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Cited by 320Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeural and Behavioral Psychology StudiesTreatment of Major Depression

Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy and predictors of treatment response

Open access
Ritchey, Maureen, Dolcos, Florin, Eddington, Kari M., Strauman, Timothy J., Cabeza, Roberto·2011·Journal of Psychiatric Research
DOI 10.1016/j.jpsychires.2010.09.007PMC PMC3042483
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Abstract

Major depressive disorder (MDD) is characterized by the presence of disturbances in emotional processing. However, the neural correlates of these alterations, and how they may be affected by therapeutic interventions, remain unclear. The present study addressed these issues in a preliminary investigation using functional magnetic resonance imaging (fMRI) to examine neural responses to positive, negative, and neutral pictures in unmedicated MDD patients (N = 22) versus controls (N = 14). After this initial scan, MDD patients were treated with cognitive behavioral therapy (CBT) and scanned again after treatment. Within regions that showed pre-treatment differences between patients and controls, we tested the association between pre-treatment activity and subsequent treatment response as well as activity changes from pre- to post-treatment. This study yielded three main findings. First, prior to treatment and relative to controls, patients exhibited overall reduced activity in the ventromedial prefrontal cortex (PFC), diminished discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus, and enhanced responses to negative versus positive stimuli in the left anterior temporal lobe (ATL) and right dorsolateral PFC. Second, CBT-related symptom improvement in MDD patients was predicted by increased activity at baseline in ventromedial PFC as well as the valence effects in the ATL and dorsolateral PFC. Third, from pre- to post-treatment, MDD patients exhibited overall increases in ventromedial PFC activation, enhanced arousal responses in the amygdala, caudate, and hippocampus, and a reversal of valence effects in the ATL. The study was limited by the relatively small sample that was able to complete both scan sessions, as well as an inability to determine the influence of comorbid disorders within the current sample. Nevertheless, components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.

Integrity signals

Registry

Crossref · 10.1016/j.jpsychires.2010.09.007

Cites

74 of 74 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 30 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Patients and controls rated the pictures similarly on the three-point scale.

    “patients and controls rated the pictures similarly on our three-point scale”
    Quote in the paperSubstantial claim
  • Findingown data

    After cognitive behavioral therapy, patients with major depressive disorder showed stronger arousal-related responses in the amygdala, caudate, and hippocampus compared with before treatment.

    “enhanced arousal responses in the amygdala, caudate, and hippocampus”
    Quote in the paperSubstantial claim
  • Findingown data

    After cognitive behavioral therapy, patients with major depressive disorder showed a reversal of valence-related effects in the anterior temporal lobe compared with before treatment.

    “a reversal of valence effects in the ATL”
    Quote in the paperSubstantial claim
  • Findingown data

    Before treatment, depressed patients showed less discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus than controls.

    “diminished discrimination between emotional and neutral items in the AMY, caudate, and hippocampus”
    • Also stated in: § Pre-treatment differences · boosted
      “they demonstrated similarly high AMY responses to neutral as well as emotional material, in contrast to the emotion-specific response in controls”
    Quote in the paperSubstantial claim
  • Findingown data

    After treatment, MDD patients showed greater discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus than before treatment.

    “The right AMY, right caudate, and left hippocampal ROIs included clusters exhibiting session effects for the arousal contrast, evidenced by a larger difference between emotional versus neutral trials post-treatment compared to pre-treatment.”
    • Also stated in: § Discussion · plain
      “enhanced discrimination of emotional and neutral items in the amygdala and caudate”
    Quote in the paperSubstantial claim
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data

    In the first session, there was a main effect of emotion type on ratings, with negative pictures rated as more unpleasant and positive pictures as more pleasant, but no group effect or group-by-emotion interaction.

    “There was a main effect of emotion type on ratings from the first session, F(2, 50) = 329.05, p < .001, in that negative items were rated as more unpleasant and positive items more pleasant, but no main effect of group, F(1, 25) = .04, p = .84, or interaction of emotion type and group, F(2, 50) = .86, p = .43.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the first session, there was a main effect of emotion type on response times, with response times increasing as item valence increased, but no group effect or group-by-emotion interaction.

