Cognitive behavioral therapy increases amygdala connectivity with the cognitive control network in both MDD and PTSD

Haochang Shou; Zhen Yang; Theodore D Satterthwaite; Philip A Cook; Steven E Bruce; Russell T Shinohara; Benjamin Rosenberg; Yvette I Sheline

doi:10.1016/j.nicl.2017.01.030

Cognitive behavioral therapy increases amygdala connectivity with the cognitive control network in both MDD and PTSD

Neuroimage Clin. 2017 Jan 27:14:464-470. doi: 10.1016/j.nicl.2017.01.030. eCollection 2017.

Authors

Haochang Shou¹, Zhen Yang², Theodore D Satterthwaite², Philip A Cook³, Steven E Bruce⁴, Russell T Shinohara¹, Benjamin Rosenberg², Yvette I Sheline⁵

Affiliations

¹ Department of Biostatistics and Epidemiology, University of Pennsylvania, United States.
² Department of Psychiatry, University of Pennsylvania, United States.
³ Department of Radiology, University of Pennsylvania, United States.
⁴ Department of Psychological Sciences, Center for Trauma Recovery, University of Missouri-St Louis, United States.
⁵ Department of Psychiatry, University of Pennsylvania, United States; Department of Radiology, University of Pennsylvania, United States.

Abstract

Background: Both major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are characterized by alterations in intrinsic functional connectivity. Here we investigated changes in intrinsic functional connectivity across these disorders as a function of cognitive behavioral therapy (CBT), an effective treatment in both disorders.

Methods: 53 unmedicated right-handed participants were included in a longitudinal study. Patients were diagnosed with PTSD (n = 18) and MDD (n = 17) with a structured diagnostic interview and treated with 12 sessions of manualized CBT over a 12-week period. Patients received an MRI scan (Siemens 3 T Trio) before and after treatment. Longitudinal functional principal components analysis (LFPCA) was performed on functional connectivity of the bilateral amygdala with the fronto-parietal network. A matched healthy control group (n = 18) was also scanned twice for comparison.

Results: LFPCA identified four eigenimages or principal components (PCs) that contributed significantly to the longitudinal change in connectivity. The second PC differentiated CBT-treated patients from controls in having significantly increased connectivity of the amygdala with the fronto-parietal network following CBT.

Limitations: Analysis of CBT-induced amygdala connectivity changes was restricted to the a priori determined fronto-parietal network. Future studies are needed to determine the generalizability of these findings, given the small and predominantly female sample.

Conclusion: We found evidence for the hypothesis that CBT treatment is associated with changes in connectivity between the amygdala and the fronto-parietal network. CBT may work by strengthening connections between the amygdala and brain regions that are involved in cognitive control, potentially providing enhanced top-down control of affective processes that are dysregulated in both MDD and PTSD.

Keywords: Amygdala; Cognitive behavioral therapy; Fronto-parietal network; Principal component analysis; Resting state functional connectivity.

MeSH terms

Adult
Amygdala / diagnostic imaging*
Brain Mapping
Cognition Disorders* / diagnostic imaging
Cognition Disorders* / etiology
Cognition Disorders* / rehabilitation
Cognitive Behavioral Therapy / methods*
Depressive Disorder, Major / complications*
Female
Humans
Imaging, Three-Dimensional
Longitudinal Studies
Magnetic Resonance Imaging
Male
Neural Pathways / diagnostic imaging
Neuropsychological Tests
Principal Component Analysis
Stress Disorders, Post-Traumatic / complications*
Treatment Outcome
Young Adult

Abstract

MeSH terms

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