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CME-Beitrag/CME Article

Neurobiologische Korrelate von Psychotherapie bei Angst- und Persönlichkeitsstörungen

Zur aktuellen Befundlage aus struktureller und funktioneller Bildgebung

Published Online:February 28, 2015https://doi.org/10.1024/1661-4747.57.2.113

Abstract

Die Darstellung hirnfunktioneller Korrelate von Psychotherapieeffekten könnte, so ist die Erwartung, Rückschlüsse auf die Wirkmechanismen umschriebener psychotherapeutischer Interventionen erlauben und im besten Fall ermöglichen, Prädiktoren für das Ansprechen auf unterschiedliche Therapiemethoden oder für einen drohenden Rückfall zu detektieren. Vor dem Hintergrund eines recht detailliert ausgearbeiteten Modells zu neurobiologischen Grundlagen von Angststörungen verfügen wir inzwischen über eine Reihe funktioneller und auch struktureller Studien zu Psychotherapieeffekten. Sie legen nahe, dass sich Psychotherapieeffekte bei dieser Patientengruppe vor allem auf die Amygdala und die Insel als eng mit der psychischen und somatischen Furchtsymptomatik assoziierte Hirnareale entfalten, im Weiteren auf den Hippocampus und schließlich auf ventromediale präfrontale Areale, die mit der Furchtextinktion oder allgemeiner mit der Affektsteuerung in Zusammenhang gebracht werden. Zu Psychotherapieeffekten bei Persönlichkeitsstörungen liegt nur eine sehr begrenzte Datenlage vor, die auf Effekte in ähnlichen Hirnarealen bei der Borderline-Persönlichkeitsstörung verweist. Insgesamt steckt die neurobiologische Forschung zu Psychotherapieeffekten noch in ihren Kinderschuhen und hat noch viele methodische Probleme zu lösen, bevor verlässliche Schlüsse zu differenziellen Effekten psychotherapeutischer Interventionen gezogen werden können.


Neurobiological Correlates of Psychotherapy in Anxiety and Personality Disorders – A Review on Structural and Functional Neuroimaging

Research on functional correlates of psychotherapeutic effects meets with great interest because this scientific approach could help us to understand the precise mechanisms of specific psychotherapeutic interventions or even to identify predictors of therapy response to differential treatments or to detect risk factors of early relapse. Concerning anxiety disorders a detailed model of neurobiological underpinnings already exists which has helped to conduct a number of functional and structural neuroimaging studies. Their results suggest that psychotherapy particularly exerts effects on the amygdala and the insula as two areas which are highly related to psychic and somatic fear symptoms, furthermore on the hippocampus and finally on ventromedial prefrontal areas which are associated with fear extinction or more generally with affect regulation. With regard to personality disorders there are only little data at our disposal suggesting effects on similar brain areas as in subjects with anxiety disorders. Up to now, neurobiological research on psychotherapeutic effects is still at its beginning, and faces with a number of methodological problems which have to be solved before valid conclusions can be drawn with regard to differential neurofunctional effects of single interventions.

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