There is mounting recognition in the scientific community that combining different treatment approaches for mental health conditions can create a benefit greater than the sum of its parts.
As a clinical psychologist and neuroscience researcher, I have been working to integrate insights from both fields to expand treatment options for those suffering from depression, anxiety and related conditions. Designing a treatment plan that pays careful attention to the sequence and dose of both biological and behavioral therapies might benefit people in new ways that neither approach can achieve on its own.
Anxiety and depression are the most prevalent mental health conditions around the world. Globally, about 280 million people experience depression, and as many as 1 in 3 will meet the diagnostic criteria for an anxiety disorder at some point in their lives. There are numerous effectivetreatment options for both conditions, including medications, psychotherapy, lifestyle changes and neurostimulation.
Doctors and therapists recommend many patients seeking mental health care try more than one approach simultaneously, such as medication and therapy. This is based on the idea that if they were to respond well to any of the prescribed treatments, they would experience a net benefit more quickly or more strongly than if they were to try each sequentially. However, researchers have historically studied each approach in isolation. Most research has focused on comparing individual treatments one at a time to a control, such as a pill placebo or a psychotherapy waitlist.
Depression is a leading cause of disability around the world.
Neuroplasticity refers to the brain’s capacity to flexibly adjust in response to an ever-changing environment – it’s a critical component of learning. In animal studies, deficits in neuroplasticity are seen as changes to molecular and neural pathways, such as a decreased number of synapses, or points of contact between neurons, following chronic stress. These changes might be related to mental patterns and symptoms of depression and anxiety in people, such as when patients report a reduced capacity to think, feel and act flexibly. They may also be linked to thinking about, remembering and interpreting information in a way that tends to be biased toward the negative.
Research has shown that many effective biological treatments, including medications and neurostimulation, can enhance oralter neuroplasticity. Certain lifestyle changes such as regular exercise can have similar effects. Scientists consider this key to how they reduce symptoms. Unfortunately, symptoms often return when these treatments are discontinued. Relapse is particularly apparent for medications. For both older and newer antidepressant and anti-anxiety medications, relapse rates begin climbing shortly after patients stop treatment.
Patients can experience a relapse of symptoms after they stop taking antidepressants or anti-anxiety medications. Vasil Dimitrov/E+ via Getty Images
In contrast, behavioral treatments such as psychotherapy introduce new skills and and habits that may be more long-lasting. Benefits continue even after the most intense phase of treatment ends. Regular meetings with a therapist over the course of several months can help many patients learn to cope with negative symptoms and life circumstances in new ways. But such learning depends on neuroplasticity to forge and retain these new, helpful pathways in the brain.
Researchers hypothesize that enhancing or modulating plasticity with a biological intervention like medication may not only reduce symptoms but may also provide a window of opportunity for behavioral interventions like psychotherapy to be more effective. Learning-based interventions like cognitive-behavioral or exposure therapy, if properly timed, could harness the enhanced neuroplasticity that biological interventions induce and improve long-term outcomes.
Think of pathways in the brain as roads. Biological treatments transform a sparsely connected set of roads – consisting only of a few well-trodden pathways that represent unhelpful thoughts, fears and habits – into a denser network of interconnected, freshly paved roadways. Behavioral treatments can be likened to repeatedly driving over a specific subset of new roads that lead to more balanced perspectives on yourself and the world around you, learning them until you can drive down them effortlessly, no GPS required. This ensures that those now familiar roadways will be readily available to you in the future and protect you against the return of anxiety and depression.
Synergies in combined treatment
Designing combined treatments to explicitly promote synergy is relatively new, and there is increasing evidence supporting it. A few specific examples are noteworthy.
First, some studies have shown that D-cycloserine, an antibiotic used to treat tuberculosis, may make exposure therapy for anxiety conditions more effective by helping patients learn to quell their fears. D-cycloserine may also enhance the antidepressant effects of a type of neurostimulation called transcranial magnetic stimulation, which stimulates nerve cells using magnetic fields.
Several studies suggest that pairing neurostimulation with cognitive-behavioral approaches like cognitive-behavioral therapy or cognitive control training may yield longer-term reductions in depression and anxiety.
Similarly, low doses of ketamine, a drug used in general anesthesia, with rapid antidepressant effects, can be used to “prime the pump” for new, helpful learning. A study my team and I conducted found that daily computer-based exercises of 30 to 40 minutes over four days following a single ketamine dose led to a ninefold increase in the duration of antidepressant effects – 90 days of reduced symptoms – compared with ketamine alone, which led to 10 days of reduced symptoms.
Researchers are exploring the potential of psychedelics to treat many mental health conditions.
