Disentangling the Neural Basis of Cognitive Behavioral Therapy in Psychiatric Disorders: A Focus on Depression

Abstract

Background: Major depressive disorder (MDD) stands among the most frequent psychiatric disorders. Cognitive behavioral therapy (CBT) has been shown to be effective for treating depression, yet its neural mechanisms of action are not well elucidated. The objective of this work is to assess the available neuroimaging studies exploring CBT’s effects in adult patients with MDD. Methods: Computerized databases were consulted till April 2018 and a research was conducted according to PRISMA guidelines in order to identify original research articles published at any time in English and French languages on this topic. Results: Seventeen studies were identified. Only one study was randomized comparing CBT to pharmacological interventions, and none included an effective control. Following CBT, changes occurred in cerebral areas that are part of the fronto-limbic system, namely the cingulate cortex, prefrontal cortex and amygdala-hippocampal complex. However, the pattern of activation and connectivity in these areas varied across the studies. Conclusion: A considerable heterogeneity exists with regard to study design, adapted CBT type and intensity, and employed neuroimaging paradigms, all of which may partly explain the difference in studies’ outcomes. The lack of randomization and effective controls in most of them makes it difficult to draw formal conclusion whether the observed effects are CBT mediated or due to spontaneous recovery. Despite the observed inconsistencies and dearth of data, CBT appears to exert its anti-depressant effects mainly by modulating the function of affective and cognitive networks devoted to emotions generation and control, respectively. This concept remains to be validated in large scale randomized controlled trials.

Internet-Delivered Cognitive Behavior Therapy for Young Taiwanese Female Nursing Students with Irritable Bowel Syndrome—A Cluster Randomized Controlled Trial

“…We observed greater differences between ICBT and the other two methods, particularly on week 18, where ICBT exhibited notable efficacy regarding anxiety and depression. Our study results are in accordance with previous published data [47,48]. Findings from a recent meta-analysis examining the neural basis of CBT, and its effects on symptoms of anxiety and depression, showed that CBT exerts its effects on anxiety and depression by enhancing the top–down cognitive control of emotions (e.g., prefrontal regions) and/or decreasing the bottom–up flow of fear-related emotions from limbic structures [49].…”

Mecanismos Neurocognitivos de la motivación en el entrenamiento físico

“…El proceso puede ser internalizado luego de un breve periodo de tiempo, pero requerirá de práctica y repetición para aumentar su eficacia [38].…”

Noninvasive Brain Stimulation and Psychotherapy in Anxiety and Depressive Disorders: A Viewpoint

“…A discrepancy exists among the available studies regarding the type of psychotherapy intervention, the number of psychotherapy and NIBS sessions, the pharmacological profiles of treated patients, the presence of psychiatric comorbidities and the presence of a sham intervention. All the reported studies applied NIBS techniques over the PFC, a region that was previously found to have an enhanced activity or an increase in its functional connectivity with other areas (fronto-limbic connections) following psychotherapy [3,36]. Therefore, tDCS and rTMS may have acted by enhancing CBT effects on the top-down cognitive control of emotion.…”