Brain imaging and psychotherapy: methodological considerations and practical implications
Abstract
The development of psychotherapy has been based on psychological theories and clinical effects. However, an investigation of the neurobiological mechanisms of psychological interventions is also needed in order to improve indication and prognosis, inform the choice of parallel pharmacotherapy, provide outcome measures and potentially even aid the development of new treatment protocols. This neurobiological investigation can be informed by animal models, for example of learning and conditioning, but will essentially need the non-invasive techniques of functional neuroimaging in order to assess psychotherapy effects on patients' brains, which will be reviewed here. Most research so far has been conducted in obsessive compulsive disorder (OCD), anxiety disorders and depression. Effects in OCD were particularly exciting in that both cognitive behavioural therapy and medication with a selective serotonin inhibitor led to a reduction in blood flow in the caudate nucleus. In phobia, brief courses of behavioural therapy produced marked reductions of paralimbic responses to offensive stimuli in line with the clinical improvement. Findings in depression are less consistent, with both increases and decreases in prefrontal metabolism being reported. However, they are important in pointing to different mechanisms for the clinical effects of pharmacotherapy (more "bottom up") and psychotherapy (more "top down"). For the future it would be desirable if the findings of psychotherapy changes to brain activation patterns were confirmed in larger groups with homogenous imaging protocols. Functional imaging has already made great contributions to the understanding of the neural correlates of psychopathology. For example, evidence converges to suggest that the subgenual cingulate is crucial for mood regulation. One current clinical application of these findings is deep brain stimulation in areas highlighted by such imaging studies. I will discuss their initial application in depression and OCD, and suggest potential alternative options based on recent developments in neurofeedback technology.
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There are inconsistencies in the literature regarding the specific brain regions and direction of activation changes within regions following psychological therapy.
“There are, however, inconsistencies in the literature regarding the specific brain regions and direction of activation changes within regions (Goldapple et al., 2004; Linden, 2008) with some research being at odds with the model; for example, findings of decreased pre-frontal activation following psychological therapy (Taylor and Liberzon, 2007).”
From Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety (2018) · cites this paper as Linden, 2008
Cites
Deep Brain Stimulation for Treatment-Resistant Depression
Mayberg, H. S., Lozano, A. M., Voon, V., McNeely, H. E., Seminowicz, D., Hamani, C., Schwalb, J. M., & Kennedy, S. H. (2005) · Neuron · doi:10.1016/j.neuron.2005.02.014 · Cited by 4,059 · see citing works
Subgenual prefrontal cortex abnormalities in mood disorders
Drevets, W. C., Price, J. L., Simpson, J. R., Todd, R. D., Reich, T., Vannier, M., & Raichle, M. E. (1997) · Nature · doi:10.1038/386824a0 · Cited by 2,693 · see citing works
Pain Affect Encoded in Human Anterior Cingulate But Not Somatosensory Cortex
Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997) · Science · doi:10.1126/science.277.5328.968 · Cited by 2,629 · see citing works
Cognitive processes mediating behavioral change.
Bandura, A., Adams, N. E., & Beyer, J. (1977) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.35.3.125 · Cited by 1,392 · see citing works
Neuroimaging studies of mood disorders
Drevets, W. C. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)01020-9 · Cited by 1,313 · see citing works
Baxter, L. R. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820090009002 · Cited by 1,293 · see citing works
Goldapple, K., Segal, Z., Garson, C., Lau, M., Bieling, P., Kennedy, S., & Mayberg, H. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.1.34 · Cited by 1,068 · see citing works
Cognitive processes mediating behavioral change.
Bandura, A., Adams, N. E., & Beyer, J. (1977) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.35.3.125 · Cited by 957 · see citing works
Control over brain activation and pain learned by using real-time functional MRI
deCharms, R. C., Maeda, F., Glover, G. H., Ludlow, D., Pauly, J. M., Soneji, D., Gabrieli, J. D. E., & Mackey, S. C. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0505210102 · Cited by 876 · see citing works
Activation of Heschl’s Gyrus during Auditory Hallucinations
Dierks, T., Linden, D. E. J., Jandl, M., Formisano, E., Goebel, R., Lanfermann, H., & Singer, W. (1999) · Neuron · doi:10.1016/s0896-6273(00)80715-1 · Cited by 752 · see citing works
Self-citationCortical Representation of the Sensory Dimension of Pain
Hofbauer, R. K., Rainville, P., Duncan, G. H., & Bushnell, M. C. (2001) · Journal of Neurophysiology · doi:10.1152/jn.2001.86.1.402 · Cited by 611 · cited 1× · see citing works
“Hypnotic suggestions can result in modulation of specific brain areas, related to the intensity (somatosensory cortex) and affective quality (ACC, amygdala) of pain [14, 22, 23] (Fig.”
