October 24, 2004
Effects of Psychotherapy on the Brain

Some of the following information is taken from “The emerging dialogue between psychoanalysis and neuroscience: neuroimaging perspectives” by Manfred Beutel, Emily Stern and David Silbersweig (2003?), Journal of the American Psychoanalytic Association, 51/3, 773-801.

The successful rehabilitation of affect/emotion as a crucial focus of investigation due to the experimental work of LeDoux and others on the neural pathways of fear and anxiety has increased the relevance of neuroscience to psychoanalysis.

Eric Kandel postulated that as learning has a measurable impact on the brain, so successful psychotherapy is also likely to lead to neural changes.

Psychotherapy and the Brain

Neural plasticity has been demonstrated in the human brain in somatosensory systems, the motor cortex, higher cortical functions including language, as well as in affective pathways.

Psychotherapy can be surmised to lead to better modulation of potentially indeletable neuronal response patterns at the level of the limbic system by higher cortical (heteromodal association) centers.  Basic relational schemata and expectations are likely to be stored in implicit memory systems and changing the connections and characteristics of brain pathways underlying implicitly stored experiences associated with affect states and interpersonal relationships is likely to involve considerable amounts of time and effort..  Phylogenetically old systems of emotional appraisal are connected to neocortical linguistic function, which may be a precursor for gaining access to those levels of emotional evaluation by verbal exchange.

The most frequently cited studies on changes of brain function following psychotherapy has been done by Baxter et al (1992) and repeated by the same group (Schwartz et al 1996).  OCD patients were compared on an SSRI (Prozac) or a CBT approach. PET scans were performed pre-and post-treatment (at a ten week interval).  According to this group, OCD consists of a self-reinforcing loop between orbitofrontal cortex, caudate nucleus, and thalamus which is difficult to interrupt.  Consistent with their theory, both treatments led to metabolic decreases in the head of the right caudate nucleus and orbitofrontal cortex.

A PET study by Brody et al (2001) with severely depressed patients showed normalization after 12 weeks of treatment of neural metabolic abnormalities in patients treated either with an SSRI (Paxil) or with interpersonal psychotherapy.

In another PET study, Furmark et al (2002) demonstrated significant reductions in activity in the amygdala, hippocampus and adjacent neural areas in anxious patients treated either with CBT or citalopram.

Viinamäki et al (1998) demonstrated normalization of serotonin uptake in a patient with borderline personality disorder treated with psychodynamic psychotherapy.

All of these studies used control patients.

Eventually, I hope to organize a research study at NYU in which patients with a schizophrenic disorder will be given a fMRI pre- and post-treatment-the latter being psychodynamically informed psychotherapy.  I predict a trend towards normalization of temperofrontal cortical activity, particularly in the amygdala, hippocampus and adjacent neural regions.  In particular, I anticipate a reversal of any hypofrontality and an attenuation of activity in limbic areas.  A further prediction (one in which simple neuropsychological measures will be used) is that with a reduction in anxiety and fear, neurocognitive functioning will improve, in particular, but not limited to, attention/concentration and working memory.


Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net