BJPsych Kaleidoscope February 2020

magazine-coverI’m not being funny or nothing – some of my best friends are psychologists – but what exactly is it that goes on in psychological therapies?

Of course, as a psychiatrist, I can never truly be informed: our guilds have a mutual exclusion pact – they could tell me, but they’d have to kill me after. Besides me being facetious, the actual underlying question is important. For both medication and therapy trials, we tend to just look at global outcomes versus doing nothing, rather than asking how is the intervention creating change. For medication, the complexity is understanding the pharmacology and neurobiology; for therapy, it is trying to unpick the ‘goodness’ of the sessions. Big asks – how does one weigh sunshine? – but a fascinating new study analysed transcripts of 17,000 patients’ therapy, covering nearly 100,000 sessions. A deep learning computing model explored the language and techniques used within, categorising and clustering therapists’ comments. Key features, notably the use of ‘change methods’ by the psychologists, were associated with more reliable clinical improvement, whereas greater use of non-therapy related content led to reduced gains and increased drop-outs. The data are doubly fascinating: firstly, it opens up analysis of actual therapy session content (though you might argue about computers assigning meaning); secondly, it helps support the specific drivers of gains from psychological therapy, and further refinement and improvement of evidence-based interventions.

Enough mind, more brain.

Problems with hippocampal neurogenesis are seen in several mental illnesses, including psychosis, and these changes have indeed been argued to causally drive some pathology. So, a therapeutic target perhaps? Kaleidoscope describes novel work on rodents with a ketamine-induced model of psychosis that had transplants of bone marrow derived mesenchymal stem cells transplanted into their ventricles. This multipotent cells can differentiate into several lineages, including promoting neurogenesis, and have immunomodulatory properties. Those rodents given the transplant showed an increase in new neuron production and behavioural improvements. All very exciting, though a cue for those psychologist friends of mine to note it has just been shown in mice.

 

Read the full February 2020 Kaleidoscope column in BJPsych.

Last month's quiz answers can be now be found in the January 2020 Kaleidoscope column.

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