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Brain Sci. 2018, 8(8), 150; https://doi.org/10.3390/brainsci8080150

Disentangling the Neural Basis of Cognitive Behavioral Therapy in Psychiatric Disorders: A Focus on Depression

1
EA 4391 Excitabilité Nerveuse et Thérapeutique, Université Paris-Est, 94010 Créteil, France
2
Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France
3
Neurology Division, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut 1100, Lebanon
*
Author to whom correspondence should be addressed.
Received: 12 July 2018 / Revised: 7 August 2018 / Accepted: 8 August 2018 / Published: 9 August 2018
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Abstract

Background: Major depressive disorder (MDD) stands among the most frequent psychiatric disorders. Cognitive behavioral therapy (CBT) has been shown to be effective for treating depression, yet its neural mechanisms of action are not well elucidated. The objective of this work is to assess the available neuroimaging studies exploring CBT’s effects in adult patients with MDD. Methods: Computerized databases were consulted till April 2018 and a research was conducted according to PRISMA guidelines in order to identify original research articles published at any time in English and French languages on this topic. Results: Seventeen studies were identified. Only one study was randomized comparing CBT to pharmacological interventions, and none included an effective control. Following CBT, changes occurred in cerebral areas that are part of the fronto-limbic system, namely the cingulate cortex, prefrontal cortex and amygdala-hippocampal complex. However, the pattern of activation and connectivity in these areas varied across the studies. Conclusion: A considerable heterogeneity exists with regard to study design, adapted CBT type and intensity, and employed neuroimaging paradigms, all of which may partly explain the difference in studies’ outcomes. The lack of randomization and effective controls in most of them makes it difficult to draw formal conclusion whether the observed effects are CBT mediated or due to spontaneous recovery. Despite the observed inconsistencies and dearth of data, CBT appears to exert its anti-depressant effects mainly by modulating the function of affective and cognitive networks devoted to emotions generation and control, respectively. This concept remains to be validated in large scale randomized controlled trials. View Full-Text
Keywords: depression; MDD; neuroimaging; MRI; cognitive behavioral therapy; CBT; cognitive therapy; behavioral therapy depression; MDD; neuroimaging; MRI; cognitive behavioral therapy; CBT; cognitive therapy; behavioral therapy
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Chalah, M.A.; Ayache, S.S. Disentangling the Neural Basis of Cognitive Behavioral Therapy in Psychiatric Disorders: A Focus on Depression. Brain Sci. 2018, 8, 150.

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