Longitudinal Effects of Cognitive Behavioral Therapy on Neural Emotion Regulation in Major Depressive Disorder
Rubin-Falcone, H., Weber, J., Kishon, R., Ochsner, K., Delaparte, L., Doré, B., … & Miller, J. M. (2018). Longitudinal effects of cognitive behavioral therapy for depression on the neural correlates of emotion regulation. Psychiatry Research: Neuroimaging, 271, 82-90.
The article by Falcone et al. points out that Major Depressive Disorder is perceived as the leading cause of disability by 2030. CBT for depression has been shown to produce remission in some patients, with its efficacy comparable to other antidepressants used as first-line options. The treatments, however, leave several patients with significant symptoms and functioning that is impaired, the vigorous treatment notwithstanding. In this study, the author selected patients with MDD and used as the inclusion criteria: A DSM-IV diagnosis of MDD, Age18-60; 17-item Hamilton Rating Scale for Depression (HRSD) score ≥ 16; Capacity to provide informed consent, and lack of significant benefit from any current psychiatric medications and ability to tolerate washout. A summary of the selection criteria is shown below
The authors scanned 31 participants with MDD before starting the 14 CBT sessions by utilizing functional magnetic resonance imaging (fMRI) and a task where the participants took part in a voluntary emotion strategy while at the same time recalling autobiographical memories that were negative. The study also scanned 18 healthy subjects as controls. 23 MDD participants and 12 healthy controls completed the fMRI scanning post-treatment and repeat scanning without intervention, respectively.
The study’s primary findings showed that BOLD signal regulation-dependent emotion reduction is longitudinally enhanced as a clinical improvement function with CBT for the treatment of depression. The longitudinal emotion regulation-dependent BOLD contrast changes that correlate with outcomes of treatment could represent changes that correlate with treatment outcome and may represent a change in negative autobiographical memories self-referential processing or in the negative meaning of memories’ processing. Thus, the authors concluded that better outcomes treatment was linked to emotion regulation-dependent BOLD contrast longitudinal enhancement within the lingual gyrus, medial prefrontal cortex, and subgenual anterior cingulate. Treatment outcome was not predicted for emotion regulation-dependent BOLD contrast at the baseline; neither did it differ between the control and MDD groups.
The study had limitations, including different treatment conditions’ lack of randomization, the placebo condition, and the sample size that was quite modest, especially in the control group. Further, the sample size included participants with comorbid personality disorder and anxiety disorders; hence, the MDD specificity could not be ascertained. Lastly, MDD patients have a tendency to over-generalize any negative memories; hence recalling memories in this study may have differed between the controls and the MDD patients.
References
Rubin-Falcone, H., Weber, J., Kishon, R., Ochsner, K., Delaparte, L., Doré, B., … & Miller, J. M. (2018). Longitudinal effects of cognitive behavioral therapy for depression on the neural correlates of emotion regulation. Psychiatry Research: Neuroimaging, 271, 82-90.
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Longitudinal effects of cognitive behavioral therapy for depression on the neural correlates of emotion regulation