Psychobiology of

Psychotherapy

Presenter : Sarin Dominic Chairperson : Mr. M. A. Tripathi

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 Outline of the presentation
● Psychobiological perspective of psychotherapy

● Neurobiological correlates of theoretical foundation of

psychotherapy

● Researches on neurobiological changes in psychotherapy

● Towards neuropsychotherapy. An evaluation

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 Introduction
● Psychotherapy can have the most profound influence on a
person’s belief system, emotional state and behavior, and it
is perhaps therefore not surprising that it may also lead to
significant structural and functional changes in the brain
(Kandel, 1998).

● With growing sophistication in its methods, neuroscience

has started to identify neural correlates not only of mental
disorders but also of therapeutic changes.

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● These developments point the way towards a new era of
psychotherapy research and practice in which specific
modes of psychotherapy can be designed to target specific
sites of brain functioning.

● These researches also facilitated in identifying neural

correlates of psychotherapeutic principles, which
contribute to further development of theory of
psychotherapy.

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 Key words
● Psychobiology: The branch of science dealing with the
biological basis of behavioral and mental phenomena. (Oxford
Dictionary)

● Psychotherapy: Psychotherapy is the treatment, by

psychological means, of problems of an emotional nature in
which a trained person deliberately establishes a professional
relationship with the patient with the object of removing,
modifying, or retarding existing symptoms, mediating
disturbed patterns of behavior, and promoting positive
personality growth and development. (Wolberg, 1988)
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 Psychobiological perspective. What it is?

● Cartesian dualism - psychotherapy is a treatment for

`psychologically based' disorders, while `biologically
based' disorders should be treated with medication.

● What we call `mind' can be understood as the activity of

the brain (Andreasen, 1997).

● Mental phenomena arise from the brain, but subjective

experience also affects the brain.

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● Development of the functional neuroimaging techniques
over the past two decades, allow us to follow the changing
pattern of brain metabolism or activation over the course
of a psychological intervention.

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 Why psychobiological perspective?
● Provides insight into the neural basis of psychological
recovery
● Provides an objective means of monitoring the progress
and outcome of psychotherapy
● Inform the development of new biologically informed
treatments.
● Inform the choice of parallel pharmacotherapy

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 Environmental impact on gene
expression
● The learning process that occurs in psychotherapy may
produce alterations of gene expression and thereby alter
the strength of synaptic connections. (Gabbard, 2000)

● The study of the plasticity of the brain has shown that once
genes are activated by cellular developmental processes,
the rate at which those genes are expressed is highly
regulated by environmental signals throughout life.

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 Neuroplasticity and memory
● Growth and differentiation of the brain are not only
determined genetically, but also by its continuous
interaction with the environment.

● There is a life-long re-mapping of cortical networks

according to the individual experience, including the
generation of neurones in the adult hippocampus

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● Neuroplasticity is a prerequisite for any enduring change in
behavior,cognition, and emotion, which is the focus of
psychotherapy.

● In order to produce lasting effects, psychotherapy should

arrive at restructuring neural networks, particularly in the
subcortical-limbic system which is responsible for
unconscious emotional motivations and dispositions.

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● Process of psychotherapy always involves self directed
neuroplasticity. It is the conscious voluntary directing of
attention and practice with voluntary behaviours.

● It can can be produce durable biological changes in the

brain (Herman, 2010)

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● Psychotherapy is a new attachment relationship which is
able to restructure attachment-related implicit procedural
memory (Amini et al, 1996)

● Implicit memory system contains stored patterns of bodily

and emotional interaction which are prereflectively activated
by subtle situational cues (e.g. facial expressions, gestures,
undertones, atmospheres), it is crucial for the patient’s
relationships as well as for the therapeutic process.

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 Attachment, relational changes
and the brain
● The ‘biological turn’ of psychology has also drawn renewed
attention to John Bowlby’s attachment theory of social
bonding.

● There is growing evidence that the attachment system is a

central organizing system in the brain of higher social
mammals, allowing infants to use their parents for regulating
their inner states until their own psychoneurobiologic
functions become mature and autonomous.

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● Developing nervous system consists of ‘open homeostatic
loops’ which require external regulation or ‘tuning’ from
others

● Attachment deficits may result in disorganized behavioral

repertoires, as well as an impaired physiologic capacity for
self-regulation of stress and affects.

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● Perception of one's place in a relationship may influence
the activity of neurotransmitters and their effect on the
brain.(Gabbard, 2000)

● Alterations in relationships have been shown to produce

lasting biochemical changes. (Suomi, 1991)

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 Mirror neurons and empathy
● Mirror neurons discharge both when an action is
performed and when a similar action is observed in
another individual.

● They represent a system that matches intentional behavior

of others to one’s own action experience, and in this way
they form a link of mutual understanding through bodily
simulation or resonance.

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 Researches on neurobiological changes in
Psychotherapies
● A number of neuroimaging techniques has allows the non-
invasive investigation of the neuro-plastic change
associated with psychotherapeutic treatment.

● These techniques include magnetic resonance imaging

(MRI), positron emission tomography (PET) and single
photon emission computed tomography (SPECT).

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● Barsaglini et al (2013) conducted a systematic review on
the effects of psychotherapy on brain function.
● They examined imaging studies on various psychiatric
disorders including obsessive-compulsive disorder, panic
disorder, unipolar major depressive disorder, posttraumatic
stress disorder, specific phobia and schizophrenia.
● Neurobiological changes before and after psychotherapy
were studied upon.

