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Neural predictors and effects of cognitive behavioral therapy for depression: the role of emotional reactivity and regulation

Published online by Cambridge University Press:  11 February 2019

Harry Rubin-Falcone*
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, New York, NY, USA
Jochen Weber
Affiliation:
Department of Psychology, Columbia University, New York, NY, USA
Ronit Kishon
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA
Kevin Ochsner
Affiliation:
Department of Psychology, Columbia University, New York, NY, USA
Lauren Delaparte
Affiliation:
Department of Psychology, Stony Brook University, Stony Brook, NY, USA
Bruce Doré
Affiliation:
Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
Sudha Raman
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, New York, NY, USA
Bryan T. Denny
Affiliation:
Department of Psychology, Rice University, Houston, TX, USA
Maria A. Oquendo
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
J. John Mann
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, New York, NY, USA
Jeffrey M. Miller
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, New York, NY, USA
*
Author for correspondence: Harry Rubin-Falcone, E-mail: harry.falcone@nyspi.columbi.edu

Abstract

Background

Cognitive behavioral therapy (CBT) is an effective treatment for many patients suffering from major depressive disorder (MDD), but predictors of treatment outcome are lacking, and little is known about its neural mechanisms. We recently identified longitudinal changes in neural correlates of conscious emotion regulation that scaled with clinical responses to CBT for MDD, using a negative autobiographical memory-based task.

Methods

We now examine the neural correlates of emotional reactivity and emotion regulation during viewing of emotionally salient images as predictors of treatment outcome with CBT for MDD, and the relationship between longitudinal change in functional magnetic resonance imaging (fMRI) responses and clinical outcomes. Thirty-two participants with current MDD underwent baseline MRI scanning followed by 14 sessions of CBT. The fMRI task measured emotional reactivity and emotion regulation on separate trials using standardized images from the International Affective Pictures System. Twenty-one participants completed post-treatment scanning. Last observation carried forward was used to estimate clinical outcome for non-completers.

Results

Pre-treatment emotional reactivity Blood Oxygen Level-Dependent (BOLD) signal within hippocampus including CA1 predicted worse treatment outcome. In contrast, better treatment outcome was associated with increased down-regulation of BOLD activity during emotion regulation from time 1 to time 2 in precuneus, occipital cortex, and middle frontal gyrus.

Conclusions

CBT may modulate the neural circuitry of emotion regulation. The neural correlates of emotional reactivity may be more strongly predictive of CBT outcome. The finding that treatment outcome was predicted by BOLD signal in CA1 may suggest overgeneralized memory as a negative prognostic factor in CBT outcome.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2019 

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