Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder

Abstract

Objectives. Somatoform disorder patients demonstrate a disturbance in the balance between internal and external information processing, with a decreased focus on external stimulus processing. We investigated brain activity of somatoform disorder patients, during the processing of rewarding external events, paying particular attention to the effects of inpatient multimodal psychodynamic psychotherapy. Methods. Using fMRI, we applied a reward task that required fast reactions to a target stimulus in order to obtain monetary rewards; a control condition contained responses without the opportunity to gain rewards. Twenty acute somatoform disorder patients were compared with twenty age-matched healthy controls. In addition, 15 patients underwent a second scanning session after participation in multimodal psychodynamic psychotherapy. Results. Acute patients showed diminished hemodynamic differentiation between rewarding and non rewarding events in four regions, including the left postcentral gyrus and the right ventroposterior thalamus. After multimodal psychodynamic psychotherapy, both regions showed a significant normalization of neuronal differentiation. Conclusion. Our results suggest that diminished responsiveness of brain regions involved in the processing of external stimuli underlies the disturbed balance of internal and external processing of somatoform disorder patients. By providing new approaches to cope with distressing events, multimodal psychodynamic psychotherapy led to decreased symptoms and normalization of neuronal activity.

Key words::

• fMRI
• brain imaging
• reward
• somatoform disorder
• psychotherapy

Acknowledgements

The authors thank the staff of the Department of Neurology of the Otto-von-Guericke-University of Magdeburg for their support. We also thank Jennifer Dent, Sascha Qian and Niall Duncan for their helpful propositions concerning the script. Financially, this study was supported by the Science and Technology Fellowship Programme in China (to MG). We are also indebted to the German research Foundation (DFG-SFB 779-A6), the Hope of Depression Research Foundation (HDRF), the CRC and the EJLB Michael Smith Foundation for providing generous financial support to GN. MG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Statement of interest

None to declare.