Talking therapy changes the brain

Researchers from Massachusetts General Hospital (MGH) have identified changes in the metabolic activity of a key brain region in patients successfully treated for depression with psychodynamic psychotherapy – talking therapy.

The study involved 16 patients with major depression who were offered weekly psychodynamic psychotherapy sessions. Each of the participants had unsuccessfully tried treatment for their depression with medication. Nine of the patients completed the course of psychotherapy and ‘almost all’ reported a greater than 50% reduction in their depression.

The study participants had a range of tests before and after treatment, including PET scans and an assessment of their depression symptoms. They also received a standardised test of their psychological mindedness before the treatment.

The results were very interesting. The initial scans showed that metabolic activity of the right insula was higher in participants with more severe depression symptoms. This is an area of the brain that is associated with emotional regulation and that has been linked to depression. Those participants who reported a reduction in their depressive symptoms showed a reduction in metabolic activity in the right insula; this was also associated with an increase in their psychological insight.

In a way, it is not surprising that psychological changes are matched by changes in brain activity. We would hardly expect it to be otherwise. And we do not need brain scans to demonstrate the effectiveness of psychodynamic psychotherapy – ‘almost all’ the nine participants told the researchers that they felt better after this treatment. It may also be simplistic to associate attributes such as psychological mindedness to specific areas of the brain. Nonetheless, it is still good to have a demonstration, even by such a small study, that talking changes brains.

The study had one further, intriguing finding in that metabolic differences were also found in the pre-treatment scans between participants who completed the treatment and those who dropped out. A higher level of activity in the right precuneus was seen in those who stayed in treatment. The right precuneus has been associated with memory and self awareness.

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