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Dec. 9, 2009 - Freedomain Radio - Stefan Molyneux

33:32

1524 'Mapping the Effects of Talk Therapy on the Brain' - Dr Gabriel Dichter - The Freedomain Radio Interview

Dr Gabriel Dichter, the Director of UNC-CH Clinical Affective Neuroscience, describes his amazing work on brain imaging.

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	So I think, first and foremost, the work that you've been doing on the effects of psychotherapy on brain function, I just find fascinating.
	I've been doing quite a bit of research lately trying to make the case for the effectiveness of psychotherapy.
	I've been looking for brain scans and scientific evidence and of course a lot of it is self-reporting, which is not the end of the world, but I'd like something a little bit more material.
	That's right. That's right. Well, I mean, there's no doubt that, you know, psychotherapy is effective.
	And like you said, if you really want to know if it's effective, just ask people if they're feeling better.
	But there is something very tangible about looking at differences in brain structure and brain function that, you know, gets people's attention and makes some people think it's more, quote unquote, real, even though, you know, wouldn't you expect any change in somebody's behavior to be accompanied by brain function.
	But nevertheless, now we have the tools to actually realize that.
	And I agree, it's very powerful.
	I mean, the case for changing your diet, you can look at the scales and see what's changing in your weight.
	If you go to the gym, you can lift more weights and I'm sure you can see changes in muscle density and bone density and so on.
	But it seems very counterintuitive to a lot of people, the idea that Talking, I mean, I went through years of it myself, so I know that psychotherapy is much more than talking, but the very idea, it's like talking at a broken bone and having it heal.
	I mean, it's very counterintuitive to a lot of people, and I was wondering if you could tell us a little bit about what you've explored in that and how you think it might be working.
	Absolutely. And to extend the analogies, my graduate advisor always used to caution me that just because cream helps sore muscles doesn't mean that sore muscles are caused by a lack of cream.
	Just because you apply something and make it better, you know very little about the mechanism by which it's helping.
	Sort of just starting in terms of what we know about psychotherapy and putting the brain imaging data aside for a minute, Everybody in this area has an opinion about what is most effective, but what's without question is that cognitive and behavioral approaches time and again have proven their efficacy.
	So a cognitive approach would involve asking somebody to examine their cognitions and their patterns of thinking, perhaps their maladaptive patterns of thinking.
	Do they blame themselves for things?
	Do they think that they are the reason for failures in their life rather than sort of random happenstance occurrences?
	And then the behavioral approach is simply telling people, you need to do this before our next session.
	You need to get out of the house three times, you need to get to work on time, and you need to call two friends.
	And we really don't care That's how your parents treated you.
	I mean, we care, but it's really not about that stuff.
	What we're interested here is getting you feeling better and we know that these approaches work and so it's really sort of Very simple at its core a lot of quote-unquote homework given and these simple interventions done well and carried out faithfully over two to three months have profound impacts and in the study you're talking about that we recently published in biological psychiatry we did a purely behavioral intervention so we really didn't even examine what they were thinking during particular situations we just told them They have to complete a checklist of things to do before the next session,
	i.e. get out of the house.
	And just that simple intervention, which can be taught to a graduate student to administer in a couple hours, you know, you don't need to have 20 years of experience as a seasoned psychotherapist.
	You can really teach almost any professional to do this.
	That type of intervention not only causes 75% of the patients to remit, as we call it, have a significant reduction in their symptoms over a certain criteria, but it also produces these profound changes in their brain function.
	So a really simple targeted intervention causes not only people to feel better, but changes in areas of the brain that we think are really relevant to what we're trying to impact in psychotherapy.
	Right. The metaphor that pops into my mind is if you go to a physiotherapist, they don't really care how you got the injury.
	I mean, it doesn't really matter to them, but what you need to do is these exercises to strengthen and make better.
	So in a sense, the history is not important.
	What is important are the tangible material exercises you do in the present and future to regain function.
	That's right. A lot of people do like to talk about...
