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One of the most popular therapies for depression is cognitive behavioural therapy, which can help people learn coping mechanisms for common problems, reinforce positive actions, and challenge negative thinking. But can thinking and acting differently result in long-lasting brain changes?
According to recent research from Stanford Medicine, researchers found that it can. If the appropriate patients are matched with a therapy. A third of patients in a study with people who had both depression and obesity--a combination that is challenging to treat--saw a reduction in depression thanks to cognitive behavioural therapy that emphasised problem solving. Additionally, adaptive modifications in brain circuitry were observed in these patients.
Moreover, these neural adaptations were apparent after just two months of therapy and could predict which patients would benefit from long-term therapy.
The findings add to evidence that choosing treatments based on the neurological underpinnings of a patient's depression -- which vary among people -- increases the odds of success.
The same concept is already standard practice in other medical specialties.
What does the research say?
"If you had chest pain, your physician would suggest some tests -- an electrocardiogram, a heart scan, maybe a blood test -- to work out the cause and which treatments to consider," said Leanne Williams, PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioural sciences, and the director of Stanford Medicine's Center for Precision Mental Health and Wellness.
"Yet in depression, we have no tests being used. You have this broad sense of emotional pain, but it's a trial-and-error process to choose a treatment, because we have no tests for what is going on in the brain." Williams and Jun Ma, MD, PhD, professor of academic medicine and geriatrics at the University of Illinois at Chicago, are co-senior authors of the study published Sept. 4 in Science Translational Medicine. The work is part of a larger clinical trial called RAINBOW (Research Aimed at Improving Both Mood and Weight).
The form of cognitive behavioural therapy used in the trial, known as problem-solving therapy, is designed to improve cognitive skills used in planning, troubleshooting and tuning out irrelevant information. A therapist guides patients in identifying real-life problems -- a conflict with a roommate, say -- brainstorming solutions and choosing the best one.
These cognitive skills depend on a particular set of neurons that function together, known as the cognitive control circuit.
Previous work from Williams' lab, which identified six biotypes of depression based on patterns of brain activity, estimated that a quarter of people with depression have dysfunction with their cognitive control circuits -- either too much or too little activity.
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The participants in the new study were adults diagnosed with both major depression and obesity, a confluence of symptoms that often indicates problems with the cognitive control circuit. Patients with this profile generally do poorly on antidepressants: They have a dismal response rate of 17%.
Of the 108 participants, 59 underwent a year-long program of problem-solving therapy in addition to their usual care, such as medications and visits to a primary care physician. The other 49 received only usual care.
They were given fMRI brain scans at the beginning of the study, then after two months, six months, 12 months and 24 months. During the brain scans, the participants completed a test that involves pressing or not pressing a button according to text on a screen -- a task known to engage the cognitive control circuit. The test allowed the researchers to gauge changes in the activity of that circuit throughout the study.
"We wanted to see whether this problem-solving therapy in particular could modulate the cognitive control circuit," said Xue Zhang, PhD, a postdoctoral scholar in psychiatry who is the lead author of the study.
