psychotherapy - psychotherapy and the brain

what parts of brain are higher in the cognitive hierarchy?

PFC and anterior cingulate cortex

what parts of the brain are lower in the cognitive hierarchy?

hippocampus and amygdala

what brain area is top-down processing mediated by?

PFC

what brain area is bottom-up processing mediated by?

lower-order brain structures

which kind of processing is the main target in CBT?

top-down processing

does bottom-up processing change with CBT?

yes, though not targeted as explicitly

what does Linden say about CBT and the brain?

cognitive restructuring increases top-down cognitive control over negative emotion

what does Linden say about medication and the brain?

medication decreases bottom-up reactivity to emotional reactivity

what does CBT primarily produce symptom reduction through?

its impact on higher-order executive functions

what higher-order executive functions are impacted by CBT?

problem solving, cognitive reappraisal, self-referential thinking

which brain areas have altered activity from CBT for depression?

higher order regions

what does CBT for depression modulate?

top-down processes involved in encoding and retrieval of negative associative memories, rumination, and over-processing or irrelevant information

what brain areas have altered activity from CBT for anxiety?

higher-order regions and lower-order regions

what does CBT for anxiety modulate?

bottom-up structures

what brain areas have altered activity after exposure and restructuring?

increased activity in higher-order regions and decreased activity in lower-order regions

what brain area has altered activity after CBT or medication for social anxiety?

decreased activity in lower-order regions

what brain areas have altered activity after behavior therapy or medication for OCD?

decreased activation in higher order areas

which brain regions are involved in cognitive control of emotion?

higher-order cortical regions

what patterns of activation are associated with cognitive reappraisal?

increased activation of higher-order regions and decreased activity of lower-order regions

what did Shou et al (2017) find about CBT and the brain?

CBT increased state connectivity between amygdala and fronto-parietal network in clients with MDD and PTSD

what did Young et al (2017) find about therapy and the brain?

symptom improvement in CBT or ACT for SAD was correlated with increased connectivity between the amygdala and the PFC during an emotion regulation task

what did Mason et al (2016) find about CBT and the brain?

CBT for psychosis associated with greater connectivity between amygdala and PFC in a social threat task

what is the Gotnik et al (2016) study?

systematic review of 11 studies examining brain changes after 8 week MBSR program

what increases did Gotnik et al (2016) find?

increase in volume, activity, and connectivity of PFC, cingulate cortex, insula, and hippocampus

what decreases did Gotnik et al (2016) find?

decrease in amygdala activity and increased connectivity with PFC

what class of medication is recommended as the first-line pharmacological treatment for depression?

SSRIs

how are SSRIs different from previous medications?

side effect profile more mild, less fatal in case of overdose, no evidence that they’re more effective

who is the benefit of SSRIs most pronounced for?

people with severe depression

why is it important for people to continue to take their SSRIs even if they feel better?

the course of an average major depressive episode is 9 months

what is deep-brain stimulation?

neurostimulator implanted in brain sends electrical impulses to specific subcortical regions of the brain

why is deep brain stimulation good for research?

bc control is built in, sham vs active stimulation

what did Helen Mayberg (2005) study?

targeted subgenual cingulate in 6 patients with treatment-resistant depression

what were Mayberg (2005)’s results?

4 of 6 patients achieved sustained clinical response or remission at 6 months

what conditions is deep brain stimulation starting to be applied to?

OCD and anorexia nervosa

what was the Reiff et al (2020) study?

scoping review of 161 studies on clinical application of psychedelic drugs for psychiatric disorders

what psychedelics were included in Reiff et al (2020)?

psilocybin, LSD, ayahuasca, MDMA

how did Reiff et al (2020) define psychedelic-assisted therapy?

preparatory therapy, psychedelic sessions (high dose of drug), processed in integrative therapy

why combine psychedelics with psychotherapy according to Dworkin (2023)?

psychological and physical safety, may enhance magnitude and duration of benefit

why is it difficult to do control trials of psychedelics?

people know whether or not they’ve been given psychedelics

if you just give someone a biological explanation of depression, how will they rate psychotherapy’s effectiveness?

less effective

if you give someone a biological explanation of depression and a brain-level psychotherapy description, how will they rate psychotherapy’s effectiveness?

more effective

if you give someone a biological explanation of depression and a mind-level psychotherapy description, how will they rate psychotherapy’s effectiveness?

no change