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More Than Just Talk: How Psychotherapy Can Help Rewire the Brain

woman in therapy session

The human brain is constantly changing. Our gray matter is responsive to music, mayhem and medicine, adapting with exposure to these and other stimuli, including psychotherapy. Science has shown that many forms of psychotherapy, whether used in conjunction with medications or without, can actually cause physiological changes in the brain that result in better treatment outcomes for people with trauma, addiction and other mental health disorders.

Through functional neuroimaging scans, researchers involved in more than 20 scientific studies have provided evidence of structural and functional changes in the brains of patients receiving psychotherapy for conditions such as depression and anxiety. These studies show physical changes in the brain that correlate to noticeable improvements for the patient.

Additional research studies have revealed that medications and substances of abuse also cause changes within the brain, altering the wiring within its reward center, thereby impacting levels of neurotransmitters like dopamine and serotonin that are sent along the nerve pathways in the body. Studies also reveal that after cessation of medication or substance use, and with sustained abstinence supported by therapy, a person’s brain structures can eventually return to a normal state. When a client who has given up drugs in treatment starts to feel less anxious or sleeps better, it is the brain healing.

All of these studies illustrate the amazing plasticity of the human brain — a plasticity that  makes it responsive not just to the substances people abuse or the medications they take, but also to psychotherapies that modify how we think and feel about things and how we behave.

Your Brain on Psychotherapy

Psychotherapy can help people with mental health disorders change the thoughts and actions that contribute to their symptoms — and actually alter the brain areas involved in controlling related emotions and behaviors — so they can stop being hindered by their illness and begin enjoying more of life’s experiences. Here are a few examples of evidence-based therapies that can have a significant impact on common mental health disorders:


Psychodynamic Therapy (PDT) – When undertaken for 12 months or more, PDT has been shown to increase production levels of the feel-good neurotransmitters serotonin and dopamine within the midbrain, helping improve symptoms for patients with atypical depression. While PDT has not proven to be as effective in patients with major depressive disorder, research indicates that relapse rates among all depression patients treated with some type of psychotherapy are generally lower than among those treated with antidepressants alone.

How PDT Works: Psychodynamic therapy involves action. Rather than simply talking about feelings and the reasons behind those feelings, in PDT patients work on why they do things. The goal of PDT is to uncover the unconscious motivations behind our actions, with the premise that doing comes first, and if we change what we do in certain situations, we can change how we think and feel about them.

Interpersonal Therapy (IPT) – In a study conducted at Christian-Albrechts University in Kiel, Germany, researchers used brain scanning to track brain changes caused by the use of interpersonal psychotherapy in depressed patients. The findings showed that IPT was associated with changes at the brain’s cellular level, increasing the production of a brain protein involved in creating neural pathways.

How IPT Works: This therapy focuses primarily on a client’s interpersonal relationships. The approach tackles the stress the client is under, the resources the client brings to the problem, and the social context of the problem. IPT is generally used over shorter time frames, typically three or four months.


Cognitive Behavioral Therapy (CBT) – This widely used therapy can bring relief to people with anxiety by focusing on how we think and act, with the premise that if we change our thoughts about certain situations that challenge us, we can change the way we feel and behave around them.

Research findings from a collaborative study in Switzerland shed light on why CBT may be particularly helpful in addressing anxiety issues. It can change key brain structures involved in self-control and emotion regulation. For example, in people with social anxiety disorder, regulation of excessive anxiety by frontal and lateral brain areas is impaired. Evidence shows that putting the emotion-regulating methods of CBT into practice restores the balance between cortical and subcortical brain areas, diminishing anxious responses to previously problematic stimuli.

CBT, which includes subtypes such as exposure therapy and acceptance and commitment therapy, also is used to help resolve depression, chronic pain, eating disorders, anger issues, low self-esteem and addiction.

How CBT Works: In cognitive behavioral therapy, clients learn to apply new strategies for dealing with anxiety in various situations through the use of role plays, video recordings and observations that promote self-awareness, helping them see where they can develop new views of a situation, and new actions to take within it.

