Sunday, 20 May 2012

Feeling Depressed? Get...Botox? - Bodily Feedback and the implications of Embodied Cognition for Psychiatry

I have written a lot about embodied cognition recently, which might seem strange for a blog from a Psychiatry Society. Granted, in part this has been due the fact I have a psychology exam on it in a week's time. But there are also more substantial reasons why it's taken up so much blogging space.


For one, there is a huge problem with the computer metaphor of mind in which amodal, abstract symbols are manipulated based on complex algorithms and the embodied approach provides a decent stab at an alternative. I also think any theory which potentially revolutionises our concept of the mind will have important implications for clinical Psychology and Psychiatry. In order for Psychiatrists to understand what happens when the mind (to put it crudely) goes wrong, they need to have a decent working model of 'normal' mind in the first place.

As such I have been meaning for a while now to write a post considering the possible implications of embodied cognition for Psychiatry. Since embodied cognition is a relatively new and emerging field and it takes time for new theories to trickle into the realms of psychiatric research, a quick search of the literature found only one directly relevant paper - Thomas Fuchs 'Embodied Cognitive Neuroscience and its implications for Psychiatry' - but this is for another day.

Today I came across an interesting paper by Wollmer et al 2012 courtesy of @Keith_Laws which utilises an intriguing finding from bodily feedback studies for the purposes of treatment for Depression. The treatment is...botulinum toxin - that's right, botox.

The rationale for such a treatment is grounded partly in the research by Havas et al 2010. Havas reported that bodily feedback from the inability to frown (due to paralysis of the relevant facial muscles in subjects with botox) lead to a decreased ability in emotional-language processing. Wollmer states that further studies have shown that botox affects emotional experience, increases emotional wellbeing and also reduces levels of fear and sadness in subjects. 

In a randomized double-blind placebo-controlled trial, Wollmer demonstrated that these findings have the potential to be implemented as a therapy for people with Depression. They report that scores on the Hamilton Depression Rating Scale decreased by 47% in the botox group compared with 9% in the control. This effect developed within a few weeks (about the same time period for SSRI's) and were sustained until the end of the 16 week follow up period.

Importantly, this was a pilot study, involving only 30 participants. In addition subjects remained on medication hence any interpretations of the effects of botox as a therapy must be viewed in light of it as an adjunctive treatment. Admittedly, it's getting late and I haven't read the paper thoroughly or checked the stats either, so I welcome further limitations that might confound results. That said, the effect sizes look pretty good and I wonder how they compare to pharmacological and psychological treatments?

Although the kinds of implications of embodiment for psychiatry I was considering were in terms of a renewed emphasis on the environment (Clark's extended mind) and a move away from the chemical imbalance theory of mind in the brain, I think this kind of research is still an interesting one. It highlights the increasing importance the role of the body has on cognition (in the case emotional processing) and provides a great example of the weird and wonderful discoveries we have yet to grasp when it comes to the mind and its well being.


8 comments:

  1. Botox is all about becoming more confident about yourself. Work on your emotional issues first before getting any type of procedure done.

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  2. Nice study, pilotish though it is. There is actually really good evidence that the population spits into two groups, one that would respond to this type of intervention and one that would not. Jim Laird's Feelings: Perception of the Self summarizes much of that under-appreciated work.

    One problem with putting embodied cognition and therapy together is getting past the meta-cognition centric view of psychotherapy. If one takes a more behavioral view, there are still plenty of scientific challenges, but not metaphysical ones.

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  3. Well that’s really great and I appreciate it. Thanks for taking the time to discuss this, I feel strongly about it and love learning more on this topic.

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  4. Depression is a mental disorder. Though there are a lot of ways how to heal or treat depression but talking is one of the best and natural way.

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  5. being depress is a mental disorder and that's true..if we have problems we should not suppress our feelings, let it out..if you have a close friend try to open up with them or just simply go to church and pray..

    adult psychology

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