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 (i.e., “SN”) reflecting emotion/motivation and the default mode network (i.e., “DMN”) reflecting self-referentiality. Using resting-state functional connectivity 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., 2018), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the 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 with changes 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.

Emotion Regulation Therapy and Its Potential Role in the Treatment of Chronic Stress-Related Pathology Across Disorders

“…86 A recent follow-up once again using seed-based rsFC with seeds in the insula and PCC revealed ERT-linked changes in resting state connectivity which were associated with decreases in GAD and MDD diagnostic severity ( r ’s = 0.4–0.6) and increases in both attention and metacognitive regulation ( r ’s = 0.3–0.5). 87 Taken together, these preliminary findings provide initial support for our hypotheses that the salutatory effects of ERT result in part through normalization of emotion regulatory mechanisms.…”

Brain Networks Connectivity in Mild to Moderate Depression: Resting State fMRI Study with Implications to Nonpharmacological Treatment

“…This implicates disruption of normal relationships between three key networks of triple network model [ 54 ], namely, DMN, ECN, and ASN assuming DMN is anticorrelated with two others. Global increase of DMN–ECN FC is not a typical finding in depression (see results directly contradicting ours in [ 8 ] and indirectly in [ 38 , 52 ]); however, it is possibly related to some depression-specific cognitive processes [ 19 ]. So the difference between ours and previous results may be caused by relatively mild and supposedly more “psychogenic” conditions in our case lacking some neural markers typical for more serious conditions while sharing cognitive features of depression such as rumination and cognitive control deficits.…”

“…Sad mood induction in depression leads to posterior cingulate uncoupling from the prefrontal cortex and precuneus [ 51 ]. Some antidepressant medications increase FC of posterior cingulate to medial prefrontal area [ 52 ], and psychotherapy increases it to precuneus [ 38 ], which may suggest that low strength of these connections is related to depression.…”

“…The relationships between FC measures and depression severity are unclear for all global networks, including DMN. In some studies, FC findings were unrelated to clinical or behavioral measures [ 11 , 23 , 38 ].…”

Mindfulness‐based cognitive therapy on bereavement grief: Alterations of resting‐state network connectivity associate with changes of anxiety and mindfulness

“…Previous literature has observed the mindfulness‐related changes of resting‐state brain functions on stressful populations, which are partly consistent with such conjecture. For example, King et al demonstrated the increased functional connectivity between PCC and dorsolateral prefrontal cortex (DLPFC) in patients with post‐traumatic stress disorder after a 16‐week mindfulness‐based exposure training (King et al, 2016); Scult et al also observed the enhanced PCC‐DLPFC connectivity strength in 21 patients with general anxiety disorder (GAD) following a 20‐week mindful emotion regulation therapy (Scult et al, 2019). In addition, another study revealed the decreased magnitude of PCC‐seeded internetwork connectivity (PCC‐insula and PCC‐dorsal anterior cingulate cortex), without prominent changes of PCC‐DLPFC connectivity, after an 8‐week MBCT in 32 GAD patients (Zhao et al, 2019).…”