Department of Psychiatry, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
Department of Psychology, Columbia University, New York, NY, USA.
Psychiatry Res Neuroimaging. 2018 Jan 30;271:82-90. doi: 10.1016/j.pscychresns.2017.11.002. Epub 2017 Nov 8.
Cognitive behavioral therapy (CBT) is effective for a substantial minority of patients suffering from major depressive disorder (MDD), but its mechanism of action at the neural level is not known. As core techniques of CBT seek to enhance emotion regulation, we scanned 31 MDD participants prior to 14 sessions of CBT using functional magnetic resonance imaging (fMRI) and a task in which participants engaged in a voluntary emotion regulation strategy while recalling negative autobiographical memories. Eighteen healthy controls were also scanned. Twenty-three MDD participants completed post-treatment fMRI scanning, and 12 healthy volunteers completed repeat scanning without intervention. Better treatment outcome was associated with longitudinal enhancement of the emotion regulation-dependent BOLD contrast within subgenual anterior cingulate, medial prefrontal cortex, and lingual gyrus. Baseline emotion regulation-dependent BOLD contrast did not predict treatment outcome or differ between MDD and control groups. CBT response may be mediated by enhanced downregulation of neural activity during emotion regulation; brain regions identified overlap with those found using a similar task in a normative sample, and include regions related to self-referential and emotion processing. Future studies should seek to determine specificity of this downregulation to CBT, and evaluate it as a treatment target in MDD.
认知行为疗法（CBT）对大量患有重度抑郁症（MDD）的患者有效，但它在神经水平上的作用机制尚不清楚。由于 CBT 的核心技术旨在增强情绪调节能力，我们在 14 次 CBT 治疗前使用功能磁共振成像（fMRI）对 31 名 MDD 参与者和一项任务进行了扫描，参与者在回忆消极的自传体记忆时采用了自愿的情绪调节策略。还扫描了 18 名健康对照者。23 名 MDD 参与者完成了治疗后的 fMRI 扫描，12 名健康志愿者在没有干预的情况下重复扫描。更好的治疗效果与亚属前扣带回、内侧前额叶皮质和舌回内情绪调节依赖性 BOLD 对比的纵向增强相关。基线情绪调节依赖性 BOLD 对比不能预测治疗效果，也不能区分 MDD 组和对照组。CBT 反应可能是通过增强情绪调节过程中的神经活动的下调来介导的；在正常样本中使用类似任务发现的大脑区域与 CBT 反应相关，包括与自我参照和情绪处理相关的区域。未来的研究应该确定这种下调对 CBT 的特异性，并将其评估为 MDD 的治疗靶点。
