Table 1.
Neuroimaging studies of psychotherapy
| Study | Therapy | Imaging | Results |
|---|---|---|---|
| Depression
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| MRI
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| Buchheim 2012 (MDD) | PSY, 15mo | fMRI, pre, post | Attachment picture with personal sentence task showed decreased activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex post-tx |
| Costafreda 2009 (MDD) | CBT, 16wk | sMRI, pre | Predictor: no predictor of response to CBT tx |
| Dichter 2009 (MDD) | BAT, 8–14wk | fMRI, pre, post | Reward processing task showed changes in paracingulate gyrus, orbitofrontal gyrus, and caudate post-tx |
| Dichter 2010 (MDD) | BAT, 8–14wk | fMRI, pre, post | Cognitive control emotion processing task showed decreased activation in paracingulate gyrus, orbitofrontal cortex, and frontal pole post-tx; predictor: activation in paracingulate gyrus pre-tx predicted response to tx |
| Forbes 2010 (MDD) | CBT, 8wk | fMRI, pre | Predictors: during reward processing task, increased striatal activity during reward anticipation predicted lower level of anxiety symptoms post-tx; increased striatal activity during reward outcome predicted better clinical severity post-tx |
| Fu 2008 (MDD) | CBT, 16s | fMRI, pre, post | Sad facial processing task showed decreased amygdala and increased dorsal anterior cingulate activity post-tx. Predictor: increased dorsal anterior cingulate activity at baseline predicted greater improvement post-tx |
| Lehto 2008a (AtD, NAtD) | PSY, 12mo | SPECT, pre, post | Midbrain serotonin transporter density increased post-tx in AtD; striatum dopamine transporter density did not change post-tx |
| Lehto 2008b (MDD, DD) | PSY, 1yr | SPECT, pre, post | Midbrain serotonin and striatum dopamine transporter binding did not change post-tx |
| Mackin 2013 (LLD) | PST, 12wk | sMRI, during tx | Nonresponders showed decreased cortical thickness in multiple regions in comparison with tx responders |
| Ritchey 2011 (MDD) | CBT, 30wk | fMRI, pre, post | Predictors: emotion processing tasks at baseline showed that increased activation in ventromedial prefrontal cortex (overall contrast), and in left anterior temporal lobe/ventrolateral prefrontal and right dorsolateral prefrontal cortices (negative versus positive emotion contrast), predicted greater improvement post-tx |
| Siegle 2006 (MDD) | CBT, 12wk | fMRI, pre | Predictor: during negative word emotion task, lower subgenual cingulate and higher right amygdala activity predicted better response to tx |
| Siegle 2012 (MDD) | CBT, 16–20s | fMRI, pre, post | Predictor: during negative word emotion task at baseline, lower subgenual anterior cingulate activation predicted better response to tx |
| Yoshimura 2013 (MDD) | CBT, 12wk | fMRI, pre, post | Self-referential processing task showed increased activation for positive stimuli |
| or decreased activation for negative stimuli in the medial prefrontal and ventral anterior cingulate cortices | |||
| PET
|
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| Brody 2001a (MDD) (B, F, K, L, R) | IPT, 12wk | PET-FDG, pre, post | Resting metabolism in right prefrontal cortex and left anterior cingulate gyrus decreased post-tx; in left temporal lobe resting metabolism increased post-tx |
| Brody 2001b (MDD) (R) | IPT, 12wk | PET-FDG, pre, post | Resting metabolism in ventral frontal lobe, ventral anterior cingulate gyrus, and anterior insula decreased with improved mood; in dorsolateral prefrontal cortex resting metabolism increased with improved cognition |
| Goldapple 2004 (MDD) (B,F,K,L,R) | CBT,15–20s | PET-FDG, pre, post | Resting metabolism increased in hippocampus and dorsal cingulate and decreased in dorsal, medial, and ventral frontal cortex post-tx |
| Hirvonen 2011 (MDD) | PSY, 16wk | PET, pre, post | Dopamine receptor binding did not change in striatum or thalamus post-tx |
