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Emily,

In your post, you brought up a really important observation that I think merits more discussion.  In all the conversations I've had with psychologists or psychiatrists, I've consistently heard that neither pharmacotherapy nor talk therapy work as well as they do in tandem.  You brought this point up, and I'd like to continue discussion about it because it reflects a lot about the current therapeutic paradigm.  The obvious question this raises is why the two strategies work the best together?  What kind of interaction between talk therapy related changes and pharmacotherapy is taking place in the brain?  People in the forum and in general seem to be wary of pharmacotherapy nowadays, which doesn't all together surprise me because that strategy seems to be to flood the entire brain with a chemical that's intended to affect a very small portion of the brain.  I, for one, think talk therapy is a very interesting therapeutic option because it has the capacity to do the opposite of the pharmacotherapy.  Brain imaging technologies demonstrate that asking a person to do tasks like recalling a memory, describing a situation, imagining an alternative to a crisis, (tasks that are often done in a psychology session!) increase blood flow to very specific parts of the brain.  This, with Dr. Yadin's account of neuroplasticity suggests that talk therapy could start with very local change (that perhaps extrapolates to much larger change) while pharmacotherapy targets the whole brain at once.  Isn't it weird, then, that both of these strategies work best together???

To step away from the neurobiological questions these findings raise, I think the social message is pretty clear: that treating those who seek treatment with drugs alone is not sufficient, and though it may be more costly and time consuming and less efficient, talk therapy is a must.  This all leads me to another question that was raised in class on Tuesday.  I can't help wondering if you have to have the title and the credentials of a psychologist to create this kind of change in another person.  Is it possible that a religious advisor, a good friend, a mentor, a parent, or any trustworthy confidante can fill the role of a psychologist just as effectively?  I think the answer must be yes, based not only on the anecdotal evidence I can provide based on feelings of a "new perspective" after confiding in a trusted friend about a crisis, and also when considering how many people simply do not have access to credentialed psychological care.  Does this then mean that advisors, friends, parents are all psychologists without the formal training and the degree?  Are we all capable of profound psychological and neurobiological impact on those we have meaningful discussions with?  Is it just me, or does this seems to hearken back to our conversation on diversity and education and the ability to change the brain....?  

Lastly, I'd like to draw attention to a recent study called "Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear." that looked at the effects of the "cognitive enhancer", D-cycloserine on NMDA receptors.  Basically, this study found that people who were given this drug learned and extinguished their fear of heights more quickly than the control.  This drug seem to have very interesting implications for the future of pharmacotherapy.... Could this be used to enhance talk therapy?  What kinds of people would benefit from this drug?

 The study can be found at:

http://archpsyc.ama-assn.org/cgi/content/full/61/11/1136