Friday, March 13, 2009

Doidge (Neuroplasticity) review - part 2 (Taub)

Doidge devotes a chapter to the work of Edward Taub. I think Taub's ideas are simple but brilliant. He developed a treatment called "constraint-induced movement therapy" which appears to be remarkably effective to help with recovery from strokes and other injuries.

The simple idea is to restrain the normal limb, almost continuously, for at least weeks at a time, after a neurological injury. Otherwise, the normal limb will compensate for the affected limb. If the normal limb is constrained, the brain itself will develop new pathways to improve the function of the affected limb.

This treatment has good evidence-based support:

{this 2008 study is from Lancet Neurology, one of the top journals in neurology}

{another very important study from 2006 in JAMA}

I'm curious about the applications of this sort of therapeutic idea to psychiatry. Psychiatric symptoms can be like other neurological impairments, and the psychoanalytic phenomenon of "defences" may be analogous to the tendency for a neurologically-injured person to favour the non-affected limb, while the affected limb loses more and more function. A psychological therapy which challenges defences may be something like a Taubian "constraint-induced movement therapy" for the mind.

Importantly, in order for Taub's therapy to work, the constraint has to be applied almost continuously during waking hours, for at least weeks at a time. It is an immersive experience. It is an interesting challenge to find more psychological therapies that can be "immersive" in this way.

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