Journal Mobile Options
Table of Contents
Vol. 83, No. 3, 2014
Issue release date: May 2014
Psychother Psychosom 2014;83:142-147

Review of Psychodynamic Psychotherapy Neuroimaging Studies

Abbass A.A. · Nowoweiski S.J. · Bernier D. · Tarzwell R. · Beutel M.E.
aDepartment of Psychiatry and bCentre for Emotions and Health, Dalhousie University, Halifax, N.S., and cFaculty of Medicine, University of British Columbia, Vancouver, B.C., Canada; dMelbourne Centre for ISTDP, Melbourne, Vic., Australia; eClinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Mainz, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


The clinical efficacy of psychodynamic psychotherapy (PDT) has undergone extensive study and review. Recently, researchers have studied the effects of this treatment on brain metabolic or synaptic activity, but the collective findings have never been reviewed. The objective of this review was to describe the findings of all neuroimaging studies of any form of PDT treatment. An extensive literature search through databases along with surveying of research groups were undertaken to acquire all available published studies. Eleven series were included in the final sample, consisting of 2 randomized controlled trials, 5 controlled trials and 4 case series, altogether involving 210 people: 94 healthy controls and 116 people with mood disorders, panic disorder, somatoform disorders and borderline personality disorder. A variety of neuroimaging techniques were used to examine regional metabolic activity and synaptic neurotransmission before and after treatment. The common finding was normalization of synaptic or metabolic activity in limbic, midbrain and prefrontal regions, occurring in association with improved clinical outcomes. PDT has demonstrable effects on brain function in diverse clinical populations as evidenced by a modest group of mixed neuroimaging studies. © 2014 S. Karger AG, Basel

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Shedler J: The efficacy of psychodynamic psychotherapy. Am Psychol 2010;65:98-109.
  2. Abbass A, Kisely S, Kroenke K: Short-term psychodynamic psychotherapy for somatic disorders: systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009;78:265-274.
  3. Town JM, Abbass A, Hardy G: Short-term psychodynamic psychotherapy for personality disorders: a critical review of randomized controlled trials. J Pers Disord 2011;25:723-740.
  4. Leichsenring F, Rabung S: Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008;300:1551-1565.
  5. Quidé Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M: Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review. Neurosci Biobehav Rev 2012;36:626-644.
  6. Sözeri-Varma G, Karadag F: The biological effects of psychotherapy in major depressive disorders: a review of neuroimaging studies. Psychology 2012;3:857-863.

    External Resources

  7. Fitzgerald PB, Laird AR, Maller J, Daskalakis ZJ: A meta-analytic study of changes in brain activation in depression. Hum Brain Mapp 2008;29:683-695.
  8. Nikolaus S, Antke C, Müller HW: In vivo imaging of synaptic function in the central nervous system. II. Mental and affective disorders. Behav Brain Res 2009;204:32-66.
  9. Nikolaus S, Antke C, Beu M, Müller HW: Cortical GABA, striatal dopamine and midbrain serotonin as the key players in compulsive and anxiety disorders: results from in vivo imaging studies. Rev Neurosci 2010;21:119-139.
  10. Roffman JL, Gerber AJ, Glick DM: Neural models of psychodynamic concepts and treatments: implications for psychodynamic psychotherapy; in Levy RA, Ablon JS, Kachele H (eds): Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence. New York, Springer, 2012, pp 193-218.

    External Resources

  11. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ 2009;339:b2535.
  12. Hirvonen J, Hietala J, Kajander J, Markkula J, Rasi-Hakala H, Salminen JK, Någren K, Aalto S, Karlsson H: Effects of antidepressant drug treatment and psychotherapy on striatal and thalamic dopamine D2/3 receptors in major depressive disorder studied with [11C]raclopride PET. J Psychopharmacol 2011;25:1329-1336.
  13. Lehto SM, Tolmunen T, Joensuu M, Saarinen PI, Valkonen-Korhonen M, Vanninen R, Ahola P, Tiihonen J, Kuikka J, Lehtonen J: Changes in midbrain serotonin transporter availability in atypically depressed subjects after one year of psychotherapy. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:229-237.
  14. Buchheim A, Viviani R, Kessler H, Kächele H, Cierpka M, Roth G, George C, Kernberg OF, Bruns G, Taubner S: Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PLoS One 2012;7:e33745.
  15. Beutel ME, Stark R, Pan H, Silbersweig D, Dietrich S: Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Res 2010;184:96-104.
  16. Lai C, Daini S, Calcagni ML, Bruno I, de Risio S: Neural correlates of psychodynamic psychotherapy in borderline disorders: a pilot investigation. Psychother Psychosom 2007;76:403-405.
  17. Saarinen PI, Lehtonen J, Joensuu M, Tolmunen T, Ahola P, Vanninen R, Kuikka J, Tiihonen J: An outcome of psychodynamic psychotherapy: a case study of the change in serotonin transporter binding and the activation of the dream screen. Am J Psychother 2005;59:61-73.

