November 07, 2007

New Research on the Effects of Psychotherapy on Psychiatric Disorders

A new, small study attempting to gauge the effectiveness of psychotherapy on borderline personality disorder involved giving participants brain scans (called functional MRIs, or fMRIs) before and after 12 weeks of inpatient therapy. Though this study, which appears in the November issue of the Journal of Psychiatric Research, looked specifically at people diagnosed with borderline personality disorder, it brings up the importance of therapy for people suffering from most mental disorders.

The study consisted of a very small number of female participants (6 people). Because of the small sample size, the results cannot be accurately generalized to the rest of the mentally ill population (until further studies are performed). Nevertheless, the study found that four to six of the females responded positively to the psychotherapy they received as measured by fMRIs. The participants, after psychotherapy, showed changes in the areas of their brains thought to be related to borderline personality disorder. Though this study seems to demonstrate that psychotherapy changes the brain, the authors did not state whether the effects of therapy, i.e., the changes in the brain, are lasting.

The study relates directly to what we've covered in the past about the positive effects cognitive behavioral therapy (CBT) has on schizophrenia. [To Learn More About CBT for schizophrenia]

Another thing to point out is that this study was done in Germany, in America, long-term therapy is much less affordable and thus less accessible.

Schnella K and Herpertz SC(2007). Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder, Journal of Psychiatric Research, 41(10):837-847.


Interesting, but early and very small as this study admits. These findings, including the recent ones about CBT and schizophrenia, need to be replicated, replicated,replicated, and have a larger body of participants. And - the biggy - long term follow up - life long. Not that that should preculde us from trying something that does no harm and may have lasting benefits - why wait?

First note on this study: gender. Female. Maybe someone can answer - are studies involving therapy usually equally weighted by gender? And how about by age? Thinking of my son and what I have been told by therapists - guys in the late teens early 20's are not big on therapy -yes, I know there are exceptions, but from my understanding and experience, this is not a receptive crowd. Girls - with exceptions, but a different story. Not to be sexist - but lets face it - we're different. One look on the parents board demonstrates that fact - a few special dads and a whole lotta moms.

I would assume the participants consented to particpate in this study, and I am wondering if 'placebo effect' had any bearing on why they responded positively - that is, the 'good' chemicals that are released with hope, activity, attention from others, etc. Is it a real change in thinking that will last in the long term, or is it a repsonse to being cared for, stimulated in a gentle way in a safe place, etc. I recognize this study asks that of itself. This is very much a drop in a bucket - more like a drop in the grand canyon.

By my understanding of borderline, it would be something those who suffer this disease or disorder embrace.

What are the long term benefits - as the study asks - will this last? My question, again do we temporarily flood the brain with chemicals induced naturally, as exercise does for example, but does it 'wear off'? Another analogy would be smoking - it can give a temporary relief from anxiety, symptoms, clear a persons mind, etc.

I also wonder if being an inpatient - in a stable, controlled, structured and regulated environment had any contribution to their improvement. In my experience and observations, I would say yes.

And of those who participate in these studies, where there is consent, you have people in a different space than those who will not participate, are not in a regular relationship with health care providers, do not necessarily have the degree of insight needed to feel therapy would be beneficial. If a person goes unwillingly, I think they could still benefit as someone is making contact with them and caring - 'good' chemicals then released - is it the therapy itself or is it the contact and relationships that are so often lacking for our dear sufferers that are affecting the brain in a positive way?

I should be hopeful for everything. And I am sorry if my questions sound negative - we all need hope. But hard questions need to be asked and conclusions need to stand up to scrutiny. Maybe I should care less about why therapy works and more about the results for whatever reason.

I feel caution when such studies are released because public perception (the public often having short attention spans and just picking up a little here and a little there) and even those of some 'professionals' and paraprofessionals may use them to minimize brain illnesses and intensify the blame and shame game - not blaming the reasearchers, but people can use research to their own biases with negative kickback - as the pro I recently heard in a social setting being harshly judgemental. No stone unturned, but please, with care.

