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Cognitive–behavioural therapy is efficacious in the treatment of major
depressive disorder but response rates are still far from
To better understand brain responses to individualised emotional stimuli
and their association with outcome, to enhance treatment.
Functional magnetic resonance imaging data were collected prior to
individual psychotherapy. Differences in brain activity during passive
viewing of individualised self-critical material in 23 unmedicated
out-patients with depression and 28 healthy controls were assessed. The
associations between brain activity, cognitive and emotional change, and
outcome were analysed in 21 patients.
Patients showed enhanced activity in the amygdala and ventral striatum
compared with the control group. Non-response to therapy was associated
with enhanced activity in the right amygdala compared with those who
responded, and activity in this region was negatively associated with
outcome. Emotional but not cognitive changes mediated this
Amygdala hyperactivity may lessen symptom improvement in psychotherapy
for depression through attenuating emotional skill acquisition.
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