Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Nov 1;66(9):886-97.
doi: 10.1016/j.biopsych.2009.06.021. Epub 2009 Sep 2.

The effects of psychotherapy on neural responses to rewards in major depression

Gabriel S Dichter  1 , Jennifer N Felder, Christopher Petty, Joshua Bizzell, Monique Ernst, Moria J Smoski
Affiliations

The effects of psychotherapy on neural responses to rewards in major depression

Gabriel S Dichter et al. Biol Psychiatry. .

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The Wheel of Fortune task; (a) The four different wheel types; (b) The timing of three task processes, i.e., reward selection, reward anticipation, and reward feedback.
Figure 2
Figure 2
Top Left: Percentage of high risk selections (i.e., smaller pie slices) for the 10/90 and 30/70 conditions for both diagnostic groups at both timepoints. Top Right. Average confidence ratings (range = 1 to 6) for both diagnostic groups at both timepoints. Note that the unequal wheels are subdivided based on selection selections on a trial-by-trial basis (i.e., “risky” or “safe” selections). Bottom Left: Ratings of feedback valence for win trials for both diagnostic groups at both timepoints. On win trails, the range and direction of the ratings were 1 = Neutral, 6 = Very Happy, whereas on no-win trials, the range and direction of the ratings were 1 = Very Sad, 6 = Neutral. Bottom Right: Ratings of feedback valence for non-win trials for both diagnostic groups at both timepoints. On win trails, the range and direction of the ratings were 1 = Neutral, 6 = Very Happy, whereas on no-win trials, the range and direction of the ratings were 1 = Very Sad, 6 = Neutral.
Figure 3
Figure 3
Reward selection (top) and anticipation (bottom) fMRI results (money vs. control). Activation images denote voxels with significant Group (Depressed, Nondepressed) X Time (Time 1, Time 2) interactions. Neurological convention (right on right) is used and coordinates are in MNI space. Signal intensity is T statistic units.
Figure 4
Figure 4
Reward feedback fMRI results for win (top) and non-win (bottom) trials, relative to control feedback. Activation images denote voxels with significant Group (Depressed, Nondepressed) X Time (Time 1, Time 2) interactions. Neurological convention (right on right) is used and coordinates are in MNI space. Signal intensity is T statistic units.
See this image and copyright information in PMC

References

    1. Mayberg HS. Limbic-cortical dysregulation: a proposed model of depression. J Neuropsychiatry Clin Neurosci. 1997;9(3):471–481. - PubMed
    1. Ressler KJ, Mayberg HS. Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nat Neurosci. 2007;10(9):1116–1124. - PMC - PubMed
    1. Mayberg HS. Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull. 2003;65:193–207. - PubMed
    1. Seminowicz DA, Mayberg HS, McIntosh AR, Goldapple K, Kennedy S, Segal Z, Rafi-Tari S. Limbic-frontal circuitry in major depression: a path modeling metanalysis. Neuroimage. 2004;22(1):409–418. - PubMed
    1. Greicius MD, Flores BH, Menon V, Glover GH, Solvason HB, Kenna H, Reiss AL, Schatzberg AF. Resting-state functional connectivity in major depression: abnormally increased contributions from subgenual cingulate cortex and thalamus. Biol Psychiatry. 2007;62(5):429–437. - PMC - PubMed

Publication types