Canada AM, August 2002

Allan Abbass, MD, FRCPC, Director of Education Department of Psychiatry, Dalhousie University, Halifax, Canada.

AM: Studies surrounding depression and mental illness are revealing new insights into talk therapy.  There is evidence now that therapy and drugs produce similar changes in the brain.  Joining us now to talk about all this from Halifax is Dr. Allan Abbass who is the chair of psychotherapy at the Canadian Psychiatric Association.  Doctor, thank you very much for joining us this morning on Canada AM. 

AM: Take us through the details here in terms of the findings that we may be seeing similar outcomes between talk therapy and pharmaceutical intervention.

ABBASS: This is a report that shows the same thing that a number of other studies are showing: that psychotherapy has a direct brain effect as well as medications have direct brain effects. Further, they seem to work in same brain areas when they produce the same results.  Both of these treatments work on stimulating certain areas of the brain.  We have known for a long time that psychotherapy effects the brain as well as the body but these studies help clarify the details of that. They can also eventually help us to sort out what specific types of treatment may be warranted in specific types of problems. 

AM: Does the new evidence say that one is better than the other?

ABBASS: No it doesn’t.  In fact most studies that are head to head comparison studies show that psychotherapies and mediation treatments seem to have a similar outcome overall.  With certain conditions there is definitely an advantage of medications and psychotherapy is being added on to medications. With other conditions, psychotherapy seems to be a primary intervention and treatment of choice. But there is such a broad range of these conditions.  This study focused on, and most of the studies focus on depression and anxiety where both treatments are quite effective.

AM: How does therapy change the body, in terms of dealing with these kinds of problems?        

ABBASS: There are different ways it works.  One way would be to understand that if emotions were blocked off the person would be underutilizating part of the brain and using energy to avoid emotional experiences. If the therapy helps the person get back to those emotions, we are basically restimulating that part of the brain so that the person  has more access to their overall emotions, general health and well being.  You know that adverse emotions like for example: the stress of a terrorist attack or even a minor trauma can result in physical effects. This is because brain and emotional effects have a bodily effect.  So we know psychotherapies can impact on physical health.

AM: How surprising are these kinds of results, especially on the psychotherapy front?

ABBASS:  They are not that surprising. This study highlights some recent studies but there are similar studies that go back a long time.  For example we know that psychotherapy is effective with conditions like hypertension, skin conditions, stomach conditions there is a broad range of physical conditions that are affected by psychotherapy through it’s effect on the brain.  So this has been known for a long time.  But these are the kind of studies that help scientists and people who use imaging research to see the psychological effects on the brain.  So it’s a good integrative type of investigation. 

AM: So with the increasing evidence of the affect of psychotherapy does that mean less use of drugs?

ABBASS:   I don’t think it will mean less use of drugs, there are some patients and conditions that should definitely be treated with medications and psychotherapy is something that may be added on to assist in other areas.

AM: So are drugs still the lead in terms of a clinical treatment and then therapy? Is there any kind of protocol there?

ABBASS: With certain conditions medications are definitely the main stay of treatment and psychotherapy is secondary.  Mainly some certain conditions such as schizophrenia, bipolar disorder, severe depression, medications are something that are definitely necessary and psychotherapy may be added on. There is some evidence that it can help in certain areas with those problems.   In other conditions medication may or may not be necessary.

AM:  And very quickly, if you can give me a sense of what these kinds of studies this evidence does for increasing the awareness around psychotherapy and indeed the acceptability.

ABBASS:  Well I hope that it does have that effect on decision making with people who have access to decide (funding of specific treatment programs )

AM: Dr. Abbass I am going to have to leave it right there. Thank you very much, thank you for joining us on Canada AM. 

ABBASS:  You’re welcome