Hi Jackie, I am aware of numerous studies that are mentioned by the National Institutes of Health, which indicate that CBT and Psychotherapy alter neural activity in the frontal lobes, specifically those affecting meta cognitive processing and cognitive control. However this evidence is correlational, as the type of therapy, the skill of therapists, the length of therapy, the type of disorder the patient is being treated for varies and as a result it is difficult to definitely state based on a convergence of evidence that specific therapies have specific results.

I have attached excerpts form my thesis and another document I have busy upon which show results found with Therapy:

"A pivotal finding discussed by the National Institute of Mental Health (NIMH)

(2005) which is mentioned here very briefly, is that PET was used on N=17 patients who were unmedicated patients with Depression, and compared against depressed patients who were on paroxetine (Paxil). Those who were not medicated received CBT of between 15-20 sessions. The findings of the study were that CBT “increased blood flow and metabolic activity in the Hippocampus and Dorsal Cingulate....and decreased activity throughout the Frontal Cortex" (2005, pp 18-19). This is a significant finding as brain areas that were linked to thinking, possibly perseverative cognitions and Meta cognitive processes were reduced whilst brain areas linked to memory, attention and motivation were increased in activity.Though it is attractive to use this as a strategic part of the argument for the effectiveness of CBT and theories relating to Cognitive processes, other factors could have played a role, and

further research needs to duplicate and verify this finding".

"At level one, of the STAR*D Trial, (NIMH, 2006) citalopram (an SSRI antidepressant) was administered for eight weeks and 30% of the sample achieved remission within an 8 – 12 weeks period. Of the 70% who did not achieve remission, psychosocial factors, co-existing medical disorders, anxiety and substance abuse were found to play a role. This outlines the role of other variables which could act as vulnerability factors, or complicate the Depression profile of a patient. At Level two the patients (n=1 439) were provided with two options for treatment. They could choose Cognitive Therapy (CT), (16 sessions in a 12 week period) as a stand- alone treatment, or add another pharmacological treatment whilst continuing to take citalopram, or have CT along with citalopram. It was found that CT, CT with citalopram, and other pharmacological treatments used in conjunction with citalopram were as effective as each other."

In general the evidence indicates a trend that activity within the brain is altered by Therapy. If you need copies of the studies please let me know and I will email them to you, as well as other ones which I have perused with regards to metabolic changes as a result of therapy. Hope this helps!

Thank you Andre ! Your review..."Essentials of psychoanalytic process and change..." is reminiscent of what I have been tossing around in my head for months. I had read several statements to the effect that psychotherapy (Cozolino), specifically psychodynamic, attachment based (Wallin) and relational/experiential in nature, created new neuronal pathways but was having difficulty finding current research and biological imaging evidence. My question began with why does therapy work sometimes and not others? So many explanations fell on client commitment, resistance, etc. but I could not reconcile that there must be differences in the way the motivated client is impacted by the process and/or techniques applied to their situation. Then after hearing a lecture on neuroscience and therapy I looked into Cozolino's and Wallin's writings and began to wonder how most effectively to be with clients in a way that brings lasting change. Thanks for adding to my pool of information as I continue to ask these questions.

van der Kolk has published on increases in size of hypothalamus as a function of EMDR therapy - don't have the reference, but it was some time ago, and he's not the only one who's looked at this specific subject. Reference should be easy to find. Hope that helps.

You can DeRubeis, Siegle & Hollon (2008) in nature.com/reviwes/neuro, is a good opinion article about CBT and later Quide et al (2012) in Neuroscience and Biobehavioral Reviews revised this opinión in their review.

Here's one specific example:

Felmingham, K., Kemp, A., Williams, L., Das, P., Hughes, G., Peduto, A., & Bryant, R. (2007). Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Psychological Science, 18(2), 127-129.

