Does Therapy Change the Brain?

Magnetic resonance imaging (MRI) and other scanning tools have been widely used in recent years in the research on mental health and psychotherapy. Studies have provided evidence of unique prefrontal cortex (PFC) and limbic networks in people with various psychological conditions. Further examination has been able to show progression of neurological changes that occur with certain mental health issues. But what has not been explored fully is the effect of therapy on these neurological constructs.

Therapy is often the first line of treatment for mental health problems such as depression, anxiety, posttraumatic stress, and phobias. However, until now, there has been no comprehensive analysis of how therapy affects specific regions of the brain involved in these conditions. To that end, Irene Messina of the Department of Philosophy, Sociology, Education, and Applied Psychology at the University of Padua in Italy recently analyzed 16 separate studies representing 193 participants.

She used meta-analysis on several subsets of data and was only able to provide partially consistent results. When she looked at anxiety and depression, Messina discovered that therapy had an influence on transforming areas of the PFC and also the posterior cingulated gyrus and precuneus regions, all areas involved in emotion processing and emotion regulation. When she looked at phobia, Messina found that some of the same neurological areas were affected by therapy; however, the data could have included responses to stimuli used during the studies.

Unfortunately, Messina was not able to detect any broad similarities in therapy effects. Although the impact of depression and anxiety therapy did appear to have small similarities across studies, it was still not significant or similar enough to be considered conclusive evidence. This is surprising because the PFC is directly involved in emotion control, working memory and attention, all domains that are positively influenced by therapy.

Messina suggests these results be interpreted in light of the fact that medication was not controlled for and could play a critical role in neurological changes. Further, only specific areas of the brain were examined in this analysis. She added, “Other cerebral and mental mechanisms may be involved, such as semantic processes, but more studies are required in order to clarify the influence of these less studied mechanisms on psychotherapy.”

Messina, I., Sambin, M., Palmieri, A., Viviani, R. (2013). Neural correlates of psychotherapy in anxiety and depression: A meta-analysis. PLoS ONE 8(9): e74657. doi:10.1371/journal.pone.0074657

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