Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2023-04-01 Epub Date: 2023-03-06 DOI:10.1037/ccp0000804

David F Tolin, Hannah C Levy, Lauren S Hallion, Bethany M Wootton, James Jaccard, Gretchen J Diefenbach, Michael C Stevens

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Abstract

Objective: Cognitive behavioral therapy (CBT) is efficacious for hoarding disorder (HD), though results are modest. HD patients show an increase in activity in the dorsal anterior cingulate cortex (dACC) when making decisions. The aim of this study is to determine whether CBT's benefits follow improvements in dACC dysfunction or abnormalities previously identified in other brain regions.

Method: In this randomized clinical trial of 64 treatment-seeking HD patients, patients received group CBT, delivered weekly for 16 weeks, versus wait list. Functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects.

Results: During acquiring decisions, activity decreased in several regions, including right dorsolateral prefrontal, right anterior intraparietal area, both right and left medial intraparietal areas, left and right amygdala, and left accumbens. During discarding decisions, activity decreased in right and left dorsolateral prefrontal, right and left rostral cingulate, left anterior ventral insular cortex, and right medial intraparietal areas. None of the a priori brain parcels of interest significantly mediated symptom reduction. Moderation effects were found for left rostral cingulate, right and left caudal cingulate, and left medial intraparietal parcels.

Conclusions: Therapeutic benefits of CBT for HD do not appear to be mediated by changes in dACC activation. However, pretreatment dACC activation predicts outcome. Findings suggest the need to re-evaluate emerging neurobiological models of HD and our understanding of how CBT affects the brain in HD, and perhaps shift focuses to new neural target discovery and target engagement trials. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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囤积症认知行为疗法随机试验后神经活动的变化。

目的：认知行为疗法（CBT）对囤积症（HD）有一定疗效，但效果一般。囤积症患者在做决定时，背侧前扣带回皮层（dACC）的活动会增加。本研究的目的是确定 CBT 的疗效是否随 dACC 功能障碍的改善或之前在其他脑区发现的异常而增加：在这项对 64 名寻求治疗的 HD 患者进行的随机临床试验中，患者接受了每周一次、为期 16 周的集体 CBT 治疗，而候补患者则接受了集体 CBT 治疗。在模拟决定是否获取和丢弃物品的过程中，使用功能磁共振成像检查神经活动：结果：在做出获取决定时，多个区域的神经活动减少，包括右侧背外侧前额叶、右侧顶内前区、右侧和左侧顶内内侧区、左侧和右侧杏仁核以及左侧伦琴。在做出放弃决定时，左右背外侧前额叶、左右喙扣带回、左侧腹前岛叶皮层和右侧顶叶内侧区域的活动减少。没有一个先验脑区对症状减轻有明显的中介作用。左侧喙扣带回、右侧和左侧尾状扣带回以及左侧内侧顶叶区的调节效应被发现：结论：CBT对HD的治疗效果似乎不是由dACC激活的变化介导的。然而，治疗前的dACC激活可预测治疗结果。研究结果表明，有必要重新评估新出现的HD神经生物学模型以及我们对CBT如何影响HD患者大脑的理解，或许可以将重点转移到新的神经靶点发现和靶点参与试验上。(PsycInfo Database Record (c) 2023 APA, 版权所有）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.