Hi Jackie, I am aware of numerous studies that are mentioned by the National Institutes of Health, which indicate that CBT and Psychotherapy alter neural activity in the frontal lobes, specifically those affecting meta cognitive processing and cognitive control. However this evidence is correlational, as the type of therapy, the skill of therapists, the length of therapy, the type of disorder the patient is being treated for varies and as a result it is difficult to definitely state based on a convergence of evidence that specific therapies have specific results.

I have attached excerpts form my thesis and another document I have busy upon which show results found with Therapy:

"A pivotal finding discussed by the National Institute of Mental Health (NIMH)

(2005) which is mentioned here very briefly, is that PET was used on N=17 patients who were unmedicated patients with Depression, and compared against depressed patients who were on paroxetine (Paxil). Those who were not medicated received CBT of between 15-20 sessions. The findings of the study were that CBT “increased blood flow and metabolic activity in the Hippocampus and Dorsal Cingulate....and decreased activity throughout the Frontal Cortex" (2005, pp 18-19). This is a significant finding as brain areas that were linked to thinking, possibly perseverative cognitions and Meta cognitive processes were reduced whilst brain areas linked to memory, attention and motivation were increased in activity.Though it is attractive to use this as a strategic part of the argument for the effectiveness of CBT and theories relating to Cognitive processes, other factors could have played a role, and

further research needs to duplicate and verify this finding".

"At level one, of the STAR*D Trial, (NIMH, 2006) citalopram (an SSRI antidepressant) was administered for eight weeks and 30% of the sample achieved remission within an 8 – 12 weeks period. Of the 70% who did not achieve remission, psychosocial factors, co-existing medical disorders, anxiety and substance abuse were found to play a role. This outlines the role of other variables which could act as vulnerability factors, or complicate the Depression profile of a patient. At Level two the patients (n=1 439) were provided with two options for treatment. They could choose Cognitive Therapy (CT), (16 sessions in a 12 week period) as a stand- alone treatment, or add another pharmacological treatment whilst continuing to take citalopram, or have CT along with citalopram. It was found that CT, CT with citalopram, and other pharmacological treatments used in conjunction with citalopram were as effective as each other."

In general the evidence indicates a trend that activity within the brain is altered by Therapy. If you need copies of the studies please let me know and I will email them to you, as well as other ones which I have perused with regards to metabolic changes as a result of therapy. Hope this helps!

Tom, Mariantonia, and Cynthia thank you for the references and direction toward EMDR, CBT and PTSD.

Cheryl thank you for all the information! I would love to read the two studies you quoted. I appreciated your statement that, "However this evidence is correlational, as the type of therapy, the skill of therapists, the length of therapy, the type of disorder the patient is being treated for varies and as a result it is difficult to definitely state based on a convergence of evidence that specific therapies have specific results." My question is perhaps then more related to the process' and not the content's (therapies, techniques used) impact on the brain. I wonder if it would be possible to isolate one from the other in such a way to make a definitive conclusion or to determine markers for better pairing individuals, their condition, the therapist, and the techniques or therapies used? Just thinking out loud! Thank you for the information you offered!!

