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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 ---------------------------------------------------------------------- Study suggests psychotherapy can produce brain changes ---------------------------------------------------------------------- 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." ---------------------------------------------------------------------- Janet Paterson - 48 - 7 - [log in to unmask] - Bermuda