Does psychotherapy have a biological basis?

Does psychotherapy have a biological basis?

In a word, yes.  Psychotherapy has a solid basis in biological processes.  Changes in thought processes can be linked to changes in the structure or function of neural activity (Stahl, 2013).  Numerous imaging and functional scanning studies demonstrate that psychotherapy changes how the brain functions, and these changes can be demonstrated on a biological level.  A few of these studies are highlighted here to illustrate the point.

A systematic review by Zantvoord, Diehle, & Lindauer (2013) identified 16 studies that examined brain imaging with PTSD patients receiving trauma-processing therapies including TF-CBT and EMDR. The studies reviewed showed various biological factors at play including increased activity in the mid-prefrontal cortex and decreased activity in the amygdala following TF-CBT (Zantvoord, Diehle, & Lindauer, 2013). Furthermore, Lindauer et al. (2008) showed that following TF-CBT, the neural circuitry of working memory in the dorsolateral prefrontal cortex showed decreased activity.  Disturbances in this brain region appears to play a part in the development and maintenance of PTSD (Lindauer et al, 2008).

Too many studies demonstrate the biological basis of therapy to give a solid accounting of this evidence.  Thome et al (2016) compared the use of psychotherapy versus pharmacology to help reduce anxiety in reconsolidation phases of traumatic memories.  The reality that both therapy and pharmacologic agents can produce similar results demonstrates that therapy has a biological component.  Even (traditionally) less structured forms of therapy such as psychodynamic therapy has been shown through brain imaging to change the structure and function of neural pathways (Abbass, Nowoweiski, Bernier, Tarzwell, & Beutel, 2014).

The summation of evidence that psychotherapy can alter the chemistry, structure, and function of the brain makes it clear that psychotherapeutic interventions are an  important aspect of effective treatment for mental disorders.

Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments.

Culture, religion, and socioeconomic status are active influences in people’s lives, so these factors will inherently have influence on the choices people are willing to consider.  Some cultures may believe more in therapy than in pharmacology, as may certain religious groups.  Some religious groups may shun all forms of mental health intervention believing that these illnesses reflect a lack of faith or misunderstanding of how to bring life into balance.

All three of these specific factors have systemic impacts that can influence a patient’s willingness to engage in psychotherapy, and this can limit the potential gains from therapy if the patient is hesitant to participate (Mott, Stanley, Street, Grady,  & Teng, 2014).  Patient’s understanding of treatment processes has an important impact on the willingness to engage in therapy, and health literacy is closely correlated with socioeconomic factors (Hodgkinson, Godoy, Beers, & Lewin, 2017).

Because these factors are systemic in nature, they permeate the lives of the patient and the therapist alike, so accounting for these factors is among the most foundational elements of therapy.  Failure to account for culture, religion, and socioeconomics is a failure by the therapist to truly see the client and understand their lived experience.  While no therapist can truly understand every client’s experience, recognizing the importance of these factors is a beginning step to accounting for them within the context of therapy.

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