Mechanisms of Emotion Regulation Underlying Successful CBT in Depression
Condition: Major Depressive Disorder
MeSH terms: Depressive Disorder; Depressive Disorder, Major
Study type: Observational [Patient Registry]

Summary: 
      This research aims to elucidate mechanisms through which change occurs during cognitive
      behavior therapy (CBT) for depression. Assessing meta-cognitive processes of self-knowledge
      (top-down), electrophysiological and behavioral correlates of emotion processing (bottom-up),
      and their relation to treatment outcome will provide new insights into the mechanisms of
      emotion regulation deficits in depression. It will also contribute toward the clinical goal
      of identifying patients who may benefit most from CBT for unipolar depression.
    

Detailed description: 
      This R21 application aims to clarify the neurobiological mechanisms by which change occurs
      during cognitive behavior therapy (CBT) for major depressive disorder (MDD). This
      hypothesis-driven study will explore the association between the psychological constructs of
      psychological mindedness (PM) and mindfulness (M) during the time course of CBT for MDD, and
      its relationship to electrophysiological and behavioral measures of automatic (i.e.
      stimulus-driven or bottom-up) emotion processing. This objective is motivated by the
      following rationale: PM and M represent different meta-cognitive processes of self-knowledge
      deemed critical for emotion regulation (ER) and CBT success. Event-related potentials (ERPs)
      to salient affective pictures reflect different stages of motivated attention. Using advanced
      analytic EEG techniques, we have linked these stages to the hierarchical activation of
      'emotional' brain regions along the occipitotemporal ventral stream, ranging from
      preconscious stimulus categorization (right secondary visual cortex, right temporoparietal
      junction) to conscious appraisal (posterior cingulate cortex, ventromedial cortex).
      Importantly, blunted ERP responses to emotionally-arousing stimuli have been observed in
      clinical depression, and hypoactivation of right temporoparietal and dorsolateral prefrontal
      regions normalize after successful antidepressant or electroconvulsive treatment. A dichotic
      emotion recognition test, which provides an auditory measure of bottom-up emotion processing
      in form of a left ear (right hemisphere) advantage for recognizing the emotional intonation
      of speech patterns, has revealed behavioral deficits in MDD patients. Moreover, an increased
      right ear advantage for verbal stimuli (left hemisphere) is seen in CBT responders. Employing
      a sample of 60 MDD patients randomly assigned to CBT or nonspecific supportive therapy
      (placebo), we will obtain psychological, electrophysiological, behavioral and clinical
      outcome measures of response to 12 weeks of CBT in a pre-post treatment design to determine:
      (1) when and where in the brain automatic emotion processing is altered by CBT; (2) if
      changes in emotional responding are moderated or mediated by meta-cognitive processes of
      self-knowledge; and, (3) if these measures, alone or in combination, have promise as markers
      of CBT treatment response. Existing ERP and behavioral data for healthy adults (HC) obtained
      using the same experimental protocols will provide normative (yardstick) data. This study
      brings together experienced clinical psychologists and psychiatrists doing treatment and
      research in depression with investigators having expertise in affective neuroscience and
      electrophysiological studies in MDD. It will provide a critical new step for outlining the
      affective-cognitive and neurophysiological mechanisms of ER by which change through CBT
      occurs. Apart from their theoretical relevance, the findings of this project will also aid in
      developing novel and more targeted interventions and in identifying patients who may benefit
      most from CBT for unipolar depression.
    

Intervention name(s): Cognitive Behavior Therapy (CBT); Nonspecific Supportive Therapy (PBO)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Following established procedures at the DES at NYSPI, 12 sessions of individual manual-driven CBT (Emery, 2000) will be conducted by highly trained master degree clinicians.; As a non-CBT intervention that includes warmth, genuineness and empathy (Linde et al., 2011), nonspecific supportive therapy (PBO) will be administered in a parallel format to CBT, also consisting of 12 individual sessions.
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Right-handed MDD patients (N = 60; Beck Depression Inventory [BDI] > 12, Hamilton Rating
        Scale for Depression [HRSD] > 13), aged 18 to 65 (~half male), recruited through the
        Depression Evaluation Service at NY State Psychiatric Institute (NYSPI)
      
Keywords: Cognitive Behavioral Therapy (CBT); Motivated Attention; Psychological Mindedness; Mindfulness; Visual Half-Field paradigm; Dichotic Listenting; Emotion Recognition Task; Left Ear Advantage (LEA); Emotion Regulation; Event-Related Potential (ERP); Meta-Cognitive Processes