| Karlsson 2010 (MDD) | PSY, 16wk | PET, pre, post | Serotonin receptor binding increased post-tx |
| Kennedy 2007 (MDD) | CBT, 16wk | PET-FDG, pre, post | Resting metabolism decreased in bilateral lateral orbitofrontal, left dorsomedial prefrontal, posterior cingulate, and right thalamus; increased in subgenual cingulate, right inferior occipital and occipital-temporal, and left inferior temporal regions post-tx |
| Konarski 2009 (MDD) | CBT, 16wk | PET-FDG, pre | Predictor: increased resting metabolism in the pregenual/subgenual anterior cingulate region predicted nonresponse to tx |
| McGrath 2013 (MDD) | CBT, 12wk | PET-FDG, pre | Predictors: in the right anterior insula, decreased resting metabolism predicted remission after CBT treatment while increased metabolism predicted remission after escitalopram pharmacotherapy |
| SPECT
|
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| Amsterdam 2013 (MDD) | CBT, 12wk | SPECT, pre, post | Serotonin transporter binding increased in bilateral medial temporal lobes post-tx |
| Martin 2001(MDD) (B, F, K, L, R) | IPT, 16wk | SPECT, pre, 6wk | Resting blood flow in right basal ganglia and posterior cingulate increased at 6 weeks of tx |
| Obsessive Compulsive Disorder
| |||
| Nakatani 2003 (F, K, L, R) | BT, variable | CT-Xe, pre, post | Resting blood flow in right caudate decreased post-tx |
| MRI
|
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| Freyer 2011 | CBT, 8–12wk | fMRI, pre, post | Strategy switching task showed increased activation in right putamen and caudate post-tx; smaller changes in right pallidum post-tx correlated with greater clinical improvement |
| Hoexter 2012 | CBT, 12wk | sMRI, pre, post | Orbitofrontal, anterior cingulate, temporolimbic, striatum or thalamus regional volumes did not show changes post-tx |
| Hoexter 2013 | CBT, 12wk | sMRI, pre | Predictor: larger volume in right medial prefrontal predicted response to tx |
| Huyser 2010 (child) | CBT, 16s | fMRI, pre, post | Tower of London task showed increased activation in left dorsolateral prefrontal and parietal cortices post-tx |
| Nabeyama 2008 | BT, 12wk | fMRI, pre, post | Stroop task showed increased activation in cerebellum and parietal cortex and decreased activation in orbitofrontal cortex, middle frontal gyrus, and temporal regions post-tx |
| Nakao 2005 (K, L) | BT, 12wk | fMRI, pre, post | Provocation task showed decreased activation in orbitofrontal, dorsolateral prefrontal, and anterior cingulate cortices post-tx; Stroop task showed increased activation in cerebellum and parietal cortex post-tx |
| O’Neill 2012 (child) | CBT, 12wk | 1H-MRS, pre, post | Predictors: baseline N-acetyl compounds, glutamine and glutamate, and myo- inositol levels in left thalamus predicted response to tx |
| O’Neill 2013 | CBT, 4wk | 1H-MRS, pre, post | Predictors: baseline N-acetyl compounds in right pregenual anterior cingulate cortex predicted response to tx |
| Whiteside 2012a | BT, 8wk | 1H-MRS, pre, post | Increased N-acetyl aspartate in left caudate post-tx; changes in levels of many neurochemicals correlated with changes in symptom measures |
| Whiteside 2012b (child) | BT, 10–18s | 1H-MRS, pre, post | Decreased glutamine and glutamate levels in right caudate post-tx |
| Zurowski 2012 | inCBT, 3 mo | 1H-MRS, pre, post | Predictor: myo-inositol in right orbitofrontal cortex predicted response to tx |
| PET
|
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| Apostolova 2010 | CBT, 40s | PET-FDG, pre, post | Resting metabolism in right caudate increased post-tx |
| Baxter 1992 (F, K, L, R) | BT, 10wk | PET-FDG, pre, post | Resting metabolism in right caudate decreased post-tx |
| Brody 1998 (R) | BT, 8–12wk | PET-FDG, pre | Predictor: higher resting metabolism in left orbitofrontal cortex predicted greater response to tx |
