Psychotherapy Still Vital to Psychiatry’s Treatment Armamentarium, Says Gabbard

Psychotherapy is a highly effective treatment of psychiatric disorders that have strong biological underpinnings. Glen O. Gabbard, M.D., a professor of psychiatry at SUNY Upstate Medical University in Syracuse and a clinical professor of psychiatry at Baylor College of Medicine, described data from several psychotherapy studies at a symposium at APA’s 2014 annual meeting. He noted that there is a tendency to think of psychotherapy as appropriate for “psychologically based disorders” and medication as the treatment of choice for “biologically based disorders.” He stressed that this distinction is specious and reflects a disconcerting return to Cartesian dualism.

Gabbard pointed out that psychotherapy changes the brain and that mind is the activity of the brain. However, biological reductionism must be avoided because all aspects of experience cannot be reduced to the causal consequences of brain mechanisms alone. He noted that while the brain can be observed from a third-person perspective, mind can be known only from within. Hence there are two ways of knowing or understanding that use different languages and require different kinds of explanations.

He summarized research on psychotherapy that demonstrates brain changes resulting from psychological approaches to treatment. Cognitive therapy of schizophrenia has been shown to reduce key symptoms of schizophrenia, even in the absence of medication. Six psychotherapeutic approaches geared to borderline personality disorder have been shown to be efficacious in randomized, controlled trials, suggesting that they may be acting through a similar pathway involving neurophysiological changes, specifically, amygdalar hyperactivity may be modified by increased activity of the prefrontal cortex. Major depressive disorder responds well to a variety of psychotherapies, including cognitive-behavioral therapy, interpersonal therapy, and psychodynamic psychotherapy. Some studies show that when psychotherapy and pharmacotherapy are combined in the treatment of depression, the two approaches may act on different parts of the brain.

Gabbard stressed that one of the paradoxes in psychiatric practice is that studies are showing that fewer psychiatrists are using psychotherapy in their offices at a time when research is demonstrating the great value of psychotherapy for major psychiatric disorders.

Gabbard is the editor of Psychodynamic Psychiatry in Clinical Practice, Fifth Edition, from American Psychiatric Publishing. APA members may order the book at a discount here. The book has been updated to reflect DSM-5.