Sustained anterior cingulate cortex activation during reward processing predicts response to psychotherapy in major depressive disorder

Abstract

Background The purpose of the present investigation was to evaluate whether pre-treatment neural activation in response to rewards is a predictor of clinical response to Behavioral Activation Therapy for Depression (BATD), an empirically validated psychotherapy that decreases depressive symptoms by increasing engagement with rewarding stimuli and reducing avoidance behaviors. Methods Participants were 33 outpatients with major depressive disorder (MDD) and 20 matched controls. We examined group differences in activation, and the capacity to sustain activation, across task runs using functional magnetic resonance imaging (fMRI) and the monetary incentive delay (MID) task. Hierarchical linear modeling was used to investigate whether pre-treatment neural responses predicted change in depressive symptoms over the course of BATD treatment. Result MDD and Control groups differed in sustained activation during reward outcomes in the right nucleus accumbens, such that the MDD group experienced a significant decrease in activation in this region from the first to second task run relative to controls. Pretreatment anhedonia severity and pretreatment task-related reaction times were predictive of response to treatment. Furthermore, sustained activation in the anterior cingulate cortex during reward outcomes predicted response to psychotherapy; patients with greater sustained activation in this region were more responsive to BATD treatment. Limitation The current study only included a single treatment condition, thus it unknown whether these predictors of treatment response are specific to BATD or psychotherapy in general. Conclusion Findings add to the growing body of literature suggesting that the capacity to sustain neural responses to rewards may be a critical endophenotype of MDD.

Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder

“…Reward processing is complex and consists of sensory, attention and valuation components (Schultz, 2015). A number of brain structures are involved in reward processing, including the orbitofrontal cortex, medial prefrontal cortex, dorsolateral prefrontal cortex, motor cortex, parietal association cortex, visual cortex, striatum, and amygdala (Carl et al, 2016; Schultz, 2015). …”

The anticipation and outcome phases of reward and loss processing: A neuroimaging meta‐analysis of the monetary incentive delay task

“…The insula, supplementary motor area, premotor cortex, occipital cortex, and cuneus were other regions of note where greater likelihood of activation was seen during reward anticipation (Table ). When this analysis was repeated using the eleven studies that only used a low magnitude reward (Behan et al, ; Carl et al, ; Choi et al, ; Damiano et al, ; Dillon et al, ; Figee et al, ; Jung et al, ; Kappel et al, ; Knutson, Bhanji, Cooney, Atlas, & Gotlib, ; Pfabigan et al, ; Romanczuk‐Seiferth, Koehler, Dreesen, Wüstenberg, & Heinz, ), we also found increased activation likelihood in the bilateral ventral and dorsal striatum, left supplementary motor and premotor areas and right insula (Table S, Supporting Information).…”

“…Of the 22 studies that examined reward receipt in some form, 13 used a contrast of successful reward outcome versus unsuccessful reward outcome (Bjork et al, ; Bjork, Smith, & Hommer, ; Boecker et al, ; Jung et al, ; Kirk et al, ; Knutson et al, ; Romanczuk‐Seiferth et al, ; Wu et al, ; Yan et al, ) and nine used successful reward outcome versus neutral trial outcome (Bustamante et al, ; Carl et al, ; Damiano et al, ; Dillon et al, ; Figee et al, ; Filbey et al, ; Hanssen et al, ; Mucci et al, ). To check if there was a difference between these two contrast types an additional ALE analysis was done.…”

“…;Romanczuk-Seiferth et al, 2015;Wu et al, 2014; Yan et al, 2016) and nine used successful reward outcome versus neutral trial outcome(Bustamante et al, 2014;Carl et al, 2016;Damiano et al, 2014;Dillon et al, 2010; Figee et al, 2011; Filbey et al, 2013;Hanssen et al, 2015;Mucci et al, 2015).…”

Can Understanding Reward Help Illuminate Anhedonia?

“…Behavioural activation (BA), for example, works by increasing engagement with reinforcers within the environment and overcoming avoidance [5]. Recent promising findings in adults show that greater pre-treatment anhedonia severity in a monetary reward processing task [77] and decreased neural functional connectivity, in a positive emotion upregulation task [78], are predictive of response to BA treatment. Further, BA is thought to be more cost effective and more acceptable to young people who are depressed than other psychotherapies [79], but it is still not effective for everyone.…”