TY - JOUR
T1 - The Effects of Psychotherapy on Neural Responses to Rewards in Major Depression
AU - Dichter, Gabriel S.
AU - Felder, Jennifer N.
AU - Petty, Christopher
AU - Bizzell, Joshua
AU - Ernst, Monique
AU - Smoski, Moria J.
N1 - Funding Information:
We would like to thank Todd Harshbarger and Syam Gadde for assistance with image analysis; Prue Cuper, Shian-Ling Keng, and Justin Woodlief for assistance with data collection; and magnetic resonance imaging technologists Susan Music, Natalie Goutkin, and Talaignair Venkatraman for assistance with data acquisition. This research was supported by MH078145 to GSD. Assistance for this study was provided by the Neuroimaging Core of the University of North Carolina neurodevelopmental Disorders Research Center. The author MJS was supported by National Institute of Mental Health (NIMH) T32-MH070448, a National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator award, a career development award from Duke University Medical Center, National Institute of Child Health & Development (NICHD), K12 HD043446, and NIMH K23 MH087754. The author GSD was supported by Postdoctoral Research in Neurodevelopmental Disorders, NICHD T32-HD40127, NARSAD Young Investigator awards, a career development award from University of North Carolina-Chapel Hill, National Institutes of Health/National Center for Research Resources K12 RR023248, and NIMH K23 MH081285. The authors reported no biomedical financial interests or potential conflicts of interest.
PY - 2009/11/1
Y1 - 2009/11/1
N2 - Background: Unipolar major depressive disorder (MDD) is characterized by anomalous neurobiological responses to pleasant stimuli, a pattern that may be linked to symptoms of anhedonia. However, the potential for psychotherapy to normalize neurobiological responses to pleasant stimuli has not been evaluated. Methods: Twelve adults with and 15 adults without MDD participated in two identical functional magnetic resonance imaging scans that used a Wheel of Fortune task. Between scans, MDD outpatients received Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors. Results: Seventy-five percent of adults with MDD were treatment responders, achieving post-treatment Hamilton Rating Scale for Depression score of six or below. Relative to changes in brain function in the matched nondepressed group, psychotherapy resulted in functional changes in structures that mediate responses to rewards, including the paracingulate gyrus during reward selection, the right caudate nucleus (i.e., the dorsal striatum), during reward anticipation, and the paracingulate and orbital frontal gyri during reward feedback. There was no effect of diagnostic status or psychotherapy on in-scanner task-related behavioral responses. Conclusions: Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors, results in improved functioning of unique reward structures during different temporal phases of responses to pleasurable stimuli, including the dorsal striatum during reward anticipation.
AB - Background: Unipolar major depressive disorder (MDD) is characterized by anomalous neurobiological responses to pleasant stimuli, a pattern that may be linked to symptoms of anhedonia. However, the potential for psychotherapy to normalize neurobiological responses to pleasant stimuli has not been evaluated. Methods: Twelve adults with and 15 adults without MDD participated in two identical functional magnetic resonance imaging scans that used a Wheel of Fortune task. Between scans, MDD outpatients received Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors. Results: Seventy-five percent of adults with MDD were treatment responders, achieving post-treatment Hamilton Rating Scale for Depression score of six or below. Relative to changes in brain function in the matched nondepressed group, psychotherapy resulted in functional changes in structures that mediate responses to rewards, including the paracingulate gyrus during reward selection, the right caudate nucleus (i.e., the dorsal striatum), during reward anticipation, and the paracingulate and orbital frontal gyri during reward feedback. There was no effect of diagnostic status or psychotherapy on in-scanner task-related behavioral responses. Conclusions: Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors, results in improved functioning of unique reward structures during different temporal phases of responses to pleasurable stimuli, including the dorsal striatum during reward anticipation.
KW - Cingulate gyrus
KW - depression
KW - fMRI
KW - orbital frontal cortex
KW - reward
KW - striatum
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U2 - 10.1016/j.biopsych.2009.06.021
DO - 10.1016/j.biopsych.2009.06.021
M3 - Article
C2 - 19726030
AN - SCOPUS:70349838313
SN - 0006-3223
VL - 66
SP - 886
EP - 897
JO - Biological psychiatry
JF - Biological psychiatry
IS - 9
ER -