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Neuropsychotherapy: conceptual, empirical and neuroethical issues

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Abstract

In this article we suggest a working definition for the concept of “neuropsychotherapy” encompassing three areas: the identification of mediators and targets of psychotherapeutic effects, the determination of new therapeutic routes using neurotechnology, and the design of psychotherapeutic interventions based on neuroscientific knowledge. We review neuroimaging studies of the psychotherapy of depression and discuss some of the methodological limitations inherent in functional Magnetic Resonance Imaging (fMRI) and common fallacies perpetrated in interpreting fMRI studies. Finally, we discuss some neuroethical issues related to this new and active field of research. In sum, we argue that neuroscience harbors great potential and add-on value for improving psychotherapeutic practice and research if applied properly.

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References

  1. Abler B, Erk S, Herwig U, Walter H (2007) Anticipation of aversive stimuli activates extended amygdala in unipolar depression. J Psychiatr Res 41:511–522

    Article  PubMed  Google Scholar 

  2. Anand A, Li Y, Wang Y, Gardner K, Lowe MJ (2007) Reciprocal effects of antidepressant treatment on activity and connectivity of the mood regulating circuit: an FMRI study. J Neuropsych Clin Neurosci 19:274–282

    Google Scholar 

  3. Baxter LR Jr, Schwartz JM, Phelps ME, Mazziotta JC, Guze BH, Selin CE, Gerner RH, Sumida RM (1989) Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatr 46:243–250

    CAS  PubMed  Google Scholar 

  4. Beauregard M (2009) Effect of mind on brain activity: evidence from neuroimaging studies of psychotherapy and placebo effect. Nord J Psychiatr 63:5–16

    Article  Google Scholar 

  5. Beauregard M, Levesque J, Bourgouin P (2001) Neural correlates of conscious self-regulation of emotion. J Neurosci 21:RC165

    Google Scholar 

  6. Beck AT (2008) The evolution of the cognitive model of depression and its neurobiological correlates. Am J Psychiatr 165:969–977

    Article  PubMed  Google Scholar 

  7. Birbaumer N, Veit R, Lotze M, Erb M, Hermann C, Grodd W, Flor H (2005) Deficient fear conditioning in psychopathy: a functional magnetic resonance imaging study. Arch Gen Psychiatr 62:799–805

    Article  PubMed  Google Scholar 

  8. Blair J, Mitchel D, Blair K (2005) The psychopath: emotion and the brain. Blackwell, Oxford

    Google Scholar 

  9. Brody AL, Saxena S, Stoessel P, Gillies LA, Fairbanks LA, Alborzian S, Phelps ME, Huang SC, Wu HM, Ho ML, Ho MK, Au SC, Maidment K, Baxter LR Jr (2001) Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Arch Gen Psychiatr 58:631–640

    Article  CAS  PubMed  Google Scholar 

  10. Buchheim A, Heinrichs M, George C, Pokorny D, Koops E, Hennigssen P, O’Connor MF, Gündel H (2009) Oxytocin enhances the experience of attachment security. Psychoneuroendocrinology (in press)

  11. Cojan Y, Waber L, Carruzzo A, Vuilleumier P (2009) Motor inhibition in hysterical conversion paralysis. Neuroimage 47:1026–1037

    Article  PubMed  Google Scholar 

  12. Davidson RJ, Irwin W, Anderle MJ, Kalin NH (2003) The neural substrates of affective processing in depressed patients treated with venlafaxine. Am J Psychiatr 160:64–75

    Article  PubMed  Google Scholar 

  13. DeCharms RC (2008) Applications of real-time fMRI. Nat Rev Neurosci 9:720–729

    Article  CAS  PubMed  Google Scholar 

  14. de Charms RC, Maeda F, Glover GH, Ludlow D, Pauly JM, Soneji D, Gabrieli JD, Mackey SC (2005) Control over brain activation and pain learned by using real-time functional MRI. Proc Natl Acad Sci USA 102:18626–18631

    Article  Google Scholar 

  15. Demertzi A, Liew C, Ledoux D, Bruno MA, Sharpe M, Laureys S, Zeman A (2009) Dualism persists in the science of mind. Ann N Y Acad Sci 1157:1–9

