Changes in neural activation and in functional connectivity during affective memory recall after six months of psychotherapy: An fMRI study of individuals with depression.

BACKGROUND

While psychotherapy is established as an overall effective treatment of depression, a significant proportion of patients do not achieve adequate response. Understanding the neurobiological mechanisms underlying psychotherapeutic change may inform intervention optimization. This study examined changes in neural processing of personally relevant affective memory in individuals with depression following psychodynamic psychotherapy.

METHODS

Twenty-five individuals with depression and 28 healthy controls underwent functional magnetic resonance imaging (fMRI) scanning at baseline and after six months. Depressed participants received weekly psychodynamic psychotherapy. During fMRI, participants recalled idiosyncratically meaningful affective memories cued by pictorial cues. Region-of-interest analyses examined therapy-related changes in neural activation across areas involved in emotion and memory processing, and social cognition. Seed-to-voxel analyses assessed changes in functional connectivity between those areas.

RESULTS

Following six months of psychodynamic psychotherapy, depressed individuals showed significantly increased activation in the right temporoparietal junction (TPJ) when recalling personally relevant affective memories compared to controls. Functional connectivity analyses revealed decreased coupling between bilateral amygdala and bilateral TPJ in the depressed group post-treatment.

CONCLUSIONS

Psychodynamic psychotherapy may increase neural processing in regions supporting mentalizing and the evaluation of personally relevant relational memories. Decreased amygdala-TPJ connectivity suggests reduced automatic affective response during affective memory processing. Findings need to be interpreted in light of the absence of a clinical control group and require replication.