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CBT helps psychosis patients process threats in less distressing way

CBT helps psychosis patients process threats in less distressing wayFor the first time, researchers at the Institute of Psychiatry (IOP) at King’s, have shown that Cognitive Behaviour Therapy (CBT) for psychosis affects the areas of the brain associated with responding to threat. The findings, published in the journal Brain, suggest that CBT for psychosis promotes the brain to process threats in a less distressing way, thus helping reduce the symptoms of delusions and paranoia. 

Professor Veena Kumari, lead author of the research at the IOP says: ‘This study was not meant to test the efficacy of CBT for psychosis, which is already established, but to observe changes in brain activity over the course of CBT for psychosis. It provides the first evidence that CBT for psychosis can calm down the brain’s response to perceived threat, and that CBT induces changes at the neural level’ 

The study involved 56 people with a diagnosis of paranoid schizophrenia or schizoaffective disorder. Half the participants followed a 6-8 month course of CBT for psychosis in addition to the treatment and care they were already receiving from mental health professionals, the other half continued their treatment as usual, and did not received CBT for psychosis.

The researchers then used fMRI (functional magnetic resonance imaging) scans to examine the activity of the brain when people from both groups looked at pictures of faces showing fear, anger, happiness or no particular emotion.  They took brain scans when study participants joined the study, and once more after their 6-8month course of treatment.

Whilst the first scans showed no significant differences between the two groups, the second scans revealed changes in brain response of the people who had been given a course of CBT for psychosis. In response to being shown fearful or angry faces, the patients who had received CBT for psychosis displayed reduced activity in the areas of the brain that process facial expressions (the inferior frontal gyrus), and those that are thought to play a role in processing potentially distressing information (the insula).

Professor Elizabeth Kuipers, one of the pioneers of CBT for psychosis at the IOP, says: ‘it is very exciting to be able to show neural changes after CBT that support our idea that reducing reactions to threat is helpful for those with psychosis.’ 

The research was supported by the Wellcome Trust.

Full paper: Kumari V, et al. ‘Neural changes following cognitive behaviour therapy for psychosis: a longitudinal study’, Brain (doi:10.1093/brain/awr15)
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