Cognitive behavioral therapy increases amygdala connectivity with the cognitive control network in both MDD and PTSD.
Cognitive behavioral therapy increases amygdala connectivity with the cognitive control network in both MDD and PTSD.
复制标题
DOI：
10.1016/j.nicl.2017.01.030
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Sheline YI
中科院分区：
文献类型：
--
作者：
Shou H;Yang Z;Satterthwaite TD;Cook PA;Bruce SE;Shinohara RT;Rosenberg B;Sheline YI
重度抑郁症（MDD）和创伤后应激障碍（PTSD）的特征都是内在功能连接的改变。在这里，我们调查了这些疾病的内在功能连接的变化，作为认知行为治疗（CBT）的一个功能，这两种疾病的有效治疗。53名未经药物治疗的右利手参与者被纳入一项纵向研究。患者被诊断为PTSD（n = 18）和MDD（n = 17）与结构化诊断访谈和治疗12个会话的手动CBT超过12周的时间。患者在治疗前后接受MRI扫描（Siemens 3 T Trio）。采用纵向功能主成分分析（LFPCA）对双侧杏仁核与额顶网络的功能连接进行分析。匹配的健康对照组（n = 18）也进行了两次扫描以进行比较。LFPCA确定了四个特征图像或主成分（PC），有助于显着的纵向变化的连接。第二个PC区分CBT治疗的患者从控制中有显着增加连接的杏仁核与额顶叶网络后CBT。CBT诱导的杏仁核连接变化的分析仅限于先验确定的额顶叶网络。鉴于样本量小且以女性为主，需要进一步研究以确定这些发现的普遍性。我们发现了CBT治疗与杏仁核和额顶叶网络之间连接变化相关的假设的证据。CBT可能通过加强杏仁核和参与认知控制的大脑区域之间的联系来发挥作用，从而可能增强对MDD和PTSD中失调的情感过程的自上而下的控制。在MDD和PTSD患者的功能连接中发现CBT治疗效果新的纵向降维方法表征变化的方向。研究表明，CBT增加了杏仁核与额顶叶网络的连接。CBT机制可以增强认知控制区域的连通性。事后全脑体素分析独立证实了这一发现。
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. 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. 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. 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. 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. CBT treatment effects found in functional connectivity for combined MDD and PTSD patients. Novel longitudinal dimension reduction method characterizes direction of changes. Study shows CBT increases amygdala connectivity with the fronto-parietal network. CBT mechanism may be to enhance cognitive control region connectivity. A post-hoc whole brain voxel-wise analysis independently confirmed the findings.