[Big Ideas 002] Psychotherapy

Context: This article is part of the Big Ideas series, where I synthesize takeaways from interviews by Discovery Magazine with the world’s best experts in multiple disciplines. This series is inspired by Peter Kaufman’s take on the multidisciplinary approach to thinking. Peter spent 6 months reading 140+ of these interviews, and came out knowing “every single big idea from every single domain of science”. I wrote more about Peter’s insightful ideas in this article.

Credit: Special thanks to ValueInvestingWorld for compiling the interviews in a single PDF here.

Neurobiologist Eric Kandel: Studying Fear vs. Happiness; How to Make Psychotherapy More Robust

Eric Kandel won the Nobel Prize for research on the memory of sea slugs – yes, you read that correctly, sea slugs indeed. He co-edited Principles of Neural Science, “the book every medical student in America is required to read—all 1,414 pages”. Read the original interview in the April 2006 issue here.

Fear and happiness are two basic emotions Kandel studied:

  • We could categorize fear into 2 types depending on how it originated – instinctive fear and learned fear. “Fear comes to a certain neural circuit…you can turn that circuit on and off with specific genes.”

    For example, when researchers knowcked out the stathmin gene in mice, they saw both types of fear reduced. Kandel sees the application of this gene in anti-anxiety agents, and may help to “open up a biology of security and comfort”.
  • Fear is an emotion that is produced in animal experiments using “tone and shock”, i.e., play a tone while subjecting the animals to electric shock. In contrast, it is unclear “whether we can behaviorally—without manipulating genes—produce the opposite, and that is happiness.”

Kandel received training as a psychiatrist, and is also interested in psychoanalysis. When asked about the psychology-neurobiology split, Kandel says: “I am proposing a demanding criterion (for psychotherapy): that you be able to detect abnormalities in patients beforehand by such brain-imaging techniques as functional MRI [which measures blood flow in the brain], and then use (brain) imaging to see whether or not there is a change in those markers for the disease as the therapy progresses.”

Related Reading: Types of Psychotherapy & Measurements of Effectiveness

In 2014, the US Department of Health & Human Services published Strategies for Measuring the Quality of Psychotherapy: A White Paper to Inform Measure Development and Implementation. This paper gives an overview of the types of psychotherapy, and comparison of common measurement methods.

There are 3 dominant types of psychotherapy, amongst others:

  1. Cognitive behavioral therapy (CBT): short duration of 6-16 weeks, focuses on specific, current problems;
  2. Interpersonal therapy (IPT): slightly longer duration of 12-16 weeks, focuses on the connection between mood & stress, most commonly used to treat depression;
  3. Psychodynamic therapy: longer duration that could stretch years, focuses on how past experience relates to the present.

The white paper summarizes the research into effectiveness of psychotherapy:

There are 3 key ways to measure the effectiveness of psychotherapy:

  1. Structure measures: focuses on the capacity of the service provider, “most often used in accreditation or certification programs”. KPIs could include info on staffing, data systems, and treatment procedures;
  2. Process measures: focuses on “whether individuals receive care or treatments that have evidence of improving outcomes”, typically measured based on claims (e.g., track frequency of visits), medical records or self-reported content of therapy;
  3. Outcome measures: focuses on “whether individuals receiving psychotherapy experience improvements in their symptoms and functioning”. This is also the category that the authors of the white paper recommend doubling down on.

Stay tuned for more articles in the “Big Idea” series! And please share interesting “big ideas” by reaching me at fullybookedclub.blog@gmail.com or on LinkedIn.

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