Functional connectivity changes between frontopolar cortex and nucleus accumbens following cognitive behavioral therapy in major depression: A randomized clinical trial

• Published in: Psychiatry research. Neuroimaging 2023-07, Vol.332, p.111643-111643, Article 111643
• Main Authors: Katayama, Nariko, Nakagawa, Atsuo, Umeda, Satoshi, Terasawa, Yuri, Shinagawa, Kazushi, Kikuchi, Toshiaki, Tabuchi, Hajime, Abe, Takayuki, Mimura, Masaru
• Format: Article
• Language: English
• Subjects: Adult; Cerebral Cortex; Cognitive Behavioral Therapy; Depression; Depressive Disorder, Major - diagnostic imaging; Depressive Disorder, Major - therapy; Frontal pole; Functional magnetic resonance imaging; Humans; Major depressive disorder; Mood disorder; Neuroimaging; Nucleus Accumbens - diagnostic imaging; Psychotherapy
• ISSN: 0925-4927; 1872-7506
• DOI: 10.1016/j.pscychresns.2023.111643

•Cognitive behavioral therapy provides therapeutic benefits.•The cognitive behavioral therapy showed greater improvement than the talking control group.•The most prominent therapeutic brain change following CBT is the fronto-limbic.•Cognitive behavioral therapy could promote the functional connectivity change. Cognitive behavioral therapy (CBT) is a psychotherapy that challenges distorted cognitions; however, the neural mechanisms that underpin CBT remain unclear. Hence, we aimed to assess the treatment-related resting-state functional connectivity (rsFC) changes in the brain regions associated with future thinking and the associations between rsFC changes and clinical improvements. Thirty-eight adult patients with MDD were randomly assigned with equal likelihood to receive 16-week individual CBT or talking control with a 12-month follow-up period. We evaluated the rsFC changes in the frontal regions, nucleus accumbens, amygdala, and limbic structures key to the depression pathophysiology and future thinking with 2 ×  2 mixed ANOVA interaction analysis. Pearson's correlation analysis with Bonferroni's correction was also performed to examine the associations with clinical symptoms, such as depression severity and automatic thoughts in follow-up evaluations. Treatment-specific changes include enhancement in frontopolar connectivity with the nucleus accumbens. An increased rsFC was associated with lower negative automatic thoughts postoperatively, together with lower depressive symptoms and higher positive automatic thoughts at follow-up. Conclusively, rsFC changes in the fronto-limbic neural control circuit after CBT, particularly between the frontal pole and nucleus accumbens, may be clinically meaningful functional changes related to the depression recovery process.