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Front. Psychol. | doi: 10.3389/fpsyg.2019.00660

Neurobiological mechanisms of metacognitive therapy – an experimental paradigm

 Lotta Winter1, 2,  Mesbah Alam1, 3, Hans E. Heissler1, 3, Assel Saryyeva1, 3,  Denny Milakara4, 5, Xingxing Jin6,  Ivo Heitland1, 7, Kerstin Schwabe1, 3,  Joachim K. Krauss1, 3 and  Kai G. Kahl1, 7*
  • 1Hannover Medical School, Germany
  • 2Department of Psychiatry, Social Psychiatry and Psychotherapy, Germany
  • 3Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
  • 4Center for Stroke Research Berlin (CSB), Germany
  • 5Charité Medical University of Berlin, Germany
  • 6Department of Neurosurgery, Zhongda Hospital, Southeast University, China
  • 7Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinischen Hochschule Hannover, Germany

Introduction: The neurobiological mechanisms underlying the clinical effects of psychotherapy are scarcely understood. In particular, the modifying effects of psychotherapy on neuronal activity are largely unknown. We here present data from an innovative experimental paradigm using the example of a patient with treatment resistant obsessive-compulsive disorder (trOCD) who underwent implantation of bilateral electrodes for deep brain stimulation (DBS). The aim of the paradigm was to examine the short term effect of metacognitive therapy (MCT) on neuronal local field potentials (LFP) before and after 5 MCT sessions.

Methods: DBS electrodes were implanted bilaterally with stereotactic guidance in the bed nucleus of the stria terminalis/ internal capsule (BNST/IC). The period between implantation of the electrodes and the pacemaker was used for the experimental paradigm. DBS electrodes were externalized via extension cables, yielding the opportunity to record LFP directly from the BNST/IC. The experimental paradigm was designed as follows: a) baseline recording of LFP from the BNST/IC, b) application of 5 MCT sessions over 3 days, c) post MCT recording from the BNST/IC. The Obsessive-Compulsive Disorder- scale (OCD-S) was used to evaluate OCD symptoms.

Results: OCD symptoms decreased after MCT. These reductions were accompanied by a decrease of the relative power of theta band activity, while alpha, beta, and gamma band activity was significantly increased after MCT. Further, analysis of BNST/IC LFP and frontal cortex EEG coherence showed that MCT decreased theta frequency band synchronization.

Discussion: Implantation of DBS electrodes for treating psychiatric disorders offers the opportunity to gather data from neuronal circuits, and to compare effects of therapeutic interventions. Here we demonstrate direct effects of MCT on neuronal oscillatory behavior, which may give possible cues for the neurobiological changes associated with psychotherapy.

Keywords: Metacognitive Therapy (MCT), LFP = local field potential, deep brain stimulation (DBS), treatment resistance OCD, BNST/IC

Received: 10 Sep 2018; Accepted: 11 Mar 2019.

Edited by:

Gerald Matthews, University of Central Florida, United States

Reviewed by:

Susana Ochoa, Parc Sanitari Sant Joan de Déu, Spain
Bartosz Zurowski, Department of Psychiatry and Psychotherapy, University Medical Center Schleswig-Holstein, Germany
Karin Carter, Greater Manchester Mental Health NHS Foundation Trust, United Kingdom  

Copyright: © 2019 Winter, Alam, Heissler, Saryyeva, Milakara, Jin, Heitland, Schwabe, Krauss and Kahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Kai G. Kahl, Hannover Medical School, Hanover, 30625, Germany,