Emotional Trauma

Eye Movement Desensitization and Reprocessing (EMDR) – This approach uses a set of well-researched, standardized protocols, integrating elements from several other treatment approaches. EMDR therapy is effective for treating trauma because it helps reduce flashbacks and intrusive thoughts. Some clients report improvement after just a few sessions.

How EMDR Works: The goal of EMDR is to process traumatic experiences in new, healthy ways. This “reprocessing” happens while the client focuses on a light or other object with their eyes. EMDR usually occurs in several phases, during which the client is eased into a learning state that allows them to revisit traumatic experiences, learn only what was useful from them, and discard the rest. Old memories are processed and stored in new ways with enhanced perspective.

Studies that track clients before and after receiving EMDR therapy have demonstrated changes in the hippocampus, indicating alterations in memory storage. EEG studies have demonstrated enhanced function in several areas of the brain after EMDR and decreased activation in other areas, indicating desensitization and inhibition of trauma responses.

Borderline Personality Disorder

Transference-Focused Psychotherapy (TFP) – This form of psychodynamic treatment is designed especially for patients with borderline personality disorder (BPD), a disorder characterized by intense emotional reactivity. TFP is distinguished from other treatments for BPD by its premise that psychological structure underlies the symptoms of the disorder. Treatment focuses on a person’s unique psychological make-up, and their ways of experiencing self, others and the environment.

How TFP Works: Transference is when someone transfers feelings about one person to another. TFP works by helping people navigate these feelings and understand their reactivity (how their feelings about one person or situation don’t necessarily apply to another).

A small study of 10 women with BPD who received TFP treatment showed increased activation in brain regions associated with cognitive control and decreased activation in regions of the brain associated with emotional reactivity.

Dialectical Behavior Therapy (DBT) – This approach incorporates tools from cognitive behavioral therapy, combining them with Eastern concepts of acceptance and mindfulness, to treat borderline personality disorder (BPD) and a variety of other mental health disorders.

How DBT Works: The combined tools are used in dialectical behavior therapy to teach people with BPD emotion-regulation strategies to improve self-representation and emotional reactivity.

In a 12-month study of people with BPD, brain scanning was used to track the physiological results of participants who were receiving DBT treatment. Brain scans of the participants who received therapy showed decreased activation of the amygdala, a region of the brain that is involved in our memory of emotions, particularly fear, and our emotional behavior. The patients who had received therapy also demonstrated improved overall emotion regulation.

Changes in Gray Matter Lead to Changes in Outlook, Behavior

While it may be hard to believe that psychotherapy is capable of producing physical brain changes that can be as effective as taking medication, the proof is in the gray matter. Scientists have demonstrated that brain changes resulting from psychotherapy are enduring, and crucial for long-term recovery from mental illness.

These findings challenge a longstanding “brain bias” that exists in the field of psychiatry — the view that the brain’s physical structure is unchanging and should be the primary focus of treatment, while psychological factors are secondary. Based on this bias, some will argue that medications provide the best results. But the latest scientific revelations indicate that, for those willing to invest time in therapy, the coping strategies and behavioral tools they learn will help manage life’s slings and arrows in the short term, while the brain’s circuitry works to catch up and affect lasting change in the long term.

The take-away message? Even if you are already taking medication that helps manage your symptoms, you can complement the medicine’s therapeutic benefits with psychotherapy. Find the psychotherapy that works for you and stick with it — your brain will adapt in ways that will enhance your healing, making you feel even better over time.

More Than Just Talk: How Psychotherapy Can Help Rewire the Brain

David Sack, M.D.

Dr. David Sack is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CMO of Elements Behavioral Health, he oversees a nationwide network of treatment centers including drug and alcohol rehab programs at The Ranch in Tennessee and The Right Step in Texas.

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APA Reference
Sack, D. (2017). More Than Just Talk: How Psychotherapy Can Help Rewire the Brain. Psych Central. Retrieved on August 13, 2020, from


Last updated: 24 Jul 2017
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