Mental Health and the Brain: Talk Therapies

Mental Health and the Brain: A Discussion Fall, 2008 a course at Bryn Mawr College and associated public conversation

Our eighth session and resulting on-line forum discussion considered pharmacotherapy and experiential therapy in the context of our earlier discussions of the brain. This week, we will continue our discussion of pharmacotherapy and move on to begin to think about additional forms of talk therapy in the context of earlier discussions of the brain.

Readings for this week

Psychoanalysis

• What is psychoanalysis?
• Dream interpretation and psychoanalysis
  
• Psychoanalysis then and now
  
• Freud is widely taught at universities, except in the psychology department
• A new and controversial short term psychotherapy
• Psychoanalytic therapy wins backing
• Have you ever been in psychotherapy, doctor?

Cognitive behavioral therapy

• Making sense of cognitive behavioral therapy
• Changing politicians' minds about changing our minds?
• Dodo bird, phoenix, or urban legend? The question of psychotherapy equvalence
• Like drugs, talk therapy can change brain chemistry

Where we've been ...

forms of talk therapy (with a medical professional) that are used as a continuous crutch for people throughout life is an unneccessary strain upon an already strained healthcare system. I think the type of support that people get via talk therapy when they don't really have an underlying problem can and should be found among friends and family ...For that reason I instinctively dislike activities like the one we all participated in last monday. I think they can be breading gounds for peoples desire to seek self affirmation when what they might need is a stern but caring friend/realitve to tell them to cut the crap and do x y or z ... MartinBayer

people in today’s society have begun to depend upon talk therapy so completely that often times they are no longer capable of thinking about issues and problems by themselves and coming to productive and coherent solutions ... llamprou

we aren't as clueless to the machinations of our mind as we sometimes imagine/present ourselves to be. But I think a lot of times we are clueless as to how we can exact change, and that is where professional help can be of use to most people ... ysilverman

I thought the talk therapy activity was interesting and difficult. I like being given ample time to consider different situations, especially when people are involved. I find that .... when put in groups ... I go blank. I don't like saying things that don't have some sort of conscious foundation in my head in front of a group of people, since I like to be able to expand on and defend my views .... I think it's also hard to genuinely tell someone you barely know why you think you can relate them to others in your life ... kgins

I really enjoyed the exercise we did in class with Sarah. For me, it was a novel way to enact the working of tacit knowledge. Prior to the exercise, I did not have a working knowledge that I may have certain intution about people. The exercise brought to light some of those unconscious understandings and crafting a story after being drawn to a particular person pushed me to examine and understand my intuition in a way that I likely would not have done otherwise ... I think a general sense of interpersonal disconnection is very much a theme of modernity. As such, therapy can enable an interpersonal connection that people may not be encouraged to foster in daily life ... Sophie F

So, one of my issues with therapy is... how does it work? What is the mechanism? I am not arguing that talking, or culture, can't affect our brains. I'm just saying that if most or all of us exists in the neural circuitry of our brain, then why don't we focus on manipulating that circuitry to achieve the changes we want? ... This is why drugs are particularly interesting to me right now. They seem to provide a concrete way of providing change. This also seems to be why drugs have more credibility than therapy too. Some guy in a white coat can stand up there and say "Pill X affects structure Y which is responsible for symptom Z." ...
I'm not saying that therapy doesn't work. I'm sure it does for some people... maybe it could for all people. I think we can accept that and move on. I think a more useful question is how does it work? How does it change the neural connections that shape my experience. I feel like the answer to this question, as well as a more subtle understanding of the connections in the brain and our ability to manipulate them will lead to the next generation of treatment ... ryan g

The more I learn about the physiological effects of talk therapy, the more I find it hard to talk in terms of the story teller, because it seems to be glossing over, as Ryan mentioned, the physical mechanisms in the brain for how it works. We know the story teller does effect changes in brain chemistry that can be measured through scientific tests, and I feel like this should prove once and for all that talk therapy and drugs are working towards the same goal ... kmanning

"This fascinating study showed that although CBT and paroxetine seemed to improve depression to the same degree, they did so by acting on different brain circuits—CBT seems to work top-down, whereas pharmacotherapy works more bottom-up."

