Psychiatric Times.
No. 9
The Impact of Psychotherapy on the Brain
By Glen O. Gabbard, M.D. |
September 1, 1998
Dr. Gabbard is the Bessie Walker Callaway Distinguished Professor of Education and Psychoanalysis at the Menninger Clinic and Karl Menninger School of Psychiatry and Mental Health Sciences.
Effects of Psychological Factors
Cancer research has shown positive effects of group psychotherapy, and by inference, a powerful effect on the brain and the body. Spiegel et al. (1989) conducted a controlled study in which metastatic breast cancer patients were randomly assigned to group psychotherapy or a control condition. Those in group psychotherapy lived an average of 18 months longer than controls. In a study of malignant melanoma patients, Fawzy et al. (1993) placed patients in either a support group or a control condition. They found that patients in the support group have more favorable death rates and more lengthy remissions than the controls. Most remarkable, this effect appeared to occur even though the support group lasted only six weeks.
A group of Pittsburgh investigators (Thase et al. 1998) studied 78 unmedicated patients with mild major depressive episodes. They were examined for sleep architecture changes before and after six weeks of cognitive-behavior therapy. The psychotherapy affected the neurobiological sleep variables in the same way as antidepressant medications.
While all of these studies are preliminary and require replication and further research, there can be little doubt that we are entering a new frontier in the mind-brain specialty known as psychiatry.
We now know that the brain is characterized by considerable plasticity and that genes are not static but responsive to environmental factors which we are only beginning to understand. Kandel (1998) has suggested that by producing changes in gene expression, psychotherapy may alter the strength of synaptic connections. Biological and psychosocial factors appear to have equal weight in development. There is a reciprocal effect of gene expression on environment and environment on gene expression in every family system. We can no longer afford a reductionism in either a biological or psychosocial direction.
All this evidence of the impact of psychotherapy on the brain opens up new lines of investigation to enhance our understanding of psychopathology and treatment: a) the mechanisms of action of psychotherapy, b) the interrelationships of the mechanisms of action of medication and psychotherapy, and c) a clearer understanding of pathogenesis itself and the malleability of some components of the pathogenetic mechanisms of major psychiatric disorders.
References
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Baxter LR, Schwartz JM, Bergman KS et al. (1992), Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry 49(9):681-689.
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Fawzy FI, Hyun CS, Fawzy NW et al. (1993), Malignant melanoma effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 50(9):681-689.
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Gabbard GO, Goodwin F (1996), Clinical psychiatry in transition: Integrating biological and psychosocial perspectives. In: Review of Psychiatry, American Psychiatric Press, pp 527-548.
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Kandel ER (1998), A new intellectual framework for psychiatry. Am J Psychiatry 155(4):457-469.
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Spiegel D, Bloom J, Kraemer HC, Gottheil E (1989), Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2(8668):888-891.
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Thase ME, Fasiczka AL, Berman SR et al. (1998), Electroencephalographic sleep profiles before and after cognitive-behavior therapy of depression. Arch Gen Psychiatry 55(2):138-144.
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Ursano R, Silberman EK (1994), Psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy. In: The American Psychiatric Press Textbook of Psychiatry, 2nd ed. Hales E, Yudofsky SC, Talbott, eds. Washington, D.C.: American Psychiatric Press.
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Viinamäki H, Kuikka J, Tiihonen J, Lehtonen J (1998), Change in monoamine transporter density related to clinical recovery: A case-control study. Nord J Psychiatry 52:39-44.
10.
(The preceeding is a summary of Dr. Gabbard's presentation as the third annual Gene Usdin, M.D., Distinguished Visiting Lecturer in Psychiatry. Previous lecturers were Jerry M. Lewis, M.D., and Peter V. Rabins, M.D.-Ed.)
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