What Is Neuromodulation? A Clinical Psychology and Cognitive Psychology Podcast Episode.



When it comes to treatments for mental health conditions, I always like to be pushing the boundaries of what we look at on the podcast and making us, as psychology students and professionals, think deeper about our amazing profession. This episode is no different as today we examine a very interesting new treatment for conditions that could represent a fundamental shift in how we treat mental conditions. If you’re interested in clinical psychology at all, then this is certainly the podcast episode for you.


Today’s episode has been sponsored by Abnormal Psychology: The Causes and Treatments For Depression, Anxiety and More. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.


Introduction To Neuromodulation:

I will define this term in a moment but the really interesting thing about Neuromodulation is that this is a fast-growing area of medicine over the last decade. As well as it is commonly seen as a way to treat chronic illness, neurological conditions and even mental health conditions. Yet this still represents a fundamental shift for a lot of us psychologists that use drug therapy, psychotherapy and lifestyle changes to treat mental health conditions.


And let me just say right now, I am not for or against Neuromodulation at this moment in time. I am just researching it and learning about it and I will make a judgement about it at the end.


But I will say that if Neuromodulation hopes to replace psychotherapy then I seriously doubt I’ll be too impressed by it.


Anyway, there is some discussion that whilst drug and psychological therapy are the most common treatments at this moment in time, advances in Neuromodulation devices could replace all this in the future. Or at least add to this range of treatments as it could provide relief to clients who suffer from intolerable side effects or limited benefits from therapy, lifestyle changes and drugs.


Personally, I flat out know it will never replace psychotherapy because this sounds very much like the biomedical model to me first of all.


Which I’ll explain more about Neuromodulation now.


What Is Neuromodulation?

Neuromodulation uses electrical, electromagnetic or mechanical stimulation to modify how our central, autonomic or peripheral nervous systems function. Sometimes these procedures require clinical expertise or implants, but in many cases the treatment can be conducted with a handheld device that our clients can use in the comfort of their own home.


Additionally, whilst this all sounds very experimental or like an alternative treatment, its actual theoretical framework is the same as underpins conventional drug treatments. Since all of our brain activity is a combination of electrical and chemical communications throughout our nervous systems, and it’s the job of psychopharmacology to investigate this chemical communication system, by affecting the chemical signalling in the central nervous system.


Yet Neuromodulation works the other way because it regulates the electrical signalling within the central nervous system and as a result this causes neurochemical changes.


This is actually getting researchers so excited that some of them, like Nolan Williams of Stanford University, are proposing that psychiatry could be entering a brand new era that focuses on neural circuity to treat clients.


However, I will admit I have massive problems with how psychiatrists are defining these waves and eras. Since they propose that Psychiatry 1.0 was psychotherapy, then 2.0 was psychopharmacology and this 3.0 is Psychiatrist. But that implies two things that I don’t like, it implies that we all need to be moving away from psychotherapy because that is so old-hat that drug treatments are so much better. As well as it implies that psychotherapy became popular before drug treatments but anyone who knows their “big institution” and psychiatry history knows that’s flat out wrong.


This is definitely why I don’t personally like psychiatry because they really do focus too much on the biomedical model and the biological causes and treatments of mental conditions without even giving the psychological and social causes and treatments an ounce of thought.


How Is Neuromodulation Used?

Anyway, despite the massive public problems with electroconvulsive therapy and my own personal problems with the so-called therapy as a gay person. Electroconvulsive therapy continues to be used today because it is very effective in treating catatonia and people with very severe depressive episodes that are associated with bipolar disorder or major depressive disorder. As well as it can also be used to treat treatment-resistant psychotic disorders (Edemann-Callesen et al., 2021).


Moreover, electroconvulsive therapy isn’t the only treatment these days that relies on neuromodulation since there are a number of others. For example, transcranial magnetic stimulation, transcranial direct current stimulation and cranial electrotherapy stimulation (Brunye et al., 2021). All of these are minimally invasive and transcranial techniques.


There are other techniques that are a little more invasive too. For instance, Vagus nerve stimulation and deep brain stimulation that does involve putting wires into the brain to grossly oversimplify the process. And these techniques are effective in treating Post-Traumatic Stress Disorder (Gouveia et al., 2020), Generalised Anxiety Disorder (Sagliano et al., 2019), Attention Deficit Hyperactivity Disorder and Neuropathic pain (Yu et al., 2020) amongst other neurological disorders.


