The Learning Zone
The mind and the treatment of OCD and depression
Can the mind really play a role in the treatment of diseases as frequent as depression or obsessive compulsive disorder? It would seem so! In this article we write about neuroplasticity1 in these challenging mental diseases whereas in other articles we wrote about neuroplasticity in somewhat less complex situations, involving the motor cortex and sensory cortex.
Let’s start with obsessive–compulsive disorder (OCD). Did you know that it is as frequent as diabetes or asthma?! This mental disease is known by the lay public because it produces repetitive behaviors such as continuous handwashing, extensive hoarding, nervous habits such as opening and closing a door before entering and leaving a room etc.. commonly termed rituals. These behaviors are aimed at reducing negative emotions such as fear, worry, apprehension that are generated by intrusive thoughts. Generally, those who suffer from OCD recognize that their thoughts and behaviors are irrational and may become further distressed by this realization.
Jeffrey Schwartz a neuropsychiatrist at UCLA has made significant progress in the treatment of OCD, by the conscious use of directed thoughts. He has leveraged patients’ awareness that their thoughts are irrational to successfully develop a therapy to treat this disease. In the ’80s Dr Schwartz showed patients brain pictures where the bottom of the front of the brain (called the orbital frontal cortex and an area called the striatum) were overactive. These patients get signals from the amygdala, which is the lower emotional part of the limbic system, so they seem to constitute something that one might call the worry circuit. He then used these pictures to make the patients realize that the intrusive, unwanted thoughts were being caused by this part of the brain which helped them to recognize that these thoughts had nothing to do with them.
He then convinced the patients to look at themselves with the rational, calm perspective of an outside, impartial, fair-minded observer. The idea was to experience the symptoms without reacting to them. In other words, patients had to allow whatever thoughts or feelings they had to come up without doing, just watching them and trying to let them go. This allowed them to get outside of the fear. He also explained patients with OCD that by responding differently to those intrusive thoughts and urges they would change their brain and it would also empower them to not be slaves to their brains any longer. With this knowledge and thanks to training and effort, patients started to respond differently. As a result of this not only did their clinical condition improve, but PET2 scans showed also that the underlying brain wiring pattern (in the orbital frontal cortex and the striatum) changed.
This approach compares favorably with a treatment called “exposure and response prevention” to treat OCD which was not very humane as it consisted in doing things like making a person go in the bathroom and touch nasty stuff, and then not allowing them to wash their hands. This treatment, while effective, required the person to go through a lot of anxiety, so that it was extremely difficult for people to do it on their own.
Let’s now look at depression. This disease, which is more common than OCD, is often treated by medication. However, after the surprising cover story in Newsweek (2/8/2010) that anti-depressants are not more effective than placebo, physicians will probably rely even more on alternative therapies. One of these, called cognitive behavioral therapy, leverages the brain’s neuroplastic properties.
Cognitive behavioral therapy is, in essence, a form of mental training where patients are taught not to allow negative thoughts, in other words thoughts that may lead to a depression, to take hold. For example, someone who is prone to depression may have thoughts such as “I am so depressed” and when he or she receives some bad news, the reaction will be very different to that of a normal person and will ruminate thoughts like “there is no hope that things will ever improve for the rest of my life”, “I will always be faced with the same situation”, “things can only get worse” etc… A normal person instead will think to himself that things are likely to improve or may look at other positive aspects of his/her life.
Now cognitive behavioral therapy teaches patients to divert attention away from negative thoughts, not to think the negative thoughts and to concentrate instead on alternative, neutral common sense or positive thoughts. For instance, instead of thinking that there is no hope, one could concentrate on a list of things that need to be done for the day, or one could look at the positive side of events and at the positive outcomes that past events, which had seemed negative at first, have had one’s life etc.. Given the neuroplastic properties of the brain, it does not come as a surprise that these repetitive exercises are effective: by focusing our attention differently we are able to guide and leverage our rewiring mechanisms.
1 Neuroplasticity: the ability to change the structure and functioning of the brain through experiences and the conscious use of directed thoughts
2 PET: Positron emission tomography is a technique used in medicine to produce three dimensional images of functional process in the body. This technique is better suited to study the functioning of organs rather than their structure. It makes use of radioactive biologically active molecules (radionuclides) and it monitors their distribution throughout the body.
By the Horizon Research Foundation editorial board