Distinct Functional Connectivities Predict Clinical Response with Emotion Regulation Therapy

Area of Science:

• Neuroscience
• Psychiatry
• Psychology

Background:

• Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, presenting treatment challenges for a significant patient subgroup.
• Patients often exhibit heightened sensitivity to threat/safety and reward/loss, alongside negative self-referential processing (worry, rumination).
• These clinical features may stem from disruptions in the salience network and default network (DN), crucial for emotional processing and self-referentiality.

Purpose of the Study:

• To investigate the neurobiological underpinnings of Emotion Regulation Therapy (ERT) in patients with GAD (with or without MDD).
• To examine the relationship between baseline intrinsic functional connectivity (iFC) in the insula and DN hubs and treatment-induced changes in worry, somatic anxiety, and decentering.

Main Methods:

• 22 patients diagnosed with GAD (with or without MDD) underwent resting-state MRI scans before and after 16 sessions of ERT.
• Baseline iFC was analyzed in relation to the insula and key DN hubs (medial prefrontal cortex, posterior cingulate cortex).
• Associations between iFC patterns and changes in symptom severity (worry, somatic anxiety) and decentering were assessed.

Main Results:

• Reduced worry following ERT was associated with altered iFC in the insular and parietal cortices.
• Improved decentering was linked to changes in iFC within the anterior and posterior default network.
• These findings highlight the role of the default and salience networks in treatment response.

Conclusions:

• ERT shows promise for treating GAD, with or without comorbid MDD, by modulating neural networks involved in emotional regulation and self-referential processing.
• Baseline functional connectivity patterns in the salience and default networks may predict treatment outcomes.
• This research supports targeting these neural networks for improved therapeutic efficacy in anxiety and depressive disorders.