Abstract
Negative self-beliefs are a core feature of psychopathology. Despite this, we have a limited understanding of the brain mechanisms by which negative self-beliefs are cognitively restructured. Using a novel paradigm, we had participants use Socratic questioning techniques to restructure negative beliefs during ultra-high resolution 7-Tesla functional magnetic resonance imaging (UHF 7 T fMRI) scanning. Cognitive restructuring elicited prominent activation in a fronto-striato-thalamic circuit, including the mediodorsal thalamus (MD), a group of deep subcortical nuclei believed to synchronize and integrate prefrontal cortex activity, but which has seldom been directly examined with fMRI due to its small size. Increased activity was also identified in the medial prefrontal cortex (MPFC), a region consistently activated by internally focused mental processing, as well as in lateral prefrontal regions associated with regulating emotional reactivity. Using Dynamic Causal Modelling (DCM), evidence was found to support the MD as having a strong excitatory effect on the activity of regions within the broader network mediating cognitive restructuring. Moreover, the degree to which participants modulated MPFC-to-MD effective connectivity during cognitive restructuring predicted their individual tendency to engage in repetitive negative thinking. Our findings represent a major shift from a cortico-centric framework of cognition and provide important mechanistic insights into how the MD facilitates key processes in cognitive interventions for common psychiatric disorders. In addition to relaying integrative information across basal ganglia and the cortex, we propose a multifaceted role for the MD whose broad excitatory pathways act to increase synchrony between cortical regions to sustain complex mental representations, including the self.
Highlights
Beliefs that are negatively biased, inaccurate, and rigid play a key role in etiology and maintenance of psychopathology [1]
Lesions to the mediodorsal thalamus (MD) have been found to cause anterograde amnesia and impairments in updating representations of expected outcomes, while sparing the retrieval of learned cues and behavioral strategies [21, 22]. These findings suggest that updating self-beliefs and learning from new representations in working memory—fundamental aspects of cognitive restructuring—are dependent upon the coordinated activity of cortical networks with the MD [23]
This method allows for the identification of regional connectivity parameters best explained by the data at a group level and for the verification of causal excitatory or inhibitory effects of MD circuits of brain activity during cognitive restructuring [34]
Summary
Beliefs that are negatively biased, inaccurate, and rigid play a key role in etiology and maintenance of psychopathology [1]. Cognitive-behavioral therapy (CBT) and other evidence-based psychotherapeutic treatments are centered on identifying and restructuring maladaptive cognitions, often through Socratic questioning techniques [3, 4]. In the context of CBT, Socratic questioning asks a series of carefully sequenced questions to help an individual define problems, assist in the identification of maladaptive thoughts and beliefs, examine the meaning of events, and to assess the consequences of thought patterns or behaviors. Through the Socratic questioning and cognitive restructuring process, the individual learns to identify and re-evaluate their perspective towards internal thoughts, and modify processes which contribute to the maintenance of maladaptive conceptualizations [5]. Despite the importance of cognitive restructuring in psychotherapeutic interventions, the neurobiological mechanisms underpinning these processes remain largely enigmatic
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