Changes in Functional Connectivity Following Treatment With Emotion Regulation Therapy

Abstract

Emotion regulation therapy (ERT) is an efficacious treatment for distress disorders (i.e., depression and anxiety), predicated on a conceptual model wherein difficult to treat distress arises from intense emotionality (e.g., neuroticism, dispositional negativity) and is prolonged by negative self-referentiality (e.g., worry, rumination). Individuals with distress disorders exhibit disruptions in two corresponding brain networks including the salience network (SN) reflecting emotion/motivation and the default mode network (DMN) reflecting self-referentiality. Using resting-state functional connectivity (rsFC) analyses, seeded with primary regions in each of these networks, we investigated whether ERT was associated with theoretically consistent changes across nodes of these networks and whether these changes related to improvements in clinical outcomes. This study examined 21 generalized anxiety disorder (GAD) patients [with and without major depressive disorder (MDD)] drawn from a larger intervention trial (Renna et al., 2018a), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, to investigate whether ERT was associated with changes in connectivity of nodes of the DMN and SN networks to regions across the brain. Findings revealed statistically significant treatment linked changes in both the DMN and SN network nodes, and these changes were associated with clinical improvement corresponding to medium effect sizes. The results are discussed in light of a nuanced understanding of the role of connectivity changes in GAD and MDD, and begin to provide neural network support for the hypothesized treatment model predicated by ERT.

Keywords: decentering; emotion regulation; generalized anxiety disorder; major depressive disorder; reappraisal; resting state functional connectivity; worry.

Figure 1

Change in connectivity associated with each seed. Regions demonstrating pre-post emotion regulation therapy (ERT) change in resting state functional connectivity (rsFC). (A) The posterior cingulate seed showed increased connectivity with middle occipital gyrus (43, −74, 17), precuneus (13, −68, 47), cuneus (16, −65, 11), precentral gyrus (−41, −5, 53; not shown) and premotor areas/dorsolateral prefrontal cortex (DLPFC; 40, 4, 35). (B) The anterior insula seed showed increased connectivity with the cuneus (−5, −71, 29). (C) The posterior insula seed increased connectivity with anteromedial PFC/dorsal anterior cingulate cortex (dACC; −5, 46, 17) and decreased connectivity with midbrain (13, −29, −25). Cluster are significant after cluster-based correction for multiple comparisons (>9 contiguous voxels). Yellow scale indicates positive z-scores, and blue scale indicates negative z-scores.