Cognitive Behavioral Therapy Is Associated With Enhanced Cognitive Control Network Activity in Major Depression and Posttraumatic Stress Disorder.
Cognitive Behavioral Therapy Is Associated With Enhanced Cognitive Control Network Activity in Major Depression and Posttraumatic Stress Disorder.
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DOI：
10.1016/j.bpsc.2017.12.006
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Sheline YI
中科院分区：
文献类型：
--
作者：
Yang Z;Oathes DJ;Linn KA;Bruce SE;Satterthwaite TD;Cook PA;Satchell EK;Shou H;Sheline YI
严重抑郁障碍(MDD)和创伤后应激障碍(PTSD)都以抑郁症状、大脑中对认知控制重要的区域异常和对认知行为治疗(CBT)的反应为特征。然而，是否有共同的神经机制作为CBT诊断反应的基础尚不清楚。使用功能磁共振成像技术测量了104名参与者在认知控制任务中的大脑活动：28名MDD患者，53名PTSD患者和23名健康对照受试者；抑郁和焦虑症状在同一天被检测。患者亚组(n=31)进入人工CBT，并在12周时与对照组(n=19)一起重新扫描。线性混合效应模型评估了CBT前后抑郁和焦虑症状与脑活动之间的关系。在基线时，所有参与者的左侧背外侧前额叶皮质的激活与蒙哥马利-奥斯伯格抑郁评定量表的得分呈负相关；这种脑症状关联在MDD和PTSD之间没有区别。在患者接受CBT治疗后，认知控制网络中的区域，包括腹外侧额叶皮质和背外侧前额叶皮质，显示出显著的活动增加。我们的结果表明，认知控制区激活的维度异常主要与抑郁症状有关(有或没有控制焦虑唤醒)。此外，在接受CBT治疗后，MDD和PTSD患者的认知控制区激活程度相似。这些结果符合精神障碍的研究领域标准概念化，并暗示认知控制激活的改善是CBT治疗结果的跨诊断机制。
Both major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are characterized by depressive symptoms, abnormalities in brain regions important for cognitive control, and response to cognitive behavioral therapy (CBT). However, whether a common neural mechanism underlies CBT response across diagnoses is unknown. Brain activity during a cognitive control task was measured using functional magnetic resonance imaging in 104 participants: 28 patients with MDD, 53 patients with PTSD, and 23 healthy control subjects; depression and anxiety symptoms were determined on the same day. A patient subset (n = 31) entered manualized CBT and, along with controls (n = 19), was rescanned at 12 weeks. Linear mixed effects models assessed the relationship between depression and anxiety symptoms and brain activity before and after CBT. At baseline, activation of the left dorsolateral prefrontal cortex was negatively correlated with Montgomery–Åsberg Depression Rating Scale scores across all participants; this brain–symptom association did not differ between MDD and PTSD. Following CBT treatment of patients, regions within the cognitive control network, including ventrolateral prefrontal cortex and dorsolateral prefrontal cortex, showed a significant increase in activity. Our results suggest that dimensional abnormalities in the activation of cognitive control regions were associated primarily with symptoms of depression (with or without controlling for anxious arousal). Furthermore, following treatment with CBT, activation of cognitive control regions was similarly increased in both MDD and PTSD. These results accord with the Research Domain Criteria conceptualization of mental disorders and implicate improved cognitive control activation as a transdiagnostic mechanism for CBT treatment outcome.
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