How Psychotherapy Changes the Brain

By Cherise White, LMSW

The brain is an intricate system and can be described from a structural, physiological, and functional level. Looking at the brain from a functional level can be interesting as it allows for a deeper understanding of how therapy changes the brain. 

In relation to therapy, it's important to learn about some specific areas in the brain, starting with the primitive brain. The primitive brain processes threat and fear, which is why it is our emotional center and formally known as the amygdala. Another key region of the brain is the frontal lobe where our executive control center resides. This center is involved in our thinking and reasoning processes. Below I outline how different types of psychotherapy influence these areas of the brain. 

 https://brainytot.files.wordpress.com/2011/08/thoughtandemotion.jpg

https://brainytot.files.wordpress.com/2011/08/thoughtandemotion.jpg

Cognitive Behavioral Therapy

A very common treatment modality, Cognitive Behavioral Therapy (CBT), helps individuals work towards changing distorted patterns of thinking. Whitfield-Gabrieli et al. (2015) found that those who received CBT had stronger neuronal connections to the amygdala from other areas of the brain. In turn, these individuals had decreased symptoms of anxiety as a result of CBT. They noted effectiveness may be due to the improvement in functioning of the prefrontal lobe where thinking occurs. It was also highlighted that medication addresses the amygdala’s dysregulation of negative emotions. This is interesting, as it supports the saying you may often hear about therapy and medication being the best regimen for treating some mental illnesses. 

Psychodynamic Therapy

Therapy is often viewed as a “top-down” regulation approach where therapists use evidence-based therapies to help you learn how to strengthen the neuronal networks in the prefrontal cortex. This is done through providing mental tools that help individuals regulate their fear center (amygdala). Karlsson (2001) highlights that psychodynamic therapy may also follow the top-down approach within the brain and potentially affect the same brain mechanisms. For individuals with panic disorder, researchers Beutel et al. found that when in distress, the prefrontal cortex underworked and the amygdala was hyperactivated. However, once the individuals went through psychodynamic therapy a level of balance in those two areas of the brain occurred. 

Interpersonal Therapy

In interpersonal therapy (IPT), one goal is to improve mood states influenced by relationship discord, social interactions, and major life events. A study conducted at UCLA by Dr. Arthur Brody discovered that individuals with depressed symptoms who were in either the medication only group or therapy only group experienced similar changes in the brain. Both displayed reduction in elevated prefrontal cortex activity. 

Dialectical Behavior Therapy

Individuals diagnosed with borderline personality disorder (BPD) often experience intense and extreme emotions. Dialectical Behavioral Therapy (DBT), is an evidence-based therapy that treats emotional oscillation by introducing skills such as emotion-regulation. In the brain of those with BPD, there is over-activation in the amygdala. Goodman et al. (2014) found after 12 months of DBT, there was a decrease in arousal of the threat center in the brain (amygdala) as well as enhanced ability to employ emotion regulation skills. 

Overall, learning how the brain changes in therapy can be informative. Put nicely by Karlsson (2001), we can view psychotherapy as a method of learning, and learning changes the brain. Therefore, psychotherapy is a process that exceeds the simplification of people talking—it may be more accurate to say psychotherapists assist individuals in learning how to change the function of their brain.

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Cherise White is a therapist at Cobb Psychotherapy. If you would to learn more about psychotherapy and how it can support you in reaching your goals, contact Cobb Psychotherapy.