The Effects of Psychotherapy on Neural Responses to Rewards in Major Depression

Background Unipolar major depressive disorder (MDD) is characterized by anomalous neurobiological responses to pleasant stimuli, a pattern that may be linked to symptoms of anhedonia. However, the potential for psychotherapy to normalize neurobiological responses to pleasant stimuli has not been eva...

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Bibliographic Details
Published in:Biological psychiatry (1969) 2009-11, Vol.66 (9), p.886-897
Main Authors: Dichter, Gabriel S, Felder, Jennifer N, Petty, Christopher, Bizzell, Joshua, Ernst, Monique, Smoski, Moria J
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Biological and medical sciences
Brain - physiopathology
Brain Mapping
Cingulate gyrus
Depression
Depressive Disorder, Major - physiopathology
Depressive Disorder, Major - therapy
Female
fMRI
Humans
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Mood disorders
orbital frontal cortex
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychomotor Performance - physiology
Psychopathology. Psychiatry
Psychotherapy
Reward
striatum
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Summary:Background Unipolar major depressive disorder (MDD) is characterized by anomalous neurobiological responses to pleasant stimuli, a pattern that may be linked to symptoms of anhedonia. However, the potential for psychotherapy to normalize neurobiological responses to pleasant stimuli has not been evaluated. Methods Twelve adults with and 15 adults without MDD participated in two identical functional magnetic resonance imaging scans that used a Wheel of Fortune task. Between scans, MDD outpatients received Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors. Results Seventy-five percent of adults with MDD were treatment responders, achieving post-treatment Hamilton Rating Scale for Depression score of six or below. Relative to changes in brain function in the matched nondepressed group, psychotherapy resulted in functional changes in structures that mediate responses to rewards, including the paracingulate gyrus during reward selection, the right caudate nucleus (i.e., the dorsal striatum), during reward anticipation, and the paracingulate and orbital frontal gyri during reward feedback. There was no effect of diagnostic status or psychotherapy on in-scanner task-related behavioral responses. Conclusions Behavioral Activation Therapy for Depression, a psychotherapy modality designed to increase engagement with rewarding stimuli and reduce avoidance behaviors, results in improved functioning of unique reward structures during different temporal phases of responses to pleasurable stimuli, including the dorsal striatum during reward anticipation.
ISSN:0006-3223
1873-2402
DOI:10.1016/j.biopsych.2009.06.021