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 Questions of research interest included
● Are neurobiological changes which follow psychotherapy
located in the same or different regions to the ones which
showed altered function before treatment?

● Are these neurobiological changes similar or different to those

which follow pharmacological treatment?

● Could neurobiological changes provide an objective means of

monitoring the progress and outcome of psycho-therapy?

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Obsessive Compulsive Disorder

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Panic Disorder

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Depression

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Post Traumatic Stress Disorder

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Specific Phobia

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Schizophrenia

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The evidence reviewed indicated that

● Depending on the disorder under investigation,

psychotherapy results in either a normalisation of
abnormal patterns of activity, the recruitment of additional
areas which did not show altered activation prior to
treatment, or a combination of the two

● The effects of psychotherapy on brain function are

comparable to those of medication for some but not all
disorders

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● There is preliminary evidence that neurobiological changes
are associated with the progress and outcome of
psychotherapy

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● Beutel et. al. (2010)
(2010 conducted an Fmri study on changes in
brain activation pre-post short-term psychodynamic
inpatient psychotherapy on panic disorder patients.

● Responses to panic-specific negative words were compared

with linguistically matched positive and neutral words.

● According to hypotheses, patients rated affective words

more strongly than controls and selectively recalled
negative vs. positive/neutral words.

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● Before treatment, high limbic (hippocampus and amygdala)
activation was accompanied by low prefrontal activation to
negative words.

● Inhibition-related activation patterns indicated difficulties

of behavioural regulation in emotional context.

● At treatment termination, panic-related symptoms had

improved significantly, and fronto-limbic activation
patterns were normalized.

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● Fonzo et al. (2014) conducted a study on cognitive-
behavioural therapy on Generalized Anxiety Disorder and its
association with attenuation of limbic activity to threat-related
facial emotions

● Responses to threat-related emotionality (i.e., the contrast of

fear and angry vs. happy faces) were assessed at pretreatment
and again following 10 sessions of CBT in the GAD group and
a comparable waiting period in the control group.

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● At pretreatment, GAD participants displayed blunted
responses in the amygdala, insula, and anterior cingulate to
the happy face-processing comparison condition, and greater
amygdalo–insular connectivity.

● CBT was associated with attenuated amygdalar and subgenual

anterior cingulate activation to fear/angry faces and
heightened insular responses to the happy face comparison
condition, but had no apparent effects on connectivity.

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● Kumari et al. (2009) conducted a research on
Responsiveness to Cognitive Behavioural Therapy in
Schizophrenia

● Stronger dorsolateral prefrontal cortex (DLPFC) activity

(within the normal range) and DLPFC–cerebellum
connectivity during the highest memory load condition
were associated with post-CBT clinical improvement.

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● Seminowicz et al. (2013) investigated Grey matter changes
after cognitive-behavioral therapy (CBT) in patients with
chronic pain.

● Decreased pain catastrophizing was associated with

increased grey matter in the left dorsolateral prefrontal and
ventrolateral prefrontal cortices, right posterior parietal
cortex, somatosensory cortex, and pregenual anterior
cingulate cortex.

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● Yann et. Al (2012) conducted a systematic review on differrences
between effects of psychological versus pharmacological
treatments on functional and morphological brain alterations in
anxiety and major depressive disorder.

● Results suggested a functional normalization of the ‘fear network’.

● Pharmacotherapy particularly decreases over-activity of limbic

structures (bottom-up effect) while psychotherapy tends to
increase activity and recruitment of frontal areas (top-down
effect), especially the anterior cingulate cortex.

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Evaluating psychobiological approach
towards psychotherapy

● Methodological limitations of the neurobiological approach

● Incompatibility of first and third person approaches

● De-stigmatization versus de-personalization

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 Conclusion
● The studies of brain changes caused by psychotherapy are
still preliminary and require further replication.
● The action mechanisms of psychotherapy at the neural
level are largely speculative at this stage.
● Concludingly owing to the translating function and
plasticity of the brain, psychotherapy works by changing
minds and neural networks at the same time.

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● Further researches in the future with better biomarkers will
throw light into the specific mechanisms of brain
dysfunction, which help in understanding role of
psychotherapy and can result in development of
neurobiologically informed psychotherapies.

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 References
Barsaglini , A. et al.(2014). The effects of psychotherapy on
brain function: a systematic and critical review. Progress in
Neurobiology. 114:1-14.
Fuchs, T. (2004). Neurobiology and psychotherapy: an emerging
dialogue, Current Opinion in Psychiatry. 17:479–485.
Glen, G., (2000). A neurobiologically informed perspective on
psychotherapy, British Journal of Psychiatry. 177: 117-122.
Linden, D. (2008). Brain imaging and psychotherapy:
methodological considerations and practical implications,
Journal of Clinical Neuroscience. 258: 71–75.

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 References
Samardžić, L. (2013). Neurobiology of Psychotherpeutic
Relationship‐ New Perspectives, Scientific Journal of the
Faculty of Medicine in Niš. 30(2): 55-61.
Seminowicz D. et al. (2013). Cognitive-Behavioral Therapy
Increases Prefrontal Cortex Gray Matter in Patients With
Chronic Pain, The Journal of Pain. 14(12): 73-84.
Yann D et. al. (2012). Differences between effects of
psychological versus pharmacological treatments on functional
and morphological brain alterations in anxiety disorders and
major depressive disorder: A systematic review, Neuroscience
& Biobehavioral Reviews. 36 (1): 626-644.

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THANK YOU

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