International Journal of Psychophysiology, 2023, 188:S132. [To Be Presented at the 21st World Congress of Psychophysiology, June 26 - 29, 2023.]
Targeting Mechanisms of Emotion Regulation During Cognitive Behavior Therapy in Depression: Preliminary ERP Findings During Lateralized Presentations of Aversive Pictures
Jürgen Kayser1,2, Yifan Gao2, Tayler Wilson3, Rocco Rinaldi-Rose3, Christopher Aceto3, Steven D. Hollon4, Gerard E. Bruder1, Ronit Kishon1,3
1Columbia University, Department of Psychiatry, New York, NY, USA; 2New York State Psychiatric Institute, Division of Translational Epidemiology, New York, NY, USA; 3New York State Psychiatric Institute, Depression Evaluation Service, New York, NY, USA; 4Vanderbilt University, Department of Psychology, Nashville, TN, USA
Abstract
Introduction: This study aims to clarify the neurobiological mechanisms by which change occurs during cognitive behavior therapy (CBT) for major depressive disorder (MDD). Emotion regulation is deemed critical for CBT success. Event-related potentials (ERPs) to salient affective pictures reflect different stages of motivated attention, ranging from automatic or stimulus-driven categorization (bottom-up) to cognitive appraisal (top-down) during emotion processing. Blunted ERPs to emotionally-arousing stimuli have been observed in MDD. Building on prior event-related potential (ERP) findings, we examined whether abnormal early (preconscious) responsivity to negative arousing stimuli, which is indicative of right parietotemporal dysfunction in MDD patients, is moderated by or predictive of treatment response. Methods: Using highly-controlled negative/neutral picture pairs during an emotional hemifield paradigm, ERPs (72 sites) were recorded from 25 depressed patients (13 male, age 21-56 years) before and after 12 weeks of cognitive-behavioral (n=11, 73% BDI-based responder) or nonspecific-supportive (n=14, 68%) therapy. Reference-free current source density (CSD) transformations of ERPs were quantified by temporal principal components analysis (tPCA). The CSD-tPCA solution confirmed prior findings of three distinct stages of emotional processing comprising the late positive potential (negative-greater-than-neutral): early N2 sink (peak latency 208 ms), P3 source (330 ms), and late centroparietal (CP) source (575 ms). Results: Repeated measures ANOVAs of corresponding component scores revealed divergent emotional effects for N2 sink: Whereas responders had greater emotional effects over left-than-right posterior sites at baseline, with this asymmetry reversed after treatment, nonresponders showed a right-greater-than-left asymmetry at both sessions, exhibiting no emotional effects over the left hemisphere before treatment. These early effects were further differentially modulated by visual field, with responders showing amplitude enhancement with contralateral stimulation, whereas nonresponders did not. By contrast, prominent late emotional content effects were seen for CP source for responders before and after treatment at both hemispheres, whereas nonresponders failed to show notable emotional effects for CP source at any testing session or hemisphere. Conclusions: Although caution is warranted given the preliminary status of this ongoing clinical trial with its current limited sample size, findings are consistent with hypothesized differences in top-down regulation of bottom-up emotion processing that are linked to MDD treatment response. Our findings suggest that the hierarchical activation of Âemotional brain regions along the occipitotemporal ventral stream, ranging from preconscious stimulus categorization to conscious appraisal, is aberrant in treatment nonresponders, which leads to inhibition of downstream emotional processing. An increased sample size will be required to differentiate placebo response from CBT success.
Key Words: depression; cognitive behavioral therapy (CBT); treatment response; event-related potential (ERP); late positive potential (LPP); current source density (CSD); principal components analysis (PCA)
[Supported by National Institute of Mental Health (MH121915)].