Biological Basis of Psychotherapy Treatments
Introduction
Psychotherapy treatments are based on the functioning of the brain-mind and the ensuing behavior and maladaptive responses (Javanbakht & Alberini, 2019). Therefore, understanding how psychotherapy treatments can assist in improving psychopathologies can improve approaches to mental health issues. This essay discusses the biological basis of psychotherapies and how culture, socioeconomics and religion influence an individual’s perspective regarding psychotherapy treatment.
Psychotherapy has biological basis because it targets the brain and how the brain functions. Tyron (2016) explains that psychotherapy targets the maladaptives in the brain and repairs the negative brain adaptivatives by substituting them with postive pathways. The brain maps experiences using nuerons and thus psychotherapy aims to disengage the defective mappings. For example, psychotherapy treatments line the cognitive behavioral therapy (CBT) alters the biological structure of the brain. For instance, the study by Tyron (2016) indicated that CBT lowered the levels of glucose mentabolism in people with obsessive-compulsive disorder (OCD) and thus improved the OCS symptoms.
Cultural beliefs impact the perspective of people regarding psychotherapy. For instance, some cultures stigmatize mental illness and may believe only in pharmacological treatments and this may hinder people from seeking psychotherapy treatment (Wegner & Rhoda, 2015). Similarly, religious beliefs can lead people to seek divine healing when having mental health problems and thus may not seek psychotherapy treatment (Goncalves et al, 2015). Lastly, the socioeconomic status may affect the ability of an individual to seek psychotherapy treatment. For example, psychotherapy treatment may be perceived as expensive and this may hinder people from a low socio-economic status from seeking treatment (Sripada et al, 2015).
Conclusion
Psychotherapy treatment has a biological basis because it targets the maladaptive aspects in the brain. Finally, the cultural beliefs, religious beliefs, as well as the socioeconomic status impact the perspectives and ability of an individual to seek psychotherapy treatments.
References
Goncalves J, Luchetti G, Menezes P & Vallada H. (2015). Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials. Psychol Med, 45(14): 2937–2949.
Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144
Sripada R, Richards S, Sheila R, Walters H, Bohnert K, Gorman L, Kees M & Blow A. (2015). Socioeconomic Status and Mental Health Service Use Among National Guard Soldiers. Psychiatric Services, 1(66), 992-995;
Tyron W. (2016). Psychotherapy Integration via Theoretical Unification. International Journal of Integrative Psychotherapy, 7(1),1-26.
Wegner, L. & Rhoda, A. (2015). The influence of cultural beliefs on the utilization of rehabilitation services in a rural South African context: Therapists’ perspective. African Journal of Disability, 4(1), 128-136.
sample response
When reading your post, I found it very interesting that cognitive behavioral therapy (CBT) has been shown to change glucose metabolism and cause neuronal changes in the brain, leading to an improvement in symptoms for clients with mental illness. I wondered if there was a link between mental illness and type 2 diabetes. I found that depression, especially when comorbid with anxiety, is considered a risk factor for type 2. In fact, there is a direct correlation between depression and type 2 diabetes, as depressed mood can oscillate with glycemic control.
Depression and obesity are among the top health concerns among our society today. Along with type 2 diabetes, each diagnosis perpetuates the other, especially when involving the factors of sedentary lifestyle, unhealthy diet choices, and inflammation. Clients with these comorbidities can benefit from both psychotherapy and pharmacotherapy, with the goal of regulating the function between the hypothalamus, pituitary, and adrenal glands (Deschênes et al., 2018).
Psychotherapy that focuses on the stabilization of mood and reduction of perceived stress will be most beneficial for these clients. The inclusion of diet and exercise specialists should also be considered, as behavior modification can achieve overall improvement in blood glucose readings and decrease undesired psychological and physical symptoms (Wroe et al., 2018). Barriers to adequate mental health and medical care and the desire to change are often the most difficult factors for clients to overcome.
