Brain imaging and psychotherapy: methodological considerations and practical implications



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.


psychotherapy neuroimaging  phobia depression hypnosis 


Conflict of interest statement

The author has received honoraria for a book chapter by the Schattauer Verlag.


  1. 1.
    Bandura A, Adams N, Beyer J (1977) Cognitive processes mediating behavioral change. J Pers Soc Psychol 35:125–139PubMedCrossRefGoogle Scholar
  2. 2.
    Baxter LJ, Schwartz J, Bergman K, Szuba M, Guze B, Mazziotta J, Alazraki A, Selin C, Ferng H, Munford P (1992) Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry 49:681–689PubMedGoogle Scholar
  3. 3.
    Beutel M, Huber M (2008) Can it contribute to our understanding of processes of change? Neuropsychoanalysis (in press)Google Scholar
  4. 4.
    Beyer J, Krishnan K (2002) Volumetric brain imaging findings in mood disorders. Bipolar Disord 4:89–104PubMedCrossRefGoogle Scholar
  5. 5.
    de Charms R (2007) Reading and controlling human brain activation using real-time functional magnetic resonance imaging. Trends Cogn Sci 11:473–481CrossRefGoogle Scholar
  6. 6.
    de Charms R, Maeda F, Glover G, Ludlow D, Pauly J, Soneji D, Gabrieli J, Mackey S (2005) Control over brain activation and pain learned by using real-time functional MRI. Proc Natl Acad Sci U S A 102:18626–18631CrossRefGoogle Scholar
  7. 7.
    DeFelipe J (2006) Brain plasticity and mental processes: Cajal again. Nat Rev Neurosci 7:811–817PubMedCrossRefGoogle Scholar
  8. 8.
    Dierks T, Linden D, Jandl M, Formisano E, Goebel R, Lanfermann H, Singer W (1999) Activation of Heschl’s gyrus during auditory hallucinations. Neuron 22:615–621PubMedCrossRefGoogle Scholar
  9. 9.
    Dilger S, Straube T, Mentzel H, Fitzek C, Reichenbach J, Hecht H, Krieschel S, Gutberlet I, Miltner W (2003) Brain activation to phobia-related pictures in spider phobic humans: an event-related functional magnetic resonance imaging study. Neurosci Lett 348:29–32PubMedCrossRefGoogle Scholar
  10. 10.
    Drevets W, Gadde K, Krishnan K (2004) Neuroimaging studies of mood disorders. In: Charney D, Nestler E (eds) Neurobiology of mental illness. University Press, Oxford, pp 461–490Google Scholar
  11. 11.
    Drevets W, Price J, Simpson JJ, Todd R, Reich T, Vannier M, Raichle M (1997) Subgenual prefrontal cortex abnormalities in mood disorders. Nature 386:824–827PubMedCrossRefGoogle Scholar
  12. 12.
    Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Långström B, Fredrikson M (2002) Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry 59:425–433PubMedCrossRefGoogle Scholar
  13. 13.
    Goldapple K, Segal Z, Garson C, Lau M, Bieling P, Kennedy S, Mayberg H (2004) Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry 61:34–41PubMedCrossRefGoogle Scholar
  14. 14.
    Hofbauer R, Rainville P, Duncan G, Bushnell M (2001) Cortical representation of the sensory dimension of pain. J Neurophysiol 86:402–411PubMedGoogle Scholar
  15. 15.
    Hoffman R, Hawkins K, Gueorguieva R, Boutros N, Rachid F, Carroll K, Krystal J (2003) Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations. Arch Gen Psychiatry 60:49–56PubMedCrossRefGoogle Scholar
  16. 16.
    Jandl M, Steyer J, Weber M, Linden D, Rothmeier J, Maurer K, Kaschka W (2006) Treating auditory hallucinations by transcranial magnetic stimulation: a randomized controlled cross-over trial. Neuropsychobiology 53:63–69PubMedCrossRefGoogle Scholar
  17. 17.
    Kennedy S, Konarski J, Segal Z, Lau M, Bieling P, McIntyre R, Mayberg H (2007) Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial. Am J Psychiatry 164:778–788PubMedCrossRefGoogle Scholar
  18. 18.
    Linden D (2008) Changing the mind, changing the brain. Neuropsychoanalysis (in press)Google Scholar
  19. 19.
    Linden D (2006) How psychotherapy changes the brain-the contribution of functional neuroimaging. Mol Psychiatry 11:528–538PubMedCrossRefGoogle Scholar
  20. 20.
    Mayberg H, Lozano A, Voon V, McNeely H, Seminowicz D, Hamani C, Schwalb J, Kennedy S (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45:651–660PubMedCrossRefGoogle Scholar
  21. 21.
    Paquette V, Lévesque J, Mensour B, Leroux J, Beaudoin G, Bourgouin P, Beauregard M (2003) “Change the mind and you change the brain”: effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage 18:401–409PubMedCrossRefGoogle Scholar
  22. 22.
    Rainville P, Duncan G, Price D, Carrier B, Bushnell M (1997) Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 277:968–971PubMedCrossRefGoogle Scholar
  23. 23.
    Röder C, Michal M, Overbeck G, van de Ven V, Linden D (2007) Pain response in depersonalization: a functional imaging study using hypnosis in healthy subjects. Psychother Psychosom 76:115–121PubMedCrossRefGoogle Scholar
  24. 24.
    Schienle A, Schäfer A, Hermann A, Rohrmann S, Vaitl D (2007) Symptom provocation and reduction in patients suffering from spider phobia: an fMRI study on exposure therapy. Eur Arch Psychiatry Clin Neurosci 257:486–493PubMedCrossRefGoogle Scholar
  25. 25.
    Shapira N, Liu Y, He A, Bradley M, Lessig M, James G, Stein D, Lang P, Goodman W (2003) Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry 54:751–756PubMedCrossRefGoogle Scholar
  26. 26.
    Sireteanu R, Oertel V, Mohr H, Haenschel C, Linden D, Maurer K, Singer W, Schwarz M (2008) Graphical illustration and functional neuroimaging of visual hallucinations during prolonged blindfolding: a comparison to visual imagery. J Vision 8:68aCrossRefGoogle Scholar
  27. 27.
    Straube T, Glauer M, Dilger S, Mentzel H, Miltner W (2006) Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage 29:125–135PubMedCrossRefGoogle Scholar
  28. 28.
    Weiskopf N, Sitaram R, Josephs O, Veit R, Scharnowski F, Goebel R, Birbaumer N, Deichmann R, Mathiak K (2007) Real-time functional magnetic resonance imaging: methods and applications. Magn Reson Imaging 25:989–1003PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.School of Psychology and North Wales Clinical SchoolBangor UniversityBangorWales, UK

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