Hi Jackie, there may be different ways to measure it, but this would mean controlling many variables, which could be extremely difficult to do, but might work if perhaps components of a specific therapeutic approach were broken down and correlated to specific processes, with the additional use of imaging technology. The other difficulty is that it would require a case study approach with a convergence of evidence being built up by the collaboration of many Psychologists who would then conduct a case studies, with strict control of variables, and some types of therapy seem to be more difficult to measure than others, take longer to execute etc. Baselines would need to be established with regards to symptomologies, co-existing psychological/physiological disorders, psychosocial factors age gender etc and brain activity and then re tested at the conclusion of therapy. Go to the website of the Meta-cognitive Institute (Dr Adrian Wells), it should pop up easily on the internet, they have some very interesting tests that one can use. Though I am not an expert in therapy it may be possible to establish on a correlational basis which processes are dysfunctional in a specific disorder, i.e., for Depression (some basic ideas related to cognitive and meta-cognitive therapy) one could look at cognitive schemas with regards to positive and negative beliefs about coping styles related to rumination, rumination, metacognitive processes such as I-agent (main schema with regards to self and other representations of self), metacognitive processing, cognitive impairments, and deficits in relation to certain techniques within a type of therapy. One could hypothesize that a specific technique, which alters orienting attentional networks, such as attentional training, assists in diverting resources away from dysfunctional processing, allowing metacognitive processes to alter schemas and coping strategies and this may then alter patterns of activity within the left prefrontal lobe increasing factors such as cognitive control, which will then attenuate activity in the HPA axis. This is a broad sweep and is not as detailed as it should be, but I hope it provides some more help. I will find some articles for you in the next day or so and send them to you, as some are extremely interesting with regards to the relationship between therapy and physiological processes.

PS -An interesting finding I have come across is that Therapy in general alters neurocircuitry and affects brain activity, and that research is now showing a growing trend towards specific therapy types (though we have known for instance that phobias can be effectively treated with behavioural conditioning for a long time)which target specific cognitive processes that are more dominant in certain types of disorders. There are therapies such as the ones I have mentioned and many more.

Hi Cheryl- do you have the full references for the studies you mentioned in the extract from your thesis?

Thanks in advance

Hi Mark, I do have them, but you will have to sift through the NIMH reports a bit to find them. I will send you a message on your profile and attach them for you. They are extremely interesting!!

Brilliant- thank you Cheryl!

See Harper, et al., 2009: On the Neural Basis of EMDR Therapy:

Insights from QEEG Studies at mindspaces.org

Luisa Zaunmüller (http://www.uni-trier.de/?id=11122 (http://www.uni-trier.de/?id=11122) at Trier University has been doing some good work that was presented at the most recent Society f or Psychotherapy Research conference. She is probably worth emailing at [email protected]

The first coming to my mind is the classical work of Nobel laureate Erik Kandel: see for ex.:

Kandel E. R. (2001). Psychotherapy and the Single Synapse: The Impact of Psychiatric Thought on Neurobiological Research, The Journal of Neuropsychiatry and Clinical Neurosciences 2001;13:290-300.

or the review:

Etkin, A., Pittenger, C., Polan, H. J.; Kandel, E. R. (2005).Toward a Neurobiology of Psychotherapy: Basic Science and Clinical Applications, The Journal of Neuropsychiatry and Clinical Neurosciences, 17:145-158.

Also:

Gabbard, G.O. (2000). A neurobiologically informed perspective on psychotherapy, The British Journal of Psychiatry (2000), 177: 117-122.

or:

Fuchs, T. (2004). Neurobiology and psychotherapy: an emerging dialogue, Current Opinion in Psychiatry, 17(6):479-485.

As a holistic theory, Alfred Adler's Individual Psychology implies that an individual's unconscious, fictional final goal (acting almost like a hologram) influences every cell in the body. In Classical Adlerian Depth Psychotherapy, ideally, we encourage the client to recognize, modify, or even dissolve this goal. If and when this happens, the client usually experiences a host of subtle, somatic changes. This is a clinical impression, based on forty years of psychotherapy practice. However, .I cannot point to any traditional research to support this impression. For more information about Adler's holistic approach, visit www.Adlerian.us.

I thought you might have an interest in the article I just published:

Moss, R. A. (2013). Psychotherapy and the brain: The dimensional systems model and clinical biopsychology. Journal of Mind and Behavior, 34, 63-89.

It is based on a cortical columnar model and explains pscyhotherapy integration based on the model. There was a 2007 article on negative emotional meoires as related to the applied clinical biospcyhology model. I have just posted these on RG today. I hope you find these interesting.

To all who have contributed to this discussion...thank you for your references and shared resources. I am feverishly trying to catch up!