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Davis SW, Beynel L, Neacsiu AD, Luber BM, Bernhardt E, Lisanby SH, Strauman TJ. Network-level dynamics underlying a combined rTMS and psychotherapy treatment for major depressive disorder: An exploratory network analysis. Int J Clin Health Psychol 2023; 23:100382. [PMID: 36922930 PMCID: PMC10009060 DOI: 10.1016/j.ijchp.2023.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/16/2023] [Indexed: 03/07/2023] Open
Abstract
Background Despite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression, there is a limited understanding of the mechanisms of action and how potential treatment-related brain changes help to characterize treatment response. To address this gap in understanding we investigated the effects of an approach combining rTMS with simultaneous psychotherapy on global functional connectivity. Method We compared task-related functional connectomes based on an idiographic goal priming task tied to emotional regulation acquired before and after simultaneous rTMS/psychotherapy treatment for patients with major depressive disorders and compared these changes to normative connectivity patterns from a set of healthy volunteers (HV) performing the same task. Results At baseline, compared to HVs, patients demonstrated hyperconnectivity of the DMN, cerebellum and limbic system, and hypoconnectivity of the fronto-parietal dorsal-attention network and visual cortex. Simultaneous rTMS/psychotherapy helped to normalize these differences, which were reduced after treatment. This finding suggests that the rTMS/therapy treatment regularizes connectivity patterns in both hyperactive and hypoactive brain networks. Conclusions These results help to link treatment to a comprehensive model of the neurocircuitry underlying depression and pave the way for future studies using network-guided principles to significantly improve rTMS efficacy for depression.
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Affiliation(s)
- Simon W. Davis
- Department of Neurology, Duke University, Durham, NC, USA
| | | | - Andrada D. Neacsiu
- Psychiatry and Behavioral Neuroscience, Duke University, Durham, NC, USA
| | | | | | | | - Timothy J. Strauman
- Psychiatry and Behavioral Neuroscience, Duke University, Durham, NC, USA
- Psychology & Neuroscience, Duke University, Durham, NC, USA
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The neural correlates of cognitive behavioral therapy: Recent progress in the investigation of patients with panic disorder. Behav Res Ther 2014; 62:88-96. [DOI: 10.1016/j.brat.2014.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/16/2022]
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Abstract
OBJECTIVE This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research. METHOD We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research. RESULTS We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive compulsive disorder (OCD), and schizophrenia. CONCLUSIONS The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research.
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Affiliation(s)
- Carol P Weingarten
- a Department of Psychiatry and Behavioral Sciences , Duke University , Durham , NC , USA
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Strauman TJ, Goetz EL, Detloff AM, MacDuffie KE, Zaunmüller L, Lutz W. Self-regulation and mechanisms of action in psychotherapy: a theory-based translational perspective. J Pers 2013; 81:542-53. [PMID: 23072383 PMCID: PMC3561485 DOI: 10.1111/jopy.12012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychotherapy is a complex, multilayered process with the potential to bring about changes at multiple levels of functioning, from the neurobiology of the brain to the individual's role in the social world. Although studies of the mechanisms by which psychotherapy leads to change continue to appear, there remains much to be learned about how psychological interventions work. To guide explorations of how and for whom particular treatment approaches lead to change, researchers can rely on theory to identify potential loci for change and on translational research methods to integrate basic behavioral science and neuroscience with clinical science. In this article, we describe research linking individual differences in the self-regulation of personal goal pursuit with the etiology and treatment of mood disorders. The research draws upon regulatory focus theory as a model of self-regulation and on microintervention designs-controlled laboratory investigations of a specific therapeutic technique-to generate and test hypotheses about how psychological interventions can help to reverse maladaptive self-regulatory processes.
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Zaunmüller L, Lutz W, Strauman TJ. Affective impact and electrocortical correlates of a psychotherapeutic microintervention: an ERP study of cognitive restructuring. Psychother Res 2013; 24:550-64. [PMID: 24286245 DOI: 10.1080/10503307.2013.847986] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Psychotherapy for depression emphasizes techniques that can help individuals regulate their moods. The present study investigated the affective impact and electrocortical correlates of cognitive restructuring, delivered as a 90-minute psychotherapeutic microintervention in a dysphoric sample. METHOD Participants (N = 92) who reported either low or high levels of dysphoric symptoms were randomly assigned to the restructuring microintervention, a control intervention or a no-intervention condition. We obtained recordings of event-related potentials (ERPs) as well as mood self-ratings during an experimental session immediately after the psychotherapeutic microintervention and the control intervention in which a set of negatively valenced pictures (IAPS) was presented with different instructions. RESULTS Whereas the restructuring intervention group and the control intervention group reported both increases in positive and decreases in negative affect from pre- to post-intervention, the three groups differed significantly on ERP measures. CONCLUSIONS Findings provide support for current models of mechanisms of action in cognitive therapies.
