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Biological Effects of Cognitive-Behavioral Therapy
Question:
"Is therapy, such as cognitive-behavioral therapy, helpful only through psychological means, or is there a biological basis to such treatment?"
Psychotherapies quite clearly are nonpharmacological interventions, yet they seem to pack a powerful biological punch! This is quite a revelation for clinicians no matter what school of thought they belong to—be it purely biological or purely psychological views of depression. It is becoming very obvious that medications help not just through their effects on neurobiology but by also affecting a patient’s belief systems, which in turn exerts a powerful benefit to the individual’s neurobiology. This has been demonstrated by the positive neurobiological changes that occur in patients who receive a placebo medication. In other words, there is a positive, circular relationship between positive psychological changes and positive neurobiological changes.
Psychotherapy has clearly been demonstrated to help with depression. For decades we believed this occurred as a result of changing thought patterns. Now, this is true, but the untold story is about the neurobiology of psychotherapy. This is completely changing how we view how therapies help individuals. Let’s quickly review some recent relevant studies in order to explore this issue.
Abelson and colleagues1 recently published a study that showed that even a very brief CBT intervention was a very significant modulator of the hypothalamic-pituitary-adrenal axis, clearly revealing that a “psychological” intervention can have a strong biological impact, and do so rather quickly. This is powerful evidence that CBT is so much more than mere “let’s change dysfunctional thoughts to feel better.”
DeRubeis and colleagues2 recently reviewed this issue and found how patients dealt with negative emotions and cognitive tasks before and after they received CBT by studying blood flows in their amygdala and prefrontal cortex. Remember, not a medication study, only a psychotherapy study! The results are breathtaking—very clear and significant changes were noted pre- and post-CBT in blood flow to the brain clearly revealing that CBT is a potent biological intervention. Interesting!
I suggest we clinicians keep our eyes on the burgeoning data emerging from the integrated psychotherapy-neurobiology literature. It appears that the time for us to adopt a true “integrative model of biology-psychology” has come, and doing so will only help us better address the needs of our mentally challenged patients.
These are my thoughts—what do you think? I cordially invite your opinions and thoughts!
References 1. Abelson JL, Liberzon I, Young EA, Khan S. Cognitive modulation of endocrine stress response to a pharmacological challenge in normal and panic disorder subjects. Arch Gen Psychiatry. 2005;62(6):668-675. 2. DeRubeis RJ, Siegle GJ, Hollon SD. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci. 2008;9(10):788-796.
