Functional Neuroimaging—Can It Contribute to Our Understanding of Processes of Change?

Preliminary studies have shown that psychotherapeutic and pharmacological treatments of psychiatric disorders lead to measurable changes in the activity of the brain, particularly when they successfully reduce depression, fears, or obsessions. The purpose of this paper is to review the potential of functional neuroimaging in the understanding and evaluation of psychotherapy. Following an overview of basic neuroimaging concepts and procedures, promising neuroimaging paradigms probing mind-brain function are presented together with selected results on psychiatric patients and control subjects. Neuroimaging studies conducted pre- and post-psychotherapy are reviewed. Conclusions are formulated regarding an interdisciplinary dialogue between psychoanalysts and neuroscientists. Most likely, modulations of connections within the limbic system by higher cortical (prefrontal) networks are instrumental in the changes depicted in various studies. Overall, current developments open new avenues for bridging the gap between psychodynamic and biological psychiatry. Based on the studies presented and the emerging plasticity of the brain, the distinction between somatic treatments having an impact on the brain and psychological treatments with more elusive subjective effects has become obsolete. It must be assumed that psychoanalysis also has a measurable impact on brain functioning, insofar as it successfully ameliorates symptoms, changes relationship patterns, or increases mentalizing abilities.