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Affiliation(s)
- Luisa Zaunmüller
- a Clinical Psychology and Psychotherapy, Department of Psychology , University of Trier , Trier , Germany
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Messina I, Sambin M, Palmieri A, Viviani R. Neural correlates of psychotherapy in anxiety and depression: a meta-analysis. PLoS One 2013; 8:e74657. [PMID: 24040309 PMCID: PMC3770681 DOI: 10.1371/journal.pone.0074657] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022] Open
Abstract
Several studies have used neuroimaging methods to identify neural change in brain networks associated to emotion regulation after psychotherapy of depression and anxiety. In the present work we adopted a meta-analytic technique specific to neuroimaging data to evaluate the consistence of empirical findings and assess models of therapy that have been proposed in the literature. Meta-analyses were conducted with the Activation Likelihood Estimation technique, which evaluates the overlap between foci of activation across studies. The analysis included 16 studies found in Pubmed (200 foci of activation and 193 patients). Separate meta-analyses were conducted on studies of 1) depression, post-traumatic stress disorder and panic disorder investigated with rest state metabolism (6 studies, 70 patients); 2) depression, post-traumatic stress disorder and panic disorder investigated with task-related activation studies (5 studies, 65 patients); 3) the previous studies considered jointly; and 4) phobias investigated with studies on exposure-related activation (5 studies, 57 patients). Studies on anxiety and depression gave partially consistent results for changes in the dorsomedial prefrontal cortex and in the posterior cingulated gyrus/precuneus. Several areas of change in the temporal lobes were also observed. Studies on the therapy of phobia were consistent with a reduction of activity in medial temporal areas. The cluster of change in the prefrontal cortex may refer to increased recruitment of control processes, as hypothesized by influential models of emotion regulation changes due to psychotherapy. However, not all areas associated with controlled emotion regulation were detected in the meta-analysis, while involvement of midline structures suggested changes in self-related information processing. Changes in phobia were consistent with reduced reactivity to phobic stimuli.
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Affiliation(s)
- Irene Messina
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
- * E-mail:
| | - Marco Sambin
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Roberto Viviani
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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Crocker LD, Heller W, Warren SL, O'Hare AJ, Infantolino ZP, Miller GA. Relationships among cognition, emotion, and motivation: implications for intervention and neuroplasticity in psychopathology. Front Hum Neurosci 2013; 7:261. [PMID: 23781184 PMCID: PMC3678097 DOI: 10.3389/fnhum.2013.00261] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/23/2013] [Indexed: 01/16/2023] Open
Abstract
Emotion-cognition and motivation-cognition relationships and related brain mechanisms are receiving increasing attention in the clinical research literature as a means of understanding diverse types of psychopathology and improving biological and psychological treatments. This paper reviews and integrates some of the growing evidence for cognitive biases and deficits in depression and anxiety, how these disruptions interact with emotional and motivational processes, and what brain mechanisms appear to be involved. This integration sets the stage for understanding the role of neuroplasticity in implementing change in cognitive, emotional, and motivational processes in psychopathology as a function of intervention.
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Affiliation(s)
- Laura D. Crocker
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
| | - Stacie L. Warren
- Department of Mental Health, St. Louis VA Medical CenterSt. Louis, MO, USA
| | - Aminda J. O'Hare
- Department of Psychology, University of Massachusetts DartmouthNorth Dartmouth, MA, USA
| | | | - Gregory A. Miller
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
- Department of Psychology, University of DelawareNewark, DE, USA
- Department of Psychology, University of KonstanzKonstanz, Germany
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Feldstein Ewing SW, Chung T. Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:329-35. [PMID: 23815447 PMCID: PMC3864922 DOI: 10.1037/a0031491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors.
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Affiliation(s)
- Sarah W Feldstein Ewing
- University Honors College/University of New Mexico Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, NM 87131, USA.
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Morgenstern J, Naqvi NH, Debellis R, Breiter HC. The contributions of cognitive neuroscience and neuroimaging to understanding mechanisms of behavior change in addiction. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:336-50. [PMID: 23586452 DOI: 10.1037/a0032435] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the last decade, there has been an upsurge of interest in understanding the mechanisms of behavior change (MOBC) and effective behavioral interventions as a strategy to improve addiction-treatment efficacy. However, there remains considerable uncertainty about how treatment research should proceed to address the MOBC issue. In this article, we argue that limitations in the underlying models of addiction that inform behavioral treatment pose an obstacle to elucidating MOBC. We consider how advances in the cognitive neuroscience of addiction offer an alternative conceptual and methodological approach to studying the psychological processes that characterize addiction, and how such advances could inform treatment process research. In addition, we review neuroimaging studies that have tested aspects of neurocognitive theories as a strategy to inform addiction therapies and discuss future directions for transdisciplinary collaborations across cognitive neuroscience and MOBC research.
