Department of Psychology, University of Halle, Germany.
Department of Psychology, University of Halle, Germany.
J Affect Disord. 2025 Jan 1;368:872-887. doi: 10.1016/j.jad.2024.09.084. Epub 2024 Sep 17.
Depressive disorders are associated with alterations in brain function, affecting processes such as affective and reward processing and emotion regulation. However, the influence of Cognitive Behavioral Therapy (CBT) on the neuronal patterns remains inadequately understood. Therefore, this review systematically summarizes longitudinal fMRI brain activity changes in depressive patients treated with CBT and their association with symptom remission.
This systematic review was conducted according to the PRISMA statement. Out of 2149 results of the literature search, N = 14 studies met the inclusion criteria (e.g., diagnosis of a current depressive disorder, assessment of longitudinal task-based fMRI, and the analysis of functional changes before and after CBT).
The findings reveal (1) diminished limbic reactivity following CBT across various tasks, (2) increased striatal activity during reward processing, but decreased activity during affective processing and future thinking, and (3) alterations in cingulate and prefrontal cortex activity across tasks. Partially, these results are associated with symptom remission, especially in the subgenual anterior cingulate cortex.
There are heterogenous results especially in cortical areas that might partially be due to methodological issues like differences across the studies in terms of task content, statistical evaluation, and interventions. Thus, future research should focus on the standardization of methodologies.
The results indicate that CBT partially normalizes the neural patterns of depressive patients, particularly within regions involved in affective and reward processing and the development of negative cognitive biases. Overall, potential neural mechanisms underlying CBT were identified, underscoring its effectiveness on an objective neurobiological basis.
抑郁障碍与大脑功能改变有关，影响情感和奖励处理以及情绪调节等过程。然而，认知行为疗法（CBT）对神经元模式的影响仍了解不足。因此，本综述系统总结了接受 CBT 治疗的抑郁患者的纵向 fMRI 大脑活动变化及其与症状缓解的关系。
本系统评价按照 PRISMA 声明进行。在对文献进行搜索后，共得到 2149 项结果，其中 N=14 项研究符合纳入标准（例如，当前抑郁障碍的诊断、基于任务的纵向 fMRI 评估以及 CBT 前后功能变化的分析）。
研究结果显示（1）CBT 后各种任务的边缘反应性降低，（2）奖励处理时纹状体活动增加，但情感处理和未来思维时活动减少，以及（3）各种任务的扣带回和前额叶皮层活动改变。部分结果与症状缓解有关，特别是在前扣带回皮质亚区。
存在异质性结果，特别是在皮质区域，部分原因可能是由于方法学问题，例如研究之间在任务内容、统计评估和干预方面存在差异。因此，未来的研究应侧重于方法的标准化。
结果表明，CBT 部分使抑郁患者的神经模式正常化，特别是在涉及情感和奖励处理以及负面认知偏差发展的区域。总的来说，确定了 CBT 背后的潜在神经机制，强调了其在客观神经生物学基础上的有效性。