Also I just want to add hear that all of these treatments you do regularly hear about in psychology and I have mentioned basically all of these in psychology books before, so actually these are rather interesting treatment options for the future.


How Could Neuromodulation Be Used In The Future?

Looking out into the future, we have to admit that a lot of these techniques are still very new and largely not well-established. I have mentioned in my books before that they are very hopeful and interesting and exciting, but neuromodulation still has a long way to go before it will ever be considered a first-line treatment in everyday care. And this is before we mention the significant side effects of many of these more intensive procedures, because even if these techniques don’t require implants, they still carry their own set of considerations and difficulties.


And there is evidence that many of the least intensive means of neuromodulation like Transcranial Direct- Current Stimulation may not be very effective at all.


Of course, this will be likely change as these devices become more popular, are researched more and there’s more investment in the area. Yet there are still structural obstacles to overcome before these devices are widely adopted.


For example, the considerable knowledge gap between researchers, therapists and the general public so information about current research at academic centres needs to be shared with others a lot better before therapists and the clients become more interested.


Then there are problems with how neuromodulation trials are done in the first place, because in normal psychopharmacological trials you can do placebo groups, double-blind trials and randomised controlled trials to demonstrate the effectiveness of treatments. But the randomised control trials for these devices require a very different model altogether requires a so-called “sham/placebo treatment”. Therefore, it’s a lot more difficult to do placebo-controlled trials for these devices, and the available data suggests we lack the validity and replicability to know the true effectiveness of neuromodulation.


So new and standardised experimental methods are needed more than anything.


Lastly, we need to know the longer term effects that neuromodulation has on the brain, since research suggests that these techniques do enhance neuroplasticity, how the brain changes in response to the environment, but we don’t yet fully understand the full therapeutic effects of these techniques, nor how it affects the brain later on.


Clinical Psychology Conclusion

Whilst I want to finish up this podcast episode by mentioning that none of these obstacles are impossible and I truly hope that researchers do overcome them. I still very much consider myself a child of the biopsychosocial model and I have my concerns.


To me this still sounds like the medical model too much and like people and psychiatry are trying to create yet another treatment that only focuses on the biological and neurological causes of mental health conditions. Of course, our brains and what happens to us on a biological level plays a role in these conditions, but it isn’t the only cause and these neuromodulation techniques will not help to solve negative cognitive styles, negative cognitive triads or even the negative influence of a poor social support network.


I truly hope that neuromodulation proves successful as it would actually be another valuable tool in our collective arsenal that us as psychologists could choose from. But I am extremely weary of people wanting to use this to replace psychotherapy and even return us to the biomedical model completely.


Because this is something that mainstream psychology cannot allow in the slightest.


I really hope you enjoyed today’s clinical psychology podcast episode.


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Clinical Psychology References

Brunyé, T. T., Patterson, J. E., Wooten, T., & Hussey, E. K. (2021). A critical review of cranial electrotherapy stimulation for neuromodulation in clinical and non-clinical samples. Frontiers in human neuroscience, 15, 625321.


Edemann-Callesen, H., Winter, C., & Hadar, R. (2021). Using cortical non-invasive neuromodulation as a potential preventive treatment in schizophrenia-A review. Brain Stimulation, 14(3), 643-651.


Gouveia, F. V., Davidson, B., Meng, Y., Gidyk, D. C., Rabin, J. S., Ng, E., ... & Hamani, C. (2020). Treating post-traumatic stress disorder with neuromodulation therapies: transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Neurotherapeutics, 17(4), 1747-1756.


https://www.psychologytoday.com/gb/blog/balanced/202209/neuromodulation-and-psychiatry-30


Sagliano, L., Atripaldi, D., De Vita, D., D'Olimpio, F., & Trojano, L. (2019). Non-invasive brain stimulation in generalized anxiety disorder: A systematic review. Progress in neuro-psychopharmacology & biological psychiatry, 93, 31–38.

https://doi.org/10.1016/j.pnpbp.2019.03.002


Yu, K., Niu, X., & He, B. (2020). Neuromodulation management of chronic neuropathic pain in the central nervous system. Advanced functional materials, 30(37), 1908999.


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