Gregory G. Kolden

Reduced capacity to sustain positive emotion in major depression reflects diminished maintenance of fronto-striatal brain activation

Anhedonia, the loss of pleasure or interest in previously rewarding stimuli, is a core feature of major depression. While theorists have argued that anhedonia reflects a reduced capacity to experience pleasure, evidence is mixed as to whether anhedonia is caused by a reduction in hedonic capacity. An alternative explanation is that anhedonia is due to the inability to sustain positive affect across time. Using positive images, we used an emotion regulation task to test whether individuals with depression are unable to sustain activation in neural circuits underlying positive affect and reward. While up-regulating positive affect, depressed individuals failed to sustain nucleus accumbens activity over time compared with controls. This decreased capacity was related to individual differences in self-reported positive affect. Connectivity analyses further implicated the fronto-striatal network in anhedonia. These findings support the hypothesis that anhedonia in depressed patients reflects the inability to sustain engagement of structures involved in positive affect and reward.

Self-System Therapy as an Intervention for Self-Regulatory Dysfunction in Depression: A Randomized Comparison with Cognitive Therapy.

Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection.

Relationships Between Changes in Sustained Fronto-Striatal Connectivity and Positive Affect in Major Depression Resulting From Antidepressant Treatment

OBJECTIVE Deficits in positive affect and their neural bases have been associated with major depression. However, whether reductions in positive affect result solely from an overall reduction in nucleus accumbens activity and fronto-striatal connectivity or the additional inability to sustain engagement of this network over time is unknown. The authors sought to determine whether treatment-induced changes in the ability to sustain nucleus accumbens activity and fronto-striatal connectivity during the regulation of positive affect are associated with gains in positive affect. METHOD Using fMRI, the authors assessed the ability to sustain activity in reward-related networks when attempting to increase positive emotion during performance of an emotion regulation paradigm in 21 depressed patients before and after 2 months of antidepressant treatment. Over the same interval, 14 healthy comparison subjects underwent scanning as well. RESULTS After 2 months of treatment, self-reported positive affect increased. The patients who demonstrated the largest increases in sustained nucleus accumbens activity over the 2 months were those who demonstrated the largest increases in positive affect. In addition, the patients who demonstrated the largest increases in sustained fronto-striatal connectivity were also those who demonstrated the largest increases in positive affect when controlling for negative affect. None of these associations were observed in healthy comparison subjects. CONCLUSIONS Treatment-induced change in the sustained engagement of fronto-striatal circuitry tracks the experience of positive emotion in daily life. Studies examining reduced positive affect in a variety of psychiatric disorders might benefit from examining the temporal dynamics of brain activity when attempting to understand changes in daily positive affect.

Reduced right ventrolateral prefrontal cortex activity while inhibiting positive affect is associated with improvement in hedonic capacity after 8 weeks of antidepressant treatment in major depressive disorder

BACKGROUND Anhedonia, a reduced ability to experience pleasure, is a chief symptom of major depressive disorder and is related to reduced frontostriatal connectivity when attempting to upregulate positive emotion. The present study examined another facet of positive emotion regulation associated with anhedonia-namely, the downregulation of positive affect-and its relation to prefrontal cortex (PFC) activity. METHODS Neuroimaging data were collected from 27 individuals meeting criteria for major depressive disorder as they attempted to suppress positive emotion during a positive emotion regulation task. Their PFC activation pattern was compared with the PFC activation pattern exhibited by 19 healthy control subjects during the same task. Anhedonia scores were collected at three time points: at baseline (time 1), 8 weeks after time 1 (i.e., time 2), and 6 months after time 1 (i.e., time 3). Prefrontal cortex activity at time 1 was used to predict change in anhedonia over time. Analyses were conducted utilizing hierarchical linear modeling software. RESULTS Depressed individuals who could not inhibit positive emotion-evinced by reduced right ventrolateral prefrontal cortex activity during attempts to dampen their experience of positive emotion in response to positive visual stimuli-exhibited a steeper anhedonia reduction slope between baseline and 8 weeks of treatment with antidepressant medication (p < .05). Control subjects showed a similar trend between baseline and time 3. CONCLUSIONS To reduce anhedonia, it may be necessary to teach individuals how to counteract the functioning of an overactive pleasure-dampening prefrontal inhibitory system.

