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Neural effects of cognitive–behavioural therapy on dysfunctional attitudes in depression

Published online by Cambridge University Press:  22 October 2014

A. Sankar ,
J. Scott ,
A. Paszkiewicz ,
V. P. Giampietro ,
H. Steiner  and
C. H. Y. Fu
A. Sankar
Affiliation:
Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
J. Scott
Affiliation:
Academic Psychiatry, Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
A. Paszkiewicz
Affiliation:
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
V. P. Giampietro
Affiliation:
Department of Neuroimaging, Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
H. Steiner
Affiliation:
East London NHS Foundation Trust, London, UK
C. H. Y. Fu*
Affiliation:
Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK School of Psychology, University of East London, London, UK
*
* Address for correspondence: C. H. Y. Fu, School of Psychology, University of East London, AE3.11, Water Lane, London E15 4LZ, UK. (Email: [email protected])
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Abstract

Background

Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive–behavioural therapy (CBT).

Method

Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48).

Results

MDD patients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDD patients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDD patients at the follow-up scan relative to healthy controls.

Conclusions

Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.

Keywords

Brain imagingcognitive behavioural therapydepressiondysfunctional attitudesneuroimagingpsychotherapy
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1425 - 1433
Copyright
Copyright © Cambridge University Press 2014 

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