Finally, there is increasing interest in using other medications with psychedelic properties to assist in psychotherapy. The therapeutic benefits of taking these psychedelic-assisted therapies under medical supervision are attributed to the rapid neuroplasticity-enhancing and consciousness-altering effects of drugs like psilocybin and MDMA. Researchers think these short-term effects foster new insights and perspectives that psychotherapists can help patients integrate into their permanent worldview.
There is great potential in neuroscience-guided ways to combine treatments. However, it’s important to note that different treatment approaches can occasionally work against each other, lessening the long-term benefits of psychotherapy alone. For example, one study on panic disorder found that patients who learned psychotherapy techniques while taking anti-anxiety medication had a greater chance of relapse after discontinuing their use compared with those given psychotherapy alone.
Carefully designed clinical trials and long-term follow-ups are needed to fully understand how to combine the biological and the behavioral to develop treatments that are efficient, accessible, safe and enduring.
theconversation.com – Amy Cooter, Director of Research, Academic Development and Innovation at the Center on Terrorism, Extremism and Counterterrorism, Middlebury – 2025-01-22 15:12:00
The Jan. 6, 2021, storming of the Capitol was the result of a planned conspiracy to disrupt the government, prosecutors alleged. AP Photo/John Minchillo
Several of the highest-profile figures in the Jan. 6, 2021, insurrection were charged with, and convicted of, the crime of seditious conspiracy, which is defined as the act of getting together with other people to overthrow the government. They were among the roughly 1,500 people involved in the insurrection who were pardoned or had their prison sentences commuted by Donald Trump on his first day in office.
Seditious conspiracy is a serious crime of conspiring to overthrow the government or stop its normal functioning. Historically, seditious conspiracy has been difficult to successfully prosecute.
In 2009, for example, a state judge ruled that prosecutors had failed to provide sufficient evidence for members of the Michigan Hutaree militia to go to trial on that charge. Certain militia members had been accused of plotting violence against police officers. While some members faced other charges for their actions, the judge determined that a plot against law enforcement was not sufficient to support charges of attempting to overthrow the government.
In contrast, the U.S. Department of Justice charged 18 people associated with the Jan. 6 attack on the U.S. Capitol with that crime, asserting that they had intended to “oppose by force the lawful transfer of presidential power” or had committed other actions that would undermine the entire system of government.
Of those 18, four pleaded guilty, and 10 were found guilty at trial. The remaining four were found not guilty of seditious conspiracy but were convicted of other crimes that were related to the insurrection.
Capitol entry not required
Oath Keepers militia leader Stewart Rhodes’ seditious conspiracy conviction was especially significant because, unlike some other defendants, Rhodes did not physically enter the Capitol building. He was instead in “the restricted area of Capitol grounds,” according to a Justice Department statement.
His conviction was based in part on his communications, including text messages, both before Jan. 6 and on the day itself. Prosecutors successfully argued that these communications were part of a broader conspiracy to disrupt the election certification by organizing and encouraging others to participate in more direct action.
Proud Boys members Joseph Biggs, left, and Ethan Nordean, right with megaphone, walk toward the U.S. Capitol in Washington, D.C., on Jan. 6, 2021. AP Photo/Carolyn Kaster
The full effect that the pardons will have on militia actors and related groups in coming years is uncertain: Will the pardons send the message to all Americans that political violence is acceptable, or at least that it can be overlooked or forgiven if the right political figures are in power?
Amy Cooter, Director of Research, Academic Development and Innovation at the Center on Terrorism, Extremism and Counterterrorism, Middlebury
Today, GLP-1 drugs, including Wegovy, Mounjaro and Zepbound, have become household names and key tools in the fight against obesity: 1 in 8 American adults say they have used a GLP-1 drug, and forecasts show that by 2030, 1 in 10 Americans will likely be using these medications.
Now, research from my lab and others suggests that GLP-1 drugs could help treat dozens of other ailments as well, including cognitive issues and addiction problems. However, my colleagues and I also found previously unidentified risks.
I am a physician-scientist and I direct a clinical epidemiology center focused on addressing public health’s most urgent questions. My team works to address critical knowledge gaps about COVID-19, long COVID, influenza, vaccines, effectiveness and risks of commonly used drugs, and more.
On Jan. 20, 2025, my team published a study of more than 2.4 million people that evaluated the risks and benefits of GLP-1 drugs across 175 possible health outcomes. We found that these drugs lowered risks of 42 health outcomes, nearly a quarter of the total that we analyzed. These include neurocognitive disorders such as Alzheimer’s disease and dementia, substance use and addiction disorders, clotting disorders and several other conditions.