	I hate to generalize because some people have early childhood traumas and of course those are very relevant, but if you try to distill what's effective down to its core and try to think almost like an insurance provider and you want the most efficient product, that's what we've come to in terms of cognitive behavioral therapy.
	And just for those who aren't aware, and I'm sure this is the case, it's not, of course, an either-or, right?
	I mean, you could probably do both at the same time.
	So you could have, you know, tell me about your mother, to put it in a cliched way, alongside with, you know, after you tell me about your mother, you need to go and do these three things, and then other feelings will come up, which we'll process, and then you can do these things.
	So it can be a sort of blended approach.
	I guess CBT plus some really tangible exercise routines.
	Sure, that's right. And although everybody says that they are a CBT therapist, they also say that they subscribe to sort of eclectic approaches.
	Everybody has their own little twist.
	So certainly there are variations on a theme.
	But absolutely, you can mix and match, but you want to make sure you include those cognitive and or behavioral pieces.
	Because if somebody goes and does something which, according to some sort of anxiety problem, they have been avoiding, it actually does begin to change the brain, even just doing it, because you're kind of wiring together neurons that have been avoidant.
	And again, I know I'm using ridiculously layperson language.
	Absolutely. At a very simple level, Learning and motivation is comprised of multiple instances of cues, if you will, that are associated with outcomes.
	It's very much the case that something like a phobia, let's take a fear of snakes, for example.
	If you avoid the snakes and you don't experience distress, and then if you come into contact with a snake and you have this reaction of hyperventilating and your heart starts beating more quickly and you get sweaty palms, You start to associate this cue with this response and it's self-reinforcing.
	And so, you're exactly right.
	Part of what a therapy for, say, a phobia like that would involve would be to break that cue-outcome pairing, to force yourself to interact with the cue enough times That you can break that association.
	So it's very, you know, it's very reductionistic.
	It's, you know, try to make your brain make new associations and associations involve memory formation and memory formation involves the hippocampus and then all of a sudden it starts to make sense why you could have a neurobiological explanation for what's going on.
	Right, and I was just thinking in terms of depression, something like depression, where it's not quite as concrete an avoidance mechanism as a phobia.
	Phobia, I'm scared of snakes, and it's pretty easy to figure out what to do to reverse that avoidance mechanism.
	With something like depression, I guess one of the approaches would be to boil it down to depression must cause you to do something different or avoid something or a series of things in your life.
	And so you kind of need to do that George Costanza-Seinfeld opposite thing if you know that episode or whatever.
	Whatever it is that you're doing, kind of do the opposite and that will at least begin to reawaken the parts of your brain which may have gone a little to sleep based on this avoidance stuff.
	That's right, that's right. And what's really interesting in depression, and this starts to relate more to the study we've been talking about, One particular feature of depression that is very salient is a symptom domain called anhedonia, which is a 50 cent word to describe lack of pleasure in response to stimuli that should be pleasurable.
	So seeing loved ones doesn't bring you joy, engaging in hobbies doesn't bring you joy, and this can become so profound That somebody doesn't leave their bedroom, not because they're crying so much they can't move, but rather because their affective responses are so blunted that nothing seems engaging, nothing seems enjoyable. And what's fascinating is we think that that is partly accounted for by a poor prediction on the part of clinically depressed patients and how something will actually feel.
	So if you give somebody with depression a Piece of paper and say, I want you to tell me how enjoyable on a scale of one to ten you think these five activities are going to be, you know, going to the movies, getting lunch with a friend, etc., they will rate those to be relatively low.
	They'll say they'll get relatively little enjoyment.
	Then if you actually take them by the hand and make them do those things, you know, make them, you know, ask them just for the sake of argument, engage in these activities, and then ask them to do the same rating scales, they'll be a rather large disconnect.
	They'll rate them as moderately enjoyable.
	So it seems like There is a distortion there in terms of, when we talk about cues and outcomes, the prediction accuracy of how things will feel.
