We may typically think of "talking therapies" (psychotherapy) as affecting a person's mind but not the brain itself. However, they do. It is also true that they alter how we think about things by, for example, changing dysfunctional thinking or improving problem-solving skills.
Brain imaging studies have shown that the same changes in the brain that are seen from taking fluoxetine (Prozac) are also found after behavior therapy, particularly in the caudate nucleus. However, there are also studies that show different brain changes between medication management and psychotherapy. This is especially found in treatments for depression. In contrast, the changes are more alike when treating anxiety disorders.
Some researchers have found changes at the moleculalar level after psychotherapy. It appears that the learning that takes place during psychotherapy can alter gene expression in neurons. It is also known that an enzyme necessary to lay down memories can be overwhelmed by excessive mental input. Therapists can modulate the amount of learning attempted during sessions.
Some people are surprised that talking to someone can change their brain. However, it is a commonplace experience that being told something can change your physiological state. For example, if you were told by a colleague that a truck ran into your new car in the parking lot, it is almost certain that your heart rate and blood pressure would increase, galvanic skin measurements would change, and other physiological responses to distressing or threatening situations. All these changes occur as a result of someone saying words to you. Memories of this event require changes in the memory systems in the brain.
The bottom line is that our brain structure and function are changed by many things including certain medications, life experiences such as childhood abuse, nutrition and other factors. Psychotherapy can be viewed as a special type of life experience designed to relieve mental suffering by changing dysfunctional thoughts and behaviors but also by changing the brain itself.
Peter M. Hartmann, MD, DFAPA
