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EPA-0142 – Neural Changes in Depressed Patients During Psychodynamic Psychotherapy: An fMRI Study

Published online by Cambridge University Press:  15 April 2020

A. Buchheim
Affiliation:
Institute of Psychology, University Innsbruck, Innsbruck, Austria
R. Viviani
Affiliation:
Institute of Psychology, University Innsbruck, Innsbruck, Austria
H. Kessler
Affiliation:
Department of Psychiatry, University Bonn, Bonn, Germany
H. K‰chele
Affiliation:
International Psychoanalytic University, International Psychoanalytic University, Berlin, Germany
M. Cierpka
Affiliation:
Institute of Psychosomatic Cooperation Research and Family Therapy, University Heidelberg, Heidelberg, Germany
G. Roth
Affiliation:
University Bremen, Brain Research Institute, Bremen, Germany
C. George
Affiliation:
Mills College, Institute of Psychology, Oakland CA, USA
O.F. Kernberg
Affiliation:
Weill Medical College, Weill Medical College, New York, USA
G. Bruns
Affiliation:
University of Bremen, University of Bremen, Bremen, Germany
S. Taubner
Affiliation:
Department of Psychology, University of Kassel, Kassel, Germany

Abstract

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Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N=16) and control participants matched for sex, age, and education (N=17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.

Type
S500 - Symposium: Neurobiological underpinnings of cognitive and emotional aspects in psychiatric disorders and psychotherapy
Copyright
Copyright © European Psychiatric Association 2014
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