In 2019, only 9% of people received psychotherapy (Terlizzi & Zablotsky, 2020). This percentage has decreased over recent years. The purpose of this discussion post is to outline the biological basis of psychotherapy and the factors that influence psychotherapy.
Psychotherapy and biological basis
Many changes can occur because of a person’s experiences and environment. Studies have shown that patients with borderline personal disorder have higher states of methylation. These corresponded to levels of depression, impulsivity, and feelings of hopelessness. After therapy, the rate of methylation decreased significantly (Jiménez et al., 2018). In patients with PTSD, there is a dysregulation of cortisol. Cortisol is suppressed, and the brain may become sensitive to cortisol release. This would cause a person to overreact in response to a previously minor trigger. Traumatic events can cause the body to release endogenous opioids. In the future, the person may cut themselves to release tension, but they do not register the event as painful because they are dissociating. Memories are stored based upon the emotional state the person is in at the time of the event. Triggers, such as smells, sounds, or feelings, can cause a rush of negative emotions and thoughts. Through psychotherapy, memories can be reintegrated into consciousness, and can improve function in the prefrontal cortex. This also serves to downregulate the amygdala. Mindfulness can improve attention through actions on the limbic system Psychotherapy can also widen the resiliency zone, which improves the person’s reactions to stress (Wheeler, 2022).
Culture and psychotherapy
Stigmas in a person’s culture will affect a person’s willingness to seek mental health treatment. Many cultures will seek out spiritual or religious reasons for a mental illness, rather than a biologic reason. Lower income areas have a higher rate of mental illness, along with a greater lack of resources. This causes poorer outcomes for patients with a mental illness (Rathod, 2016). The provider should seek to understand the individual rather than make assumptions based upon their culture, religion, or ethnicity. The provider should assess the patient’s beliefs about the benefits of psychotherapy and the causes of mental illness.
Ethical implications for psychotherapy
Therapists have an obligation to ensure patients understand the proposed treatment. They also should understand and respect an individual’s right to participate in developing their treatment plan. The patient should also understand the outcomes and goals of treatment (Gerger et al., 2020). During group therapy, patients should be informed about the type of group, rules, and frequency and duration of group meetings. Patients should also be instructed to not socialize outside of the group setting if it is on an outpatient basis. Confidentiality should be explained, and participants should not disclose other members’ information, including names (Wheeler, 2022). In family therapy, the therapist should set rules, and ensure there are no conflicts of interest (Nichols & Davis, 2020).
Conclusion
The demand for mental health treatment continues to rise, and the demand for treatment will only continue to rise. Mental health providers should be aware of cultural, ethical, and biologic factors that may affect treatment. This will ensure that professionals provide the best possible care for their patients.
References
Gerger, H., Nascimento, A., Locher, C., Gaab, J., & Trachsel, M. (2020). What are the key characteristics of a ‘good’ psychotherapy? calling for ethical patient involvement. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00406
Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P., Jaramillo, K., & Luyten, P. (2018). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers in Genetics, 9. https://doi.org/10.3389/fgene.2018.00257
Nichols, M. P., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
Rathod, S. (2016). Contemporary psychotherapy and cultural adaptations. Journal of Contemporary Psychotherapy, 47(2), 61–63. https://doi.org/10.1007/s10879-016-9344-5
Terlizzi, E. P., & Zablotsky, B. (2020, September). Nchs data brief, number 380, september 2020 [PDF]. National center for health statistics. Retrieved December 1, 2021, from https://www.cdc.gov/nchs/data/databriefs/db380-H.pdf
Wheeler, K. (2022). Psychotherapy for the advanced practice psychiatric nurse (3rd ed.). Springer Publishing.
Discussion: Biological Basis and Ethical/Legal Considerations of Psychotherapy
Nurse practitioners have the ultimate role of providing patients with the best quality of care. However, for an effective therapeutic approach or process, a healthcare practitioner must consider other elements such as communication and differences between patients to ensure that the best quality of patient outcomes is derived. From a broader perspective, psychotherapy could offer an effective medical diagnosis and treatment similar to psychopharmacology.
Psychological and Biological Bias
Various scholars have affirmed the inherent relationship between psychotherapy and biological basis. According to Holmes (2012), neuroimaging studies concerning brain activities and response to various treatments and those that evaluate changes in brain activities during treatment or diagnosis can help providers understand the neural models. Meanwhile, these studies do not discuss the specific actions that often happen during psychotherapy. The implication is that the process of psychotherapy can operate on the principles of medication. If psychotherapy is linked to aspects of medication, then a clear correlation can be drawn with neuroscience through neurotransmitters. Furthermore, Holmes (2012) noted that psychotherapy provides biological treatment since it helps providers understand the functions of the brain and the processes that take place based on the processes such a; development, maturity, and operation. It means that psychotherapy through neuroscience offers health providers the principles of evolutionary adaptations through the lens of genetics.
