Beyond Psychotherapy

Scientists are moving ever-closer to directly diagnosing and attacking mental illness where it resides: the brain.

“The use of sophisticated technology to intervene and improve brain function is just beginning,” Brown University researcher Laurence M. Hirshberg wrote last year in issue of Child and Adolescent Psychiatric Clinics of North America. “The science-fiction fantasy of brain chip implants is getting ever closer to realization.”

Among medical therapies with promise:

•Quantified electroencephalographs (qEEG): qEEGs, which chart and measure patterns of electrical activity in the brain, show that certain psychiatric disorders — such as ADHD, mood disorders, schizophrenia, anxiety, substance abuse — seem to have distinct patterns. Reading the patterns may do much to improve diagnosis.

•Electrobiofeedback (EBF): EBP, also known as neurofeedback or neurotherapy, is an old therapy put to a new use. Patients are hooked to an EEG, MRI or some other device that provides a picture or, say, a series of beeps to show how the brain is working in overdrive. Patients use this information to consciously try to reduce the brain’s wave patterns.

•Electroconvulsive Therapy (ECT): Considered appalling a generation ago, it is back in wide use and in the limelight. A gentler version is proving safe and effective for the treatment for major depression.

•Brain Imaging: We know them as fMRIs and PET scans, short for functional magnetic resonance images and positron-electron tomography. They both produce images of the active brain. Different pictures may be able to help diagnose different psychiatric disorders.

•Psycho-enhancing drugs: Medications that may help improve the effectiveness of traditional psychotherapy. Researchers studying a fear of heights, for example, gave patients psychotherapy and the drug D-cycloserine. Seventy-five percent of patients improved compared to patients on psychotherapy and placebo.

•Genotyping: The more the Human Genome Project advances, the closer scientists are coming to identifying genes or groups of genes that may put children and adults at risk for major psychiatric disorders. Studies have already identified some genes that seem to make individuals more or less vulnerable to post-traumatic stress disorder.