| Saxena 2009 | CBT, 4wk | PET-FDG, pre, post | Resting metabolism decreased bilaterally in thalami and increased in right dorsal anterior cingulate post-tx |
| Schwartz 1996 (B, F, K, L, R) | CBT, 10wk | PET-FDG, pre, post | Resting metabolism in bilateral caudate decreased post-tx |
| SPECT
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| Yamanishi 2009 | BT, 12wk | SPECT, pre, post | Predictor: increased blood flow in bilateral orbitofrontal cortex at baseline predicted greater response to tx |
| Schizophrenia
| |||
| MRI
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| Bor 2011 | CRT, 7wk | fMRI, pre, post | Spatial n-back task showed increased activation in left inferior and middle frontal gyri, cingulate, inferior parietal lobule/precuneus post-tx |
| Eack 2010 | CET, 2yr | sMRI, pre, post | Increased volumes in left hippocampus, parahippocampal gyrus, fusiform gyrus, and amygdala post-tx |
| Haut 2010 | REM, 4–6wk | fMRI, pre, post | Working memory tasks showed increased activation in bilateral frontopolar, anterior cingulate, and left dorsolateral prefrontal cortex regions post-tx |
| Keshavan 2011 | CET, 2yr | sMRI, pre | Predictor: larger cortical surface area and gray matter volume predicted faster social cognitive response to tx |
| Kumari 2009 | CBT, 6–8mo | fMRI, fcMRI, pre | Predictors: during working memory task, increased activation in dorsolateral prefrontal cortex and increased dorsolateral prefrontal cortex-cerebellum connectivity predicted better response to CBT |
| Kumari 2010 | CBT, 6–8mo | fMRI, pre | Predictors: during monitoring of voices task, increased activation in left inferior frontal gyrus, thalamus, and precuneus predicted better response to tx; decreased deactivation in inferior parietal and medial prefrontal regions predicted better response to tx |
| Kumari 2011 | CBT, 6–8mo | fMRI, pre, post | Facial anger and fear emotions task showed decreased activation in inferior frontal, insula, thalamus, putamen, and occipital regions post-tx |
| Penades 2013 | CRT, 4m | fcMRI, DTI, pre, post | N-back test showed normalization of activation patterns in the central executive and default mode networks post-tx; increased fractional anisotropy in genu of the corpus callosum post-tx |
| Premkumar 2009 | CBT, 6–8m | sMRI, pre | Predictors: increased gray matter volumes of right cerebellum (lobule VII), inferior parietal lobule, superior temporal gyrus, left precentral gyrus, cuneus, and cerebellum (Crus I) predicted response to tx |
| Wykes 2002 (R) | CRT, 12wk | fMRI, pre, post | Verbal working memory task showed increased activation in frontal and occipital regions post-tx |
| SPECT
|
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| Penades 2002 (R) | NPR, 12wk | SPECT, pre, post | Tower of London task showed increased blood flow in prefrontal regions post-tx |
| Other conditions
| |||
| MRI
|
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| Beutel 2010 (Panic) | inPSY, 4wk | fMRI, pre, post | Negative emotion tasks showed increased activation in amygdala and hippocampus and decreased activation in prefrontal regions pre-tx that normalized post-tx |
| Bryant 2008a (PTSD) | CBT, 8s | fMRI, pre | Predictor: during facial expression of fear task, increased activation in amygdala and ventral anterior cingulate regions predicted poor response to tx |
| Bryant 2008b (PTSD) | CBT,8wk | sMRI, pre | Predictor: larger rostral anterior cingulate cortex predicted response to tx |
| DeGreck 2011 (Somato) | inPSY, 60d | fMRI, pre, post | Rewarding versus nonrewarding task activations normalized in left postcentral gyrus and right ventroposterior thalamus post-tx |
| DeLange 2008 (CFS) | CBT, 6–9mo | sMRI, pre, post | Grey matter volume in lateral prefrontal cortex increased post-tx |
| DeVito 2012 (SUD) | CBT, 8wk | fMRI, pre, post | Stroop task showed decreased activation in anterior cingulate, inferior frontal gyrus, and midbrain post-tx |