	So in terms of anhedonia, what our research has really tried to do is not only look at parts of the brain that respond to rewards or respond to pleasurable stimuli, But really focus on the chronometry of pleasurable experience.
	That is, brain systems responding to the anticipation of pleasure and brain systems responding to actual pleasurable outcomes.
	And in this particular paper, we're able to tease that apart and we know from 30 years of animal research that some parts of the brain are involved in motivation and looking forward to rewards and other parts of the brain are responsible for reward outcomes.
	And it seems that this type of, well, it's not specific to this type of therapy, but it seems that depression remission, we were able to show, may preferentially impact that anticipatory piece so that you can actually start to correct, if you will, I'm speaking loosely here, but you can start to normalize functioning of brain regions that help you look forward to pleasurable events.
	And if you think about it, Most of our life's affective experience involves anticipation, right?
	I mean, we're always looking forward to the next event, the next degree, the next, you know, motivation is all about being able to look forward to how things are going to feel in the future.
	And so by correcting that, we think we can have really a profound effect on behavior, because getting out of the door every day, frankly, involves anticipation.
	If everything seems worthless, why would you ever leave your room?
	Yeah, and the thought just struck me with relation to the deferral of gratification.
	The deferral of gratification is so fundamentally bound in with our anticipation of reward.
	The greater the reward, the more we will be willing to defer gratification.
	So if, in a sense, you don't really believe that life holds any great rewards, your deferral of gratification will be kind of low, which means that you won't actually do the things which might give you great rewards.
	You know, go to the gym, lose weight, get a degree, or whatever it is.
	That's exactly right. I mean, people who get You know, MD, PhDs, I can't even imagine that, but, you know, people have multiple advanced degrees are the ones who are able to defer gratification to the extreme.
	I mean, that's sort of, in our society at least, to some extent, how we define success.
	And, you know, this relates to sort of developmental literature.
	You know, there's the classic finding that if you give a...
	I have a five-year-old and I know if I told him, you can eat this chocolate chip cookie now or wait five minutes and I'll give you two chocolate chip cookies, There's no question.
	He's going for the immediate reward.
	But once that kid hits 10 or 12 and the prefrontal cortex develops, they're able to process that and able to defer gratification.
	And it's almost as if in some sense the ill brain, if you will, brain with psychopathology sort of regresses to some extent and deferral gratification becomes very difficult almost on a minute-by-minute basis.
	So what you're saying is you have cookies and we really should have done this interview in your office.
	That's really what I'm getting out of the last thing that you're saying.
	That's good to know. I wish. I wish.
	Now, I was really interested, I mean, in a number of things that you've published, but in particular, and I'm coming at this with a possible bias, you know, so to be completely upfront, that I have experience with therapy.
	I have no experience with medication and I found therapy to be just fantastic.
	In some of the stuff that I've read, there seems to be not a very positive correlation of outcome versus pharmacology relative to placebo, right?
	I mean, so placebo versus, you understand, right?
	So I was really, really interested, and I hope this isn't confirmation bias, it could be, but I was interested in the degree of success that you had over time relative to medication.
	If I remember rightly, it was something like 75% of people relapsed into the issue that they had before relative to 30-odd percent, if they were taking medication relative to about 30-odd percent if they did some sort of therapy, some sort of talk therapy. So that sort of fits with at least what I think, which obviously means that it's right.
	But I was wondering if you could speak a little bit more about that.
	Yeah, yeah. So in our particular study, we actually only looked at psychotherapy, but there's a Some wonderful data coming out of Vanderbilt University, Steve Holland, somebody I trained with at Vanderbilt, looking at therapy alone versus medication alone versus the combination of medication and therapy.
	And if I could try to boil down the findings over, you know, this research has been going on for, I don't know, over 10 years now, is that whatever modality of antidepressant you receive, whether it's psychotherapy or pharmacology, There seems to be equivalent rates of remission.
	However, if you terminate both forms of treatment, if you stop the psychotherapy and if you stop the medication, there's a far greater prophylactic effect of the psychotherapy because you've learned strategies that serve you well even after you stop seeing your therapist, whereas when you stop the medication, your serotonin levels, for example, may return to baseline.
