Science Behind Therapy

Science Behind Therapy

There are many different types of therapy, and while they may use varying techniques or approaches, they all share the common goal of improving your mental health. Therapy helps you learn how your own mind works. It allows you to navigate your feelings, build healthier habits, and change your mindset so that your life looks more like you want.

Many people are resistant to the idea of participating in therapy when they first start struggling with their mental health. It's common to dismiss therapy as "just talking to someone" and make excuses – I already have friends to talk to; I won't be able to open up to a stranger; I can just take medication. It may seem like therapy can't possibly be effective in reducing the symptoms of a mental health condition, but a lot of scientific evidence backs the process. 

How can therapy improve my mental health?

Over the last few decades, advances in neuroscience have uncovered that life experiences affect our brains—this is called neuroplasticity. When our senses are activated, when we learn something new, when we face stressful situations, or when we have many other kinds of experiences, our brains can change in structure and function[1]. In part, this means that events or external stressors can lead to mental health struggles, but it also means that some experiences, including therapy, can help modify brain structure and function into a healthier state[2]. Studies consistently show that behavioral and emotional interventions work just as well or even better than medication to treat various mental health conditions, including anxiety, depression, and obsessive-compulsive disorder (OCD)[3].

Figure 1

Image by Turnaround for Children

The science of how therapy works varies depending on the technique or skill you are working on. Psychotherapy produces long-term behavior change by modifying gene expression and brain structure which strengthens connections and communication between neurons[4]. For instance, studies have found that as people get better at controlling their emotions, the brain's prefrontal cortex (which is responsible for reasoning and rational thinking) changes[5]. Research on cognitive behavioral therapy (CBT) among people with psychosis found that CBT strengthened connections between the amygdala, the part of the brain responsible for fear and threat analysis, and the prefrontal cortex. This suggested that people could better perceive social threats, and the increased connectivity was associated with reduced psychotic symptoms eight years later[6].

Beyond the brain changes generated by therapy, therapy also works long-term simply because of the skills it gives people. Through therapy, people learn about themselves and can continue using this insight as they face new challenges[7].

How do I know if it's working?

Progress happens gradually – you probably won't have one big moment in which it's clear that therapy has "worked." Instead, it's slow and steady growth. You will know therapy is working for you when you notice a change in your general mood or mindset. Maybe you'll catch yourself challenging your automatic negative thoughts or processing a frustrating situation rather than immediately reacting with anger. It's helpful to identify your therapy goals early on so that you can track your progress.

The number of recommended sessions varies, but many people start to feel better after two or three months of regular treatment[8]. However, for most people, therapy isn't as much of a "quick fix" for a specific issue as it is a tool to increase your resiliency so that you're better able to cope with the many challenges we all face throughout life. 

Fast Facts:

  • Psychotherapy reduces disability, morbidity, and mortality; improves work functioning; and decreases psychiatric hospitalization[9].
  • Therapy leads to fewer relapses of anxiety and mild-to-moderate depression than medication use alone[10].
  • Short-term therapy can provide long-term benefits – a study found that PTSD patients displayed less severe symptoms two years after treatment ended, compared to six months after treatment ended[11].
  • Adolescents receiving inpatient dialectical behavior therapy (DBT) had significantly fewer constant observation hours for self-injury, incidents of suicide attempts and self-injury, restraints, and days hospitalized than adolescents pursuing treatment-as-usual[12].

[1] Voss, P. et al. (2017, October 4). Dynamic brains and the changing rules of neuroplasticity: implications for learning and recovery. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.01657

[2] Gorman, S. & Gorman, J.M. (2018, November 9). Is there a science to psychotherapy? Psychology Today. https://www.psychologytoday.com/us/blog/denying-the-grave/201811/is-there-science-psychotherapy

[3] Walton, A.G. (2016, May 6). A few things that therapy may do better than medication, according to science. Forbes. https://www.forbes.com/sites/alicegwalton/2016/05/06/a-few-things-that-therapy-may-do-better-than-medication-according-to-science/

[4] Malhotra, S. & Sahoo, S. (2017). Rebuilding the brain with psychotherapy. Indian Journal of Psychiatry, 59(4), 411-419. doi: 10.4103/0019-5545.217299

[5] Levy, R.A. & Ablon, J.S. (2010, February 23). Talk therapy: off the couch and into the lab. Scientific American. https://www.scientificamerican.com/article/talk-therapy-off-couch-into-lab/

[6] Mason, L. et al. (2017). Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery. Translational Psychiatry, 7. https://www.nature.com/articles/tp2016263

[7] Shedler, J. (2010). Getting to know me: What’s behind psychoanalysis. Scientific American. https://www.scientificamerican.com/article/getting-to-know-me/

[8] American Psychological Association. (2020, July 31). Understanding psychotherapy and how it works. https://www.apa.org/topics/psychotherapy/understanding

[9] American Psychological Association. (2012). Resolution of psychotherapy effectiveness. https://www.apa.org/about/policy/resolution-psychotherapy

[10] Brownawell, A. & Kelley, K. (2011, October). Psychotherapy is effective and here’s why. Monitor on Psychology, 42(9). https://www.apa.org/monitor/2011/10/psychotherapy

[11] Kline, A.C. et al. (2018). Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 59, 30-40. https://www.sciencedirect.com/science/article/abs/pii/S0272735817302271

[12] Tebbett-Mock, A.A., et al. (2020). Efficacy of dialectical behavior therapy versus treatment as usual for acute-care inpatient adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 59(1), 149-156. https://www.sciencedirect.com/science/article/abs/pii/S0890856719302199