A systematic review and meta-analysis of the neural correlates of psychological therapies in major depression

Abstract

Longitudinal neuroimaging studies in major depression have revealed cortico-limbic abnormalities which are modulated by treatment. We performed a systematic review and meta-analysis of psychotherapy treatment studies measuring neural function and metabolism using fMRI, PET, SPECT and MRS. Seventeen studies were included in the systematic review, total of 200 major depression participants (mean age 37.6 years), all medication free, and 116 healthy controls (mean age 36.4 years). Neuroimaging assessments were performed prior to initiation of treatment and following course of treatment. Treatment durations were: 16-30 weeks for CBT, 11 weeks for behavioral activation therapy, and up to 15 months for psychodynamic psychotherapy. The meta-analysis consisted of studies in which both groups had same serial scans and comparable tasks; total of 5 studies with visual presentation tasks of emotional stimuli: 55 patients (mean age: 38.7 years) and 55 healthy controls (mean age: 36.3 years). The meta-analysis revealed a significant group by time effect in left rostral anterior cingulate, in which patients showed increased activity following psychotherapy while healthy controls showed a decrease at follow up. Longitudinal treatment effects revealed reduced left precentral cortical activity in major depression. Findings could be indicative of improvements in emotion responsivity that may be achieved following psychotherapy.

Lightening the mood: evidence for blue light exposure in the treatment of post-concussion depression

“…Using functional magnetic resonance imaging, we showed that 30 minutes of blue-wavelength light stimulation enhanced activation of the rostral anterior cingulate cortex (rACC) when participants were anticipating rewarding stimuli [12]. This brain region is important for expectations of pleasure [13] and is often reduced in volume in patients with depression [14]. Light appears to activate many of these positive emotion and cortical alerting systems almost immediately upon exposure [15,16].…”

Widespread Morphometric Abnormalities in Major Depression

“…77 Our meta-analysis of longitudinal treatment effects after psychotherapy found a significant group by time effect in the left rostral anterior cingulate in response to emotional stimuli, in which MDD participants showed increased activity following treatment while healthy participants showed a decrease in activity at the follow-up scan. 78 Ventral-rostral regions in the anterior cingulate have a regulatory function on emotion processing, as well as in reward processing and decision making, through interconnections with core emotion processing regions, in particular the amygdala. 79 MDD is associated with a bias toward negative affective valences, which is also evident in a decreased ability to disengage from negative stimuli.…”

Beyond Broca’s area

“…Modern neuroscience is increasingly providing the crucial data to bridge this divide and to demonstrate the nuanced ways in which bio-, psycho-, and social processes are all mediated through the brain. For example, a large body of literature has demonstrated the ability of psychotherapy to alter brain activity in a way that promotes improved emotional regulation 7 . Early social experiences, such as a history of abuse and/or neglect, can blunt the brain's response to rewards in the environment (such as money or social praise), while increasing sensitivity to drugs of abuse 8,9 .…”