背景:认知行为疗法(CBT)是社交焦虑症(SAD)或重度抑郁症(MDD)患者的有效治疗方法,然而,在临床改善方面存在差异。尽管先前的研究表明,支持认知重新评估的大脑区域(例如背外侧前额叶皮层[dlPFC])的治疗前参与预示着SAD的CBT反应,尚不清楚这是否扩展到MDD或特定于CBT。当前的研究检查了CBT或支持疗法(ST)试验后SAD或MDD患者在重新评估期间的治疗前神经活动与临床改善之间的关系。一个共同的因素比较臂。
方法:参与者是75例寻求治疗的SAD(n=34)或MDD(n=41)患者,随机分为CBT(n=40)或ST(n=35)。随机化前,患者在功能磁共振成像期间完成了认知重新评估任务.此外,患者在治疗前和整个治疗期间每2周完成临床医生管理的症状测量和自我报告认知再评估.
结果:结果表明,重新评估期间治疗前的神经活动差异预测了CBT和ST反应。具体来说,在整个治疗期间症状改善的更大轨迹与CBT患者的腹外侧前额叶皮质(vlPFC)活动减少相关,但ST患者的vlPFC活性更高。此外,较少的基线dlPFC活动对应于更大的自我报告的重新评估改进轨迹,不管治疗的手臂。
结论:如果重复,研究结果表明,在重新评估期间,大脑反应的个体差异可能与症状严重程度的治疗依赖性改善相关,但是心理治疗后主观重新评估的改善,更广泛的。
BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive
reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during
reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.
METHODS: Participants were 75 treatment-seeking patients with SAD (n = 34) or MDD (n = 41) randomized to CBT (n = 40) or ST (n = 35). Before randomization, patients completed a cognitive
reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.
RESULTS: Results indicated that pre-treatment neural activity during
reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported
reappraisal improvement, regardless of treatment arm.
CONCLUSIONS: If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.