Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder

Abstract

Our results suggest that diminished responsiveness of brain regions involved in the processing of external stimuli underlies the disturbed balance of internal and external processing of somatoform disorder patients. By providing new approaches to cope with distressing events, multimodal psychodynamic psychotherapy led to decreased symptoms and normalization of neuronal activity.

Review of Psychodynamic Psychotherapy Neuroimaging Studies

“…After treatment, all included series reported group improvement from baseline clinical symptoms. Normalization of baseline scores was achieved in 8 series [12,13,15,16,18,20,21,22]. In 1 series [17], some features of borderline personality disorder remained after treatment, but the participants no longer met diagnostic criteria.…”

“…In a second series [14], posttreatment patients with depression had metabolic activity similar to controls in regions of the amygdala, hippocampus and dorsal prefrontal cortex in response to attachment-related stimuli: treated cases had less activation than controls in the subgenual cingulate cortex. In a third and fourth series [21,22], patients with somatoform disorders showed significant enhancement toward normalization and relative to controls in differential blood flow between anticipation of reward versus anticipation of no reward in regions of the postcentral gyrus, dorsal anterior cingulate, occipital cortex and ventroposterior thalamus. When presented with empathy paradigms versus control paradigms, patients showed significant enhancement toward normalization of brain activity with the emotion of anger in regions of the parahippocampal gyrus, amygdala, superior temporal gyrus, posterior insula and postcentral gyrus.…”

“…These treatments involved from 16 to 120 h of PDT treatment spread over 4-16 months. The other 3 series were conducted in inpatient settings [15,21,22] where mixed interventions along with individual PDT were employed over a period of 35-80 days.…”

“…In the four disorders studied, patterns of neural activity or neurophysiological infrastructure in regions of the dorsolateral prefrontal cortex, orbital frontal cortex, anterior cingulate cortex (ACC) and amygdala differed between clinical cases and healthy controls prior to treatment, while after treatment, the patterns seen in patients resembled those of the controls. As the posttreatment changes in baseline measures of brain function correlated with improvement in clinical presentation, these neurobiological changes appear indicative of improvement on a biological level [12,13,14,15,16,17,18,19,21,22]. Such improvements in neuroimaging measures might reflect neural correlates of the changes effected by PDT and expressed clinically as symptom reduction [1,2,3,4].…”

“…While much remains to be understood about what these patterns of activity revealed by neuroimaging means on a functional level [25], it is possible to speculate about some of the findings summarized in this review. For example, baseline overactivity in regions associated with emotion may relate to activated but unprocessed emotions that are brought to consciousness during PDT [14,15,21,22]. In depression, posttreatment reduction in regional activity in the subgenual ACC - an area associated with guilt [26], self-defeat [27] and repression of emotions [28] - may reflect overcoming of repression of emotions and reduction in unconscious guilt, thus resulting in a better relationship with oneself and antidepressant effects [14].…”