Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.
The purpose of this discussion is to provide an explanation of the biological basis of psychotherapy. Additionally, how various factors might influence perceptions and outcomes of psychotherapy will be discussed with an emphasis on the provider’s responsibility in considering those factors to provide the best care.
The Biological Basis of Psychotherapy
Neuroplasticity describes the process of positive and negative neuronal changes caused by intrinsic and extrinsic factors across the lifespan (Shaffer, 2016). This is the fundamental idea of the biological basis of psychotherapy. Neurogenesis and proliferation in response to stimulating experiences is known as arborization which persists in response to various environmental and biological factors to form both adaptive and maladaptive functions (Wheeler, 2014, p. 58). Psychotherapeutic interventions have been shown to produce beneficial changes in neurocircuitry as well as in epigenetic and neuroendocrine areas, all of which impact cognitive processes (Miller, 2017). Neuroimaging performed before and after psychotherapeutic interventions for depression and anxiety show significant neuronal activity changes in areas of the brain responsible for fear and reward responses, as well as emotion generation and regulation (Fournier & Price, 2014).
Knowing that all life experiences have the capacity to change neurobiology both positively and negatively helps to understand the biological basis of psychotherapy. Some examples of environmental factors that can influence neuronal development include culture, religion, and socioeconomic status. Awareness of how these elements may affect an individual’s perceptions of and reaction to psychotherapy is inarguably an important aspect of providing highly effective care.
Culture and Psychotherapy
Members of a specific culture share common history, knowledge, customs, rituals, beliefs, meanings, identity, values, and role responsibilities and expectations. These cultural influences determine how people perceive the world, others, themselves, and their experiences. It is generally accepted that most members of the same culture share and will follow a social scripting when interpreting meanings of behaviors, responses, and emotions. These sets of norms are learned through personal experiences and social learning observed from others within the culture and are honored or practiced in varying degrees. This is known as the Social Scripting Theory (Thomkins, et al., 2017).
With these considerations in mind, it must be assumed that some people will be hesitant or resistant to psychotherapeutic interventions due to their cultures’ values, while others might view psychotherapy as highly valued. For instance, some ethnic cultures value psychotherapy such as Ashkenazic Jewish populations who view the utilization of expert help when problems arise as a positive behavior. However, analysis reveals that some White Anglo-Saxon cultures tend to oppose the use of psychotherapy in part because psychotherapy requires not only acknowledging problems and seeking help from strangers, but also in recounting personal experiences and verbalizing thoughts and emotions which contradict commonly shared values such as stoicism, independence, self-reliance, and autonomy; while helplessness, weakness, and dependency are undesired behaviors (Midlarsky, et al., 2012). Castro, et al (2015) found no significant differences in African American veterans’ and European American veterans’ overall perceptions of mental health care. Interestingly, however, African American veterans voiced experiences with mental health providers who lacked cultural sensitivity, while European American vets voiced no similar experiences. As well, members of both racial groups and genders stated a preference for female providers, but also indicated that 3 attributes – good communication skills, empathy, and trustworthiness may override other preferences (Castro, et al., 2015).
It is important that providers practicing psychotherapy thoroughly assess cultural ideals and beliefs regarding treatment preferences and expectations (Thomkins, et al., 2017) so that individualized care can be provided. In addition, a vital component of cultural competency of the provider is self-assessment. As mentioned by Wheeler (2014, pp. 19-20), practitioners should assess themselves regarding their:
Awareness of own biases and prejudices toward differing cultures
Skills required to perform culturally-focused assessments and examinations
Knowledge of various biocultural ecologies, culture-bound factors, illnesses, and worldviews
Encounters and experience level with culturally diverse clients
Desire to be culturally-competent (Wheeler, 2014, pp. 19-20).
Religion and Psychotherapy
In the United States, 75% of people polled stated that religion is important to them. Despite this, few providers of psychotherapy receive special training in the assessment and treatment of clients who highly value spirituality or religion. Some spiritual or religious clients will seek integration of their values into psychotherapy and some may hesitate to disclose spiritual or religious problems in a non-religious setting (Captari, et al., 2018). Religious ideals may affect clients’ views and expectations of psychotherapy are demonstrated in fundamental beliefs. For example, Judaism assumes that humans are “fundamentally good”, whereas Christian theology teaches that humans are all born into “original sin” (Midlarsky, et al., 2012).
It is imperative that psychotherapy providers thoroughly assess spirituality or religious ideas and beliefs in relation to treatment expectations and outcomes (Captari, et al., 2018) so that optimal care can be provided.
An older, yet relevant study regarding the significance of religion as a factor in psychotherapy by Abernethy and Lancia (1998) described four types of religiocultural transference and countertransference and terms that providers should be aware of:
Interreligious transference – the client perceives that they and the therapist have different religious backgrounds
Intrareligious transference – the client perceives that they and the therapist have similar religious backgrounds
Interreligious countertransference – the therapist perceives that they and the client have different religious backgrounds
Intrareligious countertransference – the therapist perceives that they and the client have similar religious backgrounds (Abernethy & Lancia, 1998).
Socioeconomics and Psychotherapy
Socioeconomic status is defined by factors such as income, occupation, social hierarchy, or education level. Treatment dropout rates and successful psychotherapy may be highly influenced by socioeconomic factors such as impoverishment which has been shown to lead to decreased cognitive flexibility. In psychotherapy, cognitive flexibility is an integral component which allows for the development of a decentered point of view, behavior change, and processing of thoughts, feelings, and insights (Levi, et al., 2018). Additional evidence has shown that socially disadvantaged populations with low income, unemployment, and neighborhood deprivation have poorer psychological treatment outcomes and higher treatment dropout rates (Finegan, et al., 2018), (Levi, et al., 2018). It is also known that socioeconomic status is a significant factor in rates of psychiatric morbidity (Finegan, et al., 2018).
