherapy draws on data from the considerable number of studies that have applied clinical neuroscience approaches (primarily functional neuroimaging) to identify the brain-behavior circuits that change during therapy (for reviews, see Abbass, Nowoweiski, Bernier, Tarzwell, & Beutel, 2014;Beauregard, 2007; DeRubeis, Siegle, & Hollon, 2008;Disner, Beevers, Haigh, & Beck, 2011;Frewen, Dozois, & Lanius, 2008;Messina, Sambin, Palmieri, & Viviani, 2013). According to this model, psychotherapy may act by promoting the effectiveness of control processes of executive nature, whose neurobiological substrate may be located in prefrontal areas (see Fig.…”

“…According to this model, psychotherapy may act by promoting the effectiveness of control processes of executive nature, whose neurobiological substrate may be located in prefrontal areas (see Fig. 1, in green), representing successful activation of emotion regulation strategies in the face of exposure to emotionally salient stimuli, especially when these stimuli possess anxiogenic or other emotionally negative features (Beauregard, 2007;DeRubeis et al, 2008;Disner et al, 2011;Frewen et al, 2008;Messina et al, 2013). We place this model within the framework of a general class of theories about mental function, which we will refer to as the dual-process framework (Barrett, Tugade, & Engle, 2004).…”