To really define mental health and mental illness - I think we have to continue talking about the storyteller even in cases like my father's where the root cause of the illness could be clearly traced to a very clearly identified problem with a brain structure ... adiflesher

Throughout last class, I was thinking that perhaps the storyteller is responsible for depression, bipolar, etc ... I think a faulty storyteller can tell a story that is far from reality and lead to bad thoughts ... I think the drugs are effective in that they predispose one to more pleasant thoughts and make people receptive to therapy. However, I believe that it is only through therapy that one can adjust their storyteller to tell stories that are more in touch with reality ... Paul B

I understand talk therapy to work as a series of inputs to the brain, via the usual physical structures. These inputs are interpreted by the cognitive unconscious and the storyteller. What is special about these inputs is that they are designed to target storytelling activity and inspire introspection and revision. Perhaps by altering the existing neural circuitry ... jrlewis

Take off points - psychoanalysis, dynamic psychotherapy

Dynamic Psychotherapy is basically the same process except much faster and more directed.''When the patient comes,'' he said, ''immediately I am focusing on the patient's feelings. I am constantly, actively involved.'' Thus he altered free association, Freud's passive technique of letting the patient lie down and talk about whatever comes to mind, and replaced it with ''focused free association.'' Free association plodded an unnecessarily circuitous route through the psyche, he thought. You couldn't tell where it would take you or for how long. There were no existing studies regarding its effectiveness - and it seemed that there never would be any.

He (the therapist) forces the patients to plumb the source of their problem behavior in 15 to 40 sessions, rather than waiting until the patients are ''ready'' to bring up painful experiences. The therapist actually badgers them into discussing these episodes, refusing to let the patients shy away from discussion or cover up their emotions.

A new and controversial short term therapy

Psychoanalysis is unscientific. Its theories and assumptions are not based on observation or experiment. It is an impediment to progress in social science and it is a social nuisance, and society would be better off without its bizarre armchair fictions.

Psychoanalysis is pseudoscientific quakery?

Take off points - cognitive behavioral therapy

NPR radio clip: “Cognitive Behavior Therapy: Thinking Positive”

“… Most Cognitive-Behavioral therapies are a blend of behavioral techniques and cognitive techniques—hence the name Cognitive-Behavioral—and so they do involve some amount of thoughtful awareness. Still, this sort of awareness does not need to be extensive. You could compare it to learning to drive a car and stopping at a stop sign simply because you tell yourself that if you don’t stop you run the risk of being pursued by the police and fined. There’s some philosophical processing going on here, but it’s not necessarily very sophisticated. And so, in the same way, learning to take deep breaths when angry, for example, is relaxing, but it’s a relatively simple process.

In contrast, and using the example of driving, psychodynamic psychotherapy is a bit like learning to drive by developing the understanding of the reason for stopping at stop signs (that is, the need to be cautious when entering any intersection lest you collide with something) and also you extend this basic reason to other behavior (that is, you learn to look beyond “simple” behavior into its motives and consequences—for example, you come to understand the need to begin a trip by planning the route and checking the gas and oil, rather than just turning the key and going). And so you learn, when feeling angry, for example, to track the anger back into similar earlier experiences and feelings, many of them previously unconscious; thus you come to understand the components of your current feelings, and you are enabled to take actions with full awareness of the origins and consequences of your motives.

Many people want nothing more than to “turn the key and go,” and to watch out for police along the way. It’s your choice.”

“For people with mental illness, psychotherapy affects the brain’s neural networks in much the same way that medicines do, according to Ari Zaretsky, M.D., head of the Cognitive Behaviour Therapy Clinic at Sunnybrook and Women’s College Health Sciences Centre and an assistant professor of psychiatry at the University of Toronto.

"Many people view psychotropic drugs as the potent interventions, as if they are the biological intervention and psychotherapy is not," said Zaretsky.

Zaretsky presented evidence that different forms of psychotherapy can alter the brain’s processes for patients with different types of psychiatric disorders in much the same way that antidepressants do.

For those with psychiatric illnesses, the "experiential learning" from cognitive-behavioral therapy (CBT) has been shown to alter some of the same biological mechanisms typically affected by medications, Zaretsky said.”

“It is bad enough to be depressed because of difficult living circumstances or to be anxious because you are subjected to regular domestic violence, without being told your depression or anxiety are caused by your own dysfunctional cognitions. Blaming the victim like this imposes irrelevant therapeutic rituals on top of societal oppression”

Changing politicians' minds about changing our minds?, UK Community Psychology network