	So, you know, I don't think there's clear evidence that one is more effective in the short term than the other.
	But clearly in the long term, unless you want to be on medication for the rest of your life, which is okay, there's nothing necessarily wrong with that, but you don't have the same benefit as the learning that takes place in psychotherapy.
	And then of course, I don't have any stake in this one way or another, but we around here tend to say that we like the side effect profile of psychotherapy.
	It's pretty innocuous.
	And I think that has something to do with the fact that The medication can't target the very specific areas of the brain where a particular dysfunction may be occurring.
	It tends to be a bit of a broad light rather than a spotlight, is that fair to say?
	Actually, I don't know if I would necessarily agree with that.
	I think the best we could say now is we don't know how these medicines work.
	They're serendipitously discovered.
	One can almost make the argument that a selective serotonin reuptake inhibitor is selectively targeting one neurotransmitter, so it may have initially a relatively specific target, but as I was saying, it doesn't do anything for you once you stop using it.
	Right, and just for my listeners, if the good doctor disagrees with me, he's right.
	Just so there's no misunderstanding, he's the expert.
	You need to be careful around this because many people are using many different interventions and for each individual person anything could be effective.
	We're talking in broad strokes here.
	Right, right. You also made a very interesting claim, which I'd like to know a little bit more of the economics behind it, where you say that psychotherapy is cost-effective relative to psychopharmacology.
	Around the eighth month is when the crossover is, and I was wondering if you could speak a little bit about the economics of that.
	I feel like, again, that maybe my CV has been crossed with Steve Hollins.
	I think that was in a paper of his, but absolutely.
	You can certainly calculate the cost of treatment providers and medications themselves, which are very expensive, and you can calculate the average course of cognitive behavioral therapy may run 8 to 16 weeks, and there does seem to be that tipping point around 8 months.
	In the short term, psychotherapy can exceed the cost of medications.
	It's not uncommon for therapists to charge, particularly psychiatrists or PhD level psychologists, on the order of $150 to $200 per hour.
	That seems really aversive to people when there are generic forms of Prozac out there that may cost as little as $5 a pill.
	It takes a little while for one to catch up to the other, right?
	In the short term, psychotherapy is more expensive, so insurance companies may frown upon it, but we're trying to get that message across of, look, we've done something enduring to the person here, and just give it time and we'll save money in the long run.
	Right, right. No, and I think that's important because for a lot of people there is a very important economic calculation with regards to this stuff.
	And I think, again, deferral of gratification in terms of cost is something, again, it's a little tricky to sell to people who have a problem with that fundamentally, but I think it's important for people to hear the math.
	I've always sort of argued that outside of core education it's one of the best investments that you can make, but it's, again, so it's nice to sort of see some math that seems to confirm that.
	And another direction the field is sort of heading, and this touches on some research by Judy Garber also at Vanderbilt, is we're getting better, we're not perfect at it, but we're getting better at being able to predict who is at higher risk for developing depression.
	To take a straightforward example, Children of depressed parents are at a two- or three-fold increased risk of developing clinical depression themselves, partly due to genetics and partly due to the environment of being raised by a depressed parent.
	So if we have this information that this person is two to three times more likely and if the base rate of depression is 15% of the population, that means this person might approach a 50% chance of developing clinical, you know, full-blown depression, missed work, you know, real severe impact on functioning.
	Shouldn't we as a society feel obliged to reimburse for preventative treatment at that point?
	But it's very hard to make that argument that, again, an insurance company will agree with.
	Well, and of course, if there was, and the debate rages, I mean, the degree to which surgical intervention based upon increased possibility of things like breast cancer and so on, preventative mastectomies and so on.
	But this is something that, as you say, in genes, and I always thought these two things were separate.
	You know, you have genes and you have environment, but it seems to be that the latest research is indicating that there are certain genes that are turned on and off relative to particular environment, right?
