Cognitive therapy can change brain volume

Scientists have recently found that cognitive therapy can change the brain volume of people suffering from social anxiety disorder (SAD).

The study was completed in Linköping University, which cooperated with other Swedish universities such as the Karolinska Institutet, Uppsala University, Umeå University and Stockholm University. The study relied specifically on Internet-delivered cognitive behavioral therapy (ICBT) as treatment for the patients. Patients with SAD had their brains scanned with magnetic resonance imaging (MRI) before any treatment was administered.

Evidence from neuroimaging studies in both animals and humans has shown that the brain is remarkably adaptable. In other words, structural changes in the brain due to environmental factors, learning, behavior and emotions are rather common. The researchers at Linköping University found that there was limited literature on the structural brain changes associated with anxiety-reducing pharmacologic agents and that previous conclusions have provided varying results. These researchers decided that a multimodal study was needed to improve the understanding of the human brain. With such a study in mind, the scientists embarked on a study to record neural responsiveness in the amygdala after patients received Internet-delivered cognitive behavioral therapy.

The patients who participated in the study were directed through nine weeks of behavioral therapy. When the researchers scanned the patients’ brains after nine weeks, they found that their brain volume and activity had decreased. This decrease was specifically noted in the amygdala, an almond-shaped grouping of neurons deep in the brain’s medial temporal lobe and the brain’s integrative center for emotions, emotional behavior and motivation.

“The greater the improvement we saw in the patients, the smaller the size of their amygdalae,” Kristoffer NT Mansson, Linköping doctoral student and the study’s lead author, said in a press release. “The study also suggests that the reduction in volume drives the reduction in brain activity.”

The amygdala, anterior cingulate cortex, insula and hippocampus are all structures in the brain that have central roles in the acquisition and expression of fear. When neurons in these particular parts of the brain become overactivated, anxiety disorders have been reported.

The study was done in a randomized and controlled setting and examined cognitive behavior therapy-related changes in the brain using a multimethod neuroimaging approach. Researchers were able to evaluate the relationship between structural neuroplasticity and the functional changes of blood-oxygen level dependent (BOLD) signals in the study’s participants.

These findings were published in Translational Psychiatry, a Nature publication. The study was comprised of only 26 individuals and thus was deemed a relatively small study. Nevertheless, it was unique in its multifaceted approach, which involved testing both brain volume and brain activity.

The brain parameters of the study subjects were also compared to those of a healthy control group in order to evaluate pre-treatment differences and the normalization effects of the treatment.

“Although we didn’t look at that many patients, this work provides some important knowledge — especially for all the sufferers,” Mansson said. “Several studies have reported that certain areas of the brain differ between patients with and without anxiety disorders. We’ve shown that the patients can improve in nine weeks — and that this leads to structural differences in their brains.”

Mansson added that this experiment was just the first step of a much bigger project — to understand the psychological and biological effects of the treatment in more detail and to eventually develop more effective therapies. According to Mansson, the team plans to begin studying a larger volume of patients very soon.

Mansson is also working on a new study that will attempt to identify the point during Internet-delivered cognitive behavioral therapy at which the change in brain volume actually occurs. The research team hopes that one day these neurobiological changes may be applied on a larger scale.