Paquette Vincent, Lévesque Johanne, Mensour Boualem, Leroux Jean-Maxime, Beaudoin Gilles, Bourgouin Pierre, Beauregard Mario
Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary Road, Montréal, Québec, Canada, H3W 1W5.
Neuroimage. 2003 Feb;18(2):401-9. doi: 10.1016/s1053-8119(02)00030-7.
Questions pertaining to the neurobiological effects of psychotherapy are now considered among the most topical in psychiatry. With respect to this issue, positron emission tomography (PET) findings indicate that cognitive and behavioral modifications, occurring in a psychotherapeutic context, can lead to regional brain metabolic changes in patients with major depression or obsessive-compulsive disorder. The goal of the present functional magnetic resonance imaging (fMRI) study, which constitutes the first neuroimaging investigation of the effects of cognitive-behavioral therapy (CBT) using an emotional activation paradigm, was to probe the effects of CBT on the neural correlates of spider phobia. In order to do so, fMRI was used in subjects suffering from spider phobia (n = 12) to measure, before and after effective CBT, regional brain activity during the viewing of film excerpts depicting spiders. Normal control subjects were also scanned (once) while they were exposed to the same film excerpts. Results showed that, in phobic subjects before CBT, the transient state of fear triggered, during the viewing of the phobogenic stimuli, was correlated with significant activation of the right dorsolateral prefrontal cortex (Brodmann area-BA 10), the parahippocampal gyrus, and the visual associative cortical areas, bilaterally. For normal control subjects (n = 13), only the left middle occipital gyrus and the right inferior temporal gyrus were significantly activated. In phobic subjects before CBT, the activation of the dorsolateral prefrontal cortex (BA 10) may reflect the use of metacognitive strategies aimed at self-regulating the fear triggered by the spider film excerpts, whereas the parahippocampal activation might be related to an automatic reactivation of the contextual fear memory that led to the development of avoidance behavior and the maintenance of spider phobia. After successful completion of CBT, no significant activation was found in the dorsolateral prefrontal cortex (BA 10) or the parahippocampal gyrus. These findings suggest that a psychotherapeutic approach, such as CBT, has the potential to modify the dysfunctional neural circuitry associated with anxiety disorders. They further indicate that the changes made at the mind level, within a psychotherapeutic context, are able to functionally "rewire" the brain.
有关心理治疗神经生物学效应的问题，如今被认为是精神病学领域最热门的话题之一。关于这个问题，正电子发射断层扫描（PET）的研究结果表明，在心理治疗过程中发生的认知和行为改变，可导致重度抑郁症或强迫症患者大脑区域代谢发生变化。本功能磁共振成像（fMRI）研究的目的，是探究认知行为疗法（CBT）对蜘蛛恐惧症神经关联的影响，这是首次使用情绪激活范式对认知行为疗法效果进行的神经影像学研究。为了实现这一目的，对12名患有蜘蛛恐惧症的受试者使用fMRI，在有效的CBT治疗前后，测量他们观看描绘蜘蛛的电影片段时大脑区域的活动。正常对照受试者在观看相同电影片段时也接受了一次扫描。结果显示，在接受CBT治疗前，恐惧症患者在观看致恐惧刺激物时触发的短暂恐惧状态，与右侧背外侧前额叶皮质（布罗德曼区-BA 10）、海马旁回以及双侧视觉联合皮质区域的显著激活相关。对于正常对照受试者（n = 13），只有左侧枕中回和右侧颞下回有显著激活。在接受CBT治疗前，恐惧症患者背外侧前额叶皮质（BA 10）的激活可能反映了旨在自我调节由蜘蛛电影片段引发的恐惧的元认知策略的使用，而海马旁回的激活可能与情境恐惧记忆的自动重新激活有关，这种重新激活导致了回避行为的发展和蜘蛛恐惧症的维持。在成功完成CBT治疗后，背外侧前额叶皮质（BA 10）或海马旁回未发现显著激活。这些发现表明，诸如CBT这样的心理治疗方法有可能改变与焦虑症相关的功能失调的神经回路。它们进一步表明，在心理治疗背景下，在思维层面所做的改变能够在功能上“重新连接”大脑。
