Oxytocin and psychotherapy
In individual psychotherapy, a unique bond often develops between the patient and his or her therapist. That’s not surprising. In seeking help, patients may share deeply personal, perhaps even troubling, thoughts and secrets with their therapists. A kind of intimacy and connection is not only expected, but essential.
OT is a hormone with significant duties both above and below the neck. Oxytocin plays a major role in sexual reproduction, especially during and after childbirth when it’s released by the brain’s pituitary gland in large amounts to aid labor and promote parental bonding with the newborn.
In the past few decades, numerous studies have greatly expanded upon OT’s influence, linking it to pair bonding and various social behaviors, such as feeling empathy and compassion. Based on its role in attachment and bond-related behavior in a variety of species, the paper’s authors call OT “the paradigmatic attachment hormone.” Popular media have dubbed it “the love hormone.”
Given the nature of the patient-therapist bond, first author Kai MacDonald, MD and principal investigator David Feifel, MD, PhD, in the Department of Psychiatry at the UC San Diego School of Medicine were curious whether oxytocin might play a role there too. More specifically, would giving oxytocin to psychotherapy patients improve treatment results?
“At this point, it’s fair to say that the field of ‘psychotherapy augmentation’ (using medication to improve the outcome of psychotherapy) is still largely experimental,” said MacDonald, “though exciting work in this area has been done with a diverse variety of substances, including LSD, ecstasy and ketamine, as well as beta blockers and an (antibiotic) compound called D-cycloserine.
“None of these are used in routine practice, however. But that said, therapists may be stimulating internal oxytocin release with a number of common interventions (empathy, eye contact, etc). This latter speculation is still unproven, though I’d like to investigate it.”
In their published pilot study, MacDonald and colleagues gave 17 male psychiatric outpatients with major depressive disorder either an intranasal dose of OT or a placebo. The trial was randomized, double-blind and crossover.
The results were both surprising and expected.
First, the surprising: In contrast to earlier studies purporting OT’s beneficial psychological effects, the UC San Diego scientists reported that OT caused an increase in anxiety over the course of the therapy session among some of the depressed patients.
“Though the popular notion has been that oxytocin is an all-purpose good thing, like so many biological processes, it has a lot of nuances and facets and even a dark side,” said MacDonald. “So the idea that a single-dose of OT may cause some negative feelings is not new, though no one has shown that it increases subjective anxiety per se.
“At UCSD, we are actively engaged in exploring clinical arenas where OT may have therapeutic benefit for patients. People have asked me ‘if you give OT to a person before therapy, will they become more trusting and feel better and develop an immediate attachment?’ Our experiment calls that simple idea into question.”
In addition, MacDonald and colleagues found that while OT had no main effect on cortisol levels, eye contact or overall behavior, it did cause a decrease in nonverbal behaviors that reduce social connections, such as avoiding eye-contact or displaying physical tension. OT treatment also appeared to improve social cognition – the ability to figure out what’s going on in other people’s minds based on facial clues.
While far from conclusive, these latest findings are intriguing, said MacDonald, and emphasize the need for more research into OT and its potential therapeutic use.
“In terms of the use of OT in psychotherapy, two realities emerge,” he said. “First, variability in responses seems the rule rather than the exception, so we need to look more at that before we routinely use intranasal OT in this context. Second, it is interesting to speculate exactly which factors in an individual—their gender, history or genetic makeup—influence their OT system and their responses in therapy, and how that may influence treatment. We are just beginning to get our hands around that issue.”
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