Brain Imaging Shows the Impacts of Psychotherapy


Psychotherapy, or talk therapy, is an effective treatment for many mental health disorders. Advances in brain imaging are increasingly allowing researchers to observe the changes in the brain resulting from psychotherapy treatment.

Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing. There are several different types of psychotherapy, such as cognitive behavior therapy (CBT), interpersonal therapy and psychoanalysis. Psychotherapy can be used in combination with medication or other therapies. 


A recent study of the effects of CBT on anxiety identified areas of the brain impacted by psychotherapy. Researchers used functional magnetic resonance imaging (fMRI) to look at brain activity of people with panic disorder before and after four sessions of CBT.  More than 70% of patients receiving therapy reached recovery status compared to 7% in the control group. The fMRIs showed that in areas of the brain that are overly active in people with panic disorder, the therapy normalized brain activity. This was particularly evident in areas linked to threat monitoring, fear memory and problems with emotion regulation. In addition, the researchers suggest that effective treatment may require fewer sessions than previously thought.


Another study looked at CBT treatment for people with obsessive-compulsive disorder (OCD). Researchers used diffusion tensor imaging (DTI) technology (a noninvasive technique to measure white matter microstructures) to measure changes in white matter after CBT. White matter is the tissue in the largest and deepest part of your brain containing millions of nerve fibers that coordinate communication between different brain regions. Abnormalities in white matter are typically found in several areas of the brain in people with OCD. The patients showed recovery of white matter fiber connections in some regions after CBT. The recovery was correlated with improvements in symptoms of OCD.


A 2017 study by researchers in London found that CBT strengthens specific connections in the brains of people with schizophrenia. These changes were associated with reduced symptoms and recovery many years later. People in the study who had received medication treatment only did not show similar brain changes. The authors point out that people with schizophrenia are often not offered psychotherapies.


A 2019 study from a team of researchers in Italy looked at changes in the brain in response to two different types of psychotherapy to treat posttraumatic stress disorder (PTSD) – eye movement desensitization and reprocessing (EMDR) and trauma-focused CBT. They found similar brain changes with both therapies and similar beneficial effects in improving symptoms. While they are two distinct types of therapy, they have some core elements in common, including re-elaborating traumatic events or memories and building new positive attitudes and behaviors. The authors suggest that the research could help identify ways that brain stimulation techniques, such as transcranial magnetic stimulation (TMS) could be used in conjunction with psychotherapy to amplify the benefits.



References

Kumari, V., et al. Brain connectivity changes occurring following cognitive behavioral therapy for psychosis predict long-term recovery. Translational Psychiatry, 2017.Santarnecchi, E., et al. Psychological and Brain Conne;ctivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients. Frontiers in Psychology. 2019, 10:129.Reinecke, A, et al. Early effects of exposure-based cognitive behavior therapy on the neural correlates of anxiety. Translational Psychiatry. 2018, 8:225.Zhong, Z, et al. Abnormalities of white matter microstructure in unmedicated patients with obsessive-compulsive disorder: Changes after cognitive behavioral therapy. Brain and Behavior. 2019. DOI: 10.1002/brb3.1201


©American Psychiatric Association

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