Longitudinal effects of cognitive behavioral therapy for depression on the neural correlates of emotion regulation

Abstract

Cognitive behavioral therapy (CBT) is effective for a substantial minority of patients suffering from major depressive disorder (MDD), but its mechanism of action at the neural level is not known. As core techniques of CBT seek to enhance emotion regulation, we scanned 31 MDD participants prior to 14 sessions of CBT using functional magnetic resonance imaging (fMRI) and a task in which participants engaged in a voluntary emotion regulation strategy while recalling negative autobiographical memories. Eighteen healthy controls were also scanned. Twenty-three MDD participants completed post-treatment fMRI scanning, and 12 healthy volunteers completed repeat scanning without intervention. Better treatment outcome was associated with longitudinal enhancement of the emotion regulation-dependent BOLD contrast within subgenual anterior cingulate, medial prefrontal cortex, and lingual gyrus. Baseline emotion regulation-dependent BOLD contrast did not predict treatment outcome or differ between MDD and control groups. CBT response may be mediated by enhanced downregulation of neural activity during emotion regulation; brain regions identified overlap with those found using a similar task in a normative sample, and include regions related to self-referential and emotion processing. Future studies should seek to determine specificity of this downregulation to CBT, and evaluate it as a treatment target in MDD.

In search of convergent regional brain abnormality in cognitive emotion regulation: a transdiagnostic neuroimaging meta-analysis

“…For instance, there is some evidences that MDD patients are able to efficiently use reappraisal, when they "explicitly trained to do so" (Ebneabbasi, 2020;Liu and Thompson, 2017). Several neuroimaging studies also reported the intact neural underpinning of reappraisal in MDD (Davis, et al, 2018;Doré, et al, 2018;Loeffler, et al, 2019;Rubin-Falcone, et al, 2020;Rubin-Falcone, et al, 2018). Importantly, when non-significant results are published, they are not usually entered in ALE meta-analyses.…”

Efficacy of Cognitive Behavior Therapy with Positive Imagination of Success During Hypnotism on Athletic Performance

“…Some athletes fail to show their true performance due to anxiety and stress or being monitored by the spectators and the media. In fact, in addition to the daily stresses, the athletes would be under special stress of the competition field, which needs psychological interventions (12). McGuir and Storch (13) stated that stress and anxiety of competition and the unpleasant feelings after losing a game or the stresses before, after, or during a game are all among the reasons that make it necessary for athletes to receive professional services.…”

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

“…In major depression, precentral cortical activation has been observed in response to working memory load (Walsh et al, 2007) as well as to negative emotional pictures and facial processing of sad, angry (Frodl et al, 2009;Fu et al, 2004) and fearful (Arnone et al, 2012) expressions in major depression (meta-analysis: (Zhao et al, 2014). Longitudinal studies have further demonstrated that emotion-regulation dependent reductions in the precentral gyrus after treatment was associated with improved treatment outcome (Rubin-Falcone et al, 2018). A key mechanism in cognitive behavioral therapy is cognitive change, whereby the treatment improves the maladaptive cognitions that are characteristic of major depression (Beck, 1979).…”

“…Increases in anterior cingulate activity following psychotherapy has been associated with improvement in rumination (Yoshimura et al, 2013) and treatment response (Goldapple et al, 2004), although improvements in depression severity was also associated with decreases in anterior cingulate following long-term psychodynamic therapy (Buchheim et al, 2012), perhaps indicative of specificity of effects of the different forms of psychological therapies. Longitudinal neuroimaging studies have further revealed reductions in bilateral cerebellum that were correlated with improvement in depression (Rubin-Falcone et al, 2018). Although the cerebellum is usually associated with motor control, language and attention, cerebellar engagement has also been noted during sad mood induction by musical pieces (Mitterschiffthaler et al, 2007).…”