Abstract
Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.
Highlights
Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction
22 GAD patients completed resting state MRI scans before receiving 16 sessions of Emotion Regulation Therapy (ERT). To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity of the insula and of hubs within the default network (DN) and treatment-related changes in worry, somatic anxiety symptoms and decentering
The present study took a novel approach to examining the neural predictors of specific outcomes of ERT for GAD patients with and without comorbid MDD
Summary
Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. In an effort to synthesize these transdiagnostic features of GAD and MDD, Mennin and Fresco (2013, 2014) have posited an emotion dysregulation model, in which these conditions are marked by heightened emotional experience (i.e., motivational intensity) coupled with repetitive and perseverative forms of self-referential thinking (i.e., worry, rumination, self-criticism) that serve as compensatory strategies to reactively escape or avoid strongly felt emotional and somatic experiences The combination of these clinical features may reflect an underlying profile or endophenotype common to GAD and MDD, and may account for the relative underperformance of otherwise efficacious treatments in resolving these conditions, when comorbid (e.g., Olatunji et al, 2010). The DN is anchored by activity in the medial prefrontal cortex (MPFC; narrative and autobiographical self) and the posterior cingulate cortex (PCC; experiential self-reflection; e.g., Buckner et al, 2008; Qin and Northoff, 2011; Brewer et al, 2013)
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