Molecular Psychodynamics: How Psychotherapy Changes the Brain
Here in this review article from Psychiatric Times, University of Helsinki psychiatry professor Hasse Karlsson places one more nail in the coffin of the mind/brain split. The research discussed by the Karlsson provides further evidence, for those who need it, that psychotherapy is as much of a physiological intervention as are medications, nutritional treatments, or botanical therapies. Perhaps most significant, and ironic, is the finding of a Finnish study indicating that psychodynamic psychotherapy produces increased serotonin receptor density in the brain, whereas Fluoxetine did not. Karlsson speculates that this increased physiological change from talk therapy over that produced by medication may account for the observation of other researchers that the relapse rate for major depressive disorder is lower in patients treated by psychotherapy alone than in those receiving antidepressants alone.
One way of understanding the power of psychotherapeutic intervention is to consider its impact as an epigenetic influence. The function of our neurocircuitry is determined by two types of effects: genetic (the unalterable predisposition endowed by heredity) and epigenetic (the environmental factors that can lead to changes in gene expression -- either upregulating or downregulating the products of genes, like neurotransmitters). We may inherit cassettes of genes (rarely are single genes determinative on their own) that could theoretically increase our risk for multiple diseases, from Alzheimer's to depression to cancer. But, depending on multiple life style factors, like diet and exercise, those genes may never be expressed. Some pathogenic epigenetic influences, like environmental toxicants, can not only lead to disease expression in those exposed, but may also produce adult-onset disorders in children and grandchildren who may never have had any direct exposure themselves. (Look here, here, and here to read about the profoundly troubling findings that have emerged from animal models of transgenerational toxicity-induced disease.)
Stephen Stahl, one of the most eminent authorities on psychopharmacology, has made a suprising but scientifically sound argument: psychotherapy can be regarded as an epigenetic "drug," no less effective at altering brain circuitry than is medication. For example, he points out that the amygdala can remember, perhaps permanently, what has terrified you (e.g., the traumas of childhood) and what has been rewarding (e.g., addictive substances or behaviors). The synaptic connections formed by these experiences do not go away. But psychotherapy, through its capacity to generate new experiences and thus produce epigentic changes in the chemisry of neurocircuitry, can create new synaptic connections that eclipse or inhibit the earlier ones. Of course, for Stahl, this is ideally achieved through the synergistic epigenetic effects that come with the combination of drugs and psychotherapy. For us at the Mind-Body Clinic, the often quite modest efficacy, and not so modest adverse effects of these drugs make them an adjunctive modality of last resort. We not only seek to address upstream causes, but employ epigenetic modifiers of function that enhance health, not add new, drug-induced symptoms.
Stephen J. Ducat, ND, PhD