The impact of psychotherapy on the brain

In the past, psychotherapy was often regarded as the treatment for 'psychologically based' disorders, while pharmacotherapy was prescribed for disorders that were considered to be 'biologically based.' This distinction is rapidly becoming obsolete with advances in imaging techniques that demonstrate how psychotherapy alters the brain.(23,24*

Both behaviour therapy and fluoxetine appear to produce similar decreases in cerebral metabolic rates in the head of the right caudate nucleus when used in the treatment of obsessive-compulsive disorder.(25) The local cerebral metabolic rates for glucose can be measured using positron emission tomography methodology, and they are found to have the same response in reaction to the two different treatments.

A Finnish study(26* suggested that psychodynamic therapy may have a significant impact on the neurotransmitter serotonin. At the beginning of a 1-year psychotherapy process, single-photon emission CT (SPECT) imaging was undertaken with a 25-year-old man suffering from personality disorder and depression. Another man with similar problems also underwent imaging but did not receive psychotherapy or any other treatment.

Initial SPECT imaging showed that both patients had markedly reduced serotonin uptake in the medial prefrontal area and the thalamus compared with 10 healthy control subjects. After 1 year of psychodynamic therapy, repeat SPECT imaging showed that the patient who received the psychotherapy had normal serotonin uptake, while the control patient who did not receive psychotherapy continued to have markedly reduced serotonin uptake. Since the patient who received psychotherapy did not take medication in conjunction with the therapy, the findings suggest that the dynamic therapy itself may have normalized the serotonin metabolism. These preliminary data, as well as many other studies that do not use imaging techniques but nevertheless show results with psychotherapy that are comparable to medication, make a case for psychotherapy as an intervention that is just as 'medical' as pharmacotherapy. The brain responds to words as well as to chemicals.

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