Abstract
Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.
Highlights
Psychotic experiences can be highly distressing and people experiencing psychosis often show high levels of emotional disturbances.[1]
Two reports have arisen from an investigation of cognitive behavioural therapy for psychosis (CBTp) compared with treatment-as-usual.[13,14]
In line with our hypotheses, we found that connectivity between dorsolateral prefrontal cortex (DLPFC) and amygdala increased following CBTp
Summary
Psychotic experiences can be highly distressing and people experiencing psychosis often show high levels of emotional disturbances.[1]. For example, a recent metaanalysis showed that both clinical and demographic variables are poor predictors of relapse, with non-significant effects observed for psychosis symptoms (either positive or negative), affective symptoms or clinician-rated insight.[6] Measuring change at the level of the psychological processes that generate and maintain these symptoms may be helpful in improving the treatment evaluation as well as for predicting long-term outcomes. Functional neuroimaging has yielded robust and objective markers of threat processing in psychosis.[9,10] Recently, there has been increasing interest in utilising these psychobiological markers to investigate the neural mechanisms of psychological therapies (for reviews see Barsaglini et al.[11] and Mason et al.[12]). Two reports have arisen from an investigation of cognitive behavioural therapy for psychosis (CBTp) compared with treatment-as-usual.[13,14] In the first study, we reported reduction in brain response to social threat from pre- to post- CBTp functional MRI (fMRI) measurements.[13]
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