	Because you're raised by depressive parents, you end up with these bad coping skills or whatever.
	It's actually, it's genes plus environment, which is kind of mind-blowing to think that genes, because you think of genes in the Darwinian sense, you know, that are long-term things, and they don't really alter in your lifetime, but that's really not true as far as I understand it.
	No, that's absolutely right.
	And if you have identical twins who both have a depressed parent and they're reared apart, the rate of depression in the identical twin taken out of the bad environment, if you will, will be relatively equivalent to those who stay in that bad environment.
	It is genes and environment, but there's such a heavy influence of genes that we can really make pretty good predictions about who's going to be at risk for different types of psychiatric disorder based on the psychiatric profile of the parent, at least when you're talking about groups of subjects.
	On the individual level, we're still not as accurate as we'd like to be.
	Right, right. And on the article, and again, I'm not going to say this is all yours because I know some of it's mixed in with other people's research, but this idea that in brain imaging you may help pinpoint specific treatment modalities based upon individual patterns of brain functioning,
	that is a very, very, to me, very exciting possibility that you would really be able to target Based on how people's brains are working at the moment, how best to help them both on either psychopharmacology or treatment or both.
	Could you speak a bit more about that?
	Absolutely. We sort of have this rule of thirds in clinical psychiatry with respect to depression.
	The first treatment you offer somebody has a 33% chance of working.
	Then for those people who didn't respond, another 33% will Respond to the second treatment you offer and then finally the remaining folks to the third treatment, although there's a very small group we call treatment resistant who seem to not be helped by anything.
	So that means if each treatment takes three months to see if it works, that means that there's a significant portion of people with depression that it could take up to a year to find an effective treatment for them.
	And if you're talking about people who are potentially suicidal, I mean, that's frankly unacceptable.
	And so the hope here, and this is still a hope, sort of a holy grail, we're not there yet, but is it possible to give somebody a brain scan and based on the results of that brain scan, tell them, you know, we really think that you are a good candidate for this version of psychotherapy or this version of medication or this combination of the two.
	And we're getting better at that, again, sort of in groups of subjects.
	This is still very much in the research side of things, not so much the clinical applications yet, but we're getting closer and Helen Mayberg is really a pioneer in this area and has done some fascinating research that shows that activity in one portion of the brain, the subgenual anterior cingulate, is really predictive of who is going to respond to therapy and moreover, what kind of therapy.
	So when we talk about personalized medicine, which is A phrase you hear now with healthcare debates raging in this country.
	I think that's part of the conversation.
	Can we, you know, translational research, can we translate our research findings in this area to clinics?
	And that's a tall task because an MRI machine costs a million dollars to own and operate, but I think the more widely it gets adopted, I think those costs will come down and I think it's realistic in the next 30 to 40 years.
	That's fantastic because, of course, the social costs of mental illness and, of course, particularly depression and anxiety are completely staggering.
	I'm sure you know the numbers.
	When you look into the actual numbers of how much it costs, just from an economic standpoint for people to have these kinds of debilitating or strongly under-functioning ailments, it's huge.
	This doesn't count, of course, the cost in terms of marriages and parenting and other things that are crippled by this kind of thing.
	So anything which speeds up the treatment is huge.
	You tell the depressed person it might take up to a year to help you, you're probably going to walk out even more depressed when he walked in and that's not what you want, right?
	That's not a good way to build interpersonal rapport at the first session.
	Don't say that. No, because depression years are like dog years.
	It really is seven times.
	It feels like seven years to a depressed person.
	Joking aside, that's absolutely the case.
	People want relief right away and there's a drop-off between people who come for the first session and the second because you tell them Okay, your life is in shambles and you feel like it's all not worth it and what I want you to do is do this homework that tells you to get out the door three times this week and somebody looks at you like, are you crazy? I'm telling you that I'm in existential crisis and so there's a disconnect there.
	Anything that increases buy-in to what we're doing, I think, is a good thing.
	And brain imaging seems to be doing that.
