Neural Effects of Cognitive Behavioral Therapy in Psychiatric Disorders: A Systematic Review and Activation Likelihood Estimation Meta-Analysis

Abstract

BackgroundCognitive behavioral therapy (CBT) is a first-line psychotherapeutic treatment that has been recommended for psychiatric disorders. Prior neuroimaging studies have provided preliminary evidence suggesting that CBT can have an impact on the activity of brain regions and functional integration between regions. However, the results are far from conclusive. The present article aimed to detect characteristic changes in brain activation following CBT across psychiatric disorders.MethodWeb of Science, Cochrane Library, Scopus, and PubMed databases were searched to identify whole-brain functional neuroimaging studies of CBT through 4 August 2021. To be included in the meta-analysis, studies were required to examine functional activation changes between pre-and post-CBT. The included studies were then divided into subgroups according to different task paradigms. Then, an activation likelihood estimation algorithm (ALE) was performed in the different meta-analyses to identify whether brain regions showed consistent effects. Finally, brain regions identified from the meta-analysis were categorized into eight functional networks according to the spatial correlation values between independent components and the template.ResultsIn total, 13 studies met inclusion criteria. Three different meta-analyses were performed separately for total tasks, emotion tasks, and cognition tasks. In the total task ALE meta-analysis, the left precuneus was found to have decreased activation. For the cognition task ALE meta-analysis, left anterior cingulate (ACC) and left middle frontal gyrus (MFG) were found to have decreased activation following CBT. However, the emotion task ALE meta-analysis did not find any specific brain regions showing consistent effects. A review of included studies revealed default mode network (DMN), executive control network (ECN), and salience network (SN) were the most relevant among the eight functional networks.ConclusionThe results revealed that the altered activation in the prefrontal cortex and precuneus were key regions related to the effects of CBT. Therefore, CBT may modulate the neural circuitry of emotion regulation. This finding provides recommendations for the rapidly developing literature.

Construction of Meta-Thinking Educational Program Based on Mental-Brain Simulation (MTMBS) and Evaluating its Effectiveness on Executive Functions, Emotion Regulation, and Impulsivity in Children With ADHD: A Resting-State Functional MRI Study

“…They noted that in this group, it can improve the emotion regulation by using effective and social intervention programs. The research of Yuan et al (2022) showed that CBT in patients with psychiatric disorders is associated with a significant decrease in activity in ECN, MPFC, ACC and Precuneus, and this decrease of activity can improve cognition and regulate activities. In addition, the findings of La Buissonniere-Ariza et al (2021) and Vuper et al (2021) show that CBT improves cognitive function by affecting internal connectivity and interaction between brain networks.…”

Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing Therapeutic Components of Cognitive Behavioral Therapy

“…Yet, the fact that these adjuvant techniques do not reproduce the dual model explaining CBT efficacy may contribute to the idea that CBT, as a set of therapeutic tools, activates different processes according to the specific tool used. This may also contribute to explaining the discrepancies observed in the neural bases of CBT efficacy [ 18 , 19 ]. These findings have at least two implications: (i) the design of treatment programs will be improved by translating these findings into clinical practice, and (ii) it is necessary to study each part of CBT packages, because they may activate different underlying mechanisms.…”

“…However, data provided by neuroimaging studies about neural changes produced by CBT are more complex than the dual model [ 18 ]. A systematic review about the changes associated with CBT in mental health disorders has found a decrease in the activity of the default mode network [ 19 ]. This network includes the precuneus, posterior cingulate cortex, inferior lateral parietal gyrus, anterior cingulate cortex, and medial frontal cortex and is responsible for introspection processes, vigilance, and preparation for changes in the external environment.…”

“…These findings do not support the dual model, since some studies have shown the activation of prefrontal areas, but this activation does not always entail a deactivation of limbic areas [ 20 ]. Some researchers have also found an altered function of the anterior cingulate gyrus and precuneus, which are areas usually associated with pre-limbic emotional regulatory processing and intentional behaviors [ 19 ]. Similarly, Picó-Pérez et al [ 18 ] found that CBT in anxiety-related disorders activated associative areas, such as the dorsomedial prefrontal cortex, anterior cingulate gyrus, right inferior frontal gyrus, and anterior insular cortex.…”

Postdiction in Visual Awareness in Schizophrenia

“…CBT may add extra value to the treatment process via different mechanisms. CBT modulates selective attention, executive functions, attributions, and learning and memory by strengthening the adaptive and flexible functioning of the prefrontal cortex [ 36 , 47 ]. Altogether, the antipsychotics plus CBT combination targets symptoms and cognitive biases focusing on two distinct levels: bottom-up reduction of abnormal salience to predictions (less conviction in beliefs) by antipsychotics and the enhancement of flexible top-down control from the prefrontal cortex (revision and updating of beliefs).…”