Psychology meets laboratory

Go-ahead given for the world’s largest psychotherapy study at the Max Planck Institute of Psychiatry

Psychotherapy works, this is beyond dispute. But how does it work? And on what level? Under ideal circumstances patients experience a subjective improvement. But what about the biological effects; is it possible to demonstrate changes in the laboratory? These are exactly the questions the Max Planck Institute of Psychiatry will tackle in a large, internationally unique study, which is now starting.

“While there has been no significant advance in medication over the past 30 years, there have been dramatic improvements in psychotherapy. Unfortunately, however, we still don’t know in advance which psychotherapy will help which patient in the best and quickest way. This is exactly where our study starts,” explains Martin Keck, Director of the new study and Head Physician and Director of the MPI hospital.

Largest study worldwide

The internationally unique study aims to recruit around 1,000 patients over the next 8 years. Recruited patients will also undergo extensive blood tests and diagnostics using imaging technology and neuropsychological tests. They will receive an intensive psychotherapeutic program involving individual and group therapy. One third of the patients will be randomly assigned to schema therapy, another third to cognitive behavioral therapy and the last third will be supported by individual treatment. Over 8 weeks, the patients will complete 32 therapy sessions, which will be analyzed randomly afterwards: Supervisors will randomly select from the 32,000 videos taken and check how the therapeutic guidelines were implemented. This is the only way to validate “talking” therapy in an evidence-based manner and to generalize results. “Our aim is to gain insight into the biological effects of psychotherapy,” Keck summarizes.

How effective is schema therapy?

The study is also designed to test new psychotherapeutic approaches, such as schema therapy, by assessing their effectiveness in treating depression and providing information on which patients benefit most from certain psychotherapeutic interventions. In schema therapy, the therapists combine the methods of cognitive behavioral therapy with elements of the psychodynamic approach. As a result, and more than with classical behavioral therapy, the focus lies on emotions, past formative experiences and the relationship between patient and therapist.
 
Psychotherapy = learning

“Psychotherapy is learning,” says Elisabeth Binder, Managing Director at the MPI, “and learning leaves traces in the brain. We know this from, for example, early childhood development.” A behavior that contributes to the development and maintenance of disease, such as depression, is a learnt one. If, in the course of the psychotherapy, the behavior is identified as pathogenic, the patient can work on alternatives with the therapist – and so the brain can learn a new behavior.  

Conversely, this kind of learning also applies to the development of diseases: The body learns to be ill – and for mental disorders, it can also be unlearnt. Based on this knowledge, new therapeutic approaches can be developed. To do this, scientists must know which processes are initiated in learning. In the new MPI study, psychology meets the laboratory: Numerous biological measurements will be combined with psychotherapy and learning, thus determining the effects of psychotherapy in the laboratory.

“The uniquely close connection between research and clinical work at our Institute enables us to carry out such a complex study,” remarks Binder. “If prior to treatment, therapists had objective evidence on the success or failure of certain therapies then patients could avoid a lot of time and suffering,” Keck concludes.

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