Group Cognitive Behavior Therapy Reversed Insula Subregions Functional Connectivity in Asthmatic Patients

Abstract

Background: Group cognitive behavior therapy (GCBT) is an effective treatment in improving self-management behaviors and quality of life for asthmatic patients. However, the mechanisms by which GCBT improves asthma-related clinical symptoms remain unknown. Previous studies have indicated that insula is an important region involved in the neuropathology of asthma. Therefore, we examined the possible alteration of functional connectivity (FC) in insula subregions after GCBT in asthmatic patients.Methods: Forty-two asthmatic patients and 60 healthy controls (HCs) received resting-state functional magnetic resonance imaging (rs-fMRI) scan and clinical assessments, 17 asthmatic patients completed GCBT treatment consisting of 8 sessions, and then received rs-fMRI scan and clinical assessments.Results: Asthmatic patients had greater left ventral anterior insula (vAI) FC with the left cerebellum posterior lobe, right middle temporal gyrus, and bilateral anterior cingulate cortex (ACC), but less FC with bilateral postcentral gyrus, bilateral occipital lobe, and left precentral gyrus compared with HCs. FC between left posterior insula and left medial frontal gyrus also increased in the patients. In addition, right vAI showed increased FC with right caudate and left putamen. FC between right dorsal anterior insula (dAI) and left calcarine however decreased. The increase in FC in insula subregions were significantly improved following GCBT. FC between the left vAI connectivity and left postcentral gyrus was positively correlated with the percentage of improvement in 17-items Hamilton depression rating scale scores, and FC between the right dAI and left calcarine was negatively associated with the improvement percentage in asthma control test scores.Conclusions: This study in the first time demonstrated that GCBT led to significant improvement of FC between insula subregions and other brain regions.Clinical Trial Registration: An investigation of therapeutic mechanism in asthmatic patients: based on the results of Group Cognitive Behavioral Therapy (Registration number: ChiCTR-COC-15007442) (http://www.chictr.org.cn/usercenter.aspx).

Predicting Response to Group Cognitive Behavioral Therapy in Asthma by a Small Number of Abnormal Resting-State Functional Connections

“…It is the first study to identify therapeutic mechanism of GCBT in asthma using brain functional connections derived from resting-state fMRI. The current study further supported our previous findings that GCBT would play the therapeutic role by regulating abnormal brain activities ( Zhang et al, 2017a ,b). In the current study, we discovered discriminant FC patterns with the data-driven method including lasso, SVC, and t -test.…”

“…And these connections were increased after treatment close to the values of controls, as well as correlated with the asthma control level. These findings are consistent with those in patients with asthma ( Zhang et al, 2017a ; Li et al, 2018 ; Ritz et al, 2019 ) and chronic obstructive pulmonary disease ( Zhang et al, 2013 ), which reported that the abnormal activity in the SFG and FC between right MTG and insula were both associated with lower asthma control level and stronger airway inflammation or arterial blood PO 2 . However, GCBT reversed the abnormal FC patterns between the superior cerebellum and SFG and MTG.…”

“…In recent decades, magnetic resonance imaging (MRI) shows the advancement and provides the opportunities to investigate the neural underpinnings of GCBT non-invasively, such as GCBT in depression ( Sosic-Vasic et al, 2017 ; Sambataro et al, 2018 ) and anxiety ( Whitfield-Gabrieli et al, 2016 ; Klumpp et al, 2017 ; MinlanYuan, Meng et al, 2017 ). Meanwhile, some neurophysiological mechanisms underlying GCBT for asthma have been detected in our previous studies ( Zhang et al, 2017a , b ), and we found that abnormal spontaneous activity and insula functional connectivity (FC) would be reversed after treatment. Emotional disorder-related studies suggested that neuroimaging biomarkers could be used in predicting response to GCBT ( Doehrmann et al, 2013 ; Whitfield-Gabrieli et al, 2016 ).…”

“…One of them was eliminated due to data quality. The contents of GCBT were reported in our previous study, which consisted of eight sessions ( Zhang et al, 2017a ). This study was approved by the recommendations of the ethics committee (Zhongda Hospital, Southeast University, Nanjing, China, No.…”

Inefficient Involvement of Insula in Sensorineural Hearing Loss

“…We extracted the relative volume and mean CBF values of the two ROIs and identified changes in structure and perfusion caused by SNHL (two-sample t -test, p < 0.05). Consistent with previous research (Zamorano et al, 2017; Zhang et al, 2017b), bilateral vAI, dAI and PI subdivisions were used as seeds in the whole-brain FC analysis (see Table 2 for the coordinates of six ROIs). The resulting FC maps were transformed using Fisher’s z to yield normally distributed data and the data averaged for each subject.…”