Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD

ABSTRACT

Background: Meta-analytic results indicate that posttraumatic stress disorder (PTSD) is associated with hypoactivation of the medial prefrontal cortex (mPFC), hyperactivation of the 

amygdala, and volume reductions of the hippocampus. Effective psychotherapeutic treatments were hypothesized to normalize these neural patterns via upregulation of prefrontal 

structures, which in turn downregulate limbic regions.

Objective: To gain a sound understanding of the effects of successful psychotherapy on the 

brain, neural changes from pre- to post-treatment in PTSD patients will be aggregated.

Method: A systematic literature search identified 24 original studies employing structural or 

functional MRI measurements both before and after treatment of patients diagnosed with PTSD.

Results: In conjunction, the review returned little evidence of an activation increase in the 

mPFC/rostral anterior cingulate cortex (rACC) following successful treatment. Five out of 12 

studies observed such an increase (especially during emotion processing tasks), albeit in 

partially non-overlapping brain regions. Conversely, neither the putative related activation 

decrease in the amygdala nor volumetric changes or altered activation during the resting state 

could be convincingly established.

Conclusion: Successful psychological treatments might potentially work via upregulation of 

the mPFC, which thus may be involved in symptom reduction. However, the role of the 

amygdala in recovery from PTSD remains unclear. There is currently no indication that the 

various PTSD treatment approaches employed by the reviewed studies differ regarding their 

action mechanisms, but further research on this topic is needed.