AUTHOR=de Greck Moritz , Bölter Annette F., Lehmann Lisa , Ulrich Cornelia , Stockum Eva , Enzi Björn , Hoffmann Thilo , Tempelmann Claus , Beutel Manfred , Frommer Jörg , Northoff Georg TITLE=Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy JOURNAL=Frontiers in Human Neuroscience VOLUME=7 YEAR=2013 URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2013.00410 DOI=10.3389/fnhum.2013.00410 ISSN=1662-5161 ABSTRACT=

Somatoform disorder patients show a variety of emotional disturbances including impaired emotion recognition and increased empathic distress. In a previous paper, our group showed that several brain regions involved in emotional processing, such as the parahippocampal gyrus and other regions, were less activated in pre-treatment somatoform disorder patients (compared to healthy controls) during an empathy task. Since the parahippocampal gyrus is involved in emotional memory, its decreased activation might reflect the repression of emotional memories (which—according to psychoanalytical concepts—plays an important role in somatoform disorder). Psychodynamic psychotherapy aims at increasing the understanding of emotional conflicts as well as uncovering repressed emotions. We were interested, whether brain activity in the parahippocampal gyrus normalized after (inpatient) multimodal psychodynamic psychotherapy. Using fMRI, subjects were scanned while they shared the emotional states of presented facial stimuli expressing anger, disgust, joy, and a neutral expression; distorted stimuli with unrecognizable content served as control condition. 15 somatoform disorder patients were scanned twice, pre and post multimodal psychodynamic psychotherapy; in addition, 15 age-matched healthy control subjects were investigated. Effects of psychotherapy on hemodynamic responses were analyzed implementing two approaches: (1) an a priori region of interest approach and (2) a voxelwise whole brain analysis. Both analyses revealed increased hemodynamic responses in the left and right parahippocampal gyrus (and other regions) after multimodal psychotherapy in the contrast “empathy with anger”—“control.” Our results are in line with psychoanalytical concepts about somatoform disorder. They suggest the parahippocampal gyrus is crucially involved in the neurobiological mechanisms which underly the emotional deficits of somatoform disorder patients.