Therapy results predicted
Brains scans can reveal success odds of cognitive behavioral therapy for depression
Changes in neural activity seen after two months of cognitive behavioral therapy for depression can signal which patients will benefit long term, according to a new study.
The findings, reported in September 2024 in Science Translational Medicine, add to evidence that choosing treatments based on the neurological underpinnings of depression — which vary among people — increases the odds of success.
The form of therapy used in the trial, known as problem-solving therapy, is designed to improve cognitive skills used in planning, troubleshooting and tuning out irrelevant information. A therapist guides patients in identifying real-life problems and brainstorming to choose the best solution. These cognitive skills depend on a set of neurons known as the cognitive control circuit.
The study’s participants were adults diagnosed with both major depression and obesity, a combination that often indicates problems with the cognitive control circuit. Patients with this profile have a mere 17% response rate to antidepressants. Yet 32% of the participants responded to problem-solving therapy.
“Real-world problem solving is literally changing the brain in a couple of months.” Leanne Williams, PhD
Leanne Williams, PhD
Of the 108 participants, 59 underwent a yearlong program of problem-solving therapy in addition to their usual care, such as medications. The other 49 received only usual care.
All received fMRI brain scans at the beginning of the study and periodically over the course of two years. Among participants receiving the therapy, decreased activity in the cognitive control circuit after two months correlated with enhanced problem-solving ability later on.
“We believe they have more efficient cognitive processing, meaning now they need fewer resources in the cognitive control circuit to do the same behavior,” said Xue Zhang, PhD, a postdoctoral scholar at Stanford Medicine and the study’s lead author.
The predictive nature of these early brain changes suggests the therapy targeted the neurological mechanisms underlying the patients’ depression.
“Real-world problem solving is literally changing the brain in a couple of months,” said Leanne Williams, PhD, the Vincent V.C. Woo Professor and a professor of psychiatry and behavioral sciences. She shares senior authorship of the study with Jun Ma, MD, PhD, a professor at the University of Illinois at Chicago.
Read full story here.