    “There was also a main effect of emotion type on response times from the first session, F(2, 50) = 5.14, p = .01, in that response times increased as item valence increased, but we detected no main effect of group, F(1, 25) = .03, p = .88, or interaction of emotion type and group, F(2, 50) = 1.86, p = .17.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After treatment, the amygdala and caudate distinguished emotional from neutral items and no longer responded to neutral items with the same magnitude.

    “After treatment, these regions distinguished between emotional and neutral items, no longer responding to neutral items with the same magnitude of activation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Before treatment, MDD patients had similarly high amygdala responses to neutral and emotional material, while controls showed emotion-specific responses.

    “they demonstrated similarly high AMY responses to neutral as well as emotional material, in contrast to the emotion-specific response in controls”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depression is associated with amygdala hyper-responsivity to mild sad and neutral stimuli, though the cited study was restricted to bipolar disorder.

    “depression is associated with amygdala hyper-responsivity to mild sad and neutral stimuli in particular, though that study was restricted to individuals with bipolar disorder (Almeida et al., 2010)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Almeida et al., 2010 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The neural differences between depressed patients and healthy controls during emotion processing are sensitive to CBT, with some affected regions predicting treatment outcome and normalizing after therapy.

    “The present study provides new evidence that the neural differences between depressed patients and healthy controls during emotion processing are sensitive to cognitive behavioral therapy, with a subset of affected regions predicting treatment outcome and normalizing after therapeutic intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The three therapists were Ph.D.-level clinical psychologists with at least five years of experience in cognitive behavioral therapy.

    “The three therapists (including one of the authors, KME) were all Ph.D.-level clinical psychologists who had a minimum of five years of experience with CBT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Left ATL and vlPFC are associated with semantic elaboration.

    “The left ATL and vlPFC have been associated with semantic elaboration (Bookheimer, 2002; Martin and Chao, 2001)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Bookheimer, 2002 source

      Not checked in the free run.

    • cites Martin and Chao, 2001

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    vmPFC participates in cortical control of amygdala arousal responses during extinction and emotion regulation.

    “participates in cortical control of arousal responses in the AMY during extinction and emotion regulation (Delgado et al., 2008)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Delgado et al., 2008 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The study was limited by the small number of participants who completed both scan sessions and by the inability to determine the influence of comorbid disorders in the sample.

    “The study was limited by the relatively small sample that was able to complete both scan sessions, as well as an inability to determine the influence of comorbid disorders within the current sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Motion regressors were included as a nuisance covariate in the analysis.

    “Motion regressors were included as a nuisance covariate in the analysis”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The first and second scan sessions for each participant were processed and modeled independently.

    “The first and second scan sessions for each participant were processed and modeled independently.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Several regions with pre-treatment differences changed in a direction consistent with normalization, including vmPFC and left ATL/vlPFC.

    “Several of these regions showed a pattern of change consistent with the direction of normalization, including overall activity in vmPFC and valence-related activity in left ATL/vlPFC.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Runs with head movement greater than 3 mm were excluded from analysis, with at most one run excluded per participant.

    “runs with excessive head movement (greater than 3 mm) were excluded from analysis, with a maximum of 1 run excluded per participant.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    If the activation patterns reflect counterproductive attempts to regulate, those patients may benefit most from CBT strategies.

    “if these activation patterns reflect counterproductive attempts to regulate, it may be these patients who benefit most from the strategies learned during CBT”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    After CBT, vmPFC hypoactivation and amygdala hyperresponsivity change toward normalization, but only vmPFC effects predicted treatment-related improvement.

    “The data demonstrated that hypoactivation of the vmPFC and hyperresponsivity of the AMY change in the direction of normalization after CBT, although only vmPFC effects were predictive of treatment-related improvement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Valence effects resembling negativity biases in depressed patients predicted CBT response, but not all of these effects reversed after treatment.

