Abstract

BackgroundPediatric anxiety and depression are highly prevalent and debilitating disorders that often co-occur. Neural circuitry of reward processing has been shown to be implicated in both, and there is an emerging evidence base linking treatment response to brain patterns of reward processing. The current study aimed to add to this literature by investigating the association between clinical improvement and social and non-social reward in youth previously treated for anxiety and depression.MethodsThe current study leveraged clinical improvement data from a successful randomized controlled trial testing the efficacy of a transdiagnostic, brief behavioral treatment for youth diagnosed with anxiety or depression. Participants (N = 15) interested in engaging in a neuroimaging follow-up underwent an fMRI scan, during which they completed social (i.e., Face Task) and non-social (i.e., Piñata Task, a youth-friendly monetary incentive delay task) reward tasks. Whole-brain activation and functional connectivity analyses identified neural responses to the tasks separately; a third set of analyses directly compared clinical improvement-related findings to understand the impact of task context on neural reactivity to reward.ResultsActivation-based findings were sparse; however, connectivity as a function of degree of treatment response was apparent and robust. Within the context of social reward, significant clusters within frontal and temporal regions driven by happy face contrasts, the social reward stimulus, were observed. This supports connectivity between these regions and both amygdala and ventral striatum seeds as a function of degree of clinical improvement. Connectivity within the context of non-social reward also yielded significant clusters in temporal and parietal regions. Here too, the magnitude and direction of region coupling depended on the degree of clinical improvement and the task conditions. No differences in connectivity by task type as a function of clinical improvement were found.ConclusionFindings serve as preliminary evidence that neural regions found to be related to clinical improvement within the context of social and non-social reward are similar to regions that have been shown to support reward processing in normative samples. Implications for treatment and future work are discussed.

Highlights

  • Pediatric anxiety and depression are highly prevalent, debilitating, and associated with a chronic course and longterm impairment (e.g., Merikangas et al, 2010)

  • Anxiety and depression respond to the same classes of psychosocial and pharmacological (e.g., SSRIs) interventions (Compton et al, 2004), and treatment of one target disorder may lead to cross-over effects on the other disorder

  • Such findings are in contrast to evidence that anxiety and depression differ in their responses to intervention

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Summary

Introduction

Pediatric anxiety and depression are highly prevalent, debilitating, and associated with a chronic course and longterm impairment (e.g., Merikangas et al, 2010). The few studies that have tested transdiagnostic protocols in pediatric samples have documented the efficacy in targeting internalizing disorders (Chu et al, 2016; Ehrenreich-May et al, 2017; Weersing et al, 2017), suggesting shared processes of disorder and recovery across anxiety and depression. Such findings are in contrast to evidence that anxiety and depression differ in their responses to intervention. The current study aimed to add to this literature by investigating the association between clinical improvement and social and non-social reward in youth previously treated for anxiety and depression

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