UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
J Psychiatr Res. 2024 Apr;172:351-359. doi: 10.1016/j.jpsychires.2024.02.054. Epub 2024 Feb 26.
Cognitive Behavioral Therapy (CBT) is among the gold-standard psychotherapeutic interventions for the treatment of psychiatric disorders, including bipolar disorder (BD). While the clinical response of CBT in patients with BD has been widely investigated, its neural correlates remain poorly explored. Therefore, this scoping review aimed to discuss neuroimaging studies on CBT-based interventions in bipolar populations. Particular attention has been paid to similarities and differences between studies to inform future research. The literature search was conducted on PubMed, PsycINFO, and Web of Science databases in June 2023, identifying 307 de-duplicated records. Six studies fulfilled the inclusion criteria and were reviewed. All of them analyzed functional brain activity data. Four studies showed that the clinical response to CBT was associated with changes in the functional activity and/or connectivity of prefrontal and posterior cingulate cortices, temporal parietal junction, amygdala, precuneus, and insula. In two additional studies, a peculiar pattern of baseline activations in the prefrontal cortex, hippocampus, amygdala, and insula predicted post-treatment improvements in depressive symptoms, emotion dysregulation, and psychosocial functioning, although CBT-specific effects were not shown. These results suggest, at the very preliminary level, the potential of CBT-based interventions in modulating neural activity and connectivity of patients with BD, especially in regions ascribed to emotional processing. Nonetheless, the discrepancies between studies concerning aims, design, sample characteristics, and CBT and fMRI protocols do not allow conclusions to be drawn. Further research using multimodal imaging techniques, better-characterized BD samples, and standardized CBT-based interventions is needed.
认知行为疗法（CBT）是治疗精神障碍的黄金标准心理治疗干预方法之一，包括双相情感障碍（BD）。虽然 CBT 在 BD 患者中的临床反应已得到广泛研究，但它的神经相关性仍未得到充分探索。因此，本范围综述旨在讨论基于 CBT 的干预措施在双相人群中的神经影像学研究。特别关注了研究之间的相似点和差异，以为未来的研究提供信息。文献检索于 2023 年 6 月在 PubMed、PsycINFO 和 Web of Science 数据库中进行，共识别出 307 篇去重记录。有 6 项研究符合纳入标准并进行了综述。所有研究均分析了大脑功能活动数据。四项研究表明，CBT 的临床反应与前额叶和后扣带回皮质、颞顶联合区、杏仁核、楔前叶和岛叶的功能活动和/或连接的变化有关。在另外两项研究中，前额叶皮层、海马体、杏仁核和岛叶的基线激活的特定模式预测了治疗后抑郁症状、情绪调节和心理社会功能的改善，尽管没有显示出 CBT 特异性的效果。这些结果表明，在非常初步的水平上，基于 CBT 的干预措施有可能调节 BD 患者的神经活动和连接，特别是在与情绪处理相关的区域。尽管研究之间在目标、设计、样本特征以及 CBT 和 fMRI 方案方面存在差异，但仍无法得出结论。需要使用多模态成像技术、更好地描述的 BD 样本和标准化的基于 CBT 的干预措施进行进一步的研究。
