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Brain activity during reappraisal and associations with psychotherapy response in social anxiety and major depression: a randomized trial

Published online by Cambridge University Press:  22 May 2024

Cope Feurer Open the ORCID record for Cope Feurer [Opens in a new window] ,
Jagan Jimmy ,
Melissa Uribe ,
Stewart A. Shankman Open the ORCID record for Stewart A. Shankman [Opens in a new window] ,
Scott A. Langenecker Open the ORCID record for Scott A. Langenecker [Opens in a new window] ,
Michelle G. Craske Open the ORCID record for Michelle G. Craske [Opens in a new window] ,
Olusola Ajilore Open the ORCID record for Olusola Ajilore [Opens in a new window] ,
K. Luan Phan  and
Heide Klumpp Open the ORCID record for Heide Klumpp [Opens in a new window]
Cope Feurer*
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
Jagan Jimmy
Affiliation:
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
Melissa Uribe
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
Stewart A. Shankman
Affiliation:
Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
Scott A. Langenecker
Affiliation:
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
Michelle G. Craske
Affiliation:
Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
Olusola Ajilore
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
K. Luan Phan
Affiliation:
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
Heide Klumpp
Affiliation:
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
*
Corresponding author: Cope Feurer; Email: feurer@uic.edu
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Abstract

Background

Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.

Methods

Participants were 75 treatment-seeking patients with SAD (n = 34) or MDD (n = 41) randomized to CBT (n = 40) or ST (n = 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.

Results

Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm.

Conclusions

If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.

Keywords

CBTfMRImajor depressionpsychotherapyReappraisalsocial anxiety
Type
Original Article
Information
Psychological Medicine , First View , pp. 1 - 11
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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