Vázquez Rivera S, Gómez Magariños S, González-Blanch C
Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, c/ Prof. Martín Lagos s/n, Madrid.
Actas Esp Psiquiatr. 2010 Jul-Aug;38(4):239-48. Epub 2010 Jul 1.
Psychological therapies can modify thoughts, feelings, and behaviors of people with mental disorders, but the underlying brain mechanisms remain to be clarified. Advances in neuroimaging techniques can help us to understand of how different psychotherapies change the human brain. This review has aimed to systematically investigate the brain effects of psychological therapies for adults with anxiety disorders.
Several electronic databases (Medline, PsycINFO, EMBASE and EBSCO) up to April 2010 were searched. Abstracts which appeared to fulfill the initial selection criteria (a structured psychological treatment in adults with anxiety disorders with at least one neuroimaging study performed before and after the treatment) were selected and their original articles were then retrieved. References from the selected English and Spanish language publications were also hand searched.
Eighteen studies met the criteria for inclusion in the review. The majority of these papers reported cognitive-behavioral therapy (CBT) in specific phobia, social phobia, obsessive-compulsive disorder (OCD), posttraumatic stress disorder or panic disorder. Psychological interventions changed neural circuits involved in the pathophysiology of anxiety disorders, especially activity in frontal-striatal circuits in OCD and prefrontal areas in arachnophobia. However, the results are largely inconsistent among themselves and with the neurobiological models of anxiety, in particular as regards the changes at the limbic level.
Despite the variety of methodological concerns, initial neuroimaging studies have showed that psychological interventions can change brain function related to anxiety disorders in the patients who respond to treatment. Neuromodulation mechanisms related to specific anxiety disorders remained to be elucidated. Future studies should delineate the process of “normalization” that occurs in the brain during a psychological treatment, helping to enrich the current neurobiological models of the origins, maintenance and treatment of anxiety disorders.
心理治疗可以改变精神障碍患者的思维、情感和行为，但其潜在的大脑机制仍有待阐明。神经成像技术的进步有助于我们理解不同的心理治疗如何改变人类大脑。本综述旨在系统地研究针对成人焦虑症的心理治疗对大脑的影响。
检索了截至2010年4月的多个电子数据库（Medline、PsycINFO、EMBASE和EBSCO）。选择了似乎符合初始选择标准的摘要（对患有焦虑症的成人进行结构化心理治疗，且在治疗前后至少进行一项神经成像研究），然后检索其原始文章。还手工检索了所选英文和西班牙文出版物的参考文献。
18项研究符合纳入本综述的标准。这些论文大多报道了针对特定恐惧症、社交恐惧症、强迫症（OCD）、创伤后应激障碍或惊恐障碍的认知行为疗法（CBT）。心理干预改变了与焦虑症病理生理学相关的神经回路，尤其是强迫症中额叶-纹状体回路和恐蛛症中前额叶区域的活动。然而，这些结果彼此之间以及与焦虑症的神经生物学模型在很大程度上不一致，特别是在边缘系统水平的变化方面。
尽管存在各种方法学问题，但初步的神经成像研究表明，心理干预可以改变对治疗有反应的患者中与焦虑症相关的大脑功能。与特定焦虑症相关的神经调节机制仍有待阐明。未来的研究应描绘心理治疗过程中大脑发生的“正常化”过程，有助于丰富当前关于焦虑症的起源、维持和治疗的神经生物学模型。