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Affiliation(s)
- Jon Morgenstern
- Department of Psychiatry, Columbia University, New York, NY 10027, USA.
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Feldstein Ewing SW, Filbey FM, Hendershot CS, McEachern AD, Hutchison KE. Proposed model of the neurobiological mechanisms underlying psychosocial alcohol interventions: the example of motivational interviewing. J Stud Alcohol Drugs 2011; 72:903-16. [PMID: 22051204 PMCID: PMC3211961 DOI: 10.15288/jsad.2011.72.903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Despite the prevalence and profound consequences of alcohol use disorders, psychosocial alcohol interventions have widely varying outcomes. The range of behavior following psychosocial alcohol treatment indicates the need to gain a better understanding of active ingredients and how they may operate. Although this is an area of great interest, at this time there is a limited understanding of how in-session behaviors may catalyze changes in the brain and subsequent alcohol use behavior. Thus, in this review, we aim to identify the neurobiological routes through which psychosocial alcohol interventions may lead to post-session behavior change as well as offer an approach to conceptualize and evaluate these translational relationships. METHOD PubMed and PsycINFO searches identified studies that successfully integrated functional magnetic resonance imaging and psychosocial interventions. RESULTS Based on this research, we identified potential neurobiological substrates through which behavioral alcohol interventions may initiate and sustain behavior change. In addition, we proposed a testable model linking within-session active ingredients to outside-of-session behavior change. CONCLUSIONS Through this review, we present a testable translational model. Additionally, we illustrate how the proposed model can help facilitate empirical evaluations of psychotherapeutic factors and their underlying neural mechanisms, both in the context of motivational interviewing and in the treatment of alcohol use disorders.
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Affiliation(s)
- Sarah W. Feldstein Ewing
- Correspondence may be sent to Sarah W. Feldstein Ewing at the above address or via email at: . Francesca M. Filbey is with the Center for Brain Health, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX. Christian S. Hendershot is also with the Centre for Addiction and Mental Health, Toronto, ON, Canada, and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Kent E. Hutchison is also with the Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
| | - Francesca M. Filbey
- Correspondence may be sent to Sarah W. Feldstein Ewing at the above address or via email at: . Francesca M. Filbey is with the Center for Brain Health, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX. Christian S. Hendershot is also with the Centre for Addiction and Mental Health, Toronto, ON, Canada, and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Kent E. Hutchison is also with the Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
| | - Christian S. Hendershot
- Correspondence may be sent to Sarah W. Feldstein Ewing at the above address or via email at: . Francesca M. Filbey is with the Center for Brain Health, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX. Christian S. Hendershot is also with the Centre for Addiction and Mental Health, Toronto, ON, Canada, and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Kent E. Hutchison is also with the Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
| | | | - Kent E. Hutchison
- Correspondence may be sent to Sarah W. Feldstein Ewing at the above address or via email at: . Francesca M. Filbey is with the Center for Brain Health, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX. Christian S. Hendershot is also with the Centre for Addiction and Mental Health, Toronto, ON, Canada, and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Kent E. Hutchison is also with the Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
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Tschacher W, Schildt M, Sander K. Brain connectivity in listening to affective stimuli: a functional magnetic resonance imaging (fMRI) study and implications for psychotherapy. Psychother Res 2011; 20:576-88. [PMID: 20845228 DOI: 10.1080/10503307.2010.493538] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
To investigate the functional connectivity among amygdala, insula, and auditory cortex during affective auditory stimulation and its relevance for psychotherapy, the authors recorded, using functional magnetic resonance imaging (fMRI), the blood oxygenation level-dependent (BOLD) responses of these brain regions in 20 healthy adults while listening to affective sounds (laughing and crying). Their connectivity was analyzed by time-series panel analysis. The authors found significant positive associations among brain regions, with time-lagged associations generally directed from the right to the left hemisphere. Associations between amygdalar and cortical regions, however, were negative; specifically, activations of the left auditory cortex preceded decreases of the right amygdala. This suggested that affect regulation using cognitive control may have been achieved through active inhibition of amygdalar structures by the cortex. The authors discuss the implications of the findings for the change mechanisms inherent in psychotherapy.
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Affiliation(s)
- Wolfgang Tschacher
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
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Fonagy P. The changing shape of clinical practice: Driven by science or by pragmatics? PSYCHOANALYTIC PSYCHOTHERAPY 2010. [DOI: 10.1080/02668731003590139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lutz W, Hill CE. Quantitative and qualitative methods for psychotherapy research: Introduction to special section. Psychother Res 2009; 19:369-73. [DOI: 10.1080/10503300902948053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Wolfgang Lutz
- a Department of Psychology , University of Trier , Trier, Germany
- b Department of Psychology , University of Maryland , College Park, Maryland, USA
| | - Clara E. Hill
- a Department of Psychology , University of Trier , Trier, Germany
- b Department of Psychology , University of Maryland , College Park, Maryland, USA
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