Brain changes following cognitive behavioral therapy for psychosis.

I've always been impressed by work of the sort done by Schwartz and others that shows cognitive behavioral therapy (CBT), when effective for obsessive-compulsive disorder, causes changes in brain activity similar to those caused by drugs that also alleviate symptoms. (One example of a CBT trick: instruct the patient, when symptoms appear, to think "That's not me, that's a part of my brain that is not working.") The journal BRAIN offers an open access article by Kumari et al. that makes further correlations of CBT with brain activity. They observe that in schizophrenia patients whose normal therapy is supplemented with cognitive behavior therapy there is decreased activation in several areas in response to fearful and angry expressions.

The cognitive behaviour therapy for psychosis...showed decreased activation of the inferior frontal, insula, thalamus, putamen and occipital areas to fearful and angry expressions at treatment follow-up compared with baseline. Reduction of functional magnetic resonance imaging response during angry expressions correlated directly with symptom improvement. This study provides the first evidence that cognitive behaviour therapy for psychosis attenuates brain responses to threatening stimuli and suggests that cognitive behaviour therapy for psychosis may mediate symptom reduction by promoting processing of threats in a less distressing way.