Cognitive behavioral therapy effects on frontopolar cortex function during future thinking in major depressive disorder: A randomized clinical trial
Cognitive behavioral therapy effects on frontopolar cortex function during future thinking in major depressive disorder: A randomized clinical trial
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DOI：
10.1016/j.jad.2021.11.034
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发表时间：
2021-11-26
影响因子：
6.6
通讯作者：
Mimura, Masaru
中科院分区：
文献类型：
--
作者：
Katayama, Nariko;Nakagawa, Atsuo;Mimura, Masaru
背景资料：尽管Beck的精神病理学理论认知模型很重要，但认知行为治疗（CBT）中未来思维的神经机制仍然难以捉摸。最近的神经影像学研究表明，额极皮层（Brodmann 10区[BA 10]）的功能与未来思维有关。我们假设，与非结构化心理治疗（谈话控制：TC）相比，CBT可能涉及与未来思维相关的BA 10中不同的神经反应。研究方法：这项随机临床试验纳入了38名患有中度至重度重度抑郁症的成年患者，他们接受了长达16周的CBT或TC，随访期为6个月。我们使用功能性磁共振成像和futurethinking任务评估了在遥远未来思维过程中BA 10激活的变化。我们在基线和治疗后评估额叶神经认知功能和临床症状。在6个月随访时评估抑郁严重程度和自动思维。结果如下：我们发现CBT后在遥远的未来思维过程中额极皮层的激活减少（t = 3.00，df=15，p = 0.009），TC后无变化。此外，BA 10活性的降低与治疗后额叶认知功能的变化（r = 0.48，p = 0.007）和治疗6个月后积极自动思维的变化（r = 0.39; p = 0.03）显著相关。局限性：相对较小的样本量和同质的临床特征可能会限制普遍性。患者接受包括抗抑郁药在内的药物治疗。结论：CBT似乎以不同于TC的方式改善未来思维过程中的额极皮质功能。更大规模的临床试验是必要的，以提供确凿的证据，是否BA 10活动可以作为一个神经标志物监测成功的抑郁症治疗与CBT。
Background: Despite the importance of Beck's theoretical cognitive model of psychopathology, the neural mechanisms underlying future thinking in cognitive behavioral therapy (CBT) remain elusive. Recent neuroimaging studies have shown that the function of the frontopolar cortex (Brodmann area 10 [BA10]) is associated with future thinking. We hypothesized that, compared with unstructured psychotherapy (talking control: TC), CBT may involve different neural responses in BA10 associated with future thinking. Methods: This randomized clinical trial included 38 adult patients with moderate-to-severe major depressive disorder who underwent up to 16 weeks of CBT or TC with a 6-month follow-up period. We evaluated changes in BA10 activation during distant future thinking using functional magnetic resonance imaging with a futurethinking task. We assessed frontal neurocognitive function and clinical symptoms at baseline and posttreatment. Depression severity and automatic thoughts were assessed at the 6-month follow-up. Results: We found decreased activation in the frontopolar cortex during distant future thinking after CBT (t = 3.00, df=15, p = 0.009) and no changes after TC. Further, the reduction in BA10 activity significantly correlated with changes in frontal cognitive function after the treatment (r = 0.48, p = 0.007), and in positive automatic thought after 6 months of treatments (r = 0.39; p = 0.03). Limitations: Relatively small sample size and homogenous clinical profile could limit the generalizability. Patients received pharmacotherapy including antidepressant. Conclusions: CBT appears to improve frontopolar cortex function during future thinking in a manner distinct from TC. Larger clinical trials are necessary to provide firm evidence whether BA10 activity may serve as a neuromarker for monitoring successful depression treatment with CBT.