Abstract
Differential DNA methylation of the hypothalamic‐pituitary‐adrenal axis related gene FKBP5 has recently been shown to be associated with varying response to environmental influences and may play a role in how well people respond to psychological treatments. Participants (n = 111) received exposure‐based cognitive behavioural therapy (CBT) for agoraphobia with or without panic disorder, or specific phobias. Percentage DNA methylation levels were measured for the promoter region and intron 7 of FKBP5. The association between percentage reduction in clinical severity and change in DNA methylation was tested using linear mixed models. The effect of genotype (rs1360780) was tested by the inclusion of an interaction term. The association between change in DNA methylation and FKBP5 expression was examined. Change in percentage DNA methylation at one CpG site of intron 7 was associated with percentage reduction in severity (β = −4.26, p = 3.90 × 10−4), where a decrease in DNA methylation was associated with greater response to therapy. An interaction was detected between rs1360780 and changes in DNA methylation in the promoter region of FKBP5 on treatment outcome (p = .045) but did not survive correction for multiple testing. Changes in DNA methylation were not associated with FKBP5 expression. Decreasing DNA methylation at one CpG site of intron 7 of FKBP5 was strongly associated with decreasing anxiety severity following exposure‐based CBT. In addition, there was suggestive evidence that allele‐specific methylation at the promoter region may also be associated with treatment response. The results of this study add to the growing literature demonstrating the role of biological processes such as DNA methylation in response to environmental influences.
Highlights
Research examining genetic and biological factors involved in response to psychological therapies has gained momentum in recent years
We examined the association between changes in DNA methylation in two regions of FKBP5 and therapy outcome at posttreatment and follow-up in a sample of adults (n = 111) with fearrelated anxiety diagnoses receiving exposure-based cognitive behavioural therapy (CBT)
This study explores response to a psychological therapy across the whole treatment period, and builds on previous research demonstrating that epigenetic changes in FKBP5 may play a role in treatment response (Roberts et al, 2015; Yehuda et al, 2013)
Summary
Research examining genetic and biological factors involved in response to psychological therapies has gained momentum in recent years. Of particular relevance for the current study, changes in DNA methylation at the promoter region of FKBP5 have been implicated in response to exposure therapy in veterans with post-traumatic stress disorder (PTSD) (Yehuda et al, 2013), with decreases in region-specific DNA methylation across the course of. This study explores response to a psychological therapy across the whole treatment period, and builds on previous research demonstrating that epigenetic changes in FKBP5 may play a role in treatment response (Roberts et al, 2015; Yehuda et al, 2013). It is the first study that examines DNA methylation changes at intron 7 of FKBP5 with respect to psychological therapy response, and the first to combine genetic, epigenetic and gene expression data
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