Resources
Deschênes, S. S., Burns, R. J., & Schmitz, N. (2018). Comorbid depressive and anxiety symptoms and the risk of type 2 diabetes: Findings from the Lifelines Cohort Study. Journal of Affective Disorders, 238, p.24–31. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2018.05.029
Wroe, A. L., Rennie, E. W., Sollesse, S., Chapman, J., & Hassy, A. (2018). Is cognitive behavioural therapy focusing on depression and anxiety effective for people with long- term physical health conditions? A controlled trial in the context of type 2 diabetes mellitus. Behavioural and Cognitive Psychotherapy, 46(2), p.129–147. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1017/S1352465817000492
sample response 2
I found an article that dives into a great example how gene expression can be affected by psychotherapy, as you have mentioned in your post. It focuses on gene expression and explains that a presence of a gene does not mean it is active or turned on and that experiences by the individual during gene activation can affect if they develop a type of mental disorder. For example, PTSD can occur if the patient has the gene FKBP5 activated during a traumatic experience (Feinstein & Church, 2010). The article goes on to explain that genes cannot be removed, but psychotherapy can affect these gene variations. Expression inhibition of this gene can be achieved through psychotherapy, or further, exposure therapy to alter the strength of the synaptic connections (Feinstein & Church, 2010).
I believe this type of insight is crucial to treating patient with mental health disabilities. So often I feel as if medication is thought of as the intervention to alter biological processes. Knowing that less invasive measures are available to use alone and in conjunction with medication is the key to greater outcomes.
Psychotherapy can be affected by cultural barriers. It is pertinent providers are encouraging and engaging in action steps to ensure cultural differences do not hinder the availability of psychotherapy. An example is that black and migrant minorities have a higher rate of schizophrenia compared to white non-Hispanic individuals and have higher doses of medication, repeat hospital admissions, inferior access to psychotherapy, and more coercive care pathways (Degnan, Baker, Edge, Nottidge, & Noke, 2018). As providers, I believe it is our responsibility to break this statistic and ensure everyone is either getting the care they need or the care they desire. Thank you for sharing this week!
Kelsey Rindels
References
Degnan, A., Baker, S., Edge, D., Nottidge, W., Noke, M., Press, C. J., Husain, N., Rathod, S., & Drake, R. J. (2018). The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis. Psychological Medicine, 48(5), 714–727. https://doi-org.ezp.waldenulibrary.org/10.1017/S0033291717002264
Feinstein, D., & Church, D. (2010). Modulating gene expression through psychotherapy: The contribution of noninvasive somatic interventions. Review of General Psychology, 14(4), 283–295. https://doi-org.ezp.waldenulibrary.org/10.1037/a0021252
sample response 3
Thank you for your post this week. Intercultural therapy is based on principles of cultural variations between the therapist and the client (Montgomery et al., 2019). For a provider to offer effective psychotherapy, cultural issues should be addressed quickly along with being mindful of culturally appropriate interactions. Competency can be defined as a person being prepared or qualified to perform a task. As a therapist, cultural competency can encourage a higher rate of effectiveness in treatment. Even with cultural competency, the delivery of quality services can be difficult due to the complexity of social and psychological diversity among all individuals and even though culture is one relevant factor, other aspects of a client life may be more influential when trying to effectively treat a mental health disorder. An example of another factor that would be influential is their socioeconomic status. Individuals with a low socioeconomic background are less likely to treat their mental health even though they are more likely to experience a mental health problem due to higher stressors such as finances, employment, and social relationships (Reiss et al., 2019). These individuals are more likely to spend their time and money on daily needs such as food, housing and utilities before they would ever consider spending money on their mental health.
References
Montgomery, A., Ventriglio, A., & Bhugra, D. (2019). Standards in intercultural psychotherapy. Intercultural Psychotherapy. https://doi.org/10.1007/978-3-030-24082-0_3
Reiss, F., Meyrose, A., Otto, C., Klasen, F., & Ravens-Sieverer, U. (2019, March 13). Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. PLOS ONE. https://doi.org.10.1371/journals.pone.0213700
Discussion: Does Psychotherapy Have a Biological Basis?
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis.
Learning Objectives
Students will:
- Evaluate biological basis of psychotherapy treatments
- Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments
To prepare:
- Review this week’s Learning Resources.
- Reflect on foundational concepts of psychotherapy.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.
The answer to this week’s discussion about psychotherapy having a biological basis can be initially unclear, especially due to the conflicting evaluation between the benefits of psychopharmacology and psychotherapy. Research suggests that negative changes to the body’s and brain’s stress-response system can correct themselves when children and adults receive psychotherapy (Holttum, 2014). We already know that this can happen with medication, but how exactly does the brain correct itself after psychotherapeutic intervention?
