Abstract
Objectives
In bipolar disorder (BD), the alternation of extreme mood states indicates deficits
in emotion processing, accompanied by aberrant neural function of the emotion network.
The present study investigated the effects of an emotion-centered psychotherapeutic
intervention on amygdala responsivity and connectivity during emotional face processing
in BD.
Methods
In a randomized controlled trial within the multicentric BipoLife project, euthymic
BD patients received one of two interventions over six months: an emotion-focused
intervention where patients were guided to adequately perceive and label their emotions
(FEST, n = 28) or a specific, cognitive-behavioral intervention (SEKT, n = 31). Before and after interventions, functional magnetic resonance imaging (fMRI)
was conducted while patients completed an emotional face-matching paradigm (final
fMRI sample of pre- and post-completers, SEKT: n = 17; FEST: n = 17). Healthy controls (n = 32) were scanned twice after the same interval without receiving any intervention.
Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala
activation and connectivity.
Results
Clinically, both interventions stabilized patients’ euthymic states in terms of affective
symptoms. At the neural level, FEST versus SEKT increased amygdala activation and
amygdala-insula connectivity at post relative to pre-intervention timepoint. In FEST,
the increase in amygdala activation was associated with fewer depressive symptoms
(r = .72) six months post-intervention.
Conclusion
Enhanced activation and functional connectivity of the amygdala FEST versus SEKT may
represent a neural marker of improved emotion processing, supporting the FEST intervention
as effective tool in the relapse prevention of BD.
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References
Meyer K, Catherine HA, Fiebig J, Stamm T, Bassett TR, Bauer M, et al. (2022): Boosting the ToM network: Specific psychotherapy increases neural correlates of affective theory of mind in euthymic bipolar disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.
- A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research.American Journal of Psychiatry. 2014; 171: 829-843
- Amygdala's involvement in facilitating associative learning-induced plasticity: a promiscuous role for the amygdala in memory acquisition.Frontiers in integrative neuroscience. 2012; 6: 92
- Emotion in motion: A three-stage model of aversive classical conditioning.Neuroscience & Biobehavioral Reviews. 2020; 115: 363-377
- Attention and associative learning in humans: An integrative review.Psychological bulletin. 2016; 142: 1111
- A preliminary study of increased amygdala activation to positive affective stimuli in mania.Bipolar disorders. 2009; 11: 70-75
- Regional fMRI hypoactivation and altered functional connectivity during emotion processing in nonmedicated depressed patients with bipolar II disorder.American Journal of Psychiatry. 2012; 169: 831-840
- Amygdala and whole‐brain activity to emotional faces distinguishes major depressive disorder and bipolar disorder.Bipolar disorders. 2013; 15: 741-752
- Amygdala activation and connectivity to emotional processing distinguishes asymptomatic patients with bipolar disorders and unipolar depression.Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2019; 4: 361-370
- Neurophysiological effects of multiple mood episodes in bipolar disorder.Bipolar disorders. 2019; 21: 503-513
- Neurobiology of emotion perception I: The neural basis of normal emotion perception.Biological psychiatry. 2003; 54: 504-514
- Evidence for deficient modulation of amygdala response by prefrontal cortex in bipolar mania.Psychiatry Research: Neuroimaging. 2008; 162: 27-37
- Client-centered therapy.Curr Psychother. 2013; : 95-150
- Emotion–focused therapy.Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice. 2004; 11: 3-16
- The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: a controlled functional MRI investigation.Journal of affective disorders. 2013; 150: 1152-1157
- Neural function before and after mindfulness-based cognitive therapy in anxious adolescents at risk for developing bipolar disorder.Journal of Child and Adolescent Psychopharmacology. 2016; 26: 372-379
- Aims and structure of the German Research Consortium BipoLife for the study of bipolar disorder.International journal of bipolar disorders. 2016; 4: 1-9
- Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder.Archives of general psychiatry. 2005; 62: 996-1004
- The mindfulness‐based cognitive therapy adherence scale: Inter‐rater reliability, adherence to protocol and treatment distinctiveness.Clinical Psychology & Psychotherapy. 2002; 9: 131-138
- Improving functional outcome in bipolar disorder: a pilot study on metacognitive training.Clinical psychology & psychotherapy. 2018; 25: 50-58
- A mechanism-based approach to anti-aggression psychotherapy in borderline personality disorder: group treatment affects amygdala activation and connectivity.Brain sciences. 2021; 11: 1627
- Neuropeptide-S (NPS) receptor genotype modulates basolateral amygdala responsiveness to aversive stimuli.Neuropsychopharmacology. 2011; 36: 1879-1885
- Beyond genotype: serotonin transporter epigenetic modification predicts human brain function.Nature neuroscience. 2014; 17: 1153-1155
- The German research consortium for the study of bipolar disorder (BipoLife): a magnetic resonance imaging study protocol.International journal of bipolar disorders. 2021; 9: 1-15
Team RC (2020): R: the R project for statistical computing. 2019. URL: https://www r-project org/[accessed 2020-03-30].
