Cognitive behavioral therapy is a widely used treatment for depression, offering skills to cope with everyday struggles, reinforce healthy behaviors, and challenge negative thoughts. But can the changes in thoughts and behaviors induced by this therapy lead to lasting changes in the brain?
New research led by Stanford Medicine suggests that it can, especially when the therapy is tailored to suit the needs of the individual. In a study involving adults dealing with both depression and obesity – a challenging combination to treat – cognitive behavioral therapy focused on problem-solving resulted in a reduction in depression symptoms for one-third of participants. These individuals also showed adaptive changes in their brain circuitry, highlighting the potential for neural alterations following therapy.
These findings support the notion that selecting treatments based on the neurological roots of a patient’s depression can enhance the chances of successful outcomes, a strategy already common in other medical fields.
The study, published in Science Translational Medicine on September 4, was co-led by Leanne Williams, PhD, and Jun Ma, MD, PhD. The research is part of the larger RAINBOW clinical trial (Research Aimed at Improving Both Mood and Weight).
Problem-solving Therapy
The cognitive behavioral therapy approach used in the study is known as problem-solving therapy. It aims to enhance cognitive skills required for planning, troubleshooting, and ignoring irrelevant information. The therapist helps patients identify real-life problems, brainstorm solutions, and choose the most effective one.
These cognitive skills are reliant on a specific set of neurons that collaboratively function as the cognitive control circuit. Previous research by Williams’ team identified six depression biotypes based on brain activity patterns, revealing that a considerable proportion of individuals with depression have dysfunctions in their cognitive control circuits.
Adult participants in the study had both major depression and obesity, indicating potential issues in the cognitive control circuit. This subgroup commonly responds poorly to antidepressants, with a meager 17% success rate.
Of the 108 participants, 59 underwent a year-long problem-solving therapy program in addition to their standard care, while the remaining 49 received only customary treatment.
Brain Changes and Therapy Outcomes
Participants underwent fMRI brain scans at the beginning of the study, followed by additional scans at two months, six months, 12 months, and 24 months. During the scans, they completed tasks engaging the cognitive control circuit, allowing researchers to monitor changes in its activity over time.
Lead author Xue Zhang, PhD, noted that problem-solving therapy led to a 32% response rate, signifying a substantial improvement compared to the 17% success rate of antidepressants. Brain scans revealed that therapy-induced changes in the cognitive control circuit correlated with enhanced problem-solving abilities, indicating that the therapy was teaching the brain to process information more efficiently.
Overall depression severity improved in both groups, but the therapy group showed specific enhancements in cognitive depression symptoms, emphasizing its impact on real-world functioning. Participants reported clearer thinking, improved work performance, and better social interactions as a result of therapy.
Early Brain Changes
Remarkably, brain scans at the two-month mark showed alterations in cognitive control circuit activity in the therapy group, reflecting brain plasticity in response to real-world problem-solving activities. These early changes predicted long-term improvements in problem-solving skills and depression symptoms, indicating the potential for brain scans to identify ideal candidates for problem-solving therapy.
This approach aligns with Williams’ vision of precision psychiatry, where brain activity informs treatment decisions, expediting recovery for patients.
The study, which involved researchers from several institutions, was funded by the National Institutes of Health.
By diving deep into how cognitive behavioral therapy can lead to lasting brain changes, this research opens up new possibilities for personalized treatment strategies and improved outcomes for individuals battling depression and related conditions.
