fMRI Activation During Executive Function Predicts Response to Cognitive Behavioral Therapy in Older, Depressed Adults

Thompson, Dolores Gallagher; Kesler, Shelli R.; Sudheimer, Keith; Mehta, Kala M.; Thompson, Larry W.; Marquett, Renee; Holland, Jason M.; Reiser, Robert P.; Rasgon, Natalie; Schatzberg, Alan F.; O’Hara, Ruth

doi:10.1016/j.jagp.2014.02.001

Cited by 67 publications

(31 citation statements)

References 38 publications

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“…As hypothesized brain activity, but not clinical or demographic measures, significantly classified responder status. Findings are in keeping with accumulating reports that neural predictors are frequently better than clinical or demographic characteristics in determining who is likely to benefit from CBT (Ball et al, 2014, Klumpp et al, 2017, Thompson et al, 2015, Doehrmann et al, 2013). …”

Section: Discussionsupporting

confidence: 87%

“…Accruing data indicate brain-based predictors are frequently better in foretelling who is likely to improve following CBT relative to demographic or baseline clinical information alone (Ball et al, 2014, Klumpp et al, 2017, Thompson et al, 2015, Doehrmann et al, 2013). These reports suggest that baseline variance in brain activity interacts with CBT.…”

Section: Introductionmentioning

confidence: 99%

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Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation

Klumpp

Fitzgerald

Kinney

et al. 2017

NeuroImage: Clinical

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BackgroundCognitive Behavioral Therapy (CBT) for social anxiety disorder (SAD) and other internalizing conditions attempts to improve emotion regulation. Accumulating data indicate anterior cingulate cortex (ACC), and to a lesser extent amygdala, activation in various tasks predicts treatment outcome. However, little is known about ACC and amygdala activation to emotion regulation in predicting clinical improvement following CBT in SAD.MethodsBefore treatment, 38 SAD patients completed implicit and explicit emotion regulation paradigms during fMRI. Implicit regulation involved attentional control over negative distractors. Explicit regulation comprised cognitive reappraisal to negative images. Pre-CBT brain activity was circumscribed to anatomical-based ACC sub-regions (rostral, dorsal) and amygdala masks, which were submitted to ROC curves to examine predictive validity as well as correlational analysis to evaluate prognostic change in symptom severity.ResultsMore rostral (rACC) activity in implicit regulation and less rACC activity during explicit regulation distinguished responders (34%) from non-responders. Greater amygdala response in implicit regulation also foretold responder status. Baseline rACC and amygdala activity during attentional control correlated with pre-to-post CBT change in symptom severity such that more activation was related to greater decline in symptoms. No significant correlations were observed for explicit regulation.ConclusionsAcross forms of regulation, rACC activity predicted responder status whereas amygdala as a neuromarker was limited to implicit regulation. While the direction of effects (enhanced vs. reduced) in rACC activity was task-dependent, results suggest SAD patients with deficient regulation benefited more from CBT. Findings support previous studies involving patients with depression and suggest the rACC may be a viable marker of clinical improvement in SAD.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation

Klumpp

Fitzgerald

Kinney

et al. 2017

NeuroImage: Clinical

View full text Add to dashboard Cite

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“…Research has repeatedly demonstrated that older adults with deficits in cognitive control functions have a poor response to antidepressant medications (Alexopoulos, 2001; Alexopoulos, Kiosses, Klimstra, Kalayam, & Bruce, 2002; Kiosses, Klimstra, Murphy, & Alexopoulos, 2001; Manning et al, 2015; Morimoto et al, 2011) and some forms of psychotherapy (Thompson et al, 2015). The relationship of cognitive control dysfunction in older adults to poor antidepressants is supported by structural MRI, focal cerebral activation, and functional connectivity studies (Alexopoulos et al, 2012, 2013; Bredemeier et al, 2012; Gunning-Dixon et al, 2010; Gunning-Dixon, Brickman, Cheng, & Alexopoulos, 2009; Joormann & Gotlib, 2010; Kaiser, Andrews-Hanna, Wager, & Pizzagalli, 2015; Sheline, Price, Yan, & Mintun, 2010).…”

Section: | Introductionmentioning

confidence: 99%

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

2017

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Background Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. Methods In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. Results EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. Conclusions This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.

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“…These deficits, despite skilled therapy adaptations to compensate for them, may hamper effective CBT by impeding patients' ability to remember information discussed during therapy sessions, to acquire new, more flexible thinking styles or coping strategies, or to generalise specific issues discussed during therapy session to other situations. Consistent with this notion, there is empirical evidence to suggest that pretherapy level of cognitive function, in particular executive function [42][43][44][45] and the integrity of associated neural structures [46,47], influence the response to CBT for anxiety and depression, particularly in older adults who are likely to be cognitively compromised at least to some degree. Pretherapy level of neurocognitive function is likely to be an even stronger predictor of CBTp response in schizophrenia than the association seen in anxious, depressed or aged population, since this clinical population, on average, is known to be characterized by a range of neurocognitive deficits [48,49].…”

Section: Neuroimaging Predictors: Pre-therapy Brain Properties As Prementioning

confidence: 91%

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Kumari¹,

Terca²

2017

J Neuroimaging Psychiatry Neurol

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Up to 40% of schizophrenia patients continue to suffer from distressing symptoms despite remaining compliant with their prescribed antipsychotic medication. Additional symptom reduction following cognitive behaviour therapy for psychosis (CBTp) has been shown, but only in about 50% of such patients. A clear understanding of the neural changes following CBTp (potential mediators of improvement in target outcomes) as well as neural predictors of CBTp-led improvement (possible moderators) may help to refine or develop it further and increase its effectiveness. We provide a review of studies published to date (9 in total) examining the neural effects and/or predictors of CBTp. The studies analysed comprised of one spectroscopic imaging study on pre-vs post-CBTp changes, five functional magnetic resonance imaging studies [two analysing prevs post-CBTp changes, two analysing pre-therapy brain properties as predictors of symptom reduction following CBTp, and one analysing pre-vs post-CBTp changes in functional connectivity as the predictors of long term (over 7 years) outcome following CBTp], and three structural magnetic resonance imaging studies [two on pre-therapy brain properties as predictors of symptom change following CBTp, and one analysing pre-vs post-CBTp changes]. The findings from pre-vs post-CBTp brain activation studies demonstrate that CBTp reduces fronto-limbic activation to social threat and normalises cortico-limbic functional connectivity, indicating improved affect regulation through top-down control after CBTp. Additionally, CBTp was found to reduce pituitary volume, potentially by lowering of symptom-related distress. The findings from studies analysing pre-therapy brain properties as predictors of symptom reduction following CBTp indicate that functional and structural properties of multiple brain areas that are implicated in a range of cognitive functions, particularly the dorsolateral (cognitive flexibility), medial (self-awareness) and inferior (verbal skills) frontal cortices, hippocampus (memory) and precuneus (self-awareness), predict symptom reduction following CBTp. These results suggest a role for cognitive enhancement in the context of CBTp.

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fMRI Activation During Executive Function Predicts Response to Cognitive Behavioral Therapy in Older, Depressed Adults

Cited by 67 publications

References 38 publications

Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation

Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

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