When something sounds too simplistic to be true, it probably is.
So when this headline crossed my desk earlier this week, Clinically depressed people may have damaged brain circuits, it definitely caught my attention. I was expecting to read about a study that examined damaged brains, or, at the very least, damaged brain circuits.
Instead, what I read about was a study that looked at fMRIs of people who were depressed and not depressed, a study design replicated so often that it’s no longer interesting. It found that brain activity in a certain area of the brain was different during a particular activity in people who were depressed than those who weren’t (whopee!). But here’s the key passage:
In the depressed individuals, high levels of activity in the amygdala persisted in spite of the intense activity in the regulatory regions, and even increased in response to it, suggesting that their conscious effort to recalibrate their emotions was thwarted by dysfunctional brain circuits.
The researchers speculated that signals from the prefrontal cortical area of the brain are not getting through to the amygdala in the depressed individuals for reasons still unknown.
The findings suggest that cognitive behavioral therapies that hold that an individual can change the way they feel about a situation by changing the way they think about it may be counterproductive for some people.
Really now? Given how little we understand about how the brain works and how the brain even causes us to have a certain emotional reaction (or not have one), I think this is a pretty big logical leap from a bunch of pretty pictures. A statement like this leaves us with so many additional questions and alternative hypotheses:
1. Is this a temporary effect of the artificial experimental conditions (since it was an artificial experimental situation, not a real life situation involving real social interactions) or a long-term emotional state?
2. Could depressed individuals simply be too tired, too unfocused, and too disinterested in regulating their emotional responses to this experimental condition, since it matters little to them? After all, depressed individuals aren’t known to have the same kinds of energy levels or focus as non-depressed individuals.
3. Isn’t any comment about psychotherapy completely inane and unethical given that the study done (a) didn’t examine any aspect of psychotherapy (b) patients in psychotherapy or (c) patients in psychotherapy who were being studied? It’s like saying, “Well, we studied 21 of these orange trees over here, and their growth seems to have a negative environmental impact on global warming.”
Now, researchers are convinced that fMRIs give us valuable insights into the very nature of the brain and how it works. But all it really shows are the changes in blood oxygenation and flow that occur in response to neural activity.
I’m sure there is value to this kind of research (although I’m not aware of any research in this particular area that’s resulted in a new treatment or more effective treatment technique to date in mental health). But there is no value in the way some news organizations, perhaps with the right quotes from some of the researchers, spin this study’s results:
“Our results suggest that there is a subgroup of patients with depression for whom traditional cognitive therapy may be contraindicated,” Davidson says. “Other therapeutic interventions may benefit this subgroup more than cognitive therapy, though this remains to be studied in future research.”
No, your results do not suggest anything about psychotherapy because (a) your N is tiny (21) and (b) you didn’t study psychotherapy! This statement just flies in the face of all previous psychotherapy and depression research, and ignores the research backing the combined use of psychotherapy and antidepressant medications as being the most effective. Come back and do a study that actually looks at real patients in real psychotherapy and measure their brains in the real world, in real-world situations, then you can talk about psychotherapy’s effectiveness. Otherwise, keep your comments to what your small dataset actually measured and show.
I don’t mean to be cynical, but perhaps Davidson’s quote about psychotherapy is partially driven by one of the funding sources for the study, Wyeth-Ayerst Pharmaceuticals.
6 comments
I actually found the interpretation of the results to be rather interesting indeed. Activation of inhibitory areas (that typically inhibit the amygdala) and that are localised in the frontal lobes (where the higher cortical functions targeted by cognitive restructuring most probably reside).
Cognitive therapy isn’t JUST about challenging those amygdala responses with thoughts (frontal lobe activity) that is supposed to inhibit it though – is it???
Compassion, empathy, emotional attunement… The study doesn’t say anything at all about the effects of that.
There are a number of people who say that intense focus on cognitive restructuring and attempting to change depression through challenging ones thoughts is counter-productive. This interpretation of the study would seem to support what those people have to say.
