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Brain Scan Predicts Who Will Benefit From Cognitive Therapy

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995 ...Read More

Dr. Greg Siegle, over at the University of Pittsburgh School of Medicine, has an interesting paper about to be published in the April issue of the American Journal of Psychiatry. The topic matter of this paper is very interesting all by itself, but what really caught my eye was the fact that Greg wrote it. You see, I used to share an office with the guy in graduate school. It is a blast – a real joy – to see someone you remember fondly get mentioned for doing good work. I have a lot to thank Greg for, actually. Back in 1992 or 91, Greg was the guy who first introduced me to a then rather obscure thing called the Internet. He also helped me to learn how to program computers when I was first getting serious about it.

Greg’s paper shows that it is possible to predict with reasonable accuracy which depressed people will benefit from a course of Cognitive Behavioral Therapy for Depression, and which will not by using a sophisticated brain scanning technique known as fMRI (Functional Magnetic Resonance Imaging). Standard MRI is useful for taking pictures of the brain’s physical structures. fMRI, on the other hand, takes movies of the brain in action, showing which parts of the brain are active (e.g., metabolizing blood oxygen and sugar) at any given moment. Greg was able to use fMRI to demonstrate that depressed people who later went on to benefit from a course of CBT showed more pre-therapy activity in a region of their brains called the Amygdala, and less in a region of the brain called the Subgenual Cingulate Cortex, compared to depressed people who failed to benefit from the CBT. He explains the significance of the finding in this annoucement:

"The amygdala helps us to recognize things as being emotional. In some people with depression, the amygdala doesn’t turn off as fast as it should after it recognizes something as being negative. The subgenual cingulate cortex regulates emotions and plays a part in turning the amygdala on and off," said Dr. Siegle. "If the amygdala doesn’t get ‘turned off’ in a person with depression, when exposed to negative information, the person may ruminate, going over this information again and again. Cognitive behavioral therapy teaches people techniques to stop this rumination, so it makes sense that it would be a good treatment option for those people who can’t turn off their amygdala," said Dr. Siegle.

If this line of research bears out (and if fMRI scanning ever becomes cheap and routinely available, which has not happened yet), it may be possible to pass prospective patients through a scanner to figure out the best way to help them recover. This scenario is not likely to happen any time soon, however. The last time I got a scan, it was hundreds of dollars for just one – the one scan would cost more than an entire multi-session course of CBT! When fMRI scans can be given and interpreted for $50 or less, then we’ll talk.

Even if this isn’t a practical tool for matching patients with best therapies, this is a great finding nevertheless, as it shows (perhaps for the first time?) the parts of the brain that are ‘targeted’ by CBT, and upon which that therapy has a measureable primary ‘physical’ effect. Maybe other varieties of psychotherapy that are known to be useful for treating depression (e.g., Weissman’s "Interpersonal Therapy") can be subjected to the same sort of pre-fMRI patient scanning to see if those therapies have a different effect on brain activity. However you slice it, this is interesting stuff.

Keep Reading By Author Mark Dombeck, Ph.D.
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