title: Tracking functional brain changes in patients with depression under psychodynamic psychotherapy using individualized stimuli.
abstract: OBJECTIVE
  Neurobiological models of depression posit limbic hyperactivity that should normalize after successful treatment. For psychotherapy, though, brain changes in patients with depression show substantial variability. Two critical issues in relevant studies concern the use of unspecific stimulation experiments and relatively short treatment protocols. Therefore changes in brain reactions to individualized stimuli were studied in patients with depression after eight months of psychodynamic psychotherapy.
  
  
  METHODS
  18 unmedicated patients with recurrent major depressive disorder were confronted with individualized and clinically derived content in a functional MRI experiment before (T1) and after eight months (T2) of psychodynamic therapy. A control group of 17 healthy subjects was also tested twice without intervention. The experimental stimuli were sentences describing each participant's dysfunctional interpersonal relationship patterns derived from clinical interviews based on Operationalized Psychodynamic Diagnostics (OPD).
  
  
  RESULTS
  At T1 patients showed enhanced activation compared to controls in several limbic and subcortical regions, including amygdala and basal ganglia, when confronted with OPD sentences. At T2 the differences in brain activity between patients and controls were no longer apparent. Concurrently, patients had improved significantly in depression scores.
  
  
  CONCLUSIONS
  Using ecologically valid stimuli, this study supports the model of limbic hyperactivity in depression that normalizes after treatment. Without a control group of untreated patients measured twice, though, changes in patients' brain activity could also be attributed to other factors than psychodynamic therapy.
authors.affiliation: Department of Neurology, University of Lübeck, Lübeck, Germany; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiswede
authors.affiliation: Department of Psychology, Alpen-Adria-University of Klagenfurt, Klagenfurt, Austria; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Taubner
authors.affiliation: Institute of Psychology, University of Innsbruck, Innsbruck, Austria; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Buchheim
authors.affiliation: Department of Neurology, University of Lübeck, Lübeck, Germany.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Münte
authors.affiliation: Institute of Psychosomatic Cooperation Research and Family Therapy, University of Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stasch
authors.affiliation: Institute of Psychosomatic Cooperation Research and Family Therapy, University of Heidelberg, Heidelberg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Cierpka
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Kächele
authors.affiliation: Brain Research Institute, University of Bremen, Bremen, Germany; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Roth
authors.affiliation: Brain Research Institute, University of Bremen, Bremen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Erhard
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany; Hanse Institute for Advanced Study, Delmenhorst, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kessler
mesh_terms: D000328:Adult; D001519:Behavior; D001921:Brain / Q000503:physiopathology*; D003863:Depression / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064889:Psychotherapy, Psychodynamic