A systematic review and meta-analysis of the neural correlates of psychological therapies in major depression

• Published in: Psychiatry research. Neuroimaging 2018-09, Vol.279, p.31-39
• Main Authors: Sankar, Anjali, Melin, Alice, Lorenzetti, Valentina, Horton, Paul, Costafreda, Sergi G., Fu, Cynthia H.Y.
• Format: Article
• Language: English
• Subjects: Adult; Cognition - physiology; Cognitive behavioral therapy; Depressive Disorder, Major - diagnostic imaging; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Emotions - physiology; Female; Gyrus Cinguli - diagnostic imaging; Humans; Interpersonal; Magnetic Resonance Imaging - trends; Major depressive disorder; Male; Meta-analysis; Middle Aged; Neuroimaging; Neuroimaging - trends; Psychodynamic; Psychological intervention; Psychotherapy; Psychotherapy, Psychodynamic - methods; Psychotherapy, Psychodynamic - trends
• ISSN: 0925-4927; 1872-7506
• DOI: 10.1016/j.pscychresns.2018.07.002

•Systematic review and meta-analysis of neural effects of psychotherapies in major depression, all participants were medication-free.•Meta-analysis revealed a significant group by time effect in the left rostral anterior cingulate (rACC) in response to affective visual processing tasks.•Following psychotherapy, participants with major depression showed increased rACC activation, while healthy controls showed a decrease in activation at follow up.•Findings could reflect improvements in emotional responsivity following psychotherapy. Longitudinal neuroimaging studies in major depression have revealed cortico-limbic abnormalities which are modulated by treatment. We performed a systematic review and meta-analysis of psychotherapy treatment studies measuring neural function and metabolism using fMRI, PET, SPECT and MRS. Seventeen studies were included in the systematic review, total of 200 major depression participants (mean age 37.6 years), all medication free, and 116 healthy controls (mean age 36.4 years). Neuroimaging assessments were performed prior to initiation of treatment and following course of treatment. Treatment durations were: 16–30 weeks for CBT, 11 weeks for behavioral activation therapy, and up to 15 months for psychodynamic psychotherapy. The meta-analysis consisted of studies in which both groups had same serial scans and comparable tasks; total of 5 studies with visual presentation tasks of emotional stimuli: 55 patients (mean age: 38.7 years) and 55 healthy controls (mean age: 36.3 years). The meta-analysis revealed a significant group by time effect in left rostral anterior cingulate, in which patients showed increased activity following psychotherapy while healthy controls showed a decrease at follow up. Longitudinal treatment effects revealed reduced left precentral cortical activity in major depression. Findings could be indicative of improvements in emotion responsivity that may be achieved following psychotherapy.