Psychotherapists know that psychiatric disorders always involve activity in the brain. In this era of psychopharmacology, brain imaging, and therapeutic electrical and magnetic stimulation of the brain, scientists are beginning to get some glimpses of what that activity might be.
One source of those insights is the use of positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other scanning techniques to see how psychotherapy itself affects the brain. The findings to date — preliminary and often conflicting — usually involve two brain regions: the limbic system, a center for the integration of memory and emotion; and the prefrontal cortex, which supplies the capacity for long-term planning, judgment, and self-control.
Studies have concentrated on three disorders:
Phobias. When a person with performance anxiety has to give a speech or a person who fears snakes is confronted with one, brain scans show rising blood flow and energy consumption in the amygdala, a center for fear and anger, and sometimes in the insula, a region that registers disgust and pain. Treatment with either cognitive behavioral therapy or an antidepressant lowers this activity. Treatment also seems to cause changes in several parts of the prefrontal cortex, and in this case the effects of medication and psychotherapy may be different.
Obsessive-compulsive disorder (OCD). When the symptoms of OCD — unwanted, uncontrollable, repetitious thoughts that result in compulsive actions — are highly active, so is a brain circuit connecting part of the frontal cortex with the basal ganglia, a region involved in the coordination of movements. Successful treatment with either psychotherapy or antidepressants reduces that activity.
Depression. Results are conflicting. In some studies, treatment with cognitive behavioral or interpersonal therapy seems to heighten activity in the prefrontal cortex and decrease it in the limbic system, including the amygdala. Other studies suggest that what changes is relative activity levels in different parts of the prefrontal cortex. Different kinds of depression or depressions with different causes may create different patterns.
Brain scans may help you chose treatmentsThe ultimate goal of understanding psychotherapy’s effects on the brain is to influence the choice of treatments. A study published in 2006 found that certain brain activity patterns predicted which depressed patients would and would not respond to cognitive behavioral therapy. Some enthusiasts have imagined a day when patients could be assigned to psychotherapy, medication, or other treatments on the basis of brain scans. Some even suggest the possibility of monitoring the progress of psychiatric treatment by tests of brain health resembling the exercise stress tests by which cardiologists judge changes in heart health.
We need a much more detailed understanding of how the brain works, and much more specific testing, to achieve that end. Today, it’s difficult to get consistent results from brain scans. The symptoms of psychiatric disorders are too ambiguous. The brain changes that underlie the symptoms are too subtle and variable. And brain scans are not sensitive enough to pick up key differences.
Scientific curiosity about brain changes in psychotherapy derives from the understanding that everything we think of as being the mind happens in the brain. To explain the complicated process of psychotherapy this way may seem utopian. Nevertheless, in a Newsweek interview, Eric Kandel, who won the Nobel Prize for his work on brain changes that accompany memory and learning, has said, “We need to look for the biological effectiveness of all kinds of psychotherapy in the same way we do for drugs. I think that will be the leitmotif of the next 15 years. If we can do it, we will revolutionize the field.”
What do you think about the possibility of getting a brain scan to learn which treatment will most likely help you?
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Comments: 11
Are there methods besides medication that can help with phobias, depression or anxieties?
I am also diagnosed as Borderline Personality Disorder, but the more I read and study on this the more I am leaning toward it being Intermittent Explosive Disorder, which was unheard of before the early 00s. It only made it into the psychiatric guide in 2004.
I believe Harvard did a study on this, I just added something to my website about it today. (http://uncontrollablerage.bravehost.com)
And my therapist has me taking a Post Dialectic Behavior Training Class (see my 'Getting Tweaked" article I just posted.
Would sure like to figure out how to get into my right mind. (or my left mind, or any sort of mind I should have - the one I have is making me nuts!) hee hee!
I often think about the opening to the original Star Trek — OK, I'm dating myself — where the narrator says, "Space. The final frontier."
I, for one, think the brain is the final frontier. It is the most complicated organ in the body and the hardest to understand. And Meryl you capture something important by pointing out the problem of the brain studying itself.
Another way to think about this problem of the brain studying itself is that it's what makes us human, that ability to be self-reflective. The paradox here is being self-reflective is both very wonderful (it enables us to grow emotionally, for example) or very horrible (when we become depressed because we are harshly self-critical).
The cancer analogy is a good one. Just as there are many types and even sub-types of cancer, there are almost certainly many illnesses that we lump into one phenomenon that we call "depression."
Neuroscientists are developing ways to tease those different subtypes apart. I'm optimistic that as we learn more about the subtypes, we'll see better treatments.
I share your interest in brain scans — they tell us important things about the structure of the brain and how it functions. Some of the technology is astonishing and the pictures are stunning to look at.
Brain scans do help us make certain diagnoses. For example, if a person has had a stroke, a scan can help a doctor figure out what kind of stroke it is, where it is and what kind of treatment might be best. But right now, scans don't give us the information we need to make those kinds of choices for people who have depression or OCD.
Brain scan research is done with the help of groups of people who volunteer to participate. The results of the studies suggest general trends. But the pictures we get can't help us decide which antidepressant might be best, or whether psychotherapy would be better than medication in a given case.
We hope that kind of painless brain exam will be available in the future, but we're not there yet.
Lately, I have been thinking about self-consciousness. As someone suggested, self-reflection can be both wonderful and horrible. Having become a self-reflective person due to a combination of factors, my nature, therapy, a major life crisis at a key point in my life, my own professional training, etc., I sometimes think it has become more of a curse than a blessing.
Although, of course, I cannot know what others are thinking from observation, I sometimes observe the seeming unselfconsciousness of some people and wonder if therapy, therapeutic work, even a spiritual path or religious affiliation and commitment, might affect the degree self-consciousness we possess.
Self-forgetting seems the best state of mind, don't you think?