Cognitive behavioral therapy may reduce symptoms of depression more effectively than antidepressants in some patients, a team of researchers finds.
- The study included 108 adults diagnosed with both major depression and obesity. Only 17% of patients responded favorably to antidepressants.
- While cognitive behavioral therapy didn’t work for everyone, 32 percent of participants responded favorably, meaning the severity of their symptoms was reduced by half or more.
- According to scientists, their brains were able to process information more efficiently thanks to the therapy.
Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps people identify and change negative thought patterns to reinforce healthy behaviors and overcome emotions. It is now one of the most common treatments for depression. A new study published in the journal Science Translational Medicine confirms that it can cause lasting changes in the brain, and thus reduce depressive symptoms more effectively than antidepressants in many patients.
Problem-solving therapy for depression
In a clinical trial, researchers at Stanford University School of Medicine (USA) evaluated the effects of a CBT called problem-solving therapy (PST), designed to improve cognitive skills used to plan, troubleshoot and deal with irrelevant information. “A therapist guides patients in identifying real-life problems (a conflict with a roommate, for example), possible solutions and choices.”specifies a press release.
These cognitive skills depend on a specific set of neurons that work together, known as the cognitive control circuit. Previous work has shown that a quarter of people with depression have a dysfunction in their cognitive control circuit – either too much or too little brain activity.
Antidepressants not effective enough in some patients
The study included 108 adults diagnosed with both major depression and obesity, a combination of symptoms that often indicates problems with the cognitive control circuit. Only 17% of patients with this profile responded favorably to antidepressants, “a dismal response rate”. Among the participants, 59 followed a one-year program of problem-solving therapy, in addition to their usual care (medication, visits to the treating physician, etc.). The other 49 received only conventional care.
The volunteers underwent functional MRI brain scans at the start of the study and after two months, six months, 12 months, and 24 months. During each scan, they not only completed questionnaires assessing their depressive symptoms and cognitive abilities, but also performed a test that involved pressing or not pressing a button based on text on the screen—a task that engages the cognitive control circuit. The goal: to assess changes in the activity of this circuit throughout the study. “We wanted to see if this type of CBT could modulate the cognitive control circuit.”the researchers explain.
A reduction in depression symptoms in a third of participants
While, as with any other depression treatment, TRP didn’t work for everyone, 32% of participants responded to the therapy, meaning the severity of their symptoms was reduced by half or more. “This is a huge improvement over the 17% response rate for antidepressants.”
When the researchers looked at brain scans of the volunteers who had received only usual care, they found that:“a cognitive control circuit that became less active during the study correlated with a deterioration in problem-solving ability.” Conversely, in the group receiving CBT, “decreased activity was correlated with increased problem-solving ability.”
This may be due, scientists say, to their brains learning to process information more efficiently through therapy. “We think they have more efficient cognitive processing, meaning they now need fewer resources in the cognitive control circuit to do the same behavior. Before the therapy, their brains were working harder; now they were working smarter.”