    Article  PubMed  Google Scholar 

  16. DeRubeis RJ, Siegle GJ, Hollon SD (2008) Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci 9:788–796

    Article  CAS  PubMed  Google Scholar 

  17. Domes G, Heinrichs M, Michel A, Berger C, Herpertz SC (2007) Oxytocin improves “mind-reading” in humans. Biol Psychiatr 61:731–733

    Article  CAS  Google Scholar 

  18. Drevets WC (1999) Prefrontal cortical-amygdalar metabolism in major depression. Ann N Y Acad Sci 877:614–637

    Article  CAS  PubMed  Google Scholar 

  19. Freud S (1895) Project for a scientific psychology. In: Srachey J (ed) Standard edition of the complete psychological works of Sigmund Freud. Hogarth Press, London, pp 294–397

    Google Scholar 

  20. Frewen PA, Dozois DJ, Lanius RA (2008) Neuroimaging studies of psychological interventions for mood and anxiety disorders: empirical and methodological review. Clin Psychol Rev 28:228–246

    Article  PubMed  Google Scholar 

  21. Fu CH, Williams SC, Cleare AJ, Brammer MJ, Walsh ND, Kim J, Andrew CM, Pich EM, Williams PM, Reed LJ, Mitterschiffthaler MT, Suckling J, Bullmore ET (2004) Attenuation of the neural response to sad faces in major depression by antidepressant treatment: a prospective, event-related functional magnetic resonance imaging study. Arch Gen Psychiatr 61:877–889

    Article  PubMed  Google Scholar 

  22. Fu CH, Williams SC, Cleare AJ, Scott J, Mitterschiffthaler MT, Walsh ND, Donaldson C, Suckling J, Andrew C, Steiner H, Murray RM (2008) Neural responses to sad facial expressions in major depression following cognitive behavioral therapy. Biol Psychiatr 64:505–512

    Article  Google Scholar 

  23. Goldapple K, Segal Z, Garson C, Lau M, Bieling P, Kennedy S, Mayberg H (2004) Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatr 61:34–41

    Article  PubMed  Google Scholar 

  24. Grawe K (2004) Neuropsychotherapie. Hogrefe, Göttingen

    Google Scholar 

  25. Gross JJ (2002) Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39:281–291

    Article  PubMed  Google Scholar 

  26. Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, Shiekh M, Otto MW (2006) Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatr 63:298–304

    Article  CAS  PubMed  Google Scholar 

  27. Illes J, Bird SJ (2006) Neuroethics: a modern context for ethics in neuroscience. Trends Neurosci 29:511–517

    Article  CAS  PubMed  Google Scholar 

  28. Jauch-Chara K, Hohagen F (2009) Neurobiological correlates of psychotherapy of depression [Neurobiologische Korrelate der Psychotherapie bei Depression]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 57:105–112

    Article  Google Scholar 

  29. Kandel ER (1998) A new intellectual framework for psychiatry. Am J Psychiatr 155:457–469

    CAS  PubMed  Google Scholar 

  30. Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, Markowitz JC, Nemeroff CB, Russell JM, Thase ME, Trivedi MH, Zajecka J (2000) A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 342:1462–1470

    Article  CAS  PubMed  Google Scholar 

  31. Kennedy SH, Evans KR, Kruger S, Mayberg HS, Meyer JH, McCann S, Arifuzzman AI, Houle S, Vaccarino FJ (2001) Changes in regional brain glucose metabolism measured with positron emission tomography after paroxetine treatment of major depression. Am J Psychiatr 158:899–905

    CAS  PubMed  Google Scholar 

  32. Kennedy SH, Konarski JZ, Segal ZV, Lau MA, Bieling PJ, McIntyre RS, Mayberg HS (2007) Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial. Am J Psychiatr 164:778–788

    Article  PubMed  Google Scholar 

  33. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (2008) Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5:e45

    Article  PubMed  Google Scholar 

  34. Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E (2005) Oxytocin increases trust in humans. Nature 435:673–676

    Article  CAS  PubMed  Google Scholar 

  35. Krishnan V, Nestler EJ (2008) The molecular neurobiology of depression. Nature 455:894–902

    Article  CAS  PubMed  Google Scholar 

  36. Linden DE (2006) How psychotherapy changes the brain—the contribution of functional neuroimaging. Mol Psychiatr 11:528–538

