Within mental health treatment—and the research supporting it—exists a peculiar schism. On one side are therapists and psychologists, who do amazing things with cognitive and behavioral therapy: talking, mostly. One crucial example of this success is exposure therapy, in which fears and phobias are neutralized through incremental demonstrations of the phobia subject's real-world harmlessness, or harmlessness relative to the patient's irrational fear. On the other side of the schism is neuroscience, with psychiatry acting as a weak bridge, which, conversely, has very little to say about the actual physiology of phobias and phobia amelioration, at least in the clinical sense.
If you yourself have ever been a patient within a conventional mental health treatment structure, you've seen the schism firsthand. In one room is a doctor; the doctor prescribes drugs, which target brain chemistry. This might be very effective. In another room, likely a much friendlier-feeling one, perhaps with a bunch of toys and crayons, is a therapist or psychologist. It's here that things become dramatically more qualitative. Problems in this room become the domain of conversations rather than neurons and neurotransmitters. A solution or solution component might be "get up earlier" or exercise or be more open with so and so. The set of problems to be dealt with becomes infinitely more large in this room, but the cost is a proportional increase in vagueness and subjectivity. Nonetheless, this might also be very effective.
The rift above, a "culture gap" between disciplines, urgently needs to be overcome, according to an open-access comment published in this week's edition of Nature, authored by a team of researchers hailing from MIT, Cambridge University, and UCLA, together representing diverse fields within psychology, psychiatry, and neuroscience. Psycological treatments are too often dumped into a black box or sorts, in which their neurological underpinnings are left unexplored. Clinical treatments are evaluated by apparent changes in behavior rather than what they're actually doing, physically. That might sound just fine—if it works it works—but, what if within that corresponding neuroscience are clues to how that treatment might be more effective, or might be effective in different sorts of mental health conditions less responsive to psychological treatment?
It's that last bit that should hit hard. The researchers note that bipolar disorder, in particular, remains largely outside the bounds of psychology, which has so far proven to be relatively ineffective in treating the condition. Looking deeper, in some new mental health field combining aspects of psychology with neuroscience, might reveal a clinical entryway into the illness, one beyond, or at least in addition to, medication.
"Evidence-based psychological treatments need improvement," the researchers write. "Although the majority of patients benefit, only about half experience a clinically meaningful reduction in symptoms or full remission, at least for the most common conditions. For example, although response rates vary across studies, about 60 percent of individuals show significant improvement after [cognitive behavioral therapy] for OCD, but nearly 30 percent of those who begin therapy do not complete it. And on average, more than 10 percent of those who have improved later relapse."
Moreover, the rapid development of neuroscience generally promises entirely new psychological treatments, but as the disciplines are set up now, there's barely a mechanism for psychological insights to make it to actual neuroscientists. And if these insights aren't being shared, there's not really any mechanism for neuroscientists to get to the neuro-root of psychological treatments. (There is a root.) Part of the problem, the paper notes, is the enduring claim that psychology is a pseudoscience, despite its towering evidence base, or the persistance of stale images of "couches and quasi-mystical experiences." Blame Freud? If only it was that easy.
The paper notes that clinical researchers and neuroscientists, "meet infrequently, rarely work together, read different journals, and know relatively little of each other's needs and discoveries." So, rather than these two entirely related fields collaborating, they advance in parallel. "Neuroscience is shedding light on how to modulate emotion and memory, habit and fear learning," the Nature letter continues. "But psychological understanding and treatments have, as yet, profited much too little from such developments."
"It is time to use science to advance the psychological, not just the pharmaceutical, treatment of those with mental-health problems," the researchers summarize. "Great strides can and must be made by focusing on concerns that are common to fields from psychology, psychiatry and pharmacology to genetics and molecular biology, neurology, neuroscience, cognitive and social sciences, computer science, and mathematics. Molecular and theoretical scientists need to engage with the challenges that face the clinical scientists who develop and deliver psychological treatments, and who evaluate their outcomes. And clinicians need to get involved in experimental science."