Cognitive behavioral therapy for depression changes medial prefrontal and ventral anterior cingulate cortex activity associated with self-referential processing

Abstract

Cognitive behavioral therapy (CBT), an effective treatment for depression, targets self-referential processing of emotional stimuli. We examined the effects of CBT on brain functioning during self-referential processing in depressive patients using functional magnetic resonance imaging (fMRI). Depressive patients (n = 23) and healthy participants (n = 15) underwent fMRI scans during a self-referential task using emotional trait words. The depressive patients had fMRI scans before and after completing a total of 12 weekly sessions of group CBT for depression, whereas the healthy participants underwent fMRI scans 12 weeks apart with no intervention. Before undergoing CBT, the depressive patients showed hyperactivity in the medial prefrontal cortex (MPFC) during self-referential processing of negative words. Following CBT, MPFC and ventral anterior cingulate cortex (vACC) activity during self-referential processing among depressive patients was increased for positive stimuli, whereas it was decreased for negative stimuli. Improvements in depressive symptoms were negatively correlated with vACC activity during self-referential processing of negative stimuli. These results suggest that CBT-related improvements in depressive symptoms are associated with changes in MPFC and vACC activation during self-referential processing of emotional stimuli.

Cognitive behavioural therapy for depression: systematic review of imaging studies

“…The other two studies comparing changes to antidepressant-treated patients used comparison data from an earlier study (21,22). Treatment was generally at least 12 sessions of individually delivered CBT, though one study used group treatment (23), and one internet-based treatment (24). The reported efficacy of CBT in reviewed studies was generally comparable to existing efficacy data (25).…”

Using neuroscience as an outcome measure for behavioral interventions in Autism spectrum disorders (ASD): A review

“…Similar to the research that has occurred in individuals with anxiety, multiple studies have been completed after individuals with depression undergo cognitive behavioral therapy (CBT) (Buchheim et al, 2012;Fu et al, 2008;Goldapple et al, 2004;Kennedy et al, 2007;Yoshimura et al, 2014) or interpersonal therapy (Brody et al, 2001;Martin, Martin, Rai, Richardson, & Royall, 2001). Resting state investigations have found that patients with depression who receive CBT evidence increased activation in the dorsal anterior cingulate cortex and decreased activity in the dorsal lateral prefrontal cortex (DLPFC) and medial prefrontal frontal cortex (MPFC) (Goldapple et al, 2004;Kennedy et al, 2007).…”

“…Results suggest that following CBT, individuals with depression evidenced normalized amygdala-hippocampal activity. Yoshimura et al (2014) used functional magnetic resonance imaging (fMRI) in order to explore differences in how individuals with and without depression processed self-referential positive and negative words. Prior to treatment, the depressed group evidenced hyperactivity in the medial prefrontal cortex (MPFC) and ventral anterior cingulate cortex (vACC) during self-referential negatively-valenced words (self-negative), and hypo-activation during self-referential positivelyvalenced words (self-positive) compared to the control group.…”

“…In particular, groups that have successfully discovered neural "biomarkers" of treatment response in those conditions have a few important strategies in common. Though many groups have utilized the strategies I identify below successfully, one study in particular (Yoshimura et al, 2014) will be used to highlight how this can be done.…”

“…For example, Yoshimura et al (2014) sought to study how individuals with depression process self-relevant material in order to measure negative self-referential bias and how it might be changed by behavioral therapy. Therefore, they designed a paradigm that required participants to make self-referential vs. other-referential judgments.…”