Hello All;
 
The Brane News Of The Day:
 
I found this one epecially interesting. I've discussed clinical
depression (I like to call it CD), and cognitive therapy (CT?) with
some of you in the recent and distant past.
 
Janet
 
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Study suggests psychotherapy can produce brain changes
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Copyright ) 1996 Nando.net   Copyright ) 1996 N.Y. Times News Service
 
(Feb 14, 1996 9:17 p.m. EST) -- Psychotherapy can produce changes in
brain function similar to those seen with psychiatric medication in
patients with obsessive-compulsive disorder, a study has found.
 
"This tells us that effective behavioral treatments can have
biological effects, not just psychological ones," said Dr. Eric
Hollander, director of the obsessive-compulsive disorder treatment
program at the Mount Sinai School of Medicine in Manhattan.
 
"So you can think of these therapies as ways you can change your own
biology."
 
Obsessive-compulsive disorder affects an estimated five million
Americans. Major symptoms include obsessive thoughts, such as that
something dire will happen to loved ones, and compulsions, such as
feeling the overpowering need to wash one's hands hundreds of times
daily. People with the disorder can lose many hours of the day
absorbed in their obsessions or compulsions.
 
In the study, being published Thursday in The Archives of General
Psychiatry, nine people with obsessive-compulsive disorder underwent a
method of brain imaging, PET scans, before and after 10 weeks of
cognitive-behavioral therapy. Three of the patients showed little
improvement but six improved substantially, and their PET images
showed two significant changes in brain function.
 
One change was in the tight links in the activity of certain brain
structures.
 
"We know that in obsessive-compulsive disorder four key structures are
locked together," said Dr. Jeffrey Schwartz, a psychiatrist at the
Neuropsychiatric Institute of UCLA, in Los Angeles, who led the study.
 
"But in patients who respond to treatment, these structures can
operate more independently, as is the case in people without the
disorder."
 
The structures, which become overactive in unison, seem to underlie
the disorder's symptoms. One is the orbital frontal cortex, situated
just over the rear of the eye socket, which operates as the brain's
error-detection circuit.
 
"The orbital frontal cortex alerts the rest of the brain when
something is wrong and needs to be taken care of," Schwartz said.
 
"In obsessive-compulsive disorder it's hyperactive, so you keep
correcting what you think is not right, like checking to see the stove
is turned off over and over."
 
Connections to the caudate nucleus and the cingulate gyrus, structures
deep in the brain's core, "give you the feeling something is deadly
wrong,"
 
Schwartz said. "They make your heart pound and your gut churn with
anxiety."
 
The thalamus, the brain's relay station for sensory information, also
tends to act in unison.
 
"When one becomes more active metabolically, the other three
structures do, too," Schwartz said. "But that's not the case in
healthy people."
 
He added, "Our new major finding is that this correlation can be
reversed by cognitive-behavioral therapy alone, without medication."
 
A second finding, that the caudate nucleus becomes less active in
patients who respond to the therapy, confirms and extends more
tentative results published by the same group of researchers at UCLA
last year, in a study led by Dr. Lew Baxter, now at the University of
Alabama.
 
The caudate nucleus is unusually active in people with
obsessive-compulsive disorder. Patients who respond positively to
serotonin reuptake inhibitors like Prozac or Luvox, the usual
medications of choice, also show a lessening of activity in the
caudate nucleus.
 
In the cognitive-behavioral therapy, patients learned to relabel their
obsessive urges as such, rather than simply giving in to them. "We
tell them, instead of saying to yourself I have to wash my hands
again, tell yourself, I'm having an obsessive urge or a compulsion
again," Schwartz said.
 
Patients also were instructed to explain to themselves why the urges
and the accompanying sense of dread persisted, reminding themselves
that they had a medical condition that caused the feelings and
thoughts.
 
Then, instead of giving in to the urge, patients intentionally engaged
in 15 minutes of an activity they could be absorbed in and found
enjoyable or productive.
 
"They might practice a musical instrument, or take a walk, or knit,"
Schwartz said. "This shifts their attention away from the compulsion.
I believe this step is crucial in altering the brain's circuitry."
 
The researchers said the therapy, in which sessions were held once or
twice a week, culminated in patients' being able to dismiss their
urges as symptoms as soon as they felt them. Finally, the researchers
said, the urges themselves diminished.
 
Other studies involving this therapy have shown that for people who
are willing to try it, the benefits last in at least 80 percent of the
cases.
 
But not all patients with obsessive-compulsive disorder are willing to
undergo such therapy.
 
"It requires that a patient confront his worst fears," said Dr. Don
Black, director of the obsessive-compulsive disorder clinic at the
University of Iowa's medical school in Iowa City. "For some patients
it's too overwhelming and they can't or won't do it."
 
Dr. Michael Jenike, director of the clinic for treatment of
obsessive-compulsive disorder at the Massachusetts General Hospital,
said: "We know that the best treatment combines medication and
behavior therapy together. But this study may open up some
psychiatrists to using behavior therapy who are wedded to medications
alone."
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Janet Paterson  -  48  -  7  -  [log in to unmask]  -  Bermuda