Ashburner J, Barnes G, Chen C-C, Daunizeau J, Flandin G, Friston K, et al. (2014): SPM12 manual. Wellcome Trust Centre for Neuroimaging, London, UK. 2464.
- Valence encoding signals in the human amygdala and the willingness to eat.Journal of Neuroscience. 2020; 40: 5264-5272
- Association of serotonin transporter gene AluJb methylation with major depression, amygdala responsiveness, 5-HTTLPR/rs25531 polymorphism, and stress.Neuropsychopharmacology. 2018; 43: 1308-1316
- A generalized form of context-dependent psychophysiological interactions (gPPI): a comparison to standard approaches.Neuroimage. 2012; 61: 1277-1286
Kennedy D, Haselgrove C, Fischl B, Breeze J, Frazier J, Seidman L, et al. (2016): Harvard-Oxford cortical and subcortical structural atlases. Harvard Center for Morphometric Analysis.
- The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies.Archives of general psychiatry. 1987; 44: 540-548
- The mirror neuron system.Archives of neurology. 2009; 66: 557-560
- Neural correlates of negative emotion processing in bipolar disorder.Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2015; 60: 1-10
- Viewing socio-affective stimuli increases connectivity within an extended default mode network.NeuroImage. 2017; 148: 8-19
- Resting-state brain networks: literature review and clinical applications.Neurological sciences. 2011; 32: 773-785
- Functional connectivity and neuronal variability of resting state activity in bipolar disorder—reduction and decoupling in anterior cortical midline structures.Human brain mapping. 2015; 36: 666-682
- Abnormal functional relationship of sensorimotor network with neurotransmitter-related nuclei via subcortical-cortical loops in manic and depressive phases of bipolar disorder.Schizophrenia bulletin. 2020; 46: 163-174
- Opposing changes in the functional architecture of large-scale networks in bipolar mania and depression.Schizophrenia bulletin. 2020; 46: 971-980
- Dynamics of amygdala connectivity in bipolar disorders: a longitudinal study across mood states.Neuropsychopharmacology. 2021; 46: 1693-1701
- Increased medial orbitofrontal and amygdala activation: evidence for a systems-level endophenotype of bipolar I disorder.American Journal of Psychiatry. 2012; 169: 316-325
- Emotion processing and regulation in bipolar disorder: a review.Bipolar disorders. 2012; 14: 326-339
- Neural Subtypes of Euthymic Bipolar I Disorder Characterized by Emotion Regulation Circuitry.Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2020; 5: 591-600
- Amygdala and insula connectivity changes following psychotherapy for posttraumatic stress disorder: a randomized clinical trial.Biological psychiatry. 2021; 89: 857-867
- A randomized controlled trial of acceptance and commitment therapy for aggressive behavior.Journal of consulting and clinical psychology. 2015; 83: 199
- Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans.Behaviour research and therapy. 2015; 74: 25-31
- The effectiveness of mindfulness-based cognitive therapy on experiential avoidance and death anxiety in elderly women.Rooyesh-e-Ravanshenasi Journal (RRJ). 2021; 10: 115-124
- Reductions in experiential avoidance as a mediator of change in symptom outcome and quality of life in acceptance-based behavior therapy and applied relaxation for generalized anxiety disorder.Behaviour research and therapy. 2016; 87: 188-195
- Effect of Mindfulness Training on Distress Tolerance and Alexithymia in Mothers With Autistic Children.Caspian Journal of Neurological Sciences. 2021; 7: 216-226
- Alexithymia.Handbook of clinical neurology. 2021; 183: 47-62
- Understanding the overlap and differences in terms describing patterns of maladaptive avoidance and intolerance of negative emotional states.Personality and Individual Differences. 2020; 158109859
- The effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder: emotion dysregulation as a mediator.International journal of psychiatry in clinical practice. 2021; 25: 90-102
- Alexithymia and its associations with depression, suicidality, and aggression: an overview of the literature.Frontiers in psychiatry. 2019; 10: 203
- Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder.Psychiatry research. 2019; 273: 218-226
- Emotion regulation of hippocampus using real-time fMRI neurofeedback in healthy human.Frontiers in human neuroscience. 2019; : 242
- Insula activity in resting-state differentiates bipolar from unipolar depression: a systematic review and meta-analysis.Scientific reports. 2021; 11: 1-11
- A pilot study of mindfulness-based exposure therapy in OEF/OIF combat veterans with PTSD: altered medial frontal cortex and amygdala responses in social–emotional processing.Frontiers in Psychiatry. 2016; 7: 154
- Experiential Avoidance and Mood State in Bipolar Disorder.Journal of Cognitive Psychotherapy. 2018; 32: 88-96
Article info
Publication history
Accepted:
February 24,
2023
Received in revised form:
February 18,
2023
Received:
November 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc on behalf of Society of Biological Psychiatry.