Hope I made lick of sense.

Thanks to all the hardworking people finding and summarizing these studies and articles. My questions are reflectng on the content of the study, not on your valued contribution.


Posted by: learning at November 8, 2007 10:08 AM

Hi Learning,

Your points sound certainly reasonable - and caution is not a bad thing when research results are early and on a small sample group.

At the same time CBT (psychotherapy) has been proving to be effective in most other mental illnesses (from anxiety, to ADHD to depression) for over 35 years now in thousands of studies with long term benefits - so while I'm sure that researchers are still figuring out exactly how to implement CBT/psychotherapy for borderline personality disorder (BPD), and also schizophrenia (perhaps to a lesser degree than BPD as much more research has been done) - there is a still ton of evidence that suggests it is effective (of course, any individual results may vary).

Also - the good news is we've heard that the the NIMH (National Institute of Mental Health) is funding over 140 studies on CBT/psychotherapy in treatment of mental illnesses / psychiatric disorders - so the longer term studies with all types of patients - will be forthcoming.

Our point in covering this is really to educate people that:

1. Research clearly shows that Mental illnesses / psychiatric disorders are both psychological and biological (and just as biology can change psychology, psychology can also change biology). This is important because it helps people understand the need to address both psychological and social issues (how a person thinks, and the emotions they feel, the social relationships and environment they are in), and biology (e.g. by way of medications, or in the future new research approaches such as Transcranial Magnetic Stimulation.

2. Its important to understand that progress is being made in terms of the research and treatments based on both the biology and the psycho-social factors involved in mental illness. The future is looking better all the time.

Posted by: szadmin at November 8, 2007 10:22 AM

One important thing with any therapy is not to go home afterwards and drink alcohol soon after as this will probably wipe any memory or changes of the therapy.

Posted by: Josh at November 8, 2007 01:50 PM

Based on my understanding through past seven years of readings, the positive effects of psychotherapy on psychiatric disorders have been known for a long time. One can easily find such evidences if s/he dares to read different opinions with open mind. Dr. Loren Mosher's experiment about Soteria is one of such examples.

I fully agree with szadmin's view: "Research clearly shows that Mental illnesses / psychiatric disorders are both psychological and biological (and just as biology can change psychology, psychology can also change biology)."
And my personal experience of dealing with my wife's sz illness also supports the positive effects psychotherapy has on schizophrenia.

Posted by: JD05 at November 8, 2007 06:25 PM

I agree with everyone that psychotherapy is beneficial for all patients. What may be even more beneficial to patients is regular exercise. It is known that schizophrenics, for example, do better on their medicines. I am schizophrenic and I did so well on my medicine and exercising regularly that my doctor forgot I had an incurable condition. He took me off my meds, I became like an irrational, extremely fit animal and I lost my job as a law enforcement officer. Almost made Special Agent.

Posted by: hmmned at November 9, 2007 02:03 PM

I would like to address some of learning's comments.
I have spent almost all of my life slaloming through various psychotic episodes. After many many years, I have become instinctively familiar with how to care for, and deal with my psychosis in a way that enables me to live a somewhat meaningful life, and certainly not appear psychotic to those outside of my immediate circle. (A feat which my well known father also managed until his early and untimely death).
For me, one of my most important crutches has been the psychoanalyst I have seen on and off for twenty years now. (No behavioral therapy, I don't need someone to tell me when to change my underwear... how humiliating, can you believe it ?) My psychoanalyst treats me as a patient worthy of his attention and his respect. And, in this setting, I have nevertheless made progress, although I will never be cured of this "illness" which is such an intimate part of me by now.
Psychotherapy is very important. It keeps us human, and God knows how prone we are to dehumanizing ourselves when we are psychotic.

Posted by: dwm at February 20, 2008 01:12 PM

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