# CBT and brain scans



## poet (Nov 17, 2003)

Brain mapping may guide treatment for depressionBy Carey Goldberg, Globe Staff, 1/6/2004<http://www.boston.com/news/nation/articles/2004/01/06/brain_mapping_may_guide_treatment_for_depression?mode=PF>For the first time, researchers have mapped what happens in the brainwhen a patient recovers from depression using cognitive behavioraltherapy, a common form of psychological treatment aimed at breakingthe bad habits of thought that bring people low.The changes in the pattern of brain activity are quite different fromthose observed when patients recover with antidepressant drugs, andin some areas, even opposite, according to findings reportedyesterday.The mapping may provide a first step toward using brain scanning todetermine which patients should receive antidepressants and whichshould receive psychological training, a decision that is now oftenbased on trial and error, said Dr. Helen Mayberg, the study's seniorauthor."This experiment lays the groundwork for looking for differentmarkers that will help to optimize the treatment for a givenindividual; that's the really cool part," said Mayberg, a professorof psychiatry and neurology who conducted the study while at theUniversity of Toronto but recently moved to Emory University inAtlanta.Researchers also predict that the study could help raise the publicstanding of cognitive behavioral therapy, a series of lessons thattrains patients to recognize their negative thoughts -- "I'mworthless" or "it's hopeless" -- and combat them with facts.More highly directed and shorter-term than ordinary talk therapy, thepsychological practice is already solidly established and isroutinely paid for by insurance companies, but it tends to get muchless attention than antidepressant drug therapy.The scanning study's importance is "that you can see such a solidphysical finding from a psychological treatment," said Dr. Bruce M.Cohen, president of McLean Hospital in Belmont. He was not involvedin the research.More broadly, Cohen added, the findings represent "one more steptoward answering the question: What is happening in the brain whenit's depressed? What happens when you change the way you think ortake a drug and change the way you feel?"Mayberg and colleagues used a brain-scanning technique calledpositron emission tomography to analyze for 15 to 20 sessions thebrain metabolism of 14 subjects whose depression lifted considerablyafter cognitive behavioral therapy.They found, among other things, that some areas in the cortex -- theouter rind of the brain associated with higher functions, such asthinking -- appeared to become less active, seemingly becausepatients learned to ruminate and worry less. With antidepressants,those regions became more active.In essence, Mayberg said, depression stems from a malfunction not ina single spot in the brain, but in a network or circuit of brainconnections. The study, published in this month's Archives of GeneralPsychiatry, helps to contrast the two main approaches to fighting it."The network can reset itself via inputs working from a bottom-upperspective -- that, I think, is how drugs work -- while cognitivetherapy works by influencing top-down inputs, turning down ruminationand worry areas," said Dr. Zindel Segal, a University of Torontopsychiatry professor who worked on the study."Top-down" cognitive therapy begins with the cortex and its higherthinking functions; "bottom-up" drug therapy begins with the deeper,more primitive parts of the brain such as the brain stem and limbicsystem, which affect emotions and basic bodily functions. Eacheventually affects the other through a complex network that remainslittle understood. An estimated one-fifth of Americans suffer fromprolonged depression at some point.Insurance companies generally pay for cognitive therapy, which costsbetween $50 and $100 per session, but they sometimes only cover thetalk therapy.Studies have shown that cognitive therapy is not only at least aseffective as antidepressant drugs for some patients, but that manyare less susceptible to relapse, said Aldo Pucci, president of theNational Association of Cognitive-Behavioral Therapists.Patients typically attend an average of 16 sessions, replete withhomework, and come away with new skills that last much longer.The therapy works, Segal said, by helping patients become aware oftheir negative "self-talk" and how it interacts with their mood. Forexample, he said, if patients have thoughts like "I'm unattractive,"they are more likely to accept that thought as fact. Cognitivetherapy helps them "develop a capacity to talk back to thisdepressive propaganda."There are no national statistics available on how many people performor undergo cognitive therapy, Pucci said, but his nine year oldassociation already has 5,000 members."We maintain that for the overwhelming majority of people who aredepressed, it's their thinking that causes their depression, not somebiochemical problem," he said. The study, he said, "just supportswhat we've already been saying." Cognitive behavioral therapy"doesn't need the support, but certainly we'll take it," he said.In fact, the study does not address the origins of depression, but itdid suggest a basic aspect of antidepression therapy that surprisedMayberg: Drugs and cognitive therapy appear to operate on twodifferent tracks, with no "final common pathway," she said.--tom


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## Ian (Apr 18, 1999)

Tom,Thanks very much for posting that - it seems like clear research into cause & effect. At last indications of which treatments are suited to particular patients should soon begin to emerge.Ian


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