After some extensive research, it is more evident that psychotherapy does, in fact, have a significant impact on biological and chemical brain activity. There is an increasing consensus that psychotherapy entails a specific type of learning in the context of an emotional or therapeutic relationship that may lead to epigenetic modifications across different therapeutic treatment modalities (Jiménez et al., 2018). In order to delve deeper into the understanding of exactly how any form of talk therapy can alter gene expression, the nurse practitioner must first understand the role of epigenetics in neuroscience.
Epigenetics refer to phenotypic changes that do not alter the DNA sequence, but rather modify its structure chemically in order to dictate whether a particular gene is expressed or ignored (Stahl, 2013). This is relevant to psychotherapy because the phenomena of epigenetics is directly responsive to one’s own environment (Kumsta, 2019). An environment that cultivates active listening, goal oriented dialogue, and research based therapeutic approaches will be an environment that positively enhances epigenetic modifications. Psychotherapy targets the regulation of genes and thereby produces bottom-up change into phenotypic expressions of various traits, ultimately altering the biological basis of one’s actions and emotions without the use of medication (Kumsta, 2019). This information allows the nurse practitioner to better understand the impact that various therapeutic modalities have on each client that he or she may encounter in practice.
One’s own culture, religion, and socioeconomic status can strongly influence the environment and how effectively the psychotherapy works. A homosexual from a strict conservative religious family may struggle with acceptance. A family in poverty may not have the funds to afford consistent therapy or medications. The chosen psychotherapeutic approach has to take into account ones biologic background and expectations for treatment.
Recovery-focused practice is about focusing more on people’s strengths, and supporting them to achieve goals they have set for themselves, rather than the provider’s goals (Holttum, 2014). As a result, psychotherapy is successful in bringing about persistent changes in attitudes, habits, and conscious and unconscious behavior and it does so by producing alterations in gene expression that produce structural changes in the brain (Jiménez et al., 2018). The nurse psychotherapist creates a healing presence of acceptance, patience, lovingness, nonjudgemental attitude, understanding, good listening skills, honesty, and empathy (Wheeler, 2014). As future nurse practitioners ourselves, this discussion has provided us a better understanding of the effectiveness of the various treatments available in practice, as opposed to a consistent reliance on medication.
References
Holttum, S. (2014). When bad things happen our brains change but psychotherapy and support can help the recovery of our brains and our lives. Mental Health and Social Inclusion, 18(2), 52–58. doi:10.1108/MHSI-02-2014-0006
Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P., Jaramillo, K., & Luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An Emerging Dialog. Frontiers in genetics, 9, 257. https://doi.org/10.3389/fgene.2018.00257
Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. Psychology & Psychotherapy: Theory, Research & Practice 92(2), 190–207. https://doi-org.ezp.waldenulibrary.org/10.1111/papt.12227
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). Springer Publishing Company.
response
I appreciate your reference to the article by Kumsta (2019). I enjoyed reading it and always learn so much from others’ references. I think epigenetics is fascinating! I read an article by Kaliman (2019), in which the author discussed epigenetics and describes a study of meditation’s genetic effects. It was found that long term meditating participants had decreased expression of histone deacetylase genes which precluded increased cortisol recovery after acute psychosocial stress, as well as the downregulation of a key proinflammation gene. This data is regarded as significant because an accepted psychopharmacological method of treatment for depression as well as for inflammatory disorders focusses on the inhibition of histone deacetylase genes (Kaliman, 2019).
Another study reviewed by the author discusses DNA methylation which is a primary concept in epigenetics along with a key mechanism termed “epigenetic aging rate”. The rate of epigenetic aging is measured by noting the difference in the amount of DNA methylation and the chronological age of a subject. Evidence has shown that the cumulative effects of stress and trauma increase epigenetic aging rate, which is associated with numerous age-related chronic diseases and increased mortality risk. Conversely, a decreased epigenetic aging rate is associated with improved cognitive and physical fitness and longevity in later life. Because the rate of epigenetic aging was found to be dependent on the number of years subjects meditated, it is concluded that daily meditation significantly decreases the rate of epigenetic aging (Kaliman, 2019).
Thank you for your thoughtful discussion. I hope you find this information as interesting as I do, and that you are also having a great week!
References
Kaliman, P. (2019). Epigenetics and meditation. Current Opinion in Psychology, 28, 76–80. https://doi.org/10.1016/j.copsyc.2018.11.010
Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. Psychology and Psychotherapy: Theory, Research and Practice, 92(2), 190–207. https://doi.org/10.1111/papt.12227