Abstract
Emotion regulation therapy (ERT) is an efficacious treatment for distress disorders (i.e., depression and anxiety), predicated on a conceptual model wherein difficult to treat distress arises from intense emotionality (e.g., neuroticism, dispositional negativity) and is prolonged by negative self-referentiality (e.g., worry, rumination). Individuals with distress disorders exhibit disruptions in two corresponding brain networks including the salience network (SN) reflecting emotion/motivation and the default mode network (DMN) reflecting self-referentiality. Using resting-state functional connectivity (rsFC) analyses, seeded with primary regions in each of these networks, we investigated whether ERT was associated with theoretically consistent changes across nodes of these networks and whether these changes related to improvements in clinical outcomes. This study examined 21 generalized anxiety disorder (GAD) patients [with and without major depressive disorder (MDD)] drawn from a larger intervention trial (Renna et al., 2018a), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, to investigate whether ERT was associated with changes in connectivity of nodes of the DMN and SN networks to regions across the brain. Findings revealed statistically significant treatment linked changes in both the DMN and SN network nodes, and these changes were associated with clinical improvement corresponding to medium effect sizes. The results are discussed in light of a nuanced understanding of the role of connectivity changes in GAD and MDD, and begin to provide neural network support for the hypothesized treatment model predicated by ERT.
Highlights
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are two prevalent disorders with lifetime prevalence estimates ranging from 17 to 41% for MDD and 6% to 14% for GAD (Kessler et al, 2005; Moffitt et al, 2010)
In an initial secondary analysis of these trial data, we reported that baseline patterns of resting state functional connectivity within the default mode network (DMN) and salience network (SN) predicted clinical response to Emotion regulation therapy (ERT) (Fresco et al, 2017)
Using seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, we sought to identify patterns of ERT-linked resting-state functional connectivity (rsFC) changes of nodes within these networks across the brain and whether these changes would be associated with clinical improvement and ERT model related mechanism variables as well as reductions in MDD and GAD severity
Summary
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are two prevalent disorders with lifetime prevalence estimates ranging from 17 to 41% for MDD and 6% to 14% for GAD (Kessler et al, 2005; Moffitt et al, 2010). The strength of activation in the PCC-left DLPFC at post treatment was correlated with post-treatment PTSD avoidance symptoms (r = 0.623) and hyperarousal symptoms (r = 0.675) in patients receiving MBET but not PCGT These findings combined with results from meta-analysis showing that individuals with depression tend to have decreased connectivity between PCC and DLPFC nodes compared to healthy controls (Mulders et al, 2015) raises the possibility that interventions for depression that include mindfulness meditation exercises, such as ERT, may lead to clinical improvement in part by increasing PCC-DLPFC connectivity. Using seed-based connectivity analysis with seeds in the PCC, right anterior insula, and right posterior insula, we sought to identify patterns of ERT-linked rsFC changes of nodes within these networks across the brain and whether these changes would be associated with clinical improvement and ERT model related mechanism variables (e.g., attention control, decentering, and cognitive reappraisal) as well as reductions in MDD and GAD severity. Increased connectivity between nodes of the DMN and nodes of the FPCN would be expected to be associated with decreased depression and anxiety severity and improvements in attentional and metacognitive regulation (Mulders et al, 2015; Williams, 2016)
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