Cognitive-behavioral therapy (CBT) has been shown to strengthen specific brain connections in people with psychosis. Now, researchers at King’s College London have found that these stronger connections are associated with a long-term reduction in symptoms and recovery even eight years later.
CBT involves helping people change how they think about and respond to their thoughts and experiences. For those with psychotic symptoms — common in schizophrenia and a number of other psychiatric disorders — the therapy involves learning to think differently about unusual thought patterns, such as distressing beliefs that others are out to get them. CBT also helps the patient develop new strategies to reduce internal distress and improve well-being.
The new study follows on the heels of the team’s previous work showing how, after receiving CBT, people with psychosis displayed strengthened connections between key regions of the brain involved in processing social threat accurately. The new results show for the first time that these changes continue to have an impact years later on people’s long-term recovery.
In the original study, participants underwent fMRI imaging both before and after six months of CBT in order to observe the brain’s response to images of faces showing different expressions.
Since the participants were already taking medication when they joined the study, the researchers compared their images to those of a medication-only group. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections were a result of the CBT.
For the new study, the researchers tracked the medical records of 15 of the 22 CBT participants for eight years. The participants were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing.
The findings show that increases in connectivity between several brain regions — most importantly the amygdala (the brain’s threat center) and the frontal lobes (involved in thinking and reasoning) — are associated with long-term recovery from psychosis. This is the first time that CBT-related changes in the brain have been shown to be associated with long-term recovery in people with psychosis.
“This research challenges the notion that the existence of physical brain differences in mental health disorders somehow makes psychological factors or treatments less important,” said lead author Dr. Liam Mason, a clinical psychologist at the Maudsley Hospital where the research took place.
“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.”
The research team hopes to confirm the results in a larger sample and to identify the changes in the brain that differentiate people who experience improvements with CBT from those who do not. Ultimately, the new findings could lead to more effective and personalized treatments for psychosis by allowing researchers to determine which psychological therapies are effective.
The findings are published in the journal Translational Psychiatry.