Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression

Nadja Doerig; Tobias Krieger; David Altenstein; Yolanda Schlumpf; Simona Spinelli; Jakub Späti; Janis Brakowski; Boris B Quednow; Erich Seifritz; Martin Grosse Holtforth

doi:10.1192/bjp.bp.114.149971

Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression

Br J Psychiatry. 2016 Feb;208(2):175-81. doi: 10.1192/bjp.bp.114.149971. Epub 2015 Oct 22.

Affiliations

¹ Nadja Doerig, PhD, Neuroscience Centre, University and ETH Zurich, and Department of Psychology, University of Zurich; Tobias Krieger, PhD, Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Bern, and Department of Psychology, University of Zurich; David Altenstein, PhD, Department of Psychology, University of Zurich; Yolanda Schlumpf, PhD, Division of Neuropsychology, Department of Psychology, University of Zurich; Simona Spinelli, PhD, Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, Zurich Centre for Integrative Human Physiology, University of Zurich, Switzerland; Jakub Späti, PhD, Department of Psychophysiology, National Institute of Mental Health, National Centre of Neurology and Psychiatry, Tokyo, Japan, and Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Janis Brakowski, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich; Boris B. Quednow, PhD, Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, and Zurich Centre for Integrative Human Physiology, University of Zurich; Erich Seifritz, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, and Zurich Centre for Integrative Human Physiology, University of Zurich; Martin grosse Holtforth, PhD, Department of Psychology, University of Zurich, and Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Bern, Switzerland nadja.
² Nadja Doerig, PhD, Neuroscience Centre, University and ETH Zurich, and Department of Psychology, University of Zurich; Tobias Krieger, PhD, Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Bern, and Department of Psychology, University of Zurich; David Altenstein, PhD, Department of Psychology, University of Zurich; Yolanda Schlumpf, PhD, Division of Neuropsychology, Department of Psychology, University of Zurich; Simona Spinelli, PhD, Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, Zurich Centre for Integrative Human Physiology, University of Zurich, Switzerland; Jakub Späti, PhD, Department of Psychophysiology, National Institute of Mental Health, National Centre of Neurology and Psychiatry, Tokyo, Japan, and Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Janis Brakowski, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich; Boris B. Quednow, PhD, Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, and Zurich Centre for Integrative Human Physiology, University of Zurich; Erich Seifritz, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Neuroscience Centre, University and ETH Zurich, and Zurich Centre for Integrative Human Physiology, University of Zurich; Martin grosse Holtforth, PhD, Department of Psychology, University of Zurich, and Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Bern, Switzerland.

PMID: 26494872
DOI: 10.1192/bjp.bp.114.149971

Abstract

Background: Cognitive-behavioural therapy is efficacious in the treatment of major depressive disorder but response rates are still far from satisfactory.

Aims: To better understand brain responses to individualised emotional stimuli and their association with outcome, to enhance treatment.

Method: Functional magnetic resonance imaging data were collected prior to individual psychotherapy. Differences in brain activity during passive viewing of individualised self-critical material in 23 unmedicated out-patients with depression and 28 healthy controls were assessed. The associations between brain activity, cognitive and emotional change, and outcome were analysed in 21 patients.

Results: Patients showed enhanced activity in the amygdala and ventral striatum compared with the control group. Non-response to therapy was associated with enhanced activity in the right amygdala compared with those who responded, and activity in this region was negatively associated with outcome. Emotional but not cognitive changes mediated this association.

Conclusions: Amygdala hyperactivity may lessen symptom improvement in psychotherapy for depression through attenuating emotional skill acquisition.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Amygdala / physiopathology*
Brain Mapping
Case-Control Studies
Cross-Sectional Studies
Depressive Disorder, Major / therapy*
Emotions*
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Outpatients
Psychotherapy / methods*
Regression Analysis
Self-Assessment*
Young Adult