Emotional fMR auditory paradigm demonstrates normalization of limbic hyperactivity after cognitive behavior therapy for auditory hallucinations

To date, no study has evaluated the effects on brain function of cognitive behavior therapy (CBT) for persistent auditory hallucinations. This study explored the changes in brain activation associated with an emotional auditory paradigm when patients with schizophrenia and auditory hallucinations were treated with CBT. Functional magnetic resonance (fMR) imaging data were obtained from 55 subjects (17 patients with schizophrenia in the therapy group, 24 patients with schizophrenia in the control patient group, and 14 healthy control subjects). The patients in the experimental group were treated with 16-20 bi-weekly sessions of CBT, whereas the patients in the control group received treatment as usual. fMR images were obtained at baseline, 9 and 14 months after enrollment. Patients who received CBT showed significant decrease in brain activation in right and left amygdalae, and the left middle temporal gyrus, compared to both control groups. Significantly reductions in the brain activation of therapy patients were found in both amygdalae, but also in the left superior temporal gyrus and the right superior frontal gyrus at 14-month follow-up. Significant and stable reductions in the abnormal activation of key limbic regions appear to be attributable to the CBT during an emotional auditory paradigm in patients with schizophrenia and persistent auditory hallucinations. These results point to the availability of a biological imaging biomarker for CBT effects in patients with persistent auditory hallucinations.