	Right. And if you can show, again, if you can show brain scans before and after, you know, it's almost like, I mean, to put it in a silly context, you know, those cosmetic teeth ads that you see in the paper, you know, like before you have those snaggled tooth great white shark British teeth and afterwards you have those early whites.
	If you can show people a tangible result that they're working towards, it feels less intangible.
	To some people, which I think, you know, if you do these exercises, the likelihood is that your brain is going to light up in these areas, which it didn't before.
	It gives people, particularly the more concrete people, like the engineers, or the kind of people who don't have a lot of habit with introspection, if you give them something tangible to work towards, it can raise that payoff dangle, I think.
	I agree. And particularly with depression, where there's a lot of self-blame involved, and what did I do to deserve this?
	I think even giving somebody a picture of their brain before you've started treatment, which is one of the inducements in our studies.
	We say, you know, we'll pay you for your time and we appreciate you helping science and we'll also give you a picture of your brain.
	I think there's a sense of, you know, look, this is something I can point to.
	It's not my fault. There's something going on in my brain.
	Again, from our perspective, of course, all behaviors are controlled by the brain, but I think for the public, that's not the way people are trained to think yet.
	And this is something that I can point to that says, look, it's like a broken bone.
	I mean, a broken brain sounds really awful, but it's something that I can point to.
	Right, right. Now, the technology, I'm also, I mean, I'm a total geek for technology, so the technology that's floating out there, that seems to be relatively new, it's non-invasive, and of course, because you have to do repetitive brain scans, it's really important.
	Could you tell me a little bit about the technology and what it's measuring and what is changing that it is measuring?
	Sure. Well there are many forms of brain imaging and I think these have been used for about 10 to 15 years now.
	So they're relatively new but they're more widely accepted.
	I think the most common tool for this type of cognitive neuroscience that we're talking about, sort of neuroscience that looks at cognitions and brain function, is functional MRI. You take a standard MRI machine that would be used in a hospital, say if you had a sprained knee, and you modify it with special software to allow it to take Instead of a static picture of an organ, such as the brain, repeated pictures.
	So we might put somebody in there for 90 minutes or even two hours and take a picture of their brain every one to two seconds while they're doing some kind of simple task or game.
	And by taking repeated pictures over time and looking at how that correlates with the task that they're doing, we can get a measure of different parts of the brain that are more or less active during doing different kinds of tasks.
	For depression, what we've looked at to get at function of brain reward centers is we have very simple games of chance that almost involve gambles and so you anticipate, you know, winning a dollar in this game or losing a dollar in this game and that gets your reward part of your brain engaged.
	People who are interested in planning or problem solving, which could be affected in a disorder like schizophrenia, you might give them, I don't know, a task that involves Planning or problem solving.
	There are many examples for autism that has social deficits.
	We're doing some studies where people with autism look at pictures of faces and we see what's going on in the quote-unquote social areas of the brain.
	So you're able to tailor The task that you use in the MRI to the particular research question that you have and just to reiterate what you said, it's non-invasive, there's no injections, there's no radiation involved and you can do it repeatedly.
	There are studies where people are scanning children every year for six, seven, eight years so there really is relatively minimal risk involved and I think it's just wonderful.
	Yeah, I quite agree.
	I think that this kind of research, which helps convert some of the...
	I mean, because, you know, there's the brain, it's the old thing.
	There's the brain and there's the mind.
	And, of course, we experience the mind.
	We don't experience the brain.
	We can see the brain.
	And I think now, with these new technologies, we can see the mind, which is really the activity of the brain.
	Again, I'm using very sort of generalized terms.
	Absolutely. And we have, you know, there's so many different neuroimaging tools available.
	So what I just described is useful for looking at brain function.
	So what is area X doing in response to stimulus Y? There's other techniques, structural MRI, which allows you to look at the density of gray matter and white matter.
	There's still others that allow you to look at white fiber tracks that connect different brain regions.
	I mean, the tools seem to be expanding on a, you know, almost monthly basis.
