1
|
Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
Collapse
Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| |
Collapse
|
2
|
Strege MV, Siegle GJ, Richey JA, Krawczak RA, Young K. Cingulate prediction of response to antidepressant and cognitive behavioral therapies for depression: Meta-analysis and empirical application. Brain Imaging Behav 2023; 17:450-460. [PMID: 36622532 PMCID: PMC10329727 DOI: 10.1007/s11682-022-00756-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023]
Abstract
We sought to identify baseline (pre-treatment) neural markers associated with treatment response in major depressive disorder (MDD), specific to treatment type, Cognitive Behavioral Therapy (CBT) or pharmacotherapy (selective serotonin reuptake inhibitors; SSRI). We conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies to identify neural prognostic indicators of response to CBT or SSRI. To verify the regions derived from literature, the meta-analytic regions were used to predict clinical change in a verification sample of participants with MDD who received either CBT (n = 60) or an SSRI (n = 19) as part of prior clinical trials. The meta-analysis consisted of 21 fMRI studies that used emotion-related tasks. It yielded prognostic regions of the perigenual (meta pgACC) and subgenual anterior cingulate cortex (meta sgACC), associated with SSRI and CBT response, respectively. When applying the meta-analytic regions to predict treatment response in the verification sample, reactivity of the meta pgACC was prognostic for SSRI response, yet the effect direction was opposite of most prior studies. Meta sgACC reactivity failed to be prognostic for CBT response. Results confirm the prognostic potential of neural reactivity of ACC subregions in MDD but further research is necessary for clinical translation.
Collapse
Affiliation(s)
- Marlene V Strege
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States
| | - John A Richey
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | | | - Kymberly Young
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States
| |
Collapse
|
3
|
Klöbl M, Gryglewski G, Rischka L, Godbersen GM, Unterholzner J, Reed MB, Michenthaler P, Vanicek T, Winkler-Pjrek E, Hahn A, Kasper S, Lanzenberger R. Predicting Antidepressant Citalopram Treatment Response via Changes in Brain Functional Connectivity After Acute Intravenous Challenge. Front Comput Neurosci 2020; 14:554186. [PMID: 33123000 PMCID: PMC7573155 DOI: 10.3389/fncom.2020.554186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/31/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction: The early and therapy-specific prediction of treatment success in major depressive disorder is of paramount importance due to high lifetime prevalence, and heterogeneity of response to standard medication and symptom expression. Hence, this study assessed the predictability of long-term antidepressant effects of escitalopram based on the short-term influence of citalopram on functional connectivity. Methods: Twenty nine subjects suffering from major depression were scanned twice with resting-state functional magnetic resonance imaging under the influence of intravenous citalopram and placebo in a randomized, double-blinded cross-over fashion. Symptom factors were identified for the Hamilton depression rating scale (HAM-D) and Beck's depression inventory (BDI) taken before and after a median of seven weeks of escitalopram therapy. Predictors were calculated from whole-brain functional connectivity, fed into robust regression models, and cross-validated. Results: Significant predictive power could be demonstrated for one HAM-D factor describing insomnia and the total score (r = 0.45-0.55). Remission and response could furthermore be predicted with an area under the receiver operating characteristic curve of 0.73 and 0.68, respectively. Functional regions with high influence on the predictor were located especially in the ventral attention, fronto-parietal, and default mode networks. Conclusion: It was shown that medication-specific antidepressant symptom improvements can be predicted using functional connectivity measured during acute pharmacological challenge as an easily assessable imaging marker. The regions with high influence have previously been related to major depression as well as the response to selective serotonin reuptake inhibitors, corroborating the advantages of the current approach of focusing on treatment-specific symptom improvements.
Collapse
Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucas Rischka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Jakob Unterholzner
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Murray Bruce Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Paul Michenthaler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Edda Winkler-Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Preuss A, Bolliger B, Schicho W, Hättenschwiler J, Seifritz E, Brühl AB, Herwig U. SSRI Treatment Response Prediction in Depression Based on Brain Activation by Emotional Stimuli. Front Psychiatry 2020; 11:538393. [PMID: 33281635 PMCID: PMC7691246 DOI: 10.3389/fpsyt.2020.538393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: The prediction of antidepressant treatment response may improve outcome. Functional magnetic resonance imaging (fMRI) of emotion processing in major depressive disorder (MDD) may reveal regional brain function serving as predictors of response to treatment with selective serotonin reuptake inhibitor (SSRI). Methods: We examined the association between pre-treatment neural activity by means of fMRI during the perception of emotional stimuli in 22 patients with MDD and the treatment outcome after 6 weeks' medication with an SSRI. A whole brain correlation analysis with Beck Depression Inventory (BDI) change between pre- to post-treatment was conducted to identify neural regions associated with treatment response. Results: During the perception of positive stimuli, responders were characterized by more activation in posterior cingulate cortex (PCC), medial prefrontal cortex, and thalamus as well as middle temporal gyrus. During perception of negative stimuli, PCC, and pregenual anterior cingulate cortex showed the highest correlation with treatment response. Furthermore, responders exhibited higher activation to emotional stimuli than to neutral stimuli in all the above-mentioned regions, while non-responders demonstrated an attenuated neural response to emotional compared to neutral stimuli. Conclusion: Our data suggest that the activity of distinct brain regions is correlated with SSRI treatment outcome and may serve as treatment response predictor. While some regions, in which activity was correlated with treatment response, can be assigned to networks that have been implied in the pathophysiology of depression, most of our regions of interest could also be matched to the default mode network (DMN). Higher DMN activity has been associated with increased rumination as well as negative self-referential processing in previous studies. This may suggest our responders to SSRI to be characterized by such dysregulations and that SSRIs might modify the function associated with this network.