Don’t worry… There could be other mechanisms of change in CBT…
Hence the interpretation of the study doesn’t undermine the effectiveness of those other mechanisms of change…
I’m not worried at all, since this study has no real-world relevancy to psychotherapy.
The brain is our most complex organ. It will be decades before it is “figured out.”
No CBT I know of has an “intense focus on cognitive restructuring.” Cognitive restructuring is one of dozens of techniques in a cognitive-behavioral therapist’s arsenal, and while usually a foundation of most CBT, it is certainly not the usual focus of therapy itself.
I guess that an “intense focus on cognitive restructuring” is relative… For example, Marsha Linehan developed DBT as a varient on CBT precisely because she felt that therapy needed to be more validating, accepting, and soothing with people of certain pathologies than CBT tended to be. (Interestingly enough the kind of pathology she was most interested in was a pathology where people have dyscontrolled emotional states).
Cognitive restructuring / changing the clients ‘maladaptive’ or ‘faulty’ cognitions is more pervasive in CBT than you might think. Change change change.
I would be grateful for some empirical evidence that challenging thoughts is as similarly unconstructive as other ironic thought processes. I guess it is a novel idea to look to neuroimaging, I’m surely not saying that the results ‘prove’ this, but I’m certainly finding them suggestive.
It would be nice if this little strategy was dumped out of the arsenal methinks.
My thought was (and I know this is controversial) that while sometimes people have depression that is responsive to cognitive restructuring, for the most part cognitive restructuring doesn’t help and often serves to make things worse. Part of the assumption here is that I grant the observation that there seems to be an increase in people presenting with pre-oedipal conditions in recent years.
Here is an excerpt:
‘One of the earliest impacts of abuse and neglect is thought to be on the child’s internal representations of self and other. These representations generally arise in the context of the early parent-child relationship, wherein the child makes inferences based on how he or she is treated by his or her caretakers. In the case of abuse or neglect, these inferences are likely to be negative. For example, the young child who is being maltreated often infers negative self and other characteristics from such acts. He or she may conclude that he/she must be intrinsically unacceptable or malignant to deserve such “punishment” or neglect, or may come to see himself or herself as helpless, inadequate, or weak. As well, the abused child may come to view others as inherently dangerous, rejecting, or unavailable.
[These inferences are part of the cognitive triad for depression, perhaps]
Although typically considered to be cognitive sequelae, these early inferences and perceptions appear to form basic beliefs that function more as a general model of self and others than as actual thought, per se. Instead, some theorists refer to such intrinsic self-other perceptions as *internal working models* (Bowlby, 1982) or core *relational schemas* (Baldwin, 1992), especially when they arise from child-caretaker attachment interactions in the early years of life. [ie., in pre-oedipal phases] The notion of internalised models or schemas emphasises the structural or organising aspects of this phenomenon, as opposed to the presence of discrete cognitions or episodic memories’.
Now… This is the crucial bit (caps for emphasis and not to indicate yelling):
‘THESE CORE BELIEFS AND ASSUMPTIONS ARE OFTEN RELATIVELY NONRESPONSIVE TO SUPERFICIAL VERBAL REASSURANCE OR THE EXPRESSED ALTERNATIVE VIEWS OF OTHERS LATER IN LIFE, SINCE THEY ARE NOT, IN FACT, VERBALLY-MEDIATED’.
http://www.johnbriere.com/STM.pdf pg. 2-3.
Of course this is controversial… But I think that beating yourself up for having certain feelings (e.g., trying to counter those feelings rather than acknowledging and accepting them) is an IRONIC thought process (in the technical sense) and I found the studies findings to be suggestive of showing the neurological basis of the ironic thought process (where increased activation in frontal lobe typically inhibitory processes ironically resulted in increased activation in emotional processing areas).
Not conclusive, of course, but suggestive…