Neurobiological Foundations of Psychotherapies

Psychotherapy is a neurobiological treatment. While it has been long known – through clinical experience and research – that psychotherapy can change thoughts, emotions, and behaviors, there is ever-expanding research about the neurobiology of psychotherapy. This chapter reviews studies demonstrating experience-related brain changes, pre- vs. post-psychotherapy, psychotherapy vs. psychopharmacology, and neuroimaging markers that predict psychotherapy efficacy, and future directions are explored in neuropsychotherapy research (e.g., medication-assisted psychotherapy). Experience, learning, and memory change the brain via epigenetic, neuroanatomical, neurochemical, endocrinological, and inflammatory pathways. Just as traumatic experiences can cause lasting neurobiological disruptions, psychotherapeutic experiences can normalize brain structure and function. Psychotherapy not only changes thoughts and emotions through learning but changes gene expression and neural connections, particularly in the frontal, limbic, and basal ganglia areas. Despite the nascency of our neuroscientific understanding of psychotherapeutic change, mental health professionals can take heart that research repeatedly demonstrates the efficacy of psychotherapy even if the neuroscience behind it is just beginning to be elucidated.