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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.
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“Existent literature has suggested that CBT may alter brain functional connectivity (FC) in depression (McGrath et al. 2013), phobia, obsessive‐compulsive disorder (Linden 2006), and pain conditions (Bao et al. 2022), although findings remain inconsistent.”
In the citing paper
“Existent literature has suggested that CBT may alter brain functional connectivity (FC) in depression (McGrath et al. 2013), phobia, obsessive‐compulsive disorder (Linden 2006), and pain conditions (Bao et al. 2022), although findings remain inconsistent.”
In the citing paper
“fMRI studies have shown that both depression and anxiety are associated with hyperactivity of amygdala 62.”
From Neurobiology of resilience (2012) · cites this paper as [62]
In the citing paper
“These effects are well documented to reverse hyperactivity of PFC–amygdala microcircuits shown to be overactive in PTSD (for review see62).”
From Neurobiology of resilience (2012) · cites this paper as [62]
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Metadata
- Authors
- Linden, D. E. J.
- Affiliations
- Bangor University (GB)
- Corresponding author
- Linden, D E J
- ORCID
- Linden, D E J
- Venue
- Molecular Psychiatry
- Published
- 2006-03-07
- Volume
- 11
- Issue
- 6
- Pages
- 528-538
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- OpenAlex
- W2167882471
- Cited by
- 491
- References
- 80
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 17 · 2023: 14 · 2022: 13 · 2021: 63 · 2020: 14 · 2019: 17 · 2018: 17 · 2017: 23 · 2016: 26 · 2015: 33 · 2014: 31 · 2013: 44 · 2012: 38
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- psychotherapy, functional neuroimaging, cognitive behavioral therapy, obsessive-compulsive disorder, phobia, caudate nucleus, limbic system, selective serotonin reuptake inhibitors, pharmacotherapy, anxiety disorders, depression, treatment monitoring, hypnosis, neurofeedback
- MeSH terms
- Anxiety Disorders, Mental Disorders, Brain Mapping, Depression, Humans, Magnetic Resonance Imaging, Obsessive-Compulsive Disorder, Phobic Disorders, Psychotherapy, Cognitive Behavioral Therapy, Selective Serotonin Reuptake Inhibitors, Feedback, Psychological
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