How does psychotherapy work if depression is due to a chemical imbalance?
Every thought, feeling, and behavior is associated with a chemical change in the brain. If thoughts, feelings, and behaviors occur with a repeated pattern, structural changes can occur in the brain as well. Learning and memory involve complex chemical changes that lead to permanent structural changes in brain anatomy. For example, consider the first time that one learns how to drive a car. It requires conscious processing of complex pieces of information and integrating the information into an organized behavioral pattern. The powers of concentration at that time could be exhausting. However, with practice, the skill becomes second nature as the brain adapts the skill so that much of it occurs unconsciously. Over-learned behavior such as that ultimately leads to structural and biochemical changes in the brain.
Brain Chemistry Structure
The chemistry and structure of the brain can change via one of three methods:
- change in the environment
- change in brain chemistry via chemical modification with the use of psychotropic medication
- learning how to modify the environment or perception of the environment by developing new skills.
Moving, changing jobs, and getting married or divorced are examples of the first method, whereas psychopharmacology is the second. Psychotherapy is the third method. Brain-imaging studies have repeatedly demonstrated, for example, that changes occur in the same brain regions of patients with obsessive–compulsive disorder on fluoxetine as those receiving cognitive–behavioral therapy. Each of these methods has its own inherent costs and benefits, and therefore, none can be considered inherently better or worse than another. The effects of all three methods are generally cumulative; thus, in order for one to have the best chance of recovery from depression, a combination of two to three methods is generally warranted.