Feurer Cope, Jimmy Jagan, Uribe Melissa, Shankman Stewart A, Langenecker Scott A, Craske Michelle G, Ajilore Olusola, Phan K Luan, Klumpp Heide
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
Psychol Med. 2024 Aug;54(11):3025-3035. doi: 10.1017/S0033291724001120. Epub 2024 May 22.
Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.
Participants were 75 treatment-seeking patients with SAD ( = 34) or MDD ( = 41) randomized to CBT ( = 40) or ST ( = 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.
Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm.
If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.
认知行为疗法（CBT）是治疗社交焦虑障碍（SAD）或重度抑郁症（MDD）患者的有效方法，但临床改善情况存在差异。尽管先前的研究表明，支持认知重评的脑区（如背外侧前额叶皮层 [dlPFC]）在治疗前的激活情况可预测SAD患者对CBT的反应，但尚不清楚这是否也适用于MDD，或者是否特定于CBT。本研究考察了在进行CBT或支持性治疗（ST，一种共同因素对照治疗）试验后，SAD或MDD患者在重评过程中的治疗前神经活动与临床改善之间的关联。
75名寻求治疗的SAD患者（n = 34）或MDD患者（n = 41）被随机分配至CBT组（n = 40）或ST组（n = 35）。在随机分组前，患者在功能磁共振成像期间完成一项认知重评任务。此外，患者在治疗前以及治疗期间每2周完成一次由临床医生进行的症状测量和一项自我报告的认知重评测量。
结果表明，重评过程中的治疗前神经活动对CBT和ST反应具有不同的预测作用。具体而言，在整个治疗过程中，症状改善轨迹越大，CBT患者腹外侧前额叶皮层（vlPFC）的活动越少，而ST患者的vlPFC活动越多。此外，无论治疗组如何，基线dlPFC活动越少，自我报告的重评改善轨迹越大。
如果得到重复验证，研究结果表明，重评过程中大脑反应的个体差异可能在跨诊断层面上与症状严重程度的治疗依赖性改善相关，但更广泛地说，与心理治疗后主观重评的改善相关。
