Psychotherapy Changes the Brain, Too: A Look at PTSD Treatment

It has become fashionable nowadays in psychotherapy circles to talk about neuroscience and interventions that target the brain. Some writers refer to this bias as “neurocentrism,” the notion that our behavior is best explained by locating it in the brain.

There’s a treatment for posttraumatic stress disorder (PTSD) called Eye Movement Desensitization and Reprocessing (EMDR) that anticipated this trend 20 years ago by using gimmicky neurological language as window dressing to sell the idea that it uniquely effects the brain. This marketing has been really effective, as EMDR has become a well-known “brand name” treatment even though there’s no evidence it’s more effective than other trauma-focused approaches. What people don’t often realize is that psychotherapy has always impacted the brain because making changes in how we think and behave affects the brain.

A new study about post-traumatic stress disorder (PTSD) shows how psychotherapy changes the brain. PTSD consists of a series of struggles (e.g., intrusive thoughts, irritability) that can develop after someone experiences one or more traumatic events. Many people recover after a trauma, but about 10% may develop problems that don’t go away without treatment. In this study, researchers looked at changes in the brain and gene expression before and after cognitive behavioral therapy for PTSD.

The Study

Researchers treated 39 people with PTSD with twelve 90-minute sessions of trauma-focused cognitive behavioral therapy (CBT). Brain scans and blood draws were taken before and after treatment. I found several results really interesting.

CBT Increases Hippocampus Volume

One finding is that there was an actual change in brain matter. The hippocampus is a part of the brain involved in memory. In this study, the size of the hippocampus increased by the end of treatment and these changes were related improvement in PTSD symptoms. The hippocampus can be directly impacted by high levels of long-term stress—such as PTSD—and has been shown to atrophy under these conditions. It appears that psychotherapy can help undo these changes.

The authors note that a prior study did not find any change in hippocampus volume following therapy for PTSD. They note that in the other study, the participants were more severe and had more chronic PTSD; consequently, they speculate that earlier intervention may be extremely important in bringing about improvements.

Changes in Gene Expression

The other biological marker of change the researchers looked at was the FKBP5 gene. Genes are outside my area of expertise, so I’ll try to summarize the results as accurately as I can. Apparently there’s evidence that FKBP5 is associated with anxiety and mood-related problems, and that it can be impacted by stressful external experiences. Reduced expressions of this gene have been linked to PTSD.

There’s also a relationship between FKBP5 and the hippocampus. Expression of FKBP5 can affect secretion of the stress hormone cortisol, which in turn can lead to atrophy in the hippocampus.

Using blood tests, the researchers found that increased expression the FKBP5 gene was also tied to improvement in PTSD.

Conclusions

To summarize, it appears that psychotherapy for PTSD can lead to actual changes in the brain—including increased volume of the hippocampus and changes in gene expression. It also suggests that early treatment for PTSD may be helpful undoing some of the damage.

The point I want to underscore is this: all effective treatments impact brain function.  Whether a treatment is a drug treatment, electroshock, or psychotherapy, they all affect the structure and function of people’s brains. Dressing up a psychotherapy in the language of neuroscience doesn’t make it any more effective or scientific. Any effective treatment changes the brain.

If you want to read the article yourself, click here for a pdf.

Brian Thompson Ph.D.

Author: Brian Thompson Ph.D.

Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.