title: Cognitive behavioral therapy increases amygdala connectivity with the cognitive control network in both MDD and PTSD.
abstract: Both major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are characterized by alterations in intrinsic functional connectivity. Here we investigated changes in intrinsic functional connectivity across these disorders as a function of cognitive behavioral therapy (CBT), an effective treatment in both disorders.
  
  
  
  53 unmedicated right-handed participants were included in a longitudinal study. Patients were diagnosed with PTSD (n= 18) and MDD (n= 17) with a structured diagnostic interview and treated with 12 sessions of manualized CBT over a 12-week period. Patients received an MRI scan (Siemens 3 T Trio) before and after treatment. Longitudinal functional principal components analysis (LFPCA) was performed on functional connectivity of the bilateral amygdala with the fronto-parietal network. A matched healthy control group (n= 18) was also scanned twice for comparison.
  
  
  
  LFPCA identified four eigenimages or principal components (PCs) that contributed significantly to the longitudinal change in connectivity. The second PC differentiated CBT-treated patients from controls in having significantly increased connectivity of the amygdala with the fronto-parietal network following CBT.
  
  
  
  Analysis of CBT-induced amygdala connectivity changes was restricted to the a priori determined fronto-parietal network. Future studies are needed to determine the generalizability of these findings, given the small and predominantly female sample.
  
  
  
  We found evidence for the hypothesis that CBT treatment is associated with changes in connectivity between the amygdala and the fronto-parietal network. CBT may work by strengthening connections between the amygdala and brain regions that are involved in cognitive control, potentially providing enhanced top-down control of affective processes that are dysregulated in both MDD and PTSD.
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, United States.
authors.forename: Haochang
authors.initials: H
authors.lastname: Shou
authors.affiliation: Department of Psychiatry, University of Pennsylvania, United States.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Psychiatry, University of Pennsylvania, United States.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Satterthwaite
authors.affiliation: Department of Radiology, University of Pennsylvania, United States.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Cook
authors.affiliation: Department of Psychological Sciences, Center for Trauma Recovery, University of Missouri-St Louis, United States.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Bruce
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, United States.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.affiliation: Department of Psychiatry, University of Pennsylvania, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rosenberg
authors.affiliation: Department of Psychiatry, University of Pennsylvania, United States; Department of Radiology, University of Pennsylvania, United States.
authors.forename: Yvette I
authors.initials: YI
authors.lastname: Sheline
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000000981:diagnostic imaging; D009483:Neuropsychological Tests; D025341:Principal Component Analysis; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Amygdala; Cognitive behavioral therapy; Fronto-parietal network; Principal component analysis; Resting state functional connectivity