Abstract
Objective: Whilst there is now strong evidence that psychological therapies can alter the
activity of individual brain regions, their impact on the functional integration between regions
has not yet been systematically evaluated. This area is important given that brain
dysconnectivity has been implicated across almost all psychiatric disorders. Accordingly we
sought to establish connectivity predictors and mechanisms of effective psychological
therapies. We further establish whether connectivity changes represent normalisation of
disorder pathophysiology or compensatory changes.
Method: We reviewed studies examining structural and functional connectivity longitudinally
as either a predictor or outcome variable of successful psychological therapies across
psychiatric disorders.
Results: Fifteen studies met our inclusion criteria. All but three related to cognitive
behavioural therapy (CBT). Of these, five assessed resting state, nine probed affective
processing and one probed cognitive processing. 12 studies reported evidence of functional
connectivity as a significant predictor or outcome of CBT, with prefronto-limbic circuitry
most commonly implicated. Only six studies included healthy participants, limiting direct
inferences about normalisation as opposed to compensatory changes. Anxiety disorders were
over-represented, totalling 13 of the studies reviewed. No studies examined structural
connectivity or utilised analyses allowing the directionality of functional connectivity to be
inferred.
Conclusions: Whilst the evidence base is still in its infancy for other therapy approaches,
there was clearer evidence that functional connectivity both predicts and is altered by CBT.
Connections from prefrontal cortex appear especially key, perhaps given their role in
3
cognitive appraisal of lower-order affective, motivational and cognitive processes. A number
of recommendations are made for this rapidly developing literature.
activity of individual brain regions, their impact on the functional integration between regions
has not yet been systematically evaluated. This area is important given that brain
dysconnectivity has been implicated across almost all psychiatric disorders. Accordingly we
sought to establish connectivity predictors and mechanisms of effective psychological
therapies. We further establish whether connectivity changes represent normalisation of
disorder pathophysiology or compensatory changes.
Method: We reviewed studies examining structural and functional connectivity longitudinally
as either a predictor or outcome variable of successful psychological therapies across
psychiatric disorders.
Results: Fifteen studies met our inclusion criteria. All but three related to cognitive
behavioural therapy (CBT). Of these, five assessed resting state, nine probed affective
processing and one probed cognitive processing. 12 studies reported evidence of functional
connectivity as a significant predictor or outcome of CBT, with prefronto-limbic circuitry
most commonly implicated. Only six studies included healthy participants, limiting direct
inferences about normalisation as opposed to compensatory changes. Anxiety disorders were
over-represented, totalling 13 of the studies reviewed. No studies examined structural
connectivity or utilised analyses allowing the directionality of functional connectivity to be
inferred.
Conclusions: Whilst the evidence base is still in its infancy for other therapy approaches,
there was clearer evidence that functional connectivity both predicts and is altered by CBT.
Connections from prefrontal cortex appear especially key, perhaps given their role in
3
cognitive appraisal of lower-order affective, motivational and cognitive processes. A number
of recommendations are made for this rapidly developing literature.
| Original language | English |
|---|---|
| Pages (from-to) | 311-321 |
| Journal | Australian and New Zealand Journal of Psychiatry |
| Volume | 50 |
| Issue number | 4 |
| Early online date | 15 Jan 2016 |
| DOIs | |
| Publication status | Published - Apr 2016 |