Friday, August 31, 2012

Scientific basis of a psychotherapy.

I've been wanting to pass on elements of a nice essay written by Eric Kandel for last year's Edge question, which describes Aaron Beck's development of cognitive behavioral therapy, a systematic psychological treatment for depression that focuses on distorted thinking rather than presumed unconscious conflicts. This is a pragmatic relatively value-neutral approach that avoids considerations of, and lacks the richness of, dealing with object relations, morality, or origins. (A random aside: I remember from my postdoctoral years at Harvard Medical School's Neurobiology Department (1967-68) that Eric Kandel, trained as a psychiatrist, would drop by at our communal lunch time to talk about his new work on a strange sea slug named Aplysia, work which was the basis of his later Nobel prize for uncovering a neuronal basis for memory. He was quizzed by Hubel and Wiesel, also to win the prize for their work in vision.) Kandel describes Beck's basic innovations:
First, he introduced instruments for measuring mental illness..beginning with a Depression Inventory, a Hopelessness Scale, and a Suicide Intent Scale. These scales helped to objectify research in psychopathology and facilitated the establishment of better clinical outcome trials.
Second, Beck introduced a new short-term, evidence-based therapy he called Cognitive Behavioral Therapy.
Third, Beck manualized the treatments. He wrote a cookbook so method could be reliably taught to others. You and I could in principle learn to do Cognitive Behavioral Therapy.
Fourth, he carried out with the help of several colleagues, progressively better controlled studies which documented that Cognitive Behavioral Therapy worked more effectively than placebo and as effectively as antidepressants in mild and moderate depression. In severe depression it did not act as effectively as an anti-depressant but acted synergistically with them to enhance recovery.
Fifth and finally, Beck's work was picked up by Helen Mayberg, another one of my heroes in psychiatry. She carried out FMRI studies of depressed patients and discovered that Brodmann area 25 was a focus of abnormal activity in depression. She went on to find that if—and only if—a patient responded to cognitive behavior therapy or to antidepressants SSRI's (selective serotonin reuptake inhibitors) this abnormality reverted to normal.

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