Unfortunately, we also found that GLP-1 drugs come with significant side effects and increase the risk of 19 health conditions we studied, such as gastrointestinal issues, kidney stones and acute pancreatitis, in which the pancreas becomes inflamed and dysfunctional.
Initially, GLP-1 drugs were developed to treat diabetes.
Cognitive benefits
One of the most important health benefits we found was that the GLP-1 drugs lowered the risk of neurodegenerative disorders, including Alzheimer’s disease and dementia. These findings align with other research, including evidence from preclinical studies showing that these drugs may reduce inflammation in the brain and enhance the brain’s ability to form and strengthen connections between its cells, improving how they communicate with one another. These effects contribute to mitigating cognitive decline.
All of these studies strongly point to a potential therapeutic use of GLP-1 drugs in treatment of the cognitive decline. Ongoing randomized trials – the gold standard for evaluating new uses of drugs – are looking at the effects of GLP-1 drugs in early Alzheimer’s disease, with results expected later in 2025.
Curbing addiction and suicidal ideation
GLP-1 drugs have also demonstrated potential in reducing risks of several substance use disorders such as those involving alcohol, tobacco, cannabis, opioids and stimulants. This may be due to the ability of these drugs to modulate reward pathways, impulse control and inflammatory processes in the brain.
The effectiveness of GLP-1 drugs in curbing addictive behavior may explain their spectacular success in treating obesity, a chronic disease state that many have suggested is indeed a food addiction disorder.
Our study demonstrated a reduced risk of suicidal thoughts and self-harm among people using GLP-1 drugs. This finding is particularly significant given earlier reports of suicidal thoughts and self-injury in people using GLP-1 drugs. In response to those reports, the European Medicines Agency conducted a review of all available data and concluded that there was no evidence of increased risk of suicidality in people using GLP-1 drugs.
In addition to the well-documented effects of GLP-1 drugs in reducing risks of adverse cardiovascular and kidney outcomes, our study shows a significant effect in reducing risk of blood clotting as well as deep vein thrombosis and pulmonary embolism.
One puzzling finding in our study is the reduced risk of infectious diseases such as pneumonia and sepsis. Our data complements another recent study that came to a similar conclusion showing that GLP-1 drugs reduced risk of cardiovascular death and death due to infectious causes, primarily COVID-19.
This is especially important since COVID-19 is regarded as a significant cardiovascular risk factor. Whether GLP-1 drugs completely offset the increased risk of cardiovascular disease associated with COVID-19 needs to be thoroughly evaluated.
Some doctors are prescribing GLP-1 drugs to help with fertility issues.
Risks and challenges
Despite their broad therapeutic potential, GLP-1 drugs are not without risks.
Gastrointestinal issues, such as nausea, vomiting, constipation and gastroesophageal reflux disease are among the most common adverse effects associated with GLP-1 drugs.
Our study also identified other risks, including low blood pressure, sleep problems, headaches, formation of kidney stones, and gall bladder disease and diseases associated with the bile ducts. We also saw increased risks of drug-induced inflammation of the kidneys and pancreas – both serious conditions that can result in long-term health problems. These findings underscore the importance of careful monitoring in people who are taking GLP-1 medications.
A significant challenge with using GLP-1 drugs is the high rates at which patients stop using them, often driven by their exorbitant cost or the emergence of adverse effects. Discontinuation can lead to rapid weight gain.
That’s a problem, because obesity is a chronic disease. GLP-1 drugs provide effective treatment but do not address the underlying causes of obesity and metabolic dysfunction. As a result, GLP-1 drugs need to be taken long term to sustain their effectiveness and prevent rebound weight gain.
In addition, many questions remain about the long-term effectiveness and risks of these drugs as well as whether there are differences between GLP-1 formulations. Addressing these questions is critical to guide clinical practice.
Attitudes toward Christian nationalism don’t just boil down to views on race, religion and history − research suggests ‘moral foundations’ play a critical role
theconversation.com – Kerby Goff, Associate Director of Research at the Boniuk Institute for the Study and Advancement of Religious Tolerance, Rice University – 2025-01-22 07:43:00
The concept of Christian nationalism has taken center stage in many Americans’ minds as either the greatest threat to democracy or its only savior.
Political scientist Eric McDaniel defines Christian nationalism as the belief that the United States was founded to be a Christian nation. “In this view,” according to McDaniel, “America can be governed only by Christians, and the country’s mission is directed by a divine hand.” Why does the idea resonate with some but alarm others?
Scholars often portray Christian nationalism as rooted in a deep-seated desire to exclude non-Christians and people of color from American society. Historians point to a persistent link between racism and Christian nationalism among white Americans throughout U.S. history.
