Neural effects of cognitive–behavioural therapy on dysfunctional attitudes in depression

Abstract

Background. Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive-behavioural therapy (CBT).Method. Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48).Results. MDD patients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDD patients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDD patients at the follow-up scan relative to healthy controls.Conclusions. Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.

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

“…As for the limbic activity, Sankar and colleagues enrolled MDD patients treated with CBT (16 sessions) and healthy controls and applied a fMRI paradigm during statements attribution derived from a modified Dysfunctional Attitudes Scale [46]. Post-CBT, patients were found to have a decrease in the activity of left parahippocampal gyrus, the activity of which was reported to be increased in depression [47,48].…”

Adolescent Major Depressive Disorder: Neuroimaging Evidence of Sex Difference during an Affective Go/No-Go Task

“…The supramarginal gyrus is located within the inferior parietal lobe, a region thought to be involved in attention, processing of written language, and working memory of emotional stimuli (53). Several studies suggest a relationship between MDD and supramarginal gyrus (54, 55).…”

A quick behavioral dichotic word test is prognostic for clinical response to cognitive therapy for depression: A replication study

“…Thus, we hypothesize that individuals who respond well to CT are better able to recruit cognitive processes involving left cortical regions critical for the success of CT. Indeed, left prefrontal and temporal activity have been observed in association with CT-related skills, such as reappraisal (Price et al 2013; Silvers et al 2015), and extreme endorsement of dysfunctional attitudes, which CT aims to reduce, has been associated with greater activation of left hippocampal, left inferior parietal, and left precuneus regions in MDD patients than healthy controls (Sankar et al 2015), though the hemispheric specificity of these findings has not been tested. Together, these findings suggest that ability of individuals to access left hemisphere regions, not only during verbal dichotic listening but also during CT, may bode well for successful outcome of treatment.…”