Pretreatment brain connectivity during positive emotion upregulation predicts decreased anhedonia following behavioral activation therapy for depression

Abstract

Background: Neurobiological predictors of antidepressant response may help guide treatment selection and improve response rates to available treatments for major depressive disorder (MDD). Behavioral activation therapy for depression (BATD) is an evidence-based intervention designed to ameliorate core symptoms of MDD by promoting sustained engagement with value-guided, positively-reinforcing activities. The present study examined pre-treatment task-based functional brain connectivity as a predictor of antidepressant response to BATD.

Methods: Thirty-three outpatients with MDD and 20 nondepressed controls completed a positive emotion regulation task during fMRI after which participants with MDD received up to 15 sessions of BATD. We used generalized psychophysiological interaction analyses to examine group differences in pre-treatment functional brain connectivity during intentional upregulation of positive emotion to positive images. Hierarchical linear models were used to examine whether group differences in functional connectivity predicted changes in depression and anhedonia over the course of BATD.

Results: Compared to controls, participants with MDD exhibited decreased connectivity between the left middle frontal gyrus and right temporoparietal regions during upregulation of positive emotion. Within the MDD group, decreased connectivity of these regions predicted greater declines in anhedonia symptoms over treatment.

Limitations: Future studies should include comparison treatments and longitudinal follow-up to clarify the unique effects of BATD on neural function and antidepressant response.

Conclusions: Results are consistent with previous work showing BATD may be particularly effective for individuals with greater disturbances in brain reward network function, but extend these findings to highlight the importance of frontotemporoparietal connectivity in targeting symptoms of low motivation and engagement.

Keywords: Behavioral activation therapy; Functional brain connectivity; Major depression; Positive emotion regulation; fMRI.

Copyright © 2018. Published by Elsevier B.V.

Figures

Figure 1.

(A) Positive emotion regulation task. Each trial consisted of a fixation cross, a positive or neutral image, a regulation cue, a delay, and a query for current affect. (B) The MDD group demonstrated less connectivity between the left middle frontal gyrus (seed) and right temporoparietal regions during viewing of positively-valenced images while upregulating positive emotion compared to no regulation of emotion (Positive Increase > Positive View).