Neural Changes following Behavioral Activation for a Depressed Breast Cancer Patient: A Functional MRI Case Study

Michael J Gawrysiak,Baxter P Rogers,John H Dougherty,Derek R Hopko,Christopher R N Nicholas,John P Carvalho

doi:10.1155/2012/152916

Abstract

Functional neuroimaging is an innovative but at this stage underutilized method to assess the efficacy of psychotherapy for depression. Functional magnetic resonance imaging (fMRI) was used in this case study to examine changes in brain activity in a depressed breast cancer patient receiving an 8-session Behavioral Activation Treatment for Depression (BATD), based on the work of Hopko and Lejuez (2007). A music listening paradigm was used during fMRI brain scans to assess reward responsiveness at pre- and posttreatment. Following treatment, the patient exhibited attenuated depression and changes in blood oxygenation level dependence (BOLD) response in regions of the prefrontal cortex and the subgenual cingulate cortex. These preliminary findings outline a novel means to assess psychotherapy efficacy and suggest that BATD elicits functional brain changes in areas implicated in the pathophysiology of depression. Further research is necessary to explore neurobiological mechanisms of change in BATD, particularly the potential mediating effects of reward responsiveness and associated brain functioning.

Highlights

Investigating neurobiological processes associated with depression treatment is a burgeoning area of translational research
Pioneering studies evaluating therapy outcome and brain activity examined Interpersonal Psychotherapy (IPT; [5, 14], Cognitive Behavioral Therapy (CBT; [15,16,17]), and Behavioral Activation Treatment for Depression (BATD; [18]), demonstrating that positive treatment outcome is associated with changes in brain regions implicated in the pathophysiology of depression
Given the efficacy of behavioral activation in treating depression via increased reward exposure, this study evaluated whether BATD corresponded to predictable changes in functional brain activity

Summary

Introduction

Investigating neurobiological processes associated with depression treatment is a burgeoning area of translational research. Pioneering studies evaluating therapy outcome and brain activity examined Interpersonal Psychotherapy (IPT; [5, 14], Cognitive Behavioral Therapy (CBT; [15,16,17]), and Behavioral Activation Treatment for Depression (BATD; [18]), demonstrating that positive treatment outcome is associated with changes in brain regions implicated in the pathophysiology of depression. Given the efficacy of behavioral activation in treating depression via increased reward exposure, this study evaluated whether BATD corresponded to predictable changes in functional brain activity. To examine this question, a novel reward responsiveness paradigm (pleasurable music listening) [36, 41] was used to explore regional brain activations in a depressed breast cancer patient receiving BATD. We anticipated that these regional changes would correspond with reductions on self-reportmeasures of depression and behavioral inhibition and an increase in environmental reward and behavioral activation

Case Presentation

Findings

Discussion