Socioeconomic and Cultural Factors
Socioeconomic factors have a fundamental impact on the effectiveness of therapeutic approaches. A study by xxxx associated higher socioeconomic status with greater therapy retention. The same study concluded that patients with lower socioeconomic status are most likely to have the worst counseling outcomes and greater dysfunctions. This implies that the quality of psychotherapy plans is directly proportional to socioeconomic status. Besides, the cultural dominance of various ethnic groups can determine the quality of counseling outcomes they get. Patients from minatory groups like African Americans are linked to poor psychotherapeutic outcomes than peers from majority populations like Whites in the United States (Saroglou & Cohen, 2011). Finally, patients with strong religious faith and beliefs are likely to have better mental and physical health than individuals with no religious backgrounds (Saroglou & Cohen, 2011).
Legal and Ethical Issues and Considerations
When giving psychotherapy services to patients, it is important to consider the aspects of safety, privacy, and confidentiality. First, individuals require safe and conducive environments to share their private personal health information. Counselors need to remain extremely confidential and private with patient information to leverage trust and confidence. When a patient trusts the counseling process, they get confident to share more useful information for further treatment and more accurate outcomes.
References
Blunt, D. R. (2006). Confidentiality, Informed Consent, and Ethical Considerations in Reviewing the Client’s Psychotherapy Records. Online Submission. https://eric.ed.gov/?id=ED490794
Hawley, L. D., Leibert, T. W., & Lane, J. A. (2014). The Relationship between Socioeconomic Status and Counseling Outcomes. Professional Counselor, 4(4), 390-403. https://eric.ed.gov/?id=EJ1063209
Holmes, J. (2012). Attachment theory: a biological basis for psychotherapy? The British Journal of Psychiatry, 163(4), 430-438. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/attachment-theory-a-biological-basis-for-psychotherapy/5BC4956C5081AB9670C048CE04859304
Saroglou, V., & Cohen, A. B. (2011). Psychology of culture and religion: Introduction to the JCCP special issue. Journal of Cross-Cultural Psychology, 42(8), 1309-1319. https://journals.sagepub.com/doi/abs/10.1177/0022022111412254
Does Psychotherapy have a Biological Basis?
Neuroplasticity is the brain’s ability to form and reorganize its synaptic connections, simply said, it is the brain’s ability to re-wire itself in response to experiences. Research shows that the brain can re-wire neuronal pathways in response to both physiological and psychological influences. This can occur after experiencing a physical injury such as a stroke, or after a psychological injury such as a trauma. As such, it would make sense that good experiences can cause re-wiring similarly to the way bad or harmful experiences can. There is evidence that good influences, such as those observed from psychotherapy, contribute to re-wiring maladaptive connections formed during periods of distress (Jimenez, et al., 2018). Multiple studies have shown a significant increase in brain-derived neurotrophic factor (BDNF) which is believed to be responsible for these changes (Piotrkowicz, et al., 2021). BDNF is a neurotrophic factor the brain produces that is responsible for neuronal development, neurogenesis, and synaptic plasticity (Yang, et al., 2020).
Considerations/barriers to psychotherapy
There are a number of things to consider when thinking about barriers to obtaining psychotherapy. Some may be as simple as access to care. Nationally, there is a known disparity in equal access to healthcare, this includes mental health (NAMI, 2021). Depending on the geographical location of an individual, there may simply be fewer providers available, or there may be long waitlists before a person can be seen by a mental health professional. Additionally, personal belief systems can affect how one views mental health treatments. Religion and culture contribute to how a person may view the helpfulness of psychotherapy or even whether it is allowed by their faith. In addition, socioeconomic circumstances can prevent a person from seeking care.
Legal and Ethical Considerations
There are distinct differences between group and family therapy and individual therapy. As in all healthcare settings, mental health assures the patient of their utmost confidentiality which is protected by law. In psychotherapy, a client receives a nondisclosure agreement and is informed at the onset of treatment that all information is strictly confidential unless there is a reason to believe a credible danger to themselves or others exists. Information shared in psychotherapy sessions is intended to be solely for the practitioner and patient. When working with groups or families, other dynamics must be taken into consideration. These include keeping each person’s confidence individually when disclosures are made outside of the group/family session (Mignone, et al., 2017). Exceptions to this rule would include informing one spouse of their partner’s intent to harm them or reporting the abuse of an underage person (Mignone, et al., 2017). Additionally, it is important that all people involved in group and family therapy understand that the therapist has to maintain their confidentiality, the other members of the group do not share this responsibility and, as such, not all information provided in shared sessions are 100% confidential.
References
Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y.…& Luyten, P. (2018). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers in genetics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056612/.
Mignone, T., Klostermann, K., Mahadeo, M., Papagni, E., & Jankie, J. (2017). Confidentiality and family therapy: cultural considerations. ARC Journal of Psychiatry, 2(1), 9–16. Retrieved December 2, 2021, from https://www.arcjournals.org/pdfs/ajp/v2-i1/3.pdf.
NAMI. (2021). The doctor is out. Accesses December 2, 2021, from https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out
Piotrkowicz, M., Janoska-Jazdzik, M., Koweszko, T., & Szulc, A. (2021). The influence of psychotherapy on peripheral brain-derived neurotrophic factor concentration levels and gene methylation status: A systematic review. Journal of Clinical Medicine, 10(19), 4424.
