title: Neural effects of cognitive-behavioural therapy on dysfunctional attitudes in depression.
abstract: BACKGROUND
  Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive-behavioural therapy (CBT).
  
  
  METHODS
  Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48).
  
  
  RESULTS
  MDD patients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDD patients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDD patients at the follow-up scan relative to healthy controls.
  
  
  CONCLUSIONS
  Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.
authors.affiliation: Centre for Affective Disorders, Department of Psychological Medicine,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK.
authors.forename: A
authors.initials: A
authors.lastname: Sankar
authors.affiliation: Academic Psychiatry,Institute of Neuroscience, University of Newcastle,Newcastle upon Tyne,UK.
authors.forename: J
authors.initials: J
authors.lastname: Scott
authors.affiliation: Faculty of Medicine and Health Sciences,University of Nottingham,Nottingham,UK.
authors.forename: A
authors.initials: A
authors.lastname: Paszkiewicz
authors.affiliation: Department of Neuroimaging, Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK.
authors.forename: V P
authors.initials: VP
authors.lastname: Giampietro
authors.affiliation: East London NHS Foundation Trust,London,UK.
authors.forename: H
authors.initials: H
authors.lastname: Steiner
authors.affiliation: Centre for Affective Disorders, Department of Psychological Medicine,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK.
authors.forename: C H Y
authors.initials: CH
authors.lastname: Fu
mesh_terms: D000328:Adult; D001290:Attitude; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020534:Parahippocampal Gyrus / Q000503:physiopathology*; D010296:Parietal Lobe / Q000503:physiopathology; D013850:Thinking / Q000502:physiology*; D016896:Treatment Outcome
keywords: psychotherapy