    External Resources

  18. Tolmunen T, Joensuu M, Saarinen PI, Mussalo H, Ahola P, Vanninen R, Kuikka J, Tiihonen J, Lehtonen J: Elevated midbrain serotonin transporter availability in mixed mania: a case report. BMC Psychiatry 2004;4:27.
  19. Viinamaki H, Kuikka J, Tiihonen J, Lehtonen J: Change in monoamine transporter density related to clinical recovery: a case-control study. Nord J Psychiatry 1998;52:39-44.

    External Resources

  20. Karlsson H, Hirvonen J, Kajander J, Markkula J, Rasi-Hakala H, Salminen JK, Någren K, Aalto S, Hietala J: Research letter: psychotherapy increases brain serotonin 5-HT1A receptors in patients with major depressive disorder. Psychol Med 2010;40:523-528.
  21. de Greck M, Scheidt L, Bölter AF, Frommer J, Ulrich C, Stockum E, Enzi B, Tempelmann C, Hoffmann T, Northoff G: Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder. World J Biol Psychiatry 2011;12:296-308.
  22. de Greck M, Bölter AF, Lehmann L, Ulrich C, Stockum E, Enzi B, Hoffmann T, Tempelmann C, Beutel M, Frommer J, Northoff G: Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy. Front Hum Neurosci 2013;7:410.
  23. Eldaief M, Dougherty D: Advances in neuroimaging: impact on psychiatric practice. Psychiatric Times, October 2008.
  24. Karlsson H, Hirvonen J, Salminen J, Hietala J: Increased serotonin receptor 1A binding in major depressive disorder after psychotherapy, but not after SSRI pharmacotherapy, is related to improved social functioning capacity. Psychother Psychosom 2013;82:260-261.
  25. Boeker H, Richter A, Himmighoffen H, Ernst J, Bohleber L, Hofmann E, Vetter J, Northoff G: Essentials of psychoanalytic process and change: how can we investigate the neural effects of psychodynamic psychotherapy in individualized neuro-imaging? Front Hum Neurosci 2013;7:355.
  26. Green S, Lambon Ralph MA, Moll J, Deakin JF, Zahn R: Guilt-selective functional disconnection of anterior temporal and subgenual cortices in major depressive disorder. Arch Gen Psychiatry 2012;69:1014-1021.
  27. Takeuchi H, Taki Y, Nouchi R, Hashizume H, Sekiguchi A, Kotozaki Y, Nakagawa S, Miyauchi CM, Sassa Y, Kawashima R: Anatomical correlates of self-handicapping tendency. Cortex 2013;49:1148-1154.
  28. Schmeing JB, Kehyayan A, Kessler H, Do Lam AT, Fell J, Schmidt AC, Axmacher N: Can the neural basis of repression be studied in the MRI scanner? New insights from two free association paradigms. PLoS One 2013;8:e62358.
  29. Zantvoord JB, Diehle J, Lindauer RJ: Using neurobiological measures to predict and assess treatment outcome of psychotherapy in posttraumatic stress disorder: systematic review. Psychother Psychosom 2013;82:142-151.
  30. Konarski JZ, Kennedy SH, Segal ZV, Lau MA, Bieling PJ, McIntyre RS, Mayberg HS: Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder. J Psychiatry Neurosci 2009;34:175-180.

    External Resources

  31. Siegle GJ, Thompson WK, Collier A, Berman SR, Feldmiller J, Thase ME, Friedman ES: Toward clinically useful neuroimaging in depression treatment: prognostic utility of subgenual cingulate activity for determining depression outcome in cognitive therapy across studies, scanners, and patient characteristics. Arch Gen Psychiatry 2012;69:913-924.
  32. Blagys MD, Hilsenroth MJ: Distinctive activities of cognitive-behavioral therapy: a review of the comparative psychotherapy process literature. Clin Psychol Rev 2002;22:671-706.
  33. Ulvenes PG, Berggraf L, Hoffart A, Stiles TC, Svartberg M, McCullough L, Wampold BE: Different processes for different therapies: therapist actions, therapeutic bond, and outcome. Psychotherapy (Chic) 2012;49:291-302.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50