by Helen Borel, PhD

Ongoing investigations by researchers at the National Institutes of Health (NIH) and within the pharmaceutical industry, searching for specific chemicals to treat various psychiatric disorders, have contributed new knowledge about the brain chemistry underlying many distressing conditions, including that of both Social Anxiety Disorder (SAD) - a form of social inhibition, and Generalized Anxiety Disorder (GAD) - a nonspecific anxious condition.

Because certain antidepressants that modulate the activity of the neurotransmitter serotonin (a brain chemical usually associated with the biochemistry of depression and its regulation) have shown efficacy in some cases of SAD and GAD, scientists are studying the role of "the serotonin transmitter system" to find out how it affects one's feelings of fear and anxiety.

Cerebral Neurocircuitry (the electrical system of the brain) is run by its neurotransmitters (brain chemicals) - like dopamine, norepinephrine, and serotonin. (The serotonin system plays an important role in pain perception as well.) In addition to other cerebral and physiologic (body-wide) systems, your neurotransmitters influence the production of balanced or out-of-balance amounts of such interacting biochemicals - too much or too little of your brain chemicals have significant effects on your mood states and feelings, and thereby impact your reactions and your behaviors.

So, beside their associated relationships to brain disorders such as schizophrenia, manic-depression (bipolar disorder), and the addictions; and in addition to their influence on pleasure, normal sadness, appropriate fear, ordinary worry, anticipation, sleepiness, alertness, pain control, grief and anger - discovered levels of particular brain chemicals play specific roles in depressive mood states, in chronic depressive disorders and now, it appears, in anxiety disorders.

Brain Chemistry Changes in Response to "The Talking Cure" What's important to know, that has barely been disclosed by the medical and psychiatry communities to the public, is that particular brain chemistry levels, in prevailing forms of depression and anxiety, are not fixed for life.

Of more than one hundred investigative studies reviewed by researchers Dan J. Stein, M.D.,Ph.D.; Herman G.M. Westenberg, Ph.D.; and Michael R. Liebowitz, M.D.,¹ they reported that - IN PEOPLE UNDERGOING PSYCHOTHERAPY - THERE WERE DEMONSTRATED ANATOMICAL ALTERATIONS IN THE BRAIN ON IMAGING STUDIES (e.g., MRIs and CAT scans) and EVIDENTIAL CHANGES IN NEUROCHEMISTRY (on PETT scans and other biochemical tests).

This is scientific proof, for what heretofore could only be hypothesized, that "the talking cure" - also known as "psychotherapy" - consciously effects alterations and modulations in thought processes (the way we view events), in behaviors (the way we act), and feelings (the way we experience events and interpret or focus on our moods and emotions). Such psychotherapeutically-induced influences actually alter for the better your brain chemistry, thus your brain circuitry (electrical messenger, or neurotransmitter, system) and therefore your brain structure.

So, getting the help of a compassionate therapist as early as possible when facing loss, trauma, chronic or terminal physical illnesses, painful memories, relationship conflicts, work problems, 12-Step issues, life-goal confusions, loneliness, etc., ultimately literally heals faulty brain wiring and chemistry, thereby helping the brain anatomy form itself into a more healthy, more adaptive organ shape and feeding back, yet again, to further improved neurotransmitter levels.

Such "talking cure" anatomic and physiologic changes, which make psychotherapy patients feel better, more confident and less victim to random, painful states are permanent, making the newer, healthier ways of thinking, behaving and dealing with feelings easier and easier to achieve as the "talking" therapy progresses.

Yes, in many cases of depression or anxiety, prescription psychiatric medications work well to abate the suffering. Disadvantages are side effects such as weight gain leading to diabetogenic dangers from obesity, and impotence interfering with couples' close relationships - both of which frequently cause patients to stop taking their medications or to reduce their dosage to sub-therapeutic levels that perhaps provide sleep but don't really impact the chief psychiatric symptomatology.

(An additional concern: It is known that depression, for example, has a major negative socioeconomic effect worldwide, due to work days lost as a result of the motor retardation, hollow pain, hypersomnia or insomnia, and other symptoms afflicting depressed patients. Therefore, not only for the depressed patients themselves, it is in society's best interest to do everything possible to conquer or ameliorate this, and other mental illnesses with the greatest vigor.)

Psychotherapy is Always Required...Sometimes Together with Medications Widely accepted in psychiatry these days, where medication may be indicated, is the imperativeness of using a regimen of psychotherapy in conjunction with Rx drugs in order to amplify the plasticity of the brain. (Plasticity here refers to the brain's capacity for growth, change and flexibility.)

Habituated self-destructive behaviors and fixed negative thought processes don't change with medications alone, which only provide neurochemical change as long as the medication is being ingested by the patient. But no new ways of thinking and behaving, or of addressing uncomfortable and painful memories,or troublesome feelings and current conflicts can occur by using medications alone. Fortuitously, psychotherapy does provide the potential for lasting, positive cerebral change and neurochemical level diversity.

So, lasting alterations, that improve suffering patients' lives, can only occur during the processes that proceed in your psychotherapy sessions. In other words, brain change happens and life change follows when you collaborate on your emotional growth with a quality psychotherapist.

Psychotherapy Deals with the Complexities, Intricacies and Minute Details of Your Life Your unique Self is complex, intricate and filled with all manner of tiny details that have influenced your life and are still impacting your very existence. You may be experiencing painful, disruptive thoughts and feelings. And psychotherapy, which is incisive and offers pro-growth techniques - that affect you emotionally and cause you to try new behaviors - effectively helps you produce positive changes in your brain.

Thus, a majority of patients suffering uncomfortable or painful moods and feelings and/or losses and conflicts, often do not require medication at all. The consistent life changes - fostered and solidified during your period of psychotherapy - so thoroughly impacts brain structure, function and neurochemistry for the better, that most suffering abates progressively to a point of much happier functioning and feelings, much better living, coping and adapting. Much evidence of career and relationship successes.

We've come a long way from Freudian hypotheses and the art of psychoanalysis. All the way to scientific measures of success in human living and relief of severe emotional suffering. Happily, at last, PSYCHOTHERAPY can be lauded both as an art and as scientifically valid.

1. "Social Anxiety Disorder and Generalized Anxiety Disorder: Serotonergic and Dopaminergic Neurocircuitry," J. Clin. Psychiatry, Vol. 63 (suppl 6), 2002.

(c) copyright 2008 Dr. Helen Borel. All rights reserved.