	And as a researcher, it can be a little intimidating because The newest tool on the block all of a sudden is not the newest tool on the block and you have to go learn a whole other method, but that's the nature of the beast and that's what makes it so exciting.
	Right. And as far as I understand it, you have a paper that says, within relatively short order, there will be a home MRI, which will help you find your keys, because you'll scan it into your brain and say, please find the module which says where my keys are.
	And then all you have to do is find the MRI machine, and then you're set.
	I want the patent on that.
	That's right. I think that would make a fortune.
	That would make a fortune. I know you've got a two o'clock drop-off, so I just wanted to ask if you had any thoughts about, I know this is always prognostication in the realm of high-tech is tough, but where do you think things are going next?
	I mean, what's the next big thing that might be coming down the pipeline from this technology?
	That's a hard question.
	In terms of where psychiatric research is headed, some of the things on the horizon involve incorporating genetic information with our brain scans.
	From blood tests, simple, inexpensive blood tests, you can get sort of genetic profiles of people, if you will, and then you can look at the relation between particular genetic variants that people may have and activity of various brain regions with the hope down the line that you could,
	from a simple blood sample that might cost $20 to analyze, I think that's a very forward-thinking approach here.
	We're also looking at some of the research being done at UNC, not by my group, but by A researcher such as Joe Piven is using structural MRI in younger and younger kids to help us learn about why neurodevelopmental disorders seem to emerge when they do.
	So for example, autism is an area of research that I and others at UNC are involved in.
	And we're able to use MRIs to scan even newborns, children 6 months of age, children 12 months of age, and then see later on who develops autism, for example, and you then Retrospectively look back at their brain scans and say what's different about this baby's brain who developed autism relative to this other baby's brain that did not develop autism and can we use that down the line to help us predict who's going to develop this particular disorder and then again thinking about prevention I mean wouldn't that be incredibly helpful if though upsetting if a pediatrician could tell a parent you know you're six month old is Sort of in this range where we think there's a high chance of some difficulty in this area,
	can we suggest this preventative intervention?
	And we know that kids who are going to develop autism respond very well to these types of early interventions.
	So, I mean, I think it's really being applied across the lifespan and the volumes of data we're generating on a yearly basis are just mind-boggling.
	So it's a really exciting time.
	That's wonderful. And the last question I have, which should be relatively quick to answer if that's alright, I just want to make sure that people remember that there's a difference between mental ailments which do respond to something like therapy, like anxiety and depression have a pretty good response rate, versus things like schizophrenia which do not respond to therapy as far as I understand it, like psychotherapy at all.
	Absolutely. Absolutely different disorders have different response profiles.
	I don't mean to contradict once again, but even within schizophrenia, David Penn here at UNC has a group-based intervention for psychosis and schizophrenia, and he's getting really encouraging results.
	Is that right? Sorry, I just want to make sure I understand that so that there's a talk therapy that's showing some promising results even in the realm of schizophrenia?
	That's right. They target paranoid thoughts and they do sort of cognitive exercises to help you reappraise your delusions and he seems to be getting significant improvements in paranoia versus other forms of intervention in schizophrenia.
	Oh, listen, I couldn't be happier to be wrong.
	That is a completely wonderful finding.
	And what was the fellow's name again?
	Absolutely, you should look him up.
	His name is David Penn, P-E-N-N. We've collaborated.
	He's at UNC Chapel Hill.
	And the intervention is called SCIT, Social Cognitive Intervention Training.
	Sorry, schizophrenia. I'll have to look that up.
	No, don't worry. I'll dig it up and I'll put it on the links.
	Again, I know you have to go and I really do want to thank you so much for taking the time.
	The stuff that's going on in brain work these days is completely fascinating and I really do appreciate being able to bring some of this to the late public.
	Thank you so much. I appreciate it because I think the journal format that we communicate these results in is not often very accessible to people outside this field.
	So I think venues like this are wonderful to get the word out.
	So I appreciate it.
	All right. All the best. Thank you again.

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