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Resting-state connectivity predictors of response to psychotherapy in major depressive disorder.

New Study (1)Abstract
Despite the heterogeneous symptom presentation and complex etiology of major depressive disorder (MDD), functional neuroimaging studies have shown with remarkable consistency that dysfunction in mesocorticolimbic brain systems are central to the disorder. Relatively less research has focused on the identification of biological markers of response to antidepressant treatment that would serve to improve the personalized delivery of empirically supported antidepressant interventions. In the present study, we investigated whether resting-state functional brain connectivity (rs-fcMRI) predicted response to Behavioral Activation Treatment for Depression, an empirically validated psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors. Twenty-three unmedicated outpatients with MDD and 20 matched nondepressed controls completed rs-fcMRI scans after which the MDD group received an average of 12 sessions of psychotherapy. The mean change in Beck Depression Inventory-II scores after psychotherapy was 12.04 points, a clinically meaningful response. Resting-state neuroimaging data were analyzed with a seed-based approach to investigate functional connectivity with four canonical resting-state networks: the default mode network, the dorsal attention network, the executive control network, and the salience network. At baseline, the MDD group was characterized by relative hyperconnectivity of multiple regions with precuneus, anterior insula, dorsal anterior cingulate cortex (dACC), and left dorsolateral prefrontal cortex seeds and by relative hypoconnectivity with intraparietal sulcus, anterior insula, and dACC seeds. Additionally, connectivity of the precuneus with the left middle temporal gyrus and connectivity of the dACC with the parahippocampal gyrus predicted the magnitude of pretreatment MDD symptoms. Hierarchical linear modeling revealed that response to psychotherapy in the MDD group was predicted by pretreatment connectivity of the right insula with the right middle temporal gyrus and the left intraparietal sulcus with the orbital frontal cortex. These results add to the nascent body of literature investigating pretreatment rs-fcMRI predictors of antidepressant treatment response and is the first study to examine rs-fcMRI predictors of response to psychotherapy.

 

Crowther, A., Smoski, M.J., Minkel, J., Moore, T., Gibbs, D., Petty, C., Dichter, G.S. (2015). Resting-state connectivity predictors of response to psychotherapy in major depressive disorder. Neuropsychopharmacology, 40, 1659-1673. doi: 10.038/npp205.12

A Monthly Summary of Beck Institute Updates [April 2012]

In its efforts to encourage the growth and dissemination of CBT throughout the world, the Beck Institute has expanded its online presence across social media and other platforms. To keep you (our readers) informed of our most recent updates, we’ve decided to implement a monthly summary including: blogs, CBT articles, and CBT trainings, and other updates for our readers. Please use the following links to go back and read what you may have missed from April 2012:

See what you missed in March

Mood Disorders: Effects of Intensive CBT

NewStudy-Graphic-72x72_edited-3A recent study in the Journal of Psychiatric Practice found that Cognitive Behavioral Therapy (CBT) interventions used in an intensive partial-hospital (PH) setting are effective in treating severe mood disorders.

PH settings differ from inpatient treatment in that they are more flexible and less expensive. In this study, with CBT as the primary treatment, the length of stay was only 2 weeks. The researchers’ aims were to find the specific aspects of CBT that were successful in the treatment of mood disorders in a short-term PH setting.

The treatment included group and individual psychotherapy. Patients attended 12-20 group sessions per week. A written treatment contract was used and reviewed weekly to set specific goals and promote collaboration between patients and staff.

Group therapy was primarily CBT-oriented. The goals of therapy included teaching self-assessment (such as challenging maladaptive thoughts), behavioral coping (such as behavioral scheduling and behavioral activation), and developing better and more effective communication strategies.

The two-week treatment was divided into two stages. In the first, patients learned to identify triggers and utilize cognitive restructuring, among other interventions. The second stage included relapse prevention plans for a crisis situation and future plans (such as returning to work or school).

The researchers showed that both behavioral activation and a decrease in negative cognitions are associated with a decrease in depressive symptomatology at discharge. Additionally a decrease in negative thinking is associated with reduced general psychological distress at discharge.

Study Authors: M. S. Christopher, K. L. Jacob, E. C. Neuhaus, T. J. Neary, L. A. Fiola