Boosting the ToM network: Specific psychotherapy increases neural correlates of affective theory of mind in euthymic bipolar disorder

Abstract

Objectives: Impairments in social cognitive processes are discussed as a vulnerability factor for bipolar disorder (BD). Previous studies demonstrated aberrant neural activation in brain areas related to theory of mind (ToM) and impaired affective ToM (aToM) task performance in BD. However, it is yet unknown whether successful psychotherapy of BD influences neuroimaging markers of aToM.Methods: In the present study conducted within the multicentric randomized controlled trial of the BipoLife consortium, euthymic BD patients underwent two group interventions: a specific, cognitive-behavioral intervention (SEKT, n = 31) encompassing psychoeducation and the training of self-management, impulse regulation, and ToM and social skills versus a supportive, unstructured, emotion-focused intervention (FEST, n = 28). To compare the effect of SEKT and FEST on neural correlates of aToM, patients performed an aToM task during functional magnetic resonance imaging before and after interventions. Because ToM skills were trained in SEKT, we expected an increased ToM network activation in SEKT relative to FEST post intervention. Results: Both treatments were effective in stabilizing patients’ euthymic state in terms of affective symptoms, life satisfaction and global functioning. Confirming our expectations, patients who had completed SEKT showed an increased neural activation within four regions of the ToM brain network, the bilateral temporoparietal junction (TPJ), the posterior cingulate cortex (PCC), and the precuneus, whereas FEST patients did not. Conclusions: The stabilizing effect of SEKT on clinical outcomes went along with a boost in neural activation of the ToM network, while FEST possibly exerted its positive effect by other, yet unexplored routes.