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Susan Says: How psychotherapy works to change your brain



Mental-health care has come a long way over the last 30 years. Treatments like cognitive-behavioral therapy, dialectical behavior therapy and family-based treatment have been well researched and have shown to be effective for issues ranging from anxiety and depression to post-traumatic stress disorder and eating disorders. The problem that currently exists is that- unlike the traditional medical profession, much of behavioral health treatment does not follow the research and utilize evidence based treatments that have proven outcomes.

Some therapists see their work as an art, a delicate and individualized process that works (or doesn’t) based on a therapist’s personality and relationship with a patient. Others see therapy as a more structured process, rooted in science and proven effective in both research and clinical trials. So the question of whether psychotherapy is based on the art of developing a relationship between client and therapist or on science that utilizes prescribed techniques - as in medical treatment- is still prevalent today.

The answer really is both! Building a safe, trusting, and comfortable relationship with a therapist is important for a person to be able to honestly talk without reservation about the issues that brought them into therapy. However, this type of supportive therapy often falls short if a therapist does not utilize well researched practices that have proven outcomes for specific issues. The research is mounting that certain types of psychotherapy can have the same positive effects on the brain as psychotropic medications. With increased outcome studies in the behavioral health field, clients should be able to see a therapist who has specialized training in procedures that have been shown to be effective. Therapy should be much more than a chance to chat or vent with a supportive person with great listening skills.

One of the most researched therapeutic techniques that has been shown to change brain patterns is Cognitive Behavioral Therapy or CBT.  Cognitive Behavioral Therapy (CBT) has been studied with positive outcomes over 300 times. It has been found to be as effective as antidepressants for people with major depression and anxiety. Additionally, individuals who participated in CBT were half as likely to have a relapse of symptoms after ending treatment (Hainer, 2008). Recent studies have also shown CBT to be effective for addictions, trauma, phobias, and obsessive compulsive disorders.

CBT refers to several structured, directive types of psychotherapy that focus on the thoughts behind a patient’s feelings. The treatment helps people recognize and change thought patterns and beliefs that cause suffering and problems with functioning and relationships. Our thought patterns are so habitual, and unconscious that we don’t even notice them. How often do we think about our thinking? Thoughts often lead to feelings which, in turn, lead to behaviors. Depression is an example. Depressive thoughts can increase depressive feelings, leading to the behaviors of inactivity and isolation. Feelings of depression tell us to stay in bed and pull the covers over our head - which is the worst thing we can do.

Cognitive Behavioral Therapy involves a type of learning that has been shown through brain PET scans to cause changes in brain chemistry and function to occur. Our brain’s ability to change, repair itself, and adapt in response to our experiences relates with something called neuroplasticity, or cortical remapping.

We used to believe that our brains stopped developing in childhood, but we now know that our brains continue to develop and change over the course of our life. Throughout our lives, our brains create new neural pathways, and new connections. The neurons that are used most frequently tend to develop the strongest connections. The good news is that in therapy we can learn how to influence this process by working on what connections get strengthened and reinforced - resulting in chemical and structural changes in the brain (Fox, 2014). When we have toxic, anxious, depressive, or negative thinking, we develop these patterns of thinking and tend to remain in more of a survival mode. These thoughts become self-perpetuating because they create deeper and deeper “pathways” in the brain that get reinforced each time we entertain toxic thoughts.


In CBT therapy, clients learn that it is possible to consciously use language and practice self-talk and awareness that enables them to move from survival mode to learning mode. The research is mounting that certain types of psychotherapy can have the same positive effects on the brain as psychotropic medications. Our understanding of the relationship between counseling and brain chemistry is encouraging news for those who prefer to try talk-therapy before taking medications, and risking the side effects that often go with them.

Susan Mitchell is cofounder of Ascendant Behavioral Health and can be reached at [email protected].

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