Neural Effects of Cognitive Behavioral Therapy in Psychiatric Disorders: A Systematic Review and Activation Likelihood Estimation Meta-Analysis

Shiting Yuan, Huiqin Wu, Yun Wu, Huazhen Xu, Jianping Yu, Yuan Zhong, Ning Zhang, Jinyang Li, Qianwen Xu, Chun Wang, Shiting Yuan, Huiqin Wu, Yun Wu, Huazhen Xu, Jianping Yu, Yuan Zhong, Ning Zhang, Jinyang Li, Qianwen Xu, Chun Wang

Abstract

Background: Cognitive behavioral therapy (CBT) is a first-line psychotherapeutic treatment that has been recommended for psychiatric disorders. Prior neuroimaging studies have provided preliminary evidence suggesting that CBT can have an impact on the activity of brain regions and functional integration between regions. However, the results are far from conclusive. The present article aimed to detect characteristic changes in brain activation following CBT across psychiatric disorders.

Method: Web of Science, Cochrane Library, Scopus, and PubMed databases were searched to identify whole-brain functional neuroimaging studies of CBT through 4 August 2021. To be included in the meta-analysis, studies were required to examine functional activation changes between pre-and post-CBT. The included studies were then divided into subgroups according to different task paradigms. Then, an activation likelihood estimation algorithm (ALE) was performed in the different meta-analyses to identify whether brain regions showed consistent effects. Finally, brain regions identified from the meta-analysis were categorized into eight functional networks according to the spatial correlation values between independent components and the template.

Results: In total, 13 studies met inclusion criteria. Three different meta-analyses were performed separately for total tasks, emotion tasks, and cognition tasks. In the total task ALE meta-analysis, the left precuneus was found to have decreased activation. For the cognition task ALE meta-analysis, left anterior cingulate (ACC) and left middle frontal gyrus (MFG) were found to have decreased activation following CBT. However, the emotion task ALE meta-analysis did not find any specific brain regions showing consistent effects. A review of included studies revealed default mode network (DMN), executive control network (ECN), and salience network (SN) were the most relevant among the eight functional networks.

Conclusion: The results revealed that the altered activation in the prefrontal cortex and precuneus were key regions related to the effects of CBT. Therefore, CBT may modulate the neural circuitry of emotion regulation. This finding provides recommendations for the rapidly developing literature.

Keywords: brain network; cognitive behavioral therapy (CBT); meta-analysis; neuroimaging; psychiatric disorder.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Yuan, Wu, Wu, Xu, Yu, Zhong, Zhang, Li, Xu and Wang.

Figures

FIGURE 1
FIGURE 1
Flowchart of the searching strategy and study selection process, based on PRISMA template (Liberati et al., 2009; Moher et al., 2009).
FIGURE 2
FIGURE 2
In the cognition paradigm, significantly decreased activations across the left anterior cingulate (L ACC) and left middle frontal gyrus (L MFG) were found in patients with psychiatric disorders after CBT (p < 0.05).
FIGURE 3
FIGURE 3
In all paradigms, significantly decreased activation in the left cuneus was found in patients with psychiatric disorders after CBT (p < 0.05).
FIGURE 4
FIGURE 4
This figure shows regions that have been reported to show CBT-related changes and the overlap between regions involved in different brain networks. The subscript number next to the brain region represents the number of articles related to that brain region.

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