title: Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery.
abstract: Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Mason
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Peters
authors.affiliation: Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Williams
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Kumari
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000523:psychology; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D000066499:Facial Recognition; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D011618:Psychotic Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D012563:Schizophrenia, Paranoid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012938:Social Perception; D016896:Treatment Outcome