Harvard Mental Health Letter

Your brain and psychotherapy

Are there consistent underlying features of therapeutic change?

Early in his career, Sigmund Freud conceived what he called a project for a scientific psychology, linking an understanding of the mind to an understanding of the brain and its functions. He soon abandoned the effort because he realized that too little evidence was available. But psychotherapists know that psychiatric disorders always involve activity in the brain. In this era of psychopharmacology, brain imaging, and therapeutic electrical and magnetic stimulation of the brain, scientists are beginning to get some glimpses of what that activity might be.

One source of those insights is the use of positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other scanning techniques to see how psychotherapy itself affects the brain. The findings to date — preliminary and often conflicting — usually involve two brain regions: the limbic system, a center for the integration of memory and emotion; and the prefrontal cortex, which supplies the capacity for long-term planning, judgment, and self-control.

Studies have concentrated on three disorders:

Phobias. When a person with performance anxiety has to give a speech or a person who fears snakes is confronted with one, brain scans show rising blood flow and energy consumption in the amygdala, a center for fear and anger, and sometimes in the insula, a region that registers disgust and pain. Treatment with either cognitive behavioral therapy or an antidepressant lowers this activity. Treatment also seems to cause changes in several parts of the prefrontal cortex, and in this case the effects of medication and psychotherapy may be different.

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