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Trying to name what doesn't change: Neural nonresponse to Cognitive Therapy for depression

Published online by Cambridge University Press:  16 May 2023

Marlene V. Strege Open the ORCID record for Marlene V. Strege [Opens in a new window] ,
John A. Richey  and
Greg J. Siegle
Marlene V. Strege*
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
John A. Richey
Affiliation:
Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
Greg J. Siegle
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
*
Author for correspondence: Marlene V. Strege, E-mail: stregem@upmc.edu
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Abstract

Background

Theoretical models of neural mechanisms underlying Cognitive Behavior Therapy (CBT) for major depressive disorder (MDD) propose that psychotherapy changes neural functioning of prefrontal cortical structures associated with cognitive-control processes (DeRubeis, Siegle, & Hollon, 2008); however, MDD is persistent and characterized by long-lasting vulnerabilities to recurrence after intervention, suggesting that underlying neural mechanisms of MDD remain despite treatment. It follows that identification of treatment-resistant aberrant neural processes in MDD may inform clinical and research efforts targeting sustained remission. Thus, we sought to identify brain regions showing aberrant neural functioning in MDD that either (1) fail to exhibit substantive change (nonresponse) or (2) exhibit functional changes (response) following CBT.

Methods

To identify treatment-resistant neural processes (as well as neural processes exhibiting change after treatment), we collected functional magnetic resonance imaging (fMRI) data of MDD patients (n = 58) before and after CBT as well as never-depressed controls (n = 35) before and after a similar amount of time. We evaluated fMRI data using conjunction analyses, which utilized several contrast-based criteria to characterize brain regions showing both differences between patients and controls at baseline and nonresponse or response to CBT.

Results

Findings revealed nonresponse in a cerebellar region and response in prefrontal and parietal regions.

Conclusions

Results are consistent with prior theoretical models of CBT's direct effect on cortical regulatory processes but expand on them with identification of additional regions (and associated neural systems) of response and nonresponse to CBT.

Keywords

Cognitive therapydepressionneuroscience
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 1 , January 2024 , pp. 136 - 147
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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