Sometimes one piece of writing changes one mind. Until today I thought that talk therapy was utterly discredited. But there appears to be strong evidence that a skilled therapist can help the brain to change its relationship to the world.

Depression         From The Economist print edition (Apr 14th 2005)

FOR almost a century after Sigmund Freud pioneered psychoanalysis,

Robert DeRubeis of the University of Pennsylvania and his colleagues beg to differ, however. They have conducted the largest clinical trial ever designed to compare talk therapy with chemical antidepressants. The result, just published in Archives of General Psychiatry, is that talking works as well as pills do. Indeed, it works better, if you take into account the lower relapse rate.

The study looked at a relatively modern type of talk therapy, known as cognitive therapy, which tries to teach people how to change harmful thoughts and beliefs. Patients learn to recognise unrealistically negative thoughts when they occur, and are told how to replace them with more positive ones. It may sound too simplistic to work, but other studies have shown it can be used to treat anxiety, obsessive-compulsive disorder and eating disorders. Dr DeRubeis wondered just how effective it really was for depression.

In the study, 240 patients with moderate to severe depression were divided into three groups. One group was treated with cognitive therapy, a second with Paxil, an antidepressant drug, and members of the third group were given placebo pills. (Those in the second and third groups did not know whether their pills were placebos or not.) After 16 weeks of treatment, the results for those on cognitive therapy and drugs were identical. Some 58% had shown perceptible improvement. By contrast, only 25% of those on the placebo improved. That was encouraging. But the really surprising advantage of cognitive therapy is that it seems to keep working even after the therapy sessions are over. A year after treatments ended, only 31% of those who had received it had relapsed into their former state, while 76% of those who had been given antidepressants, and then been taken off them, had done so. Even patients who stayed on antidepressants for the intervening year did not do any better than those who had taken cognitive therapy and then quit.

If Dr DeRubeis’s study can be replicated (an important