Biology of Psychotherapy

Prof. Hani Hamed Dessoki, M.D.Psychiatry

Prof. Psychiatry,

Beni Suef University

Acting Dean, Faculty of Applied Medical Sciences

Beni Suef University

Supervisor of Psychiatry Department,

El-Fayoum University

How “talk” therapy changes our brains and genes

Psychotherapy (Chapter 19)

First Lecture Outline:History of psychotherapy

Psychotherapy approachesFoundations of counselling

Video 101: Psychodynnamics

Meaning of psychotherapy

• “A form of treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with a Patient with the object of removing, modifying a retarding existing symptoms of mediating disturbed patterns of behavior and of promoting positive personality growth and development”.

Jose Pons Madera, Ph.D. Director -Psy.D. Program Ponce School of Medicine Tel 844-5209

The therapist: a trained person help to solve this type of disturbance.Empathy, unconditioned positive regard, understanding, etc.

Techniques of Psychotherapy :

→ Fostering Insight,

→ Reducing Emotional Discomfort,

→ Encouraging Catharsis,

→ Providing Information,

→ Developing Faith & Expectancy for Change.

Goals of Psychotherapy

To change the maladaptive behavior of client,To develop the interpersonal relationship,To reduce inner conflict & personal tension,To remove factors that maintain abnormalities,To help to make adjustment with realities,Development of self-identity & self-insight,To facilitate the expressions of emotions,Modifying the cognitive structure,Facilitating decision-making.

Types of Psychotherapy

Psychodynamic Therapy,

Behavior Therapy,

Cognitive-Behavior Therapy,

Humanistic Therapy,

Group Therapy.

What is a clinical interview?

• Psychotherapy involves talking to people

• Structured and unstructured interviews

• Model of psychotherapy directs attention of interview– Psychodynamic: Focus on early experiences

– Behavioral: Focus on symptoms, ABC’s

– Cognitive: Questions about specific thought patterns

– Humanistic: Unconditional positive regard

Historical background: Beliefs and treatment of the mentally ill

Greek physician Hippocrates (ca. 400BC) promoted humane treatment. Tx based on healing powers of nature: Mentally ill patients were placed in pleasant surroundings and given soothing baths.

Lack of balance between positive and negative energies

Illness attributed to a disturbance in the

balance of bodily fluids (humorism).

Humour Season Organ Ancient name Modern MBTI Ancient characteristics

Blood spring liver sanguine artisan SP courageous, hopeful, amorous

Yellow bile summer spleen choleric idealist NF easily angered, bad tempered

Black bile autumn gall bladder melancholic guardian SJ despondent, sleepless, irritable

Phlegm winter brain/lungs phlegmatic rational NT calm, unemotional

What is Body Psychotherapy ?

Body-Psychotherapy is …

a scientifically validated, legitimate mainstream,

branch of psychotherapy, which historically

predates Psychoanalysis and Freud.

Body-Psychotherapy is …

an ethical and theoretically coherent

method of professional practice

for relieving emotional and mental distress

and for encouraging human growth.

and awareness..

Even more about Body-Psychotherapy

Body-Psychotherapy involves a developmental model;

a theory of personality; hypotheses as to the

origins of disturbances and significant alterations

to the human psyche; as well as a rich variety

of diagnostic and therapeutic techniques …

all used within the framework

of the therapeutic relationship.

The Immune System: The Mind Body Connection

Psychoneuroimmunology

• “Investigation of the bidirectional linkages between the CNS, the endocrine system, and the immune system, and the clinical implications of these linkages.”

• There are clear connections between the physiology that underlies our emotional states and the immune system:– direct neural connections

– Endocrine connections

• A matter of regulation correcting under and over activation

Functions of the Immune system

• Discriminate self from foreign matter

• Destruction and clearance of foreign substances– Virus, bacteria, toxins that might enter body,

altered self (tumor cells)

• Ignore self - don’t destroy normal cells

• However:

• Autoimmune disease: system attacks itself– GI and Joints (rheumatoid arthritis),

Key players of Immune sytem

• White Blood Cells (leukocytes)– Polymorphonuclear granulocytes

• Neutrophils

• Eosinophils

• Basophils

– Lymphocytes develop in lymph nodes• T,

• Helper- T

• B

• Natural Killer (NK) cells

– Monocytes – e.g. macrophages , dendritic cells

Where are they?• Lymph nodes and vessels

• Bone morrow

• Thymus (T-cells)

• Spleen

• GI tract – to attack food borne pathogens

• Respiratory tract – for air borne pathogens

How can psychological events affect the immune system?

• Classical Conditioning

• Activation of the HPA axis – cortisol secretion

• Activation of the Sympathetic Nervous System - NE

“If you constantly mobilize energy, You never store it; Your muscles waste away; Your vascular system is under constant pressure; and constant Cortisol production turns off growth factors and can harm every system in the body…”

stress

Stress affects on Immune System

• HPA axis and cortisol (anti-inflammation)• Stress causes dysregulated cortisol response

– Produces too much or too little– Short term stressor – raises it

• Long term and long past stresses might result in too low of cortisol – no inflammation suppression– Flattens out the diurnal cycle of cortisol production

• Depressed pts. Have blunted cortisol effect –don’t produce enough.

