Neural Reactivity to Reward as a Predictor of Cognitive Behavioral Therapy Response in Anxiety and Depression

Abstract

Background Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety and depression; however, response to CBT is heterogeneous across patients and many remain symptomatic after therapy, raising the need to identify prospective predictors for treatment planning. Altered neural processing of reward has been implicated in both depression and anxiety, and improving hedonic capacity is a goal of CBT. However, little is known about how neural response to reward relates to CBT outcomes in depression and anxiety. The current study used the reward positivity (RewP) event-related potential (ERP) component to examine whether neural reactivity to reward would predict CBT response in a sample of patients with anxiety without depression (n = 30) and comorbid anxiety and depression (CAD, n = 22). Methods Participants completed a guessing reward ERP paradigm before completing 12 weeks of standard CBT. Results The majority of the sample (68%; 35 of 52 patients) responded to treatment, and those with a reduced RewP at baseline were more likely to respond to treatment. A reduced RewP was also associated with a greater pre-to-post CBT reduction in depressive symptoms among individuals with CAD, but not among individuals with pure anxiety. Conclusions CBT may be most beneficial in reducing depressive symptoms for individuals who demonstrate decreased reward reactivity prior to treatment. CBT may target reward brain function, leading to greater improvement in symptoms. These effects may be strongest, and therefore most meaningful, for individuals with reward processing deficits prior to treatment.

Neural reactivity to reward and internalizing symptom dimensions

“…Therefore, interventions that are comprised of behavioral activation or distress-based exposures may prove to be the most beneficial treatment for patients who present with reward processing deficits. We also recently demonstrated that a more blunted RewP among adult patients with depression and anxiety predicted greater treatment gains with cognitive behavior therapy (Burkhouse et al, 2016), supporting the notion that this measure can also be useful in identifying those most likely to benefit from intervention. Future research would benefit from examining whether the RewP also demonstrates state-like properties and can be altered through treatment or environmental factors (i.e., stress).…”

Vulnerability to Depression in Youth: Advances From Affective Neuroscience

“…Combining established risk factors (e.g., parental depression) and affective measures (e.g., blunted reward responses) may further improve efforts to identify youth at greatest risk, while providing a specific target and objective marker of outcome (e.g., increasing reward reactivity). We recently demonstrated that a more blunted RewP among adult patients with depression and anxiety predicted greater treatment gains with cognitive behavior therapy (84), supporting the possibility that affective neuroscience methods can be used to identify those most likely to benefit from intervention.…”

The Utility of Event-Related Potentials in Clinical Psychology

“…ERPs can be readily integrated into traditional treatment outcome studies because they can be examined both in relationship to clinical change and as pretreatment predictors of clinical change. If ERPs can predict treatment-related responses, they could then be used to identify those patients who might respond best to treatment (Burkhouse et al 2016) or to help assign patients to specific treatments. ERPs could be used for determining what works best and for whom.…”