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Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression


Doerig, Nadja; Krieger, Tobias; Altenstein, David; Schlumpf, Yolanda; Spinelli, Simona; Späti, Jakub; Brakowski, Janis; Quednow, Boris B; Seifritz, Erich; Holtforth, Martin Grosse (2016). Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression. British Journal of Psychiatry, 208(2):175-181.

Abstract

BackgroundCognitive-behavioural therapy is efficacious in the treatment of major depressive disorder but response rates are still far from satisfactory.AimsTo better understand brain responses to individualised emotional stimuli and their association with outcome, to enhance treatment.MethodFunctional magnetic resonance imaging data were collected prior to individual psychotherapy. Differences in brain activity during passive viewing of individualised self-critical material in 23 unmedicated out-patients with depression and 28 healthy controls were assessed. The associations between brain activity, cognitive and emotional change, and outcome were analysed in 21 patients.ResultsPatients showed enhanced activity in the amygdala and ventral striatum compared with the control group. Non-response to therapy was associated with enhanced activity in the right amygdala compared with those who responded, and activity in this region was negatively associated with outcome. Emotional but not cognitive changes mediated this association.ConclusionsAmygdala hyperactivity may lessen symptom improvement in psychotherapy for depression through attenuating emotional skill acquisition.

Abstract

BackgroundCognitive-behavioural therapy is efficacious in the treatment of major depressive disorder but response rates are still far from satisfactory.AimsTo better understand brain responses to individualised emotional stimuli and their association with outcome, to enhance treatment.MethodFunctional magnetic resonance imaging data were collected prior to individual psychotherapy. Differences in brain activity during passive viewing of individualised self-critical material in 23 unmedicated out-patients with depression and 28 healthy controls were assessed. The associations between brain activity, cognitive and emotional change, and outcome were analysed in 21 patients.ResultsPatients showed enhanced activity in the amygdala and ventral striatum compared with the control group. Non-response to therapy was associated with enhanced activity in the right amygdala compared with those who responded, and activity in this region was negatively associated with outcome. Emotional but not cognitive changes mediated this association.ConclusionsAmygdala hyperactivity may lessen symptom improvement in psychotherapy for depression through attenuating emotional skill acquisition.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2016
Deposited On:24 Feb 2016 14:39
Last Modified:05 Apr 2016 20:09
Publisher:Royal College of Psychiatrists
ISSN:0007-1250
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1192/bjp.bp.114.149971
PubMed ID:26494872

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