    Article  CAS  Google Scholar 

  37. Logothetis NK (2008) What we can do and what we cannot do with fMRI. Nature 453:869–878

    Article  CAS  PubMed  Google Scholar 

  38. Maren S, Quirk GJ (2004) Neuronal signalling of fear memory. Nat Rev Neurosci 5:844–852

    Article  CAS  PubMed  Google Scholar 

  39. Martin SD, Martin E, Rai SS, Richardson MA, Royall R (2001) Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: preliminary findings. Arch Gen Psychiatr 58:641–648

    Article  CAS  PubMed  Google Scholar 

  40. Mayberg HS (2003) Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull 65:193–207

    Article  PubMed  Google Scholar 

  41. Mayberg HS (2003) Positron emission tomography imaging in depression: a neural systems perspective. Neuroimaging Clin N Am 13:805–815

    Article  PubMed  Google Scholar 

  42. Mayberg HS, Brannan SK, Mahurin RK, Jerabek PA, Brickman JS, Tekell JL, Silva JA, McGinnis S, Glass TG, Martin CC, Fox PT (1997) Cingulate function in depression: a potential predictor of treatment response. Neuroreport 8:1057–1061

    Article  CAS  PubMed  Google Scholar 

  43. Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, Silva JA, Tekell JL, Martin CC, Lancaster JL, Fox PT (1999) Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatr 156:675–682

    CAS  PubMed  Google Scholar 

  44. Mayberg HS, Silva JA, Brannan SK, Tekell JL, Mahurin RK, McGinnis S, Jerabek PA (2002) The functional neuroanatomy of the placebo effect. Am J Psychiatr 159:728–737

    Article  PubMed  Google Scholar 

  45. McCullough JP (2003) Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP). Guilford

  46. McRae K, Hughes B, Chopra S, Gabrieli JD, Gross JJ, Ochsner KN (2009) The neural bases of distraction and reappraisal. J Cogn Neurosci. doi:10.1162/jocn.2009.21243

  47. Nader K, Hardt O (2009) A single standard for memory: the case for reconsolidation. Nat Rev Neurosci 10:224–234

    Article  CAS  PubMed  Google Scholar 

  48. Nemeroff CB, Heim CM, Thase ME, Klein DN, Rush AJ, Schatzberg AF, Ninan PT, McCullough JP Jr, Weiss PM, Dunner DL, Rothbaum BO, Kornstein S, Keitner G, Keller MB (2003) Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci USA 100:14293–14296

    Article  CAS  PubMed  Google Scholar 

  49. Ochsner KN, Gross JJ (2005) The cognitive control of emotion. Trends Cogn Sci 9:242–249

    Article  PubMed  Google Scholar 

  50. Ochsner KN, Ray RD, Cooper JC, Robertson ER, Chopra S, Gabrieli JD, Gross JJ (2004) For better or for worse: neural systems supporting the cognitive down- and up-regulation of negative emotion. Neuroimage 23:483–499

    Article  PubMed  Google Scholar 

  51. Phelps EA, Delgado MR, Nearing KI, LeDoux JE (2004) Extinction learning in humans: role of the amygdala and vmPFC. Neuron 43:897–905

    Article  CAS  PubMed  Google Scholar 

  52. Raboni MR, Tufik S, Suchecki D (2006) Treatment of PTSD by eye movement desensitization reprocessing (EMDR) improves sleep quality, quality of life, and perception of stress. Ann N Y Acad Sci 1071:508–513

    Article  PubMed  Google Scholar 

  53. Schleim S, Walter H (2007) Mind reading with the brain scanner? [Gedankenlesen mit dem Hirnscanner?] Nervenheilkunde 26:505–510

    Google Scholar 

  54. Schleim S, Walter H (2008) Mind reading: a challenge for neuroethics [Gedankenlesen—Eine Herausforderung für die Neuroethik]. In: Vogelsang F, Hoppe C (eds) Without the brain, nothing works. Impulses for a neuroethics [Ohne Hirn ist alles nichts. Impulse für eine Neuroethik]. Neukirchener Verlag, Neukirchen-Vluyn, pp 150–168

  55. Schnell K, Herpertz SC (2007) Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. J Psychiatr Res 41:837–847

    Article  PubMed  Google Scholar 

  56. Schoepf D, Konradt B, Walter H (2007) Specific psychotherapy of chronic depression with the Cognitive Behavioral System of Psychotherapy [Spezifische Psychotherapie der chronischen Depression mit dem Cognitive Behavioral Analysis System of Psychotherapy]. Nervenheilkunde 26:790–802

