Neural markers of attention to aversive pictures predict response to cognitive behavioral therapy in anxiety and depression

Abstract

Excessive attention toward aversive information may be a core mechanism underlying emotional disorders, but little is known about whether this is predictive of response to treatments. We evaluated whether enhanced attention toward aversive stimuli, as indexed by an event-related potential component, the late positive potential (LPP), would predict response to cognitive behavioral therapy (CBT) in patients with social anxiety disorder and/or major depressive disorder. Thirty-two patients receiving 12 weeks of CBT responded to briefly-presented pairs of aversive and neutral pictures that served as targets or distracters while electroencephaolography was recorded. Patients with larger pre-treatment LPPs to aversive relative to neutral distracters (when targets were aversive) were more likely to respond to CBT, and demonstrated larger reductions in symptoms of depression and anxiety following treatment. Increased attention toward irrelevant aversive stimuli may signal attenuated top-down control, so treatments like CBT that improve this control could be beneficial for these individuals.

Brain-behavioral adaptability predicts response to cognitive behavioral therapy for emotional disorders: A person-centered event-related potential study

“…Figure 1 displays grand-average (between-subject) waveforms and scalp distributions to illustrate the overall pattern of effects and to provide context for the trial-level effects we report below. Findings are in line with previous studies using this task (MacNamara & Hajcak, 2009, 2010; Stange et al, 2017a) verifying the paradigm probed LPP as expected. Among the 39 participants, a total of 9,688 consecutive correct trial observations were available that also contained usable LPP data.…”

“…Anxiety and depression are prevalent, frequently comorbid and can be highly impairing (Kessler et al, 2005, 2006; Mineka et al, 1998; Kaufman & Charney, 2000). Difficulties with flexibly adapting behavior based on attentional demands could underlie dysfunction in these disorders and play a role in treatment outcome (Johnco et al, 2014; Mennin & Fresco, 2013; Stange et al, 2017a, b, in press). Cognitive behavioral therapy (CBT) is a gold-standard learning-based psychological treatment for anxiety and depressive disorders (Beck et al, 1979; Hofmann et al, 2012a) that involves practicing adaptive coping strategies to effectively modify maladaptive responses to emotional events (Arch & Craske, 2009).…”

“…No studies to our knowledge have examined relationships between brain and behavior in the context of emotional disorders. Indeed, most prior studies of ERPs, including those in the context of treatment outcome (e.g., Burkhouse et al, 2016; Leutgeb et al, 2009; Stange et al, 2017a), have ignored trial-to-trial variability in ERPs and RT (i.e., collapsing across trials to create averages), even though within-subject variation may provide important information about brain-behavioral adaptability that average scores cannot (e.g., Weinberg & Hajcak, 2011; Egner & Hirsch, 2005; Saville et al, 2012; Kerns et al, 2004; Botvinick et al, 2001). In the present study we made use of these within-subject brain-behavior patterns by assessing attention allocation on a given trial (indexed by the LPP) and performance on the subsequent trial (indexed by RT), to provide a measure of brain-behavior coupling (e.g., Adamo et al, 2015; Bender et al, 2015; Saville et al, 2012).…”

“…We used a task previously shown to elicit the LPP in healthy and anxious samples (MacNamara & Hajcak, 2009, 2010; Stange et al, 2017a), but never before analyzed in a trial-to-trial manner that links brain to behavior. First, we hypothesized that aversive targets would lead to larger LPPs than neutral targets, and that these larger LPPs would lead to slower RTs on the next trial.…”

Convergence of fMRI and ERP measures of emotional face processing in combat‐exposed U. S. military veterans

“…These results may inform mechanistic understanding of trauma‐related and other internalizing psychopathologies, and are in line with the notion that psychiatric health is dimensional, with the same biological systems at play across a range of symptomatology (Kozak & Cuthbert, ). Knowledge of how individual differences in BOLD activation relate to the LPP across the psychiatric spectrum may facilitate the use of EEG as a viable index of BOLD (e.g., Keynan et al, ), paving the way for clinicians to make biologically informed diagnostic or treatment decisions in their offices (Stange et al, ). Nonetheless, we caution that, because we only examined moderation of LPP‐BOLD associations in a limited number of neural regions (and because we observed a null effect of diagnosis and symptoms), we cannot say for certain that other brain regions do not contribute disproportionately to individual differences in the LPP at one end of the psychiatric spectrum.…”