Commentary on: “Functional Neuroimaging—Can It Contribute to Our Understanding of Processes of Change?”

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Beutel & Huber's article focuses on very important aspects of research into processes of change from a psychoanalytic point of view. We agree with the authors' statement that understanding the methodological procedures of functional neuroimaging and its limitations is the first step in considering psychoanalytic principles in the field of neuroscience.

A list of possible neuroimaging paradigms important for studying mental processes and specific symptoms is given. It is underlined that experimental stimuli need to have a strong emotional valance (e.g., videos instead of pictures to provoke changes in mental states). In the context of establishing psychoanalytically relevant aspects in functional neuroimaging, it is necessary to use paradigms that are able to address symbolic meanings and to elucidate unconscious conflicts (e.g., by verbalization or emotional-behavioral expression).

The overview of studies on symptom-related changes in the brain following therapy (psychotherapy and pharmacotherapy) shows functional changes in a broad range of psychiatric disorders (OCD, depression, anxiety disorders). However, it is still questionable whether specific functional brain changes investigated by modern functional imaging methods are able to deepen our understanding of complex interpersonal psychoanalytic processes. Paradigms that can adequately study psychodynamically relevant dimensions of symptom changes still have to be developed.

Another critical point in the studies carried out to date is the direct comparison between drug treatment and psychotherapy. It must be assumed that intrapsy-chic conflicts are just as important as biological factors in the development of symptoms in both study groups. Paradigms focusing on these intrapsychic conflicts may not demonstrate differences between psychopharma-cologically and psychotherapeutically treated patients. Improvement of symptoms