Network changes associated with transdiagnostic depressive symptom improvement following cognitive behavioral therapy in MDD and PTSD

Zhen Yang,Christos Davatzikos,Nicolas Honnorat,Steven Bruce,Yvette I Sheline,Irem Aselcioglu,Theodore D Satterthwaite,Shi Gu,Kristin A Linn,Desmond J Oathes,Danielle S Bassett,Russell T Shinohara

doi:10.1038/s41380-018-0201-7

Zhen Yang, Christos Davatzikos + Show 10 more

Open Access

https://doi.org/10.1038/s41380-018-0201-7

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Abstract

Despite widespread use of cognitive behavioral therapy (CBT) in clinical practice, its mechanisms with respect to brain networks remain sparsely described. In this study, we applied tools from graph theory and network science to better understand the transdiagnostic neural mechanisms of this treatment for depression. A sample of 64 subjects was included in a study of network dynamics: 33 patients (15 MDD, 18 PTSD) received longitudinal fMRI resting state scans before and after 12 weeks of CBT. Depression severity was rated on the Montgomery-Asberg Depression Rating Scale (MADRS). Thirty-one healthy controls were included to determine baseline network roles. Univariate and multivariate regression analyses were conducted on the normalized change scores of within- and between-system connectivity and normalized change score of the MADRS. Penalized regression was used to select a sparse set of predictors in a data-driven manner. Univariate analyses showed greater symptom reduction was associated with an increased functional role of the Ventral Attention (VA) system as an incohesive provincial system (decreased between- and decreased within-system connectivity). Multivariate analyses selected between-system connectivity of the VA system as the most prominent feature associated with depression improvement. Observed VA system changes are interesting in light of brain controllability descriptions: attentional control systems, including the VA system, fall on the boundary between-network communities, and facilitate integration or segregation of diverse cognitive systems. Thus, increasing segregation of the VA system following CBT (decreased between-network connectivity) may result in less contribution of emotional attention to cognitive processes, thereby potentially improving cognitive control.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Cognitive behavioral therapy (CBT) is an effective treatment for both major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) with efficacious but more enduring effects compared with antidepressantsNetwork changes associated with transdiagnostic depressive symptom improvement following cognitive. . .[1,2,3]
To better interpret our key finding that the changes in depressive symptoms were significantly correlated with the changes in functional role of the Ventral Attention (VA) system in patients, we examined the baseline connectivity differences between patients and controls using a two-dimensional significance test
We found that the overall VA system functional role change following CBT is not significant at the group level (p > 0.1)

Summary

Introduction

Network changes associated with transdiagnostic depressive symptom improvement following cognitive. The fact that various mental disorders involving depression can be alleviated by CBT suggests that common neural mechanisms may be engaged in treatment response. There are no published studies investigating the network mechanisms involved in transdiagnostic treatment response to CBT common to both MDD and PTSD. Previous studies of brain mechanisms involved in producing this improvement have focused on changes in cognitive control regions in MDD [4,5,6,7] and in PTSD [8,9,10,11], examined separately, following treatment. Studies examining neural substrates of CBT have demonstrated changes in cognitive control regions following various forms of treatment (reviewed in [4, 7])

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