The effectiveness of cognitive behavioral therapy (CBT) in the treatment of depression and anxiety, among other disorders, has been demonstrated in many scientific studies. CBT is a class of psychotherapeutic interventions which is always based on the premise that it is our thoughts and our interpretation of events, or the world around us, that cause our feelings and behaviors. If only the external world was to blame we would all have the same emotional reaction following a particular event. We know that is not the case. It is not only the event itself that causes distress, anger or fear but our thoughts about it.
CBT, as well as drugs for treating depression and anxiety, the so-called antidepressants and anxiolytics, are effective in making us feel better. The drugs do so by influencing chemicals in our brain. CBT, on the other hand, is a talking therapy and has nothing to do with chemicals in our brain. Or has it? Well, the brain is the organ of the mind and it stands to reason that brain functioning changes with successful psychotherapy.
Charles Darwin suggested, in the 19th century, that the domestic rabbits had smaller brains than the wild ones because the latter were considerably more challenged in their daily lives. This, of course, was a brilliant idea. It was not until the early 1960´s that research demonstrated that experience can, in fact, alter both the structure and chemistry of the cerebral cortex. Dr. Marian Diamond at the University of California at Berkeley showed, for example, that rats who live in an enriched, or complex, environment have a thicker cerebral cortex than rats living in less stimulating surroundings. Prior to this time it was generally thought that the brain was not modifiable in this way. Now it is accepted that similar principles hold true for humans as for Dr. Diamond´s rats. We can also assume that psychotherapy changes the brain as well as all the other kinds of experiences we go through during our lifetime.
It was not until relatively recently that researchers had access to the necessary tools for investigating the impact of experience, including psychotherapy, on brain functioning in living humans. Studies on the effects of psychotherapy on the brain are therefore still relatively scarce. These studies show that in many cases psychotherapy has similar effects on brain functioning as medication which is excellent news! The studies are promising but we certainly need more of them, and with larger groups of participants.
But how is the effect of psychotherapy, such as CBT, on brain functioning investigated? With sophisticated technology called functional neuroimaging it is possible to obtain a dynamic image that shows the activity or metabolism in various brain areas. In this way it is possible, although certainly neither straightforward or easy, to couple the brain´s activity with a certain stimulus or treatment. For example, it can be demonstrated how the brain of someone with spider phobia reacts to a photograph of a spider. Similarly it has been demonstrated how the brain´s activity of a phobic individual normalizes after successful CBT.
But studies in this area do not only demonstrate that CBT affects the brain. These studies might also be able to tell us how brain activity differs in those that respond to CBT and those who do not. This is very important as we know that not everybody responds to psychotherapy, or to drug treatment for that matter.
If it is the case that drug treatment and CBT influence the brain in a similar fashion does it really matter which treatment you chose? Why not just pop a pill and avoid the work and effort that CBT unavoidably entails? Consider this: in CBT you learn techniques that will always prove useful and which will aid in the prevention of relapse after formal treatment is over. These methods might also prove useful in dealing with various other problems of everyday life. This is not the case with drug treatment.
Linden, D.E.J. (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging. Molecular Psychiatry, 11, 528-538.
Porto, P. R. et al. (2009). Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders. The Journal of Neuropsychiatry and Clinical Neurosciences, 21, 114-125.
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