Does psychotherapy affect the brain by creating biological change? We know that life experiences can affect behavior, personality, and social engagement. One can infer that as brain changes occur resulting from external and internal factors, psychotherapy can provide the same type of influence. Since mental health diagnoses are not outwardly visible or supported by diagnostic testing, it is difficult to understand the biological basis for illness. In contrast, a urinary tract infection (UTI) is diagnosed by observing vital signs, lab work, and physical assessment. When treatment for the UTI is given, the improvement and resolution of the diagnosis is also easily determined by evaluating the biological assessments. The evaluation of the efficacy of psychotherapy and psychopharmacotherapeutics cannot be based upon such tangible sources.

When considering different types of mental health diagnoses, some, such as schizophrenia and mental retardation, are understood to have a strong biological basis. Other diagnoses, such as anxiety and narcissistic personality disorder, are considered to have a more psychological basis (Kim et al., 2016). One can also argue that psychopharmacotherapeutics are developed from the study of science and biology, while psychotherapy remains unscientific. However, studies have shown that some psychotherapy modalities, such as cognitive behavioral therapy (CBT), can decrease amygdala activation by targeting disturbances in neuronal communication within the brain (Michaels & Datta, 2016).

As part of a movement to improve diagnostic criteria and identify the neurobiological basis of mental health disorders, the National Institute for Mental Health (NIMH) focuses on the biological basis of abnormal functioning (Goodwin et al., 2018). The hope is that treatment choices can be made more easily and a significant reduction in stigma surrounding mental health diagnoses is achieved.

The effect of culture, religion, and socioeconomics on mental health diagnoses and the acceptance of psychotherapy must be addressed with each client. Culture and religion can influence our belief system, our understanding of health and treatment modalities, and how we feel about ourselves and our interactions with others. A thorough assessment of a client’s culture and religion can help determine a plan of care that may be successful. If the client’s support system is not accepting of the process of psychotherapy, then the client may not be able to improve with the treatment. Clients with unmet social determinants of health will need mental health care provided within a timely basis. Poverty can play a major role in a client’s cognitive ability, perception, and ability to regulate emotions. Understanding different belief systems, providing education, and listening to the client’s concerns are key to a provider’s ability to assist a client (Ravitz et al., 2019).

Resources

Goodwin, G. M., Holmes, E. A., Andersson, E., Browning, M., Jones, A., Lass-Hennemann, J.,   Månsson, K. N., Moessnang, C., Salemink, E., Sanchez, A., van Zutphen, L., & Visser, R. M. (2018). From neuroscience to evidence based psychological treatments – The promise and the challenge, ECNP March 2016, Nice, France. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 28(2), p.317–333. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1016/j.euroneuro.2017.10.036

Kim, N. S., Ahn, W., Johnson, S. G. B., & Knobe, J. (2016). The influence of framing on clinicians’ judgments of the biological basis of behaviors. Journal of Experimental    Psychology. Applied, 22(1), p.39–47. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1037/xap0000070

Michaels, T. M., & Datta, V. (2016). Evidence, not ideology, should guide the use of psychotherapy. The British Journal of Psychiatry, 209(2), p.171. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1192/bjp.209.2.171a

Ravitz, P., Berkhout, S., Lawson, A., Kay, T., & Meikle, S. (2019). Integrating evidence-supported psychotherapy principles in mental health case management: A capacity-building pilot. Canadian Journal of Psychiatry, 64(12), p.855–862. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1177/0706743719877031

response 1

Psychotherapy is very important and can be beneficial to many people who have mental illness. People sometimes just need someone to hear them out of their problems they may be encountering. Using CBT can help tremendously for some people who may have a hard time to speak out or gathering thoughts. It helps to improve life function and quality of life. CBT discover ways that emphasizes on what goes on inside a person and of their current situation instead of what ever happened to them to change their behavior of lifestyle (American Psychological Association, 2017). It is important for the practitioner to be able to note that factors such as religion, culture, and socioeconomics have to be looked at individually with each patient. When socioeconomics, religion and culture play a factor in the treatment plan the person may have an issue with their values and faith as oppose to how their treatment would be. The practitioner may want to get an understanding of the individual’s cultural and religion belief before applying a treatment plan for that patient. If understanding potential barriers at different levels, there can be an effective outcome with each individual and system-level approaches to enhance psychological state of an individual Ayvaci (2016).

References

American Psychological Association. (2017, July). What is cognitive behavioral therapy? https://www.apa.org. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

Ayvaci, E. R. (2016). Religious barriers to mental healthcare. American Journal of Psychiatry Residents’ Journal, 11(7), 11-13. https://doi.org/10.1176/appi.ajp-rj.2016.110706

response 2

The efficacy of psychotherapeutic treatment is difficult to evaluate, because as you mentioned, measurements are not tangible and outcomes are often purely subjective. This is why my initial thoughts indicated that a biological basis was not the foundation of psychotherapy like it is for psychopharmacology. However, after some research I was surprised to find a vast amount of evidence that psychotherapy plays a major role in brain activity and epigenetics. There is a growing body of evidence that conducting research in clinical practice not only improves the clinical performance of the service but can also lead to improved physical health outcomes and survival rates (Kirsten & Graham, 2017). Researchers can learn a lot by studying the neuronal connections at particular portions of the brain and through genetic testing as well. By using this information to provide some further education to the public, it will become evident that these disorders are linked to genetic dispositions and brain malfunction thereby hopefully eliminating the stigma.

In order to reach that point of brain modification in treatment however, there are a number of barriers that both clients and therapists must overcome. One study of adults from multicultural backgrounds found that the most common and significant barriers for not obtaining help were thinking that the disease will go by itself (60.1%), feeling shamed (58.9%) and thinking that they don’t have problem (54.5%) (Osama et al., 2020). In addition, these barriers can be cultural, religious, social, financial, or even educational among others. Identifying the barrier itself and negating that difference with communication is key to a successful relationship and positive outcome in treatment. In a discussion with another student, she addressed the importance of eliminating any power imbalance that the client may feel when seeking treatment. In order to do this, it is important to maintain full transparency with the client, identify appropriate expectations, put aside biases, and also not be afraid to ask the client questions about those cultural differences that you may share with him or her.

References

Kirsten V., S., & Graham R., T. (2017). Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations. British Journal of Clinical Psychology, 56(3), 347–356. https://doi-org.ezp.waldenulibrary.org/10.1111/bjc.12142

Osama, M., Rana M., Noor Kifah Al-Tameemi, & Karen Riley. (2020). Challenges associated with mental health management: Barriers and consequences. Saudi Pharmaceutical Journal, 28(8), 971–976. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsps.2020.06.018