If stress causes Cortisol to be levels high:

• Inversely related to # of lymphocytes in blood

• Impairs immune function by

– decreasing IL-2

– Kills WBC

– Decreases tumor necrosis factor

– Decreases inflammation response

Stress effects

• Lab stressors (mental arithmetic) that causes NE surges, increases NK cell activity. Short run– Give beta blocker and effects is eliminated

• Other longer term stressors including exam stress:– Suppresses lymphocyte production (

• T-cell productionNK cell function

– “ production of interferon– Reactivates latent viruses – herpes– Lower antibody response to vaccinations

Anti-Inflammatory cytokines (IL-10,)

• Cytokines are regulators of host responses to infection, immune responses, inflammation, and trauma.

– Some cytokines act to make disease worse over time (proinflammatory), whereas others serve to

– reduce inflammation and promote healing (anti-inflammatory).

Stress and inflammations:

• Brief stressors increase pro-inflammatory cytokines that can maintain a long term inflammation response

• Stressors can lead to long term systemic inflammatory responses

• BUT: does not mean that all systematic inflammatons are due to psychological or environmental stressors

Changing the Stress Response: Protective Factors & Resiliency

(psychotherapy outcome)

• Feeling some degree of internal control;

• Exerting some control over your environment;

• Increasing your level of information and awareness;

• Changing your thoughts and perceptions;

• Shifting from mindless (unconscious) reaction to

mindful recognition;

• Creative solution-focused problem-solving;

• Support from others in our socio-familial environment;

• Not living alone !!

The Neuroscience of Empathy Fatigue: Our

Emotional Brain

• There are discrete, basic, and universal emotions that

persons react to on a M-B-S level;

• Emotions involve different body systems which arouse

our parasympathetic and sympathetic system;

• Chronic activation of the nervous system (stress

response) has both a physiological and emotional cost;

• 80% of all physical illness is cause by stress (Kabit-Zinn,

1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)

Biology of Psychotherapy

• Yet growing evidence frombrain imaging research suggests that the form of therapy known as cognitive behavioral therapy, or CBT, produces changes in the brain similar to those produced by medications when they work.

• This "proof" of how a person's brain can be transformed by therapy.

• Psychological interventions can profoundly change a person's symptoms.

• Cognitive behavioral therapy emphasizes the role our thoughts play in how we feel.

• Even if stressful external situations don't change, changing how we think about them can prevent a negative emotional response such as depression.

• The therapist's role is to help patients be more rational in their assessment of such situations and not make unwarranted worst-case-scenario assumptions about them.

• It is a time-limited therapy that involves active collaboration between patient and therapist.

• Psychiatric conditions from depression to panic disorder may benefit from CBT, but it is research into its role in the treatment of obsessive-compulsive disorder that has yielded the most fascinating results.

• In a study that compared CBT to Prozac, researchers used a brain-scanning technique called positron emission tomography (PET) to measure the rate of glucose metabolism in the OCD brain after Prozac treatment alone and after therapy treatment alone.

• The results were essentially identical: both interventions decreased the rate of glucose metabolism to levels seen in healthy people without OCD, and the rate of the decrease seemed proportional to the degree of improvement in their OCD symptoms.

• Studies like this make CBT look like a biological treatment similar to medications because it, too, can be seen to work on the brain in ways that are objective and measurable. And it's free of side effects.

• Scientists have discovered several neurochemical and physiological events underlying the three pillars of psychotherapy (attachment, empathy, and fear extinction).

• Oxytocin, arginine vasopressin and the mu-opioid receptor all play a role in controlling attachment.

• While receptor genes for oxytocin and the arginine receptor, as well as activity in the anterior cingulate cortex and superior temporal sulcusregulate empathy.

• Fear extinction appears regulated by the neurotransmitter NMDA, and activity in the hippocampus, amygdala, and other brain regions.

• Antagonists (or agonists) of neurotransmitters may help enhance the effects of psychotherapy, researchers speculate.

Biological marker

• A British and Australian study of children receiving psychotherapy for anxiety disorders responded differently to the therapy, depending upon the allele of a serotonin transporter gene promoter they carried.

• Children with one genotype (the “short short” variety of the promoter) were significantly more responsive to behavioral therapy than those with another, “long” version.

• Studies have prompted biologists and psychologists to look at whether genetic variation and environmental influences can provide biomarkers of a sort, predicting whether a certain psychotherapy technique could be effective.

• Psychotherapy could be enhanced by combining “talk therapy” techniques with drugs, genetic testing, and other neurobiological tools to treat mood, anxiety, or other psychological disorders.

• There’s even a new name for this new field: “therapygenetics.”