Cognitive Behavioral Therapy Normalizes Functional Connectivity for Social Threat in Psychosis.

Liam Mason,Steven C Williams,Danai Dima,Veena Kumari,Emmanuelle R Peters

doi:10.1093/schbul/sbv153

Abstract

Psychosis is often characterized by paranoia and poor social functioning. Neurally, there is evidence of functional dysconnectivity including abnormalities when processing facial affect. We sought to establish whether these abnormalities are resolved by cognitive behavioral therapy for psychosis (CBTp). The study involved 38 outpatients with one or more persistent positive psychotic symptoms, and 20 healthy participants. All participants completed an implicit facial affect processing task during functional magnetic resonance imaging (fMRI). Subsequently, patients either continued to receive standard care only (SCO, n = 16) or received CBTp on top of standard care (+CBTp, n = 22), with fMRI repeated 6–8 months later. To examine the mechanisms underlying CBTp-led changes in threat processing and appraisal, functional connectivity during the social threat (angry faces) condition was assessed separately from left amygdala and right dorsolateral prefrontal cortex (DLPFC) seeds. At baseline, patients, compared with healthy participants, showed greater amygdala connectivity with the insula and visual areas, but less connectivity with somatosensory areas. These differences normalized following CBTp and, compared with the SCO group, the +CBTp group showed greater increases in amygdala connectivity with DLPFC and inferior parietal lobule, with the latter correlating with improvement in positive symptoms. From the DLPFC seed, the +CBTp (compared with SCO) group showed significantly greater increase in DLPFC connectivity with other prefrontal regions including dorsal anterior cingulate and ventromedial prefrontal cortex. These findings indicate that CBTp strengthens connectivity between higher-order cognitive systems and those involved in threat and salience, potentially facilitating reappraisal.

Highlights

There has been a growing interest in understanding the neural effects of psychological interventions, to gain a better understanding of the maintaining mechanisms of disorders and to improve future therapies
We sought to establish whether these abnormalities are resolved by cognitive behavioral therapy for psychosis (CBTp)
Remediation of functional connectivity is likely to be of particular importance in psychosis, which has long been conceptualized as a disorder of network dysconnectivity.[3,4]

Summary

Introduction

There has been a growing interest in understanding the neural effects of psychological interventions, to gain a better understanding of the maintaining mechanisms of disorders and to improve future therapies. There is considerable evidence that interventions such as a cognitive behavioral therapy produce lasting neural activation changes in a range of disorders.[1] few to date have examined changes in the widespread connections between distributed systems. There is considerable evidence that psychological interventions target DLPFC and other prefrontal regions,[1,19] perhaps linking to a role in reappraisal of affective inputs mentioned previously.[10,11] there are no studies to date that have examined changes in functional connectivity following psychological intervention in psychosis. There was a reduction in the activation of arousal and salience regions including insula, thalamus, putamen, and visual areas, and these changes correlated with improvement in positive symptoms.[30] The present study sought to elaborate on the mechanism underlying these functional activation changes by examining, in the same patients, concomitant changes in functional connectivity with higher-order cognitive systems. We further predicted that these abnormalities would normalize following CBTp and that CBTp-led changes in connectivity would correlate with improvement in psychotic symptoms

Participants and Design

Results

Discussion