In order to provide the best care, psychotherapy providers must perform thorough socioeconomic assessments to understand any barriers associated with socially disadvantaged populations and be able to provide effective therapies such as self-affirmation and mindfulness interventions which have shown to improve cognitive control and affective states (Levi, et al., 2018).
We know that behavioral health problems affect people indiscriminately from all walks of life. Psychiatric Mental Health Nurse Practitioners must be knowledgeable of the biological basis of psychotherapy and how various factors affect individuals’ perceptions and responses to its treatment interventions. Developing self-awareness and competencies regarding cultural, religious, and socioeconomic diversities will help assure the best care and optimal outcomes.
Abernethy, A. D., & Lanica, J. J. (1998). Religion and the psychotherapeutic relationship: Transferential and countertransferential dimensions. The Journal of Psychotherapy Practice and Research, 7(4), 281–289. https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC3330516/
Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis. Journal of Clinical Psychology, 74(11), 1938–1951. https://doi.org/10.1002/jclp.22681
Castro, F., AhnAllen, C. G., Wiltsey-Stirman, S., Lester-Williams, K., Klunk-Gillis, J., Dick, A. M., & Resick, P. A. (2015). African American and European American veterans’ perspectives on receiving mental health treatment. Psychological Services, 12(3), 330–338. https://doi.org/10.1037/a0038702
Finegan, M., Firth, N., Wojnarowski, C., & Delgadillo, J. (2018). Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta‐analysis. Depression and Anxiety, 35(6), 560–573. https://doi.org/10.1002/da.22765
Fournier, J. C., & Price, R. B. (2014). Psychotherapy and neuroimaging. FOCUS, 12(3), 290–298. https://doi.org/10.1176/appi.focus.12.3.290
Levi, U., Laslo-Roth, R., & Rosenstreich, E. (2018). Socioeconomic status and psychotherapy: A cognitive-affective view. Journal of Psychiatry and Behavioral Health Forecast, 1(2), 1–3. https://www.researchgate.net/profile/Eyal_Rosenstreich/publication/328238564_Socioeconomic_Status_and_Psychotherapy_A_Cognitive-Affective_View/links/5bc0935d458515a7a9e311cd/Socioeconomic-Status-and-Psychotherapy-A-Cognitive-Affective-View.pdf
Midlarsky, E., Pirutinsky, S., & Cohen, F. (2012). Religion, ethnicity, and attitudes toward psychotherapy. Journal of Religion and Health, 51(2), 498–506. https://doi.org/10.1007/s10943-012-9599-4
Miller, C. W. T. (2017). Epigenetic and neural circuitry landscape of psychotherapeutic interventions. Psychiatry Journal, 2017, 1–38. https://doi.org/10.1155/2017/5491812
Shaffer, J. (2016). Neuroplasticity and clinical practice: Building brain power for health. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2016.01118/full
Tompkins, K. A., Swift, J. K., Rousmaniere, T. G., & Whipple, J. L. (2017). The relationship between clients’ depression etiological beliefs and psychotherapy orientation preferences, expectations, and credibility beliefs. Psychotherapy, 54(2), 201–206. https://doi.org/10.1037/pst0000070
Wheeler, K. (Ed.). (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition: A How-To Guide for Evidence-Based Practice (2nd ed.). Springer Publishing Company.
Hello Jennifer. Opponents of psychotherapy has often questioned its biological basis. However, evidence from neuroimaging studies has establishing the biological plausibility of psychotherapy. I agree with you that psychotherapies affect cognitive processes by inducing changes in neurocircuitry, as well as in the epigenetic and neuroendocrine regions (Javanbakht & Alberini, 2019). Therefore, the neurological changes associated with psychotherapy highlights its biological basis. The mechanisms underlying mental health disorders lay the foundation for understanding the biological basis of psychotherapy. Psychiatric conditions cause plastic changes in the brain. The role of psychotherapy is to reconfigure the brain by tapping into all the biological regulations that underlie complex brain responses (Wheeler, 2014). Thus, I support your argument that we can understand the biological foundation of psychotherapy by looking at both the positive and negative neurobiological changes associated with life experiences.
Another critical issue that you have explored in your discussion is how culture, religion, and socioeconomics influence attitudes toward psychotherapy. Culture is a dominant factor that influences general perceptions of mental health disorders and health-seeking behaviors. For example, ethnic/racial minorities, especially men have a negative attitude toward psychotherapy because of paternalistic societal norms and beliefs. Religion also influences the extent to which clients seek psychotherapy. As you have mentioned, religious beliefs can either enhance or undermine the effectiveness of therapy. Thus, it is necessary to find out how religion will impact the practice and outcome of psychotherapy. Finally, socioeconomic factors also affect the effectiveness of psychotherapy. Research evidence has consistently shown that clients with low socioeconomic status have a disproportionate burden of both psychiatric conditions and poorer clinical outcomes (Koç, V., & Kafa, 2018).
Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological models of psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144
Koç, V., & Kafa, G. (2018). Cross-cultural research on psychotherapy: The need for a change. Journal of Cross-Cultural Psychology, 50(1), 100-115. https://doi.org/10.1177/0022022118806577
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). Springer Publishing Company.