How Psychotherapy Changes The Brain in Attorneys

If you are an attorney who works and markets themselves at law firms in Washington, DC, or you are somebody else who has been wondering if receiving regular treatment sessions with a therapist may actually work for you, or if the cost of such treatment is even worth it . . . A recent study has provided an answer to that very question.   Investigators from Massachusetts General Hospital (MGH) have discovered that not only might psychodynamic psychotherapy be worth the time and investment, but they may also have uncovered whether or not this type of therapy would work specifically for you.

Attorneys with depression should note that psychodynamic psychotherapy is one of the three main types of therapy used to treat depression.  While cognitive behavioral therapy focuses on HOW a person thinks and interpersonal therapy focuses on interpersonal relationships, psychodynamic psychotherapy focuses on a person’s unconscious thoughts, feelings, and emotions and is more centered on the patient becoming more self-aware. Psychodynamic psychotherapy can be conducted from just a few months to well over a year. This is yet another reason to think about whether or not your time spent undergoing such therapy is worth it.  It appears that patients receiving psychodynamic psychotherapy have demonstrated actual metabolic activity in their brain, which has lead researchers to believe that there is a measurable mechanism of action behind the treatment.

The Beginning of the Study

The study examined 16 patients, all with diagnosed major depressive disorder (MDD) and a documented lack of success with medication. These patients underwent psychological testing to determine the extent of their depression as well as whether or not they had the ability to comprehend and process their own emotions, motivations and actions. Both prior to, and a week following the conclusion of the study, patients were also tested using positron emission tomography (PET) to measure the metabolic activity (glucose uptake) in their brains.

All patients were subjected to 16 psychodynamic therapy sessions (once per week) that were individualized to the patients, yet adhered to a specific theme and sequence so as best to normalize the study. Also, in adherence to strict study protocol, patients’ sessions were video recorded (with their permission) and assessed by other investigators on the team to make certain that all sessions followed the proper structure. Patients’ response to the therapy, including the development of further insight into their depression, and any self-awareness achieved, was also examined on video.  Over the course of the 16-week study, seven patients dropped out, while nine continued throughout the course of the program. The remaining participants received a second PET scan as well as further psychological testing to measure their level of depressive symptoms. 

What Happened In The Brain?

Initially, the 16 patients received pre-treatment PET scans specifically designed to measure metabolic activity within the right insular region of the brain.  The right insula of the brain is an area associated with the regulation of emotion and has been shown to be an important area of focus in people with depressive symptoms.  The MGH study was able to show that those patients with a greater degree of depression actually exhibited higher metabolic activity (higher glucose uptake) in this area of the brain.  A week following the conclusion of the 16-week study, a reduction in metabolic activity was noted in the insula of the nine participants who completed the study. Researchers were able to establish that this clinical finding had a direct correlation to the insight achieved by each patient. Although relief of depressive symptoms was not noted until an average of four weeks into the study, patients did experience a reduction in their symptoms by over 50 percent.

Pretreatment PET scans also evaluated metabolic activity in the right precuneus, which is an area of the brain that is associated with memory and self-awareness.  Those participants that went on to complete the study had higher metabolic activity here as well.  These results show a strong physiological correlation between a person’s individual self-awareness and their ability to successfully adhere to, and respond to psychodynamic psychotherapy.  In psychodynamic psychotherapy, it is important that the patient is both insightful and self-aware in order for them to have any response.

This study demonstrates through the use of PET imaging whether or not a patient may be more responsive to this particular form of treatment and could help potentially eliminate time and money wasted on treatments that are unsuitable for particular individuals.  With an exhaustive number of therapies and options that exist for the treatment of depression, finding a way to pre-determine a successful outcome would be an enormous leap forward in the struggle to conquer depression.  Further large scale studies will need to be done in order to fully determine the value of the measurement of metabolic activity in the precuneus as a determining factor in the overall success of psychodynamic psychotherapy.

Conclusion:  Self-awareness and insight is critical for an individual to progress with psychodynamic psychotherapy, and brain scans may reveal the degree to which an individual's brain is prepared to adhere to psychotherapy effectively.  For attorneys in Washington, DC . . . A brain scan could be beneficial.

- Laura Wells

Goldberg, J. (Ed.). (2014, August 21). Psychodynamic Therapy for Depression: Techniques, Effectiveness, and More. Retrieved November 17, 2014, from http://www.webmd.com/depression/guide/psychodynamic-therapy-for-depression

Massachusetts General Hospital. (2014, October 27). PET scans reveal how psychodynamic therapy for depression may change brain function. ScienceDaily. Retrieved November 16, 2014 from www.sciencedaily.com/releases/2014/10/141027144852.htm