Cognitive behavioural therapy (CBT) has proven effective in the treatment of many psychological disorders including depression, anxiety and behavioural problems. For the first time, a new study from King's College London and South London and Maudsley NHS Foundation Trust has shown that CBT leads to the strengthening of specific connections in the brains of patients suffering from psychosis. Amazingly these changes persist, and these stronger connections are associated with long-term reduction in symptoms even eight years later.
CBT is a specific type of talking therapy. It involves one on one sessions with a professional therapist where patients are taught techniques to change the way people think and respond to their experiences and thoughts. Psychotic symptoms are common in conditions such as schizophrenia, severe depression and many other psychiatric disorders. In these patients CBT aims to retrain the brain to help sufferers to respond differently to unusual, and often very distressing, experiences. It provides patients with strategies to deal with negative thoughts, feelings, and beliefs, thereby reducing distress and improving wellbeing.
The findings of this study, published in Translational Psychiatry show that patients with psychosis, who were treated with CBT, had strengthened connections between parts of the brain that are involved in detecting and responding to social threat. As part of the study there was a control group, who continued on standard medication. The patients in this group did not display these strengthened connections, suggesting that it was the CBT that was having the effect.
Functional MRI imaging was used to image the brains of patients as they were shown images of faces displaying various emotions. The imaging showed that psychosis was associated with weak connections between the amygdala area of the brain, which deals with threat perception, and the frontal lobes, which are required for thinking and reasoning. CBT strengthened these connections, enabling patients to better think and reason with themselves when they perceive a potential threat.
The head author and clinical psychologist, Dr Liam Mason, said:
"This research challenges the notion that the existence of physical brain differences in mental health disorders somehow makes psychological factors or treatments less important. Unfortunately, previous research has shown that this "brain bias" can make clinicians more likely to recommend medication but not psychological therapies. This is especially important in psychosis where only one in ten people who could benefit from psychological therapies are offered them."
This study was quite small, only 15 patients were followed up, but it does indicate that a much larger study is needed, along with a potential frame shift in how we treat psychiatric problems.