Yang, T., Nie, Z., Shu, H., Kuang, Y., Chen, X., Cheng, J.,…& Liu, H. (2020). The role of BDNF on neural plasticity in depression. Frontiers in cellular neuroscience, 14, 82. https://doi.org/10.3389/fncel.2020.00082
Week One Discussion
The purpose of this week’s discussion is to describe whether psychotherapy has a biological basis. Psychotherapy has been shown to be just as effective as psychopharmacology when it comes to symptoms of anxiety, influencing behavioral changes, and improving mental state. There is little known about the biological mechanism of psychotherapy (Zilcha-Mano et al., 2020). The question remains, how exactly does psychotherapy achieve the same changes that psychopharmacology achieves?
Biological Basis of Psychotherapy
With the help of research, there is evidence to show that shifting the focus of a patient’s treatment plan from strictly pharmacology to an integrative approach that includes both pharmacology and psychotherapy can be beneficial to the patient (Prosser et al., 2016). How does psychotherapy affect and change the brain? For example, oxytocin is a hormone that affects organs in the body and works as a chemical messenger in the brain. It is important for providers to establish trust and a therapeutic alliance with their patients while maintaining boundaries. It has been argued that oxytocin serves specifically as a biological mechanism. Oxytocin has an anxiety lowering effect, can increase calmness, decrease negative moods, and decrease stress. These effects are mediated by the amygdala, hypothalamic (pituitary) adrenal axis, and the cardiovascular system. Oxytocin may be released in a patient when a safe situation is sensed. This is only one example of a biological mechanism theory behind successful psychotherapy (Zilcha-Mano et al., 2020).
Culture, Religion, and Socioeconomic Views on Psychotherapy
Culture, religion, and socioeconomic factors can all influence a patient’s view on the value of psychotherapy and treatment interventions. Being aware of different backgrounds and cultures, as well as being aware of your own values can help a provider be successful in their approach to psychotherapy. Respecting and maintaining the professional relationship involves eliminating any perceived judgement as this may be a hinderance to treatment. In some cultures, speaking about mental illness is considered taboo, thereby stopping people from seeking help. One example could be parenting styles on children. Cultural and religious influences on parenting can turn into shame in a child and affect the maturation process as well as the child’s view on seeking help (Kirby et al., 2019).
It has been discussed whether nurses should do psychotherapy, and the conclusion is that nurses possess a unique perspective of the patient in a holistic way, and exposure to different ethnicities, socioeconomic status, cultures, and personalities that enable us to connect with patients from diverse backgrounds (Wheeler, 2020).
Legal and Ethical Considerations
There are many legal and ethical considerations to be made when providing psychotherapy to patients in multiple settings such as individual, group, and family therapy. Legal and ethical considerations must be made during treatment planning that align with providers local regulations and licensure requirements. Providers must be aware of and follow these laws/mandates/scopes of practice. Confidentiality is an important consideration when providing psychotherapy. Informed consent must be fully understood and delivered to each patient. Patients must be aware that group therapy will involve the sharing of information by other patients at their own accord and agree that there is a level of privacy that must be maintained by group participants (Saks, 2016). Anything that is said in group therapy should not be repeated outside of the group. This could hinder a patient’s openness to share and fully engage in psychotherapy and individual therapy may need to be considered for these patients when group therapy is not shown to be beneficial. Family therapy could be beneficial to the patients, but boundaries should be assessed. If there is something that the patient is not comfortable speaking about in front of their family, it should be known, and the provider should be made aware of this. The patient should have full understanding of what family therapy will entail.
References
Kirby, J. N., Sampson, H., Day, J., Hayes, A., & Gilbert, P. (2019). Human evolution and culture in relationship to shame in the parenting role: Implications for psychology and psychotherapy. Psychology and Psychotherapy, 92(2), 238–260. https://doi.org/10.1111/papt.12223
(Peer reviewed journal, not advertising information, focused on disseminating information by reputable sources, primary source original research)
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson. Chapter 2, “Basic Techniques of Family Therapy” (pp. 33–35 only)
Prosser, A., Helfer, B., & Leucht, S. (2016). Biological v psychosocial treatments: A myth about pharmacotherapy v psychotherapy. The British Journal of Psychiatry, 208(4), 309–311. https://doi.org/10.1192/bjp.bp.115.178368
(Peer reviewed journal, not advertising information, focused on disseminating information by reputable sources)
Saks, E. R. (2016). Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy. JOURNAL OF THE AMERICAN PSYCHOANALYTIC ASSOCIATION, 64(5), 1081–1088. https://doi.org/10.1177/0003065116673180
(Peer reviewed journal, not advertising information, focused on disseminating information by reputable sources)
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
Zilcha-Mano, S., Shamay-Tsoory, S., Dolev-Amit, T., Zagoory-Sharon, O., & Feldman, R. (2020). Oxytocin as a biomarker of the formation of therapeutic alliance in psychotherapy and counseling psychology. Journal of Counseling Psychology, 67(4), 523–535. https://doi.org/10.1037/cou0000386
(Peer reviewed journal, not advertising information, focused on disseminating information by reputable sources)
