Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Veena Kumari and Taylor Terca

Abstract

Up to 40% of schizophrenia patients continue to suffer from distressing symptoms despite remaining compliant with their prescribed antipsychotic medication. Additional symptom reduction following cognitive behaviour therapy for psychosis (CBTp) has been shown, but only in about 50% of such patients. A clear understanding of the neural changes following CBTp (potential mediators of improvement in target outcomes) as well as neural predictors of CBTp-led improvement (possible moderators) may help to refine or develop it further and increase its effectiveness. We provide a review of studies published to date (9 in total) examining the neural effects and/or predictors of CBTp. The studies analysed comprised of one spectroscopic imaging study on pre- vs post-CBTp changes, five functional magnetic resonance imaging studies [two analysing prevs post-CBTp changes, two analysing pre-therapy brain properties as predictors of symptom reduction following CBTp, and one analysing pre- vs post-CBTp changes in functional connectivity as the predictors of long term (over 7 years) outcome following CBTp], and three structural magnetic resonance imaging studies [two on pre-therapy brain properties as predictors of symptom change following CBTp, and one analysing pre- vs post-CBTp changes]. The findings from pre- vs post-CBTp brain activation studies demonstrate that CBTp reduces fronto-limbic activation to social threat and normalises cortico-limbic functional connectivity, indicating improved affect regulation through top-down control after CBTp. Additionally, CBTp was found to reduce pituitary volume, potentially by lowering of symptom-related distress. The findings from studies analysing pre-therapy brain properties as predictors of symptom reduction following CBTp indicate that functional and structural properties of multiple brain areas that are implicated in a range of cognitive functions, particularly the dorsolateral (cognitive flexibility), medial (self-awareness) and inferior (verbal skills) frontal cortices, hippocampus (memory) and precuneus (self-awareness), predict symptom reduction following CBTp. These results suggest a role for cognitive enhancement in the context of CBTp.

Published on: June 07, 2017
doi: 10.17756/jnpn.2017-014
Citation:  NKumari V, Terca T. 2017. Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging. J Neuroimaging Psychiatry Neurol 2(1): 11-19.

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