In the current issue of Psychotherapy and Psychosomatics a new study identifies biological characteristics who may predict who is going to respond to psychotherapy. Psychodynamic psychotherapy has been used to treat depression for more than a century. However, not all patients respond equally well, and there are few reliable predictors of treatment outcome. The authors used resting 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) scans immediately before and after a structured, open trial of brief psychodynamic psychotherapy (n = 16) in conjunction with therapy process ratings and clinical outcome measures to identify neural correlates of treatment response. Results showed that retreatment glucose metabolism within the right posterior insula correlated with depression severity. Reductions in depression scores correlated with a pre- to post-treatment reduction in right insular metabolism, which in turn correlated with higher objective measures of patient insight obtained from videotaped therapy sessions. Pretreatment metabolism in the right precuneus was significantly higher in patients who completed treatment and correlated with psychological mindedness.
Even though these findings are just preliminary and require replication, they suggested the presence of specific neural correlates of short-term psychodynamic psychotherapy for depression. Resting brain metabolism seemed to predict both clinical course and relevant psychotherapeutic process during short-term psychodynamic psychotherapy for depression. Furthermore, this may be a promise for the use of brain imaging to improve the efficiency of treatment selection, either pharmacotherapy or psychotherapy.