Zusammenfassung
Die Untersuchung neurobiologischer Grundlagen von psychotherapeutischen Interventionen hat in den letzten Jahren an Bedeutung gewonnen. Therapieassoziierte funktionelle Veränderungen wurden in einer Reihe psychiatrischer Erkrankungen untersucht. Dabei konnte gezeigt werden, dass bei Erkrankungen, bei denen Emotionen eine zentrale Rolle spielen (u. a. Depressionen, Angsterkrankungen, Borderline-Persönlichkeitsstörung), häufig Dysfunktionen in den Hirnregionen auftreten, die mit der Regulierung von Emotionen assoziiert werden. Psychotherapeutische Interventionen können zu einer Art „Normalisierung“ der neuronalen Aktivität in diesen Bereiche führen (z. B. Amygdala, ventromedialer präfrontaler Kortex, anteriorer zingulärer Kortex, orbitofrontaler Kortex). Daneben zeigte sich eine therapiebedingte Anpassung der neuronalen Reaktionen auch in Bereichen, die für Aufmerksamkeitsprozesse und die visuelle Wahrnehmung relevant sind. Andere Studien hatten zum Ziel, neurobiologische Parameter zu finden, die dazu genutzt werden können, den therapeutischen Erfolg vorherzusagen bzw. die Wahl zwischen verschiedenen therapeutischen Strategien zu vereinfachen. Bei der Depression spielen beispielsweise die Amygdala und der anteriore zinguläre Kortex eine herausragende Rolle. Insgesamt ist das Wissen über neurobiologischen Grundlagen von psychotherapeutischen Interventionen noch unzureichend. Eine relativ geringe Zahl an Studien und methodische Probleme (u. a. kleine Stichproben, unzureichende Kontrollbedingungen, große Variabilität der verwendeten Verfahren) erschweren es, zuverlässige Aussagen zu treffen.
Abstract
In the last few years the investigation of the neurobiological basis of psychotherapeutic treatments has gained importance. Therapy-associated functional changes have been studied in a number of different psychiatric diseases. It has been shown that diseases with a central role of emotions (e.g. depression, anxiety disorders, borderline personality disorder) often demonstrate dysfunctions in brain areas that are linked to emotional regulation. Psychotherapeutic interventions can lead to a kind of normalization of brain responses in these areas (e.g. amygdala, ventromedial prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex). In addition, therapy-associated transformations were also demonstrated in areas which are related to attention processes and visual perception. Other studies have aimed at finding neurobiological parameters that can be used to predict a therapeutic outcome or to choose between various therapeutic strategies. For instance, in depression, the amygdala and the anterior cingulate cortex are assumed to play a major role. Altogether, knowledge on the neurobiological basis of psychotherapeutic procedures is limited. A comparatively small number of studies and several methodological problems (e.g. small sample sizes, insufficient control groups, variability of methods used) make it difficult to propose reliable statements.
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Karch, S., Heinzel, S., Pogarell, O. et al. Neurobiologische Grundlagen psychotherapeutischer Verfahren. Psychotherapeut 57, 204–212 (2012). https://doi.org/10.1007/s00278-012-0902-3
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DOI: https://doi.org/10.1007/s00278-012-0902-3