Collapse
Affiliation(s)
- Antonia Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland.,Clinic for Psychiatry and Psychotherapy Clienia, Oetwil am See, Switzerland
| | - Bianca Bolliger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland
| | - Wenzel Schicho
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland
| | - Josef Hättenschwiler
- Center for Treatment of Anxiety and Affection Disorder Zentrum für Angst- und Depressionsbehandlung Zürich (ZADZ), Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland
| | - Annette Beatrix Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland
| | - Uwe Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Zurich, Switzerland.,Center for Psychiatry Reichenau, Academic Hospital University of Konstanz, Konstanz, Germany
| |
Collapse
|
5
|
Grodin EN, Lim AC, MacKillop J, Karno MP, Ray LA. An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention. Front Psychiatry 2019; 10:408. [PMID: 31244697 PMCID: PMC6580427 DOI: 10.3389/fpsyt.2019.00408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual's openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non-treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non-treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.
Collapse
Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mitchell P. Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
6
|
Langenecker SA, Klumpp H, Peters AT, Crane NA, DelDonno SR, Bessette KL, Ajilore O, Leow A, Shankman SA, Walker SJ, Ransom MT, Hsu DT, Phan KL, Zubieta JK, Mickey BJ, Stange JP. Multidimensional imaging techniques for prediction of treatment response in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:38-48. [PMID: 30009871 PMCID: PMC6556149 DOI: 10.1016/j.pnpbp.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/31/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
A large number of studies have attempted to use neuroimaging tools to aid in treatment prediction models for major depressive disorder (MDD). Most such studies have reported on only one dimension of function and prediction at a time. In this study, we used three different tasks across domains of function (emotion processing, reward anticipation, and cognitive control, plus resting state connectivity completed prior to start of medication to predict treatment response in 13-36 adults with MDD. For each experiment, adults with MDD were prescribed only label duloxetine (all experiments), whereas another subset were prescribed escitalopram. We used a KeyNet (both Task derived masks and Key intrinsic Network derived masks) approach to targeting brain systems in a specific match to tasks. The most robust predictors were (Dichter et al., 2010) positive response to anger and (Gong et al., 2011) negative response to fear within relevant anger and fear TaskNets and Salience and Emotion KeyNet (Langenecker et al., 2018) cognitive control (correct rejections) within Inhibition TaskNet (negative) and Cognitive Control KeyNet (positive). Resting state analyses were most robust for Cognitive control Network (positive) and Salience and Emotion Network (negative). Results differed by whether an -fwhm or -acf (more conservative) adjustment for multiple comparisons was used. Together, these results implicate the importance of future studies with larger sample sizes, multidimensional predictive models, and the importance of using empirically derived masks for search areas.
Collapse
Affiliation(s)
| | - Heide Klumpp
- University of Illinois at Chicago,University of Michigan
| | | | | | | | | | | | | | | | - Sara J. Walker
- University of Michigan,University of Oregon Health Sciences
| | | | | | - K. Luan Phan
- University of Illinois at Chicago,University of Michigan
| | | | | | | |
Collapse
|
7
|
Klumpp H, Kinney KL, Kennedy AE, Shankman SA, Langenecker SA, Kumar A, Phan KL. Trait attentional control modulates neurofunctional response to threat distractors in anxiety and depression. J Psychiatr Res 2018; 102:87-95. [PMID: 29674271 DOI: 10.1016/j.jpsychires.2018.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 02/11/2018] [Accepted: 03/25/2018] [Indexed: 12/29/2022]
Abstract
Accumulating data suggest attentional control capability varies across psychiatric diagnostic boundaries. The Attentional Control Scale (ACS) assesses self-reported trait attentional control (TAC) and tracks the anterior attention system. Greater TAC is associated with less negative affect, however, its mechanisms in anxiety and depression are poorly understood. Therefore, we examined whether individual differences in TAC modulated top-down mechanisms in a clinical sample. During fMRI, 104 patients with social anxiety, generalized anxiety, and/or major depression and 34 healthy participants completed a validated attentional control paradigm comprising strings of letters superimposed on threatening and neutral face distractors. In the low perceptual load condition, a target letter was in a string of identical letters. In the high load condition, a target letter was in a mixed letter string. Whole-brain regression results for low load revealed more activation to threat (vs. neutral) distractors in the pregenual anterior cingulate cortex was predicted by better TAC (i.e., higher ACS scores). For high load, regression results showed less activation to threat (vs. neutral) distractors in the inferior frontal gyrus was predicted by better TAC. An exploratory whole-brain ANOVA revealed a main effect of group in the superior temporal gyrus and a main effect of perceptual load in parietal, frontal, and limbic regions. No other effects were detected and activation derived from significant ANOVA results did not correlate with ACS scores. In conclusion, regression findings suggest individual differences in brain-behavioral ACS-related activity in frontal structures may be useful in identifying phenotypes in internalizing conditions.
Collapse
Affiliation(s)
- Heide Klumpp
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States.
| | - Kerry L Kinney
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Amy E Kennedy
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Stewart A Shankman
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott A Langenecker
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Anand Kumar
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - K Luan Phan
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, United States
| |
Collapse
|