Neurocognitive Predictors of Behavioral Therapy Response in Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This project aims to identify brain and behavioral characteristics of individuals
      experiencing symptoms of depression that will predict the effectiveness of Behavioral
      Activation Therapy. Brain imaging aspects of the study will use functional magnetic resonance
      imaging (fMRI) and electroencephalography (EEG). Behavioral assessments will include
      self-report questionnaires, computer-based and observational tasks, and interviews.
      Assessments will focus on how individuals process positive information (such as reward) and
      negative information (such as distressing images), as well as how people make decisions.
      These assessments will be conducted across 2-3 in-person sessions prior to beginning the
      treatment, and will be repeated across 2-3 in-person sessions after completing treatment. A
      blood draw will also be conducted pre- and post- treatment. Behavior Activation therapy will
      consist of 10, 90-minute weekly therapy sessions conducted in small groups.
    

Detailed description: 
      Anxiety and mood disorders are the most prevalent class of mental health disorders, with
      lifetime prevalence estimated at 32% and 18%, respectively. These disorders have tremendous
      personal and socioeconomic impacts (cost >$1500 per-patient/year) due to days lost at work,
      increased health care utilization, and increased risk of mortality (e.g. cardiovascular
      disease). First-line treatments for depression include pharmacologic (e.g. selective
      serotonin reuptake inhibitors) and psychotherapeutic interventions (e.g. cognitive behavioral
      therapy and behavioral therapy). While both are superior to placebo treatments, only 40-60%
      of patients experience significant improvement and 15-25% of responders relapse within one
      year. Thus, long-lasting improvements are experienced by less than 50% of patients. This
      ineffectiveness has been moderately associated with symptom severity, illness duration, and
      comorbidity, but these findings do not provide any strategies for improving treatment
      effectiveness. The current study will seek to identify behavioral or cognitive-affective
      predictors that indicate how well a patient is responding to treatment so that interventions
      can be further individualized to more effectively treat refractory patients.

      The aim of this study is to identify whether neural, biological, and behavioral responses
      related to the arbitration of conflicting avoidance and approach drives can predict behavior
      therapy response for depressed individuals. This aim will be accomplished using behavioral,
      functional magnetic resonance imaging (fMRI), and genetic analyses pre and post Behavioral
      Activation therapy. Research subjects will include treatment-seeking individuals with
      clinically significant symptoms of unipolar depression. Diagnosis will be assessed using
      structured clinical interviews. Anxious and depressive symptom severity, personality
      characteristics, and general functioning will be collected via self-report paper-and-pencil
      questionnaires. Objective measures of approach, avoidance, and conflict behavioral responses
      will be collected using computer-administered testing and related neural responsivity will be
      measured using fMRI. For exploratory aims, a blood draw will be collect pre and
      post-treatment to examine genetic factors that may predict response to behavior therapy. This
      research has the potential to identify neural and behavioral approach-avoidance
      characteristics that can help predict which patients are likely to respond to behavior
      therapy for depression (i.e., predictors of treatment effectiveness) and reveal targets for
      future treatment modifications.

      Aim 1: Clarify the potential contribution of approach-avoidance behaviors and neural
      responses to depression symptom severity.

      Hypothesis 1.1: Approach-related behaviors and conflict arbitration behavior will explain a
      significant amount of variance in depressive symptoms, above and beyond avoidance-related
      behavior.

      Hypothesis 1.2: Activations within approach-related (i.e., striatum) and conflict arbitration
      (i.e., lateral PFC) neural circuitry will explain significant variance in depressive symptom
      severity above and beyond activations within avoidance-related (i.e., amygdala) neural
      circuitry. Specifically, the investigators expect increased levels of depression to relate to
      reduced striatal responsivity.

      Aim 2: Identify approach-avoidance behaviors and neural responses that predict the
      effectiveness of behavioral activation therapy (BA) for depressed subjects.

      Hypothesis 2.1: Approach-related behaviors and/or conflict arbitration behavior will help
      predict treatment response above and beyond avoidance-related behavior and baseline symptom
      severity. Specifically, the investigators expect that decreased reward sensitivity will
      predict nonresponse of depressed patients to BA.

      Hypothesis 2.2: Approach-related and conflict arbitration neural circuitry will help to
      predict treatment response above and beyond activations within avoidance-related neural
      circuitry. Specifically, the investigators expect striatal responsivity to reward to predict
      response of depressed patients to BA.

      Aim 3: Identify whether functional improvement with BA is associated with change in
      approach-avoidance behaviors and/or neural responses.

      Hypothesis 3.1: The level of change in reward sensitivity will positively relate to the level
      of improvement in overall functioning with BA.
    

Intervention name(s): Behavioral Activation therapy
Intervention type(s): Behavioral
Intervention description(s): Behavioral Activation therapy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science