| Doehrmann 2013 (SAD) | CBT, 12 wk | fMRI, pre | Predictors: during facial and emotion processing task, increased activity in dorsal and ventral occipitotemporal cortices predicted response to tx |
| Felmingham 2007 (PTSD) (F, K) | CBT, 8wk | fMRI, pre, post | Fear processing task showed increased activation in rostral anterior cingulate activity and decreased activation in right amygdala post-tx |
| Han 2012 (OLG addiction) | family tx, 3 wk | fMRI, pre, post | Parental love visual stimulation task showed increased activation in right caudate nucleus post-tx |
| Hauner 2012 (Ph-spider) | exposure tx, 1s | fMRI, pre, post, 6mo | Spider image viewing task showed increased activation in right dorsolateral prefrontal cortex and decreased activation in amygdala, insula, cingulate, and ventromedial prefrontal cortex post-tx; decreased activation in right dorsolateral prefrontal cortex and bilateral fusiform/lingual gyrus regions 6 months post-tx. Predictors: right lingual gyrus activation during the spider image viewing task immediately post-tx predicted response to tx after 6 months |
| Jensen 2012 (Fibromy) | ACT, 12wk | fMRI, fcMRI, pre, post | Pain task showed increased activation in left inferior frontal gyrus post-tx; increased ventrolateral prefrontal–thalamic connectivity post-tx |
| Kircher 2013 (Panic) | CBT, 12s | fMRI, fcMRI, pre, post | Fear conditioning task showed decreased activation in left inferior frontal gyrus post-tx; task based functional connectivity did not show changes post-tx |
| Klumpp 2013 (SAD) | CBT, 12wk | fMRI, pre, post | Predictors: during a fearful face emotion task pre-tx, activations in superior and middle temporal and inferior frontal gyri, dorsal anterior cingulate, dorsomedial prefrontal and orbitofrontal regions predicted response to tx |
| Lindauer 2005 (PTSD) | BEP, 4mo | sMRI, pre, post | Hippocampal volumes showed no change after tx |
| Maslowsky 2010 (GAD) | CBT, 8wk | fMRI, pre, post | Facial emotions task showed increased right ventrolateral prefrontal cortex activity post-tx |
| Mohr 2012 (MS) | SMT, 24wk | GdMRI, pre, 24wk post | Gd enhancing brain lesions decreased during tx, but not sustained post-tx |
| Paquette 2003 (Ph-spider) (B, F, K, L, R) | CBT, 4wk | fMRI, pre, post | Spider film viewing task showed decreased activation in right dorsolateral prefrontal cortex and parahippocampal gyrus post-tx |
| Pardini 2012 (Autism) | CT, BT, AAC, 6yr | DTI-MRI | Increased uncinate fasiculus fractional anisotropy correlated with more tx |
| Schienle 2007 (Ph-spider) | CBT, 1s | fMRI, pre, post | Spider image viewing task showed increased activation in medial orbitofrontal cortex post-tx; symptom reduction correlated with decreased activations in right amygdala and left insula. |
| Schienle 2009 (Ph-spider) | CBT, 1s | fMRI, pre, 6 mo post | Spider image viewing task showed increased activation in medial orbitofrontal cortex at 6 months post-tx |
| Schnell 2007 (BPD) (K) | inDBT, 12wk | fMRI, pre, post | Emotion arousal task showed decreased activation in left amygdala and bilateral hippocampi post-tx |
| Siniatchkin 2012 (ADHD) | RCT, 10d | fMRI, pre, post | Go/No-go task showed increased activation in anterior cingulate and dorsolateral prefrontal cortex regions post-tx |
| Straube 2006 (Ph-spider) (B, F, K, L) | CBT, 2s | fMRI, pre, post | Spider film viewing task showed decreased activation in insula and anterior cingulate cortex post-tx |
| Van Paasschen 2013(AD) | CR, 8wk | fMRI, pre, post | Face-name recognition task showed increased activation in bilateral insula, left middle frontal and right angular gyri post-tx |
| Vocks 2011 (eating) | CBT, 10wk | fMRI, pre, post | Body image viewing task showed increased activation in left middle temporal and bilateral middle frontal gyri post-tx |
| PET
