The effects of hypnotherapy compared to cognitive behavioral therapy in depression: a NIRS-study using an emotional gait paradigm

Abstract

Hypnotherapy (HT) is a promising approach to treating depression, but so far, no data are available on the neuronal mechanisms of functional reorganization after HT for depressed patients. Here, 75 patients with mild to moderate depression, who received either HT or Cognitive Behavioral Therapy (CBT), were measured before and after therapy using functional near-infrared spectroscopy. We investigated the patients' cerebral activation during an emotional human gait paradigm. Further, rumination was included as predictor. Our results showed a decrease of functional connectivity (FC) between two regions that are crucial to emotional processing, the Extrastriate Body Area (EBA) and the Superior Temporal Sulcus (STS). This FC decrease was traced back to an activation change throughout therapy in the right STS, not the EBA and was only found in the HT group, depending on rumination: less ruminating HT patients showed a decrease in right STS activation, while highly ruminating patients showed an increase. We carefully propose that this activation change is due to the promotion of emotional experiences during HT, while in CBT a focus lay on activating behavior and changing negative cognitions. HT seemed to have had differential effects on the patients, depending on their rumination style: The increase of right STS activation in highly ruminating patients might mirror the improvement of impaired emotional processing, whilst the decrease of activation in low ruminating patients might reflect a dismissal of an over-compensation, associated with a hyperactivity before therapy. We conclude that HT affects emotional processing and this effect is moderated by rumination.

Keywords: Cognitive behavioral therapy; Depression; Emotional processing; Hypnotherapy; Temporal lobe.

Fig. 1

Procedure of including and measuring patients throughout our study. Number of patients in the WIKI-D study [16] (N); intended to treat (ITT); Cognitive Behavioral Therapy (CBT); Hypnotherapy (HT)

Fig. 2

Regions of Interest in the right and left cerebral hemisphere. The dashed circles portray the STS region (Channels: 8, 19, 29 (right); 3, 13, 14, 24 (left)), the dotted circles the EBA region (Channels: 39 (right); 35 (left)). Superior Temporal Sulcus (STS); Extrastriate Body Area (EBA)

Fig. 3

Correlation between the change of connectivity between the right STS and EBA separately for the two therapy groups. Superior Temporal Sulcus (STS); Extrastriate Body Area (EBA); Cognitive Behavioral Therapy (CBT); Hypnotherapy (HT)

Fig. 4

a CS below and above zero (black line) and the regression line (dashed line) between the CS of right STS activation and rumination, the result of our regression analysis (including preactivation as additive predictor). b Categorial illustration of the association between rumination and the activation of the right STS in the HT group. Change Score (CS; Superior Temporal Sulcus (STS); Hypnotherapy (HT)

Fig. 5

The effect of rumination on the change of STS activation throughout therapy in the HT group. The figure portrays a t-test between activation before therapy (pre) compared to after therapy (post) (post–pre) in the HT group for either low or high ruminators. Superior Temporal Sulcus (STS); Hypnotherapy (HT)