Changes in Functional Connectivity Following Treatment With Emotion Regulation Therapy

Abstract

Emotion regulation therapy (ERT) is an efficacious treatment for distress disorders (i.e., depression and anxiety), predicated on a conceptual model wherein difficult to treat distress arises from intense emotionality (e.g., neuroticism, dispositional negativity) and is prolonged by negative self-referentiality (e.g., worry, rumination). Individuals with distress disorders exhibit disruptions in two corresponding brain networks including the salience network (SN) reflecting emotion/motivation and the default mode network (DMN) reflecting self-referentiality. Using resting-state functional connectivity (rsFC) analyses, seeded with primary regions in each of these networks, we investigated whether ERT was associated with theoretically consistent changes across nodes of these networks and whether these changes related to improvements in clinical outcomes. This study examined 21 generalized anxiety disorder (GAD) patients [with and without major depressive disorder (MDD)] drawn from a larger intervention trial (Renna et al., 2018a), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, to investigate whether ERT was associated with changes in connectivity of nodes of the DMN and SN networks to regions across the brain. Findings revealed statistically significant treatment linked changes in both the DMN and SN network nodes, and these changes were associated with clinical improvement corresponding to medium effect sizes. The results are discussed in light of a nuanced understanding of the role of connectivity changes in GAD and MDD, and begin to provide neural network support for the hypothesized treatment model predicated by ERT.

Positive and Negative Affect Mediate the Influences of a Maladaptive Emotion Regulation Strategy on Sleep Quality

“…Recently, emotion regulation therapy has shown reductions in symptom severity for generalized anxiety disorder and major depressive disorder patients (43). Moreover, functional changes in brain regions located within the salience network and default mode network, both of which show disruptions in depression and anxiety patients, have shown treatment-related changes following emotion regulation therapy corresponding with clinical improvements (44). Our current research indicates that future studies evaluating the potential benefits of emotion regulation therapy should simultaneously assess improvements in sleep quality and changes in psychopathology.…”

A neurobehavioral account for decentering as the salve for the distressed mind

“…Although speculative, taken together, these early findings are suggestive of a mindfulness-entrained brain network configuration characterized by coordinated increased within-network connectivity in FPCN (73) and SN [67] increased cross-network connectivity in FPCN-DMN [27,76,79,80] and FPCN-DAN [67], and altered patterns of cross-network connectivity between DMN and SN [39,76,80] [62,85], increased dmPFC-IPL connectivity [78], and increased dmPFC-insula anti-correlation [86]. Long-term meditation and MBIs also appear to lead to enduring alterations in the MTL-DMN, including greater hippocampal grey matter density [52, [87][88][89] and increased resting connectivity between hippocampus and PCC [85].…”

“…Gains in decentering predict acute and enduring improvement in distress disorders following treatment with mindfulness-based interventions (MBIs) [17][18][19][20] as well as mindfulness enriched CBTs [21][22][23][24]. Theoretical accounts [16,25,26] and empirical findings [27,28] are beginning to reveal the neurobehavioral underpinnings of decentering and suggest MBIs lead to engagement and enduring alterations in large-scale neural networks associated with attention, executive control, and self-referential processing [29][30][31]. However, as the science of decentering continues to mature [32], more work is need to carefully elucidate how mindfulness acts on the distressed brain possibly via increases in decentering [20].…”

“…Recent reports of mindfulness-linked increases in enduring cross-network connectivity between DMN and FPCN might be related to changes in executive control in mindfulness. Several independent groups report increased connectivity between PCC and dlPFC, in healthy people [76,79] and in psychiatric patients with anxious depression [27] and PTSD [80], suggesting MBIs may lead to increased access to executive attention networks during mind-wandering. Greater DMN-FPCN (PCC-dlPFC) connectivity following MBI was associated with greater clinical improvement in PTSD symptoms [80], suggesting it could be linked to a therapeutic mechanism; decreased connectivity between anterior DMN and FPCN (dlPFC) has been related to greater severity of PTSD symptoms [81].…”

A neurobehavioral account for decentering as the salve for the distressed mind

“…Gains in decentering predict acute and enduring improvement in distress disorders following treatment with mindfulness-based interventions (MBIs) [17][18][19][20] as well as mindfulness enriched CBTs [21][22][23][24]. Theoretical accounts [16,25,26] and empirical findings [27,28] are beginning to reveal the neurobehavioral underpinnings of decentering and suggest MBIs lead to engagement and enduring alterations in large-scale neural networks associated with attention, executive control, and self-referential processing [29][30][31]. However, as the science of decentering continues to mature [32], more work is need to carefully elucidate how mindfulness acts on the distressed brain possibly via increases in decentering [20].…”