Is talking therapy a waste of time?
I get it.
You don’t want to sit and talk about your fears and worries to a stranger for weeks,
and on top of that, paying a large amount of money in the process.
After all, it is just talking, and you have some biochemical alteration in your brain
that needs to be addressed, well, biochemically.
However, just as it does not make sense to ask “do drugs work?”,it is important to
note that not all therapies are created equally.
We can say that different talking therapies work for different conditions.
And Cognitive Behavioral Therapy, or CBT, is one of the most scientifically studied
talking therapies.
It can be helpful to people suffering from mood disorders or schizophrenia, for instance,
by helping them to identify abnormal beliefs and thoughts, with the goal of replacing them
with healthier ones.
For people with schizophrenia, the therapy involves learning to think differently about
unusual experiences, such as distressing beliefs that other people represent a threat.
CBT also involves developing strategies to reduce distress and improve wellbeing.
But this is not merely advice-giving, because CBT can change the structure and function
of the brain.
For example, when you see a face, the brain fusiform gyrus sends this information to the
amygdala, which plays a central role in the perception and regulation of emotions, such
as fear and anger.
With this information, the amygdala interprets the facial expression to determine which emotion
the person is displaying.
Then, it sends this information to the prefrontal cortex, where you will have the conscious
awareness of whether someone is happy or mad at you, and decide how to behave accordingly.
The brains of people with schizophrenia show alterations in this circuitry, which may contribute
to delusional beliefs, such as that someone is plotting against them.
Remarkably, after weeks of CBT, patients with schizophrenia became better at discriminating
emotions from faces.
In addition, CBT improved the connectivity between the amygdala and the prefrontal cortex
while participants were shown faces, and the more this connectivity was enhanced, the more
the participants stated that their symptoms have improved.
CBT can be effective even when delivered via the internet.
For example, people suffering from social anxiety disorder have excessive fear during
everyday social interactions.
A study from Sweden found that the more patients with social anxiety disorder fear public speaking,
the greater the volume of their amygdala.
But after undergoing internet-delivered CBT for 9 weeks, their amygdala shrunk, which
also correlated with the degree of improvement in the fear of public speaking.
This study also revealed that when these patients were criticized directly, their amygdala fired
up intensely, more than the amygdala of people without the disorder.
But after the therapy, this activity decreased to normal levels.
Many other studies have shown that CBT can change the brain, and understanding what kind
of change is necessary for clinical improvements following therapy is essential.
Soon, neuroscience-informed psychotherapy promises to personalize treatment, so that
people can be prescribed specific therapies depending on, for example, the size of their
amygdala.
But in the meantime, it is remarkable that talking therapy with a professional can significantly
change the brain for the better even when delivered online.