Increased Prefrontal Cortex Activity During Negative Emotion Regulation as a Predictor of Depression Symptom Severity Trajectory Over 6 Months

IMPORTANCE Emotion regulation is critically disrupted in depression, and the use of paradigms that tap into these processes may uncover essential changes in neurobiology during treatment. In addition, because neuroimaging outcome studies of depression commonly use only baseline and end-point data-which are more prone to week-to-week noise in symptomatology-we sought to use all data points over the course of a 6-month trial. OBJECTIVE To examine changes in neurobiology resulting from successful treatment. DESIGN, SETTING, AND PARTICIPANTS Double-blind trial examining changes in the neural circuits involved in emotion regulation resulting from 1 of 2 antidepressant treatments during a 6-month trial. Twenty-one patients with major depressive disorder and without other Axis I or Axis II diagnoses were scanned before treatment and 2 and 6 months into treatment at the universitys functional magnetic resonance imaging facility. INTERVENTIONS Venlafaxine hydrochloride extended release (with doses of up to 300 mg) or fluoxetine hydrochloride (with doses of up to 80 mg). MAIN OUTCOMES AND MEASURES Neural activity, as measured using functional magnetic resonance imaging during performance of an emotion regulation paradigm, as well as regular assessments of symptom severity using the Hamilton Depression Rating Scale. For use of all data points, slope trajectories were calculated for rate of change in depression severity and for rate of change in neural engagement. RESULTS The depressed individuals who showed the steepest decrease in depression severity over the 6-month period were the same individuals who showed the most rapid increases in activity in Brodmann area 10 and the right dorsolateral prefrontal cortex activity when regulating negative affect over the same time frame. This relationship was more robust when using only the baseline and end-point data. CONCLUSIONS AND RELEVANCE Changes in prefrontal cortex engagement when regulating negative affect correlate with changes in depression severity over 6 months. These results are buttressed by calculating these statistics, which are more reliable and robust to week-to-week variation than are difference scores.

The generic model of psychotherapy: An empirical investigation of patterns of process and outcome relationships

What is effectively therapeutic about psychotherapy? The generic model of psychotherapy provides an empirically valid conceptual representation of psychotherapy process and outcome relationships that begins to answer this question. It provides a theoretical foundation from which research investigating complex process-outcome relationships common to all psychotherapies can proceed. Moreover, the generic model is of sufficient breadth to direct empirical investigations of general principles of psychotherapeutic change. At the same time, it is of sufficient specificity to guide research that has relevance for the practicing clinician. The findings reported here also demonstrate the utility of the generic model for guiding exploratory psychotherapy research that aims to identify emerging patterns of relationships between process and outcome.

Change in early sessions of dynamic therapy: Universal processes and the generic model of psychotherapy.

The generic model of psychotherapy is offered as a transtheoretical model of universal change processes. Session 3 change processes are examined in a naturalistic study of dynamic therapy guided by the generic model. Findings replicate and extend earlier work addressing propositions of the generic model in dynamic therapy. Openness and bond contributed to in-session realizations, whereas bond and realizations fostered session progress. Session progress, bond, use of experiential operations, and less frequent use of dynamic interventions contributed to change between Sessions 2 and 4. Discussion outlines a model of change in early dynamic therapy and highlights the usefulness of the generic model for the evaluation of change processes.

The Effects of Treatments for Depression on Perceived Failure in Self-Regulation

Two studies examined the effect of treatments for depression on perceived failure in self-regulation, operationalized as within-self discrepancy. In Study 1, patients received group cognitive–behavioral therapy (CBT); in Study 2, patients received either individual CBT, interpersonal psychotherapy (IPT), or medication. Treatments showed equivalent efficacy, but only psychotherapy was associated with decreased self-discrepancy and priming reactivity. Highly self-discrepant patients showed less improvement than other patients in all treatments, even after controlling for initial severity. The findings suggest that treatments differ in their impact on self-regulatory cognition, and that highly self-discrepant patients may require longer or alternative treatment.

Using functional magnetic resonance imaging in psychotherapy research: A brief introduction to concepts, methods, and task selection

Abstract Functional magnetic resonance imaging (fMRI) has become an increasingly important methodology in the study of psychotherapy outcome and process. In this article, the authors offer a brief introduction to the use of fMRI in psychotherapy research aimed primarily at the informed clinician or investigator and with the goal of facilitating an understanding of study design and interpretation of research findings. After introducing the method and offering a rationale for its use in the study of psychotherapy, the authors outline major issues in fMRI data collection and analysis and emphasize the central role of the tasks used during the imaging session as critical to the interpretation of findings. They discuss how task selection influences the conclusions that can be drawn from fMRI studies of psychotherapeutic intervention and close with recommendations and caveats for the consumer of fMRI/psychotherapy research.

Congruence or genuineness.

Congruence or genuineness is a relational quality receiving renewed interest in recent years. This article offers a description of the conceptual nature of this construct as well as a selective review of the empirical literature documenting its relationship to outcome and other therapy change proces