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| Cervenka 2012 (SAD) | CBT, 15wk | PET, pre, post | Greater change in dopamine receptor binding potential in medial prefrontal cortex and hippocampus correlated with decreased anxiety post-tx |
| Förster 2011 (MCI, AD) | CI, 6mo | PET-FDG, pre, post | Resting metabolism showed less decline post-tx in comparison with controls |
| Furmark 2002 (Ph-social) (F, K, L, R) | CBT, 9wk | PET-H20, pre, post | Public speaking task showed decreased blood flow in bilateral amygdala hippocampus, and surrounding regions post-tx |
| Praško 2004 (Panic) (B, F, K, L) | CBT, 3 mo | PET-FDG, pre, post | Resting metabolism increased in left brain but decreased in right brain regions |
| Sakai 2006 (Panic) (K) | CBT, 6mo | PET-FDG, pre, post | Resting metabolism decreased in right hippocampus and left anterior cingulate, cerebellum, pons post-tx; increased in bilateral medial prefrontal cortex post-tx |
| SPECT
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| Laatsch 1999 (TBI) (R) | CRhT, 6–36s | SPECT, pre, end, 3–12mo post | Resting blood flow in multiple regions increased post tx |
| Lindauer 2008 (PTSD) | BEP, 16wk | SPECT, pre, post | Personal trauma script listening task showed decreased activation in the right middle frontal gyrus post-tx |
| Peres 2007 (PTSD) | exposure tx, 8wk | SPECT, pre, post | Memory retrieval task showed increased activation in bilateral parietal and left prefrontal, thalamus, and hippocampus regions, and decreased activation in left amygdala post-tx |
Notes. Neuroimaging studies of psychotherapy treatments. Study. First author of each study is given. Note is made if the study was included in reviews by (B) Beauregard (2007), (F) Frewen et al. (2008), (K) Karlsson (2011), (L) Linden (2006), (R) Roffman et al. (2005). (Child) = pediatric study. (Conditions): AD = Alzheimer’s disease, ADHD=attention deficit hyperactivity disorder, AtD = atypical depression, BPD = borderline personality disorder, CFS = chronic fatigue syndrome, DD = double depression, fibromy = fibromyalgia, GAD = generalized anxiety disorder, LLD= late life depression, MCI = mild cognitive impairment, MDD = unipolar depression, major depression, major depressive disorder, MS = multiple sclerosis, NAtD = Non atypical depression, OLG addiction = on-line game addiction, Ph = phobia, PTSD = posttraumatic stress disorder, SAD = social anxiety disorder, somato = somatoform disorder, SUD = substance use disorder, TBI = traumatic brain injury. Therapy. In = in-patient therapy; d = days, mo = months, s = sessions, wk = weeks, yr = years. AAC = augmentative and alternative communication therapy, ACT = acceptance and commitment therapy, BAT = behavioral activation therapy, BEP = brief eclectic psychotherapy, BT = behavioral therapy, CBT = cognitive or cognitive behavioral therapy, CET = cognitive enhancement therapy, CI = cognitive intervention, CR = cognitive rehabilitation, CRhT = cognitive rehabilitation therapy, CRT= cognitive remediation therapy, DBT = dialectic behaior therapy, IPT = interpersonal therapy, NPR = neuropsychological rehabilitation, PST = problem solving therapy, PSY = psychodynamic psychotherapy, RCT = response cost and token approach, REM = cognitive remediation training, SMT = stress management therapy. Imaging. CT-Xe = xenon enhanced computed tomography, DTI-MRI = diffusion tensor imaging magnetic resonance imaging, fMRI = functional MRI, fcMRI = functional connectivity MRI, GdMRI = gadolinium enhanced MRI, 1H-MRS = proton magnetic resonance spectroscopy, PET = positron emission tomography, PET-FDG = PET fluorodeoxyglucose, sMRI = structural MRI, SPECT = single photon emission computed tomography. Pre = scans conducted before therapy; post = scans conducted at or immediately after the end of therapy; specified length of time indicates longer-term follow-up scans. Results. A few examples of results from each study are presented.