    Google Scholar 

  57. Schonfeldt-Lecuona C, Connemann BJ, Spitzer M, Herwig U (2003) Transcranial magnetic stimulation in the reversal of motor conversion disorder. Psychother Psychosom 72:286–288

    Article  PubMed  Google Scholar 

  58. Seminowicz DA, Mayberg HS, McIntosh AR, Goldapple K, Kennedy S, Segal Z, Rafi-Tari S (2004) Limbic-frontal circuitry in major depression: a path modeling metanalysis. Neuroimage 22:409–418

    Article  CAS  PubMed  Google Scholar 

  59. Sessa B (2007) Is there a case for MDMA-assisted psychotherapy in the UK? J Psychopharmacol 21:220–224

    Article  CAS  PubMed  Google Scholar 

  60. Sheline YI, Barch DM, Donnelly JM, Ollinger JM, Snyder AZ, Mintun MA (2001) Increased amygdala response to masked emotional faces in depressed subjects resolves with antidepressant treatment: an fMRI study. Biol Psychiatr 50:651–658

    Article  CAS  Google Scholar 

  61. Siegle GJ, Carter CS, Thase ME (2006) Use of fMRI to predict recovery from unipolar depression with cognitive behavior therapy. Am J Psychiatr 163:735–738

    Article  PubMed  Google Scholar 

  62. Siegle GJ, Thompson W, Carter CS, Steinhauer SR, Thase ME (2007) Increased amygdala and decreased dorsolateral prefrontal BOLD responses in unipolar depression: related and independent features. Biol Psychiatr 61:198–209

    Article  Google Scholar 

  63. Spence SA, Crimlisk HL, Cope H, Ron MA, Grasby PM (2000) Discrete neurophysiological correlates in prefrontal cortex during hysterical and feigned disorder of movement. Lancet 355:1243–1244

    Article  CAS  PubMed  Google Scholar 

  64. Staudinger MR, Erk S, Abler B, Walter H (2009) Cognitive reappraisal modulates expected value and prediction error encoding in the ventral striatum. Neuroimage 47:713–721

    Article  PubMed  Google Scholar 

  65. Walter H (2009) What can we measure? Neuroimaging—an introduction into basic principles, common fallacies and their possible relevance for penal law and our idea of man. [Was können wir messen? Neuroimaging—eine Einführung in methodische Grundlagen, häufige Fehlschlüsse und ihre mögliche Bedeutung für Strafrecht und Menschenbild.] In: Schleim S, Spranger T, Walter H (eds) From Neuroethics to Neurolaw. The beginning of a new debate. [Von der Neuroethik zum Neurorecht. Der Beginn einer neuen Debatte.] Vandenhoeck & Ruprecht, Göttingen, pp 67–103

  66. Walter H, Abler B, Ciaramidaro A, Erk S (2005) Motivating forces of human actions. Neuroimaging reward and social interaction. Brain Res Bull 67:368–381

    Article  PubMed  Google Scholar 

  67. Walter H, Adenzato M, Ciaramidaro A, Enrici I, Pia L, Bara BG (2004) Understanding intentions in social interaction: the role of the anterior paracingulate cortex. J Cogn Neurosci 16:1854–1863

    Article  PubMed  Google Scholar 

  68. Walter H, von Kalckreuth A, Schardt D, Stephan A, Erk S (2009) The temporal dynamics of emotion regulation. PLoS ONE 4(8):e6726

    Article  Google Scholar 

  69. Yehuda R, LeDoux J (2007) Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron 56:19–32

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was partly supported by a BMBF grant to H.W. (01GP0804).

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The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Division of Medical Psychology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Henrik Walter & Knut Schnell

  2. Department of Psychiatry and Psychotherapy, University Medical Center, Hauptstraße 5, 79100, Freiburg, Germany

    Mathias Berger

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  1. Henrik Walter
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Correspondence to Henrik Walter.

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Walter, H., Berger, M. & Schnell, K. Neuropsychotherapy: conceptual, empirical and neuroethical issues. Eur Arch Psychiatry Clin Neurosci 259 (Suppl 2), 173–182 (2009). https://doi.org/10.1007/s00406-009-0058-5

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