White Christians, however, are not the only ones sympathetic to Christian nationalist ideas. Nearly 40% of Black Protestants and 55% of Hispanic Protestants agree with statements such as “being Christian is an important part of being truly American.” Interestingly, over one-third of Muslims agree that the U.S. government should promote Christian moral values but not make it the official religion.
While racial, religious and political tribalism appear to influence who supports and who rejects Christian nationalism, our own research suggests there are other factors at play, specifically moral differences. We set out to understand the role that different moral values play in shaping support for and opposition to Christian nationalism.
Our study drew on the most influential social science approach to understanding moral values: moral foundations theory.
Moral differences
Moral foundations theory states that humans evolved to possess six primary moral intuitions that shape moral judgments – care for the vulnerable, fairness in how people are treated, loyalty to in-groups, respect for authority, reverence for the sacred, and the safeguarding of individual liberty.
Conservatives, on the other hand, tend to score equally on all six foundations. This suggests their moral judgments often involve balancing a desire to be compassionate with a desire to safeguard the stability of the social order.
For example, research finds that prioritizing care for the vulnerable, which is most pronounced among liberals, is linked to reduced acceptance of police use of force. Conservatives, who also value respect for authority, often favor “law and order” even when it involves use of force.
What our research found
Researchers found that support for Christian nationalism was strongly associated with the moral foundations of loyalty, sanctity and liberty. selimaksan/E+ via Getty images.
With moral foundations theory as our guide, we analyzed Christian nationalism using a 2021 national survey of 1,125 U.S. adults conducted by YouGov, a global opinion research organization. We measured respondents’ moral foundations with the moral foundations questionnaire, which has been used extensively by researchers across numerous academic disciplines.
To measure Christian nationalism, we asked respondents whether they agreed with six questions, such as whether the federal government should declare the United States a Christian nation, advocate Christian values, allow prayer in public schools and allow religious symbols in public spaces, to list a few.
Support for Christian nationalism was most strongly linked to the moral foundations of loyalty, sanctity and liberty, but not to the authority foundation. We expected Christian nationalism to appeal to individuals who are enamored of authority, providing a rationale to their support for authoritarian leaders. But in our study, respect for authority did not distinguish those who supported Christian nationalism from those who opposed it.
We also found that support for Christian nationalism was linked to having a weaker fairness foundation. But it was not related to the strength of one’s care foundation.
We conclude that differences over Christian nationalism emerge not because some people care about the harm Christian nationalism could bring to non-Christian Americans, while others don’t. Rather, our findings suggest that those who support Christian nationalism do so because they are more sensitive to violations of loyalty, sanctity and liberty, and less sensitive to violations of fairness.
Our findings also revealed that support for Christian nationalism isn’t merely about racism or being ultrareligious, as critics often suggest. We accounted for endorsements of anti-Black stereotypes and religiosity. Yet, moral foundations remained the best predictors of Christian nationalist beliefs, even after taking into account these critical variables.
2 moral approaches to Christianity in the US
The Christian nationalism scale we and others have used combinesseveral different beliefs about Christianity’s role in society. So we also examined how each of the six items in our Christian nationalism scale related to each of the six moral foundations. We found two important patterns.
First, we found that the Christian nationalist desire to bring church and state closer together was most prominent among those with strong loyalty and sanctity foundations and a weak fairness foundation. This means that people who advocate for a Christian state largely do so out of loyalty – specifically, loyalty to God – and out of a desire to adhere to God’s requirements for society, as they understand them.
In line with this, support is also linked to a desire to protect the sanctity of the nation’s Christian heritage. Those who oppose bringing church and state closer together do so out of a sense that such a union would be unfair.
Second, we found that the desire to allow prayer in schools and religious symbols in public spaces was strongest among those with pronounced liberty and sanctity moral foundations. This likely means that people who favor public religious expression, but not a union of church and state, do so because they see individual religious expression as a sacred national ideal.
All in all, our study shows that support for or opposition to Christian nationalism is not merely due to religious, political or racial identities and prejudices, as many believe, but is rather due to entrenched moral differences between the two camps.
Building solidarity through diverse moral concerns
Moral divides are not necessarily impassable. It’s possible that understanding these diverging moral concerns may help build bridges between those who are sympathetic to and those who are skeptical toward Christian nationalism.
America’s founders conceived of fairness and liberty as central to a democratic society. And these values have fueled loyalty to a robust national identity ever since.
Our research suggests that the controversy surrounding Christian nationalism is driven not by a lack of moral concern by sympathizers or critics but by their different moral priorities. We believe that understanding such differences as morally rooted can open the door for mutual understanding and productive debate.
