A very bright young man who has a great potential as the therapist but who is wrestled with chronic depression for years and has developed a pattern of avoiding doing things that he knows he has to do in order to move ahead with his life led me to talk again about the relationship between depression, the limbic system (or emotional brain) and the prefrontal cortex (the rational brain) and why the treatment of chronic depression can be such a challenge and almost always requires the combination of psychotherapy and medication.
Functional brain imaging has begun to unearth patterns of interaction between key brain areas (connectosomes).
One important set of connections for people with chronic depression is the connection between key areas of the limbic system and the prefrontal cortex. It appears that depression is associated with significant alterations in functioning in both of these areas, but that different kinds of treatment affect different parts of this connectosome.
Medications primarily seem to affect alterations in the functioning of the emotional brain or limbic system. This is where most of the brain cells that contain dopamine, norepinephrine, and serotonin are located and most of the medications that we used to treat depression primarily affect those brain cells.
Psychotherapy, however, affects the prefrontal cortex which is where rational thought and planning occurs.
However because of the strong connections between the two, psychotherapy can secondarily affect activity in the limbic system and medications can affect activity in the prefrontal cortex.
T and I know no okay I will his model explains why the combination is so much more powerful as it affects both of these powerfully connected brain regions.
For many people with chronic depression they have a problem of how they think about themselves and their relationship to the world that is enduring even when they are not depressed.
Psychologist Jim McCullough has done a lot of thinking about this and developed a system of psychotherapy specifically to target this pattern of thinking, called the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Dr. McCullough noticed that people with chronic depression seem to have a persistent view of themselves as being unable to change the world. He suggested that in the area of thought related to relationships, people with chronic depression developed a way of thinking about how events take place that was similar to the way that preschool children think – they don’t see the relationship between what they do and say and how people react to them.
And since they literally don’t see this relationship it is very hard to convince them to change their behavior and their interactions with other people and with the world.
The work of psychotherapy with someone with chronic depression involves helping the person overcome this cognitive deficit by pointing out specific examples of how the attitude or perception of the person with chronic depression influences how they react to the world and, in turn, shapes their experiences.