Furmark, T., Tillfors, M., Marteinsdottir, I., Fischer, H., Pissiota, A., Långström, B., & Fredrikson, M. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.5.425 · Cited by 530 · see citing works
Neurobiology of Mental Illness
(2011) · Oxford University Press eBooks · doi:10.1093/med/9780199798261.001.0001 · Cited by 523 · see citing works
Hoffman, R. E., Hawkins, K. A., Gueorguieva, R. V., Boutros, N. N., Rachid, F., Carroll, K. M., & Krystal, J. H. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.1.49 · Cited by 517 · see citing works
How psychotherapy changes the brain – the contribution of functional neuroimaging
Linden, D. E. J. (2006) · Molecular Psychiatry · doi:10.1038/sj.mp.4001816 · Cited by 491 · see citing works
Self-citationPaquette, V., Lévesque, J., Mensour, B., Leroux, J.-M., Beaudoin, G., Bourgouin, P., & Beauregard, M. (2003) · NeuroImage · doi:10.1016/s1053-8119(02)00030-7 · Cited by 452 · see citing works
Kennedy, S. H., Konarski, J. Z., Segal, Z. V., Lau, M. A., Bieling, P. J., McIntyre, R. S., & Mayberg, H. S. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.5.778 · Cited by 420 · see citing works
Brain activation by disgust-inducing pictures in obsessive-compulsive disorder
Shapira, N. A., Liu, Y., He, A. G., Bradley, M. M., Lessig, M. C., James, G. A., Stein, D. J., Lang, P. J., & Goodman, W. K. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00003-9 · Cited by 269 · see citing works
Effects of cognitive-behavioral therapy on brain activation in specific phobia
Straube, T., Glauer, M., Dilger, S., Mentzel, H.-J., & Miltner, W. H. R. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2005.07.007 · Cited by 264 · see citing works
Real-time functional magnetic resonance imaging: methods and applications
Weiskopf, N., Sitaram, R., Josephs, O., Veit, R., Scharnowski, F., Goebel, R., Birbaumer, N., Deichmann, R., & Mathiak, K. (2007) · Magnetic Resonance Imaging · doi:10.1016/j.mri.2007.02.007 · Cited by 252 · see citing works
Volumetric brain imaging findings in mood disorders
Beyer, J. L., & Krishnan, K. (2002) · Bipolar Disorders · doi:10.1034/j.1399-5618.2002.01157.x · Cited by 231 · see citing works
Dilger, S., Straube, T., Mentzel, H., Fitzek, C., Reichenbach, J. R., Hecht, H., Krieschel, S., Gutberlet, I., & Miltner, W. H. R. (2003) · Neuroscience Letters · doi:10.1016/s0304-3940(03)00647-5 · Cited by 190 · see citing works
Symptom provocation and reduction in patients suffering from spider phobia
Schienle, A., Schäfer, A., Hermann, A., Rohrmann, S., & Vaitl, D. (2007) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-007-0754-y · Cited by 154 · see citing works
Reading and controlling human brain activation using real-time functional magnetic resonance imaging
deCharms, R. C. (2007) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2007.08.014 · Cited by 134 · see citing works
Brain plasticity and mental processes: Cajal again
DeFelipe, J. (2006) · Nature reviews. Neuroscience · doi:10.1038/nrn2005 · Cited by 128 · see citing works
Jandl, M., Steyer, J., Weber, M., Linden, D. E. J., Rothmeier, J., Maurer, K., & Kaschka, W. P. (2006) · Neuropsychobiology · doi:10.1159/000091721 · Cited by 90 · see citing works
Self-citationPain Response in Depersonalization: A Functional Imaging Study Using Hypnosis in Healthy Subjects
Röder, C. H., Michal, M., Overbeck, G., van de Ven, V. G., & Linden, D. E. J. (2007) · Psychotherapy and Psychosomatics · doi:10.1159/000097970 · Cited by 82 · see citing works
Self-citationSireteanu, R., Oertel, V., Mohr, H. M., Linden, D. E. J., & Singer, W. (2008) · Perception · doi:10.1068/p6034 · Cited by 44 · see citing works
Self-citationNeurobiology of Mental Illness
Anderson, K. E. (2005) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000152830.28345.3c · Cited by 27 · see citing works
Functional Neuroimaging—Can It Contribute to Our Understanding of Processes of Change?
Beutel, M. E., & Huber, M. (2008) · Neuropsychoanalysis · doi:10.1080/15294145.2008.10773563 · Cited by 13 · see citing works
Sireteanu, R., Oertel, V., Mohr, H. M., et al. (2010) · Journal of Vision · doi:10.1167/8.6.68 · Cited by 8 · see citing works
Flagged first, then by citations
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Sorted by citations
Marwood, L., Wise, T., Perkins, A. M., & Cleare, A. J. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.09.022 · Cited by 251 · see citing works
Neural correlates of psychotherapy in anxiety and depression: a meta-analysis
Messina, I., Sambin, M., Palmieri, A., & Viviani, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0074657 · Cited by 176 · see citing works
Fullana, M. A., Cardoner, N., Alonso, P., Subirà, M., López-Solà, C., Pujol, J., Segalàs, C., Real, E., Bossa, M., Zacur, E., et al. (2014) · Psychological Medicine · doi:10.1017/s0033291713001128 · Cited by 50 · see citing works
Stephenson, C., Philipp-Muller, A., Moghimi, E., Nashed, J. Y., Cook, D. J., Shirazi, A., Milev, R., & Alavi, N. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01852-6 · Cited by 10 · see citing works
- Authors
- Linden, D. E. J.
- Affiliations
- Bangor University (GB)
- Corresponding author
- Linden, David E. J.
- ORCID
- Linden, David E. J.
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2008-11
- Volume
- 258
- Issue
- S5
- Pages
- 71-75
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- OpenAlex
- W2035520183
- Cited by
- 70
- References
- 31
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 10 · 2013: 12 · 2012: 6
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- psychotherapy mechanisms, functional neuroimaging, obsessive-compulsive disorder, anxiety disorders, depression, cognitive behavioral therapy, selective serotonin reuptake inhibitors, phobia, subgenual cingulate, mood regulation, deep brain stimulation, neurofeedback, pharmacotherapy
- MeSH terms
- Mental Disorders, Brain, Diagnostic Imaging, Humans, Models, Biological, Psychotherapy
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