    “valence effects patterned like negativity biases in depressed patients predicted patients' response to CBT, but not all of these effects reversed after treatment”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Activation in subcortical structures may reflect essential emotional arousal responses that are symptomatic of depression but do not predict CBT efficacy.

    “activation within these subcortical structures may reflect essential responses to emotional arousal that are symptomatic of depression, but do not reflect processes that are predictive of CBT efficacy”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The pre- to post-treatment comparisons in patients were exclusively masked with the corresponding session comparisons in controls to reduce the possibility that the effects were due to repeated testing or the passage of time.

    “the pre- to post-treatment comparisons in the patient group were exclusively masked (at p = .05, a conservative threshold for exclusive masking) with the corresponding session comparisons in the control group, to mitigate concerns that these effects could be driven by repeated testing or the passage of time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Lack of reappraisal correlates with depression severity and predicts higher amygdala responses during negative picture anticipation.

    “This lack of reappraisal correlates with depression severity and predicts higher AMY responses during negative picture anticipation (Abler et al., 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Abler et al., 2007 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The study's findings suggest that components of the neural networks underlying emotion processing disturbances in major depressive disorder appear to resolve after treatment and predict treatment response, possibly reflecting improved emotion regulation with cognitive behavioral therapy.

    “components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Beck Depression Inventory and Hamilton Rating Scale for Depression have good internal consistency and reliability.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Both vlPFC and dlPFC are associated with reappraisal processes.

    “both vlPFC and dlPFC are associated with reappraisal processes (Ochsner et al., 2002)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ochsner et al., 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    vlPFC is linked with inhibitory regulation processes.

    “the vlPFC has been more specifically linked with inhibitory regulation processes (Dolcos et al., 2006)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dolcos et al., 2006 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was limited to identifying markers of response to CBT only.

    “Although the present study was limited to identifying markers of response to CBT only”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Because patients were treated until remission, the study may have reduced variability in treatment response relative to studies with a predefined number of sessions.

    “because patients were treated until remission, the present study may have reduced variability in treatment response relative to other studies that used a strictly predefined number of treatment sessions”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In one study, CBT-related improvements were greatest in patients with relatively low pre-treatment subgenual ACC reactivity to emotional stimuli, with the reverse for amygdala reactivity.

    “CBT-related improvements were greatest in patients with relatively low pre-treatment reactivity in subgenual ACC in response to emotional stimuli, compared to healthy controls, and the reverse occurred for AMY reactivity (Siegle et al., 2006)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Siegle et al., 2006 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study did not experimentally manipulate the use of specific regulation strategies within the emotion processing task.

    “we did not experimentally manipulate the use of specific regulation strategies within the emotion processing task”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some studies report increased dlPFC recruitment during executive control tasks.

    “some studies have reported increased recruitment of dlPFC during tasks that involve executive control (Harvey et al., 2005; Walter et al., 2007)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Harvey et al., 2005 source

      Not checked in the free run.

    • cites Walter et al., 2007 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Heightened physiological responses before treatment predict the efficacy of exposure therapy.

    “heightened physiological responses (e.g., heart rate) before treatment predict the efficacy of exposure therapy (Beckham et al., 1990; Lang et al., 1970)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Beckham et al., 1990 source

      Not checked in the free run.

    • cites Lang et al., 1970 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    The combination of multiple methodologies may prove more effective in predicting treatment outcomes.

    “the combination of multiple methodologies, including clinical, cognitive, neuroimaging, and genetic measures, may prove more effective in predicting treatment outcomes (Gudayol-Ferré et al., 2010; Kemp et al., 2008)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Gudayol-Ferré et al., 2010

      Not checked in the free run.

    • cites Kemp et al., 2008 source

      Not checked in the free run.

30 of 30

  • The paper relies on this without support.

    The Beck Depression Inventory and Hamilton Rating Scale for Depression have good internal consistency and reliability.

    “Both scales have been shown to have good internal consistency and reliability.”

  • The paper relies on this without support.

    Some degree of emotion regulation is likely to have occurred naturally during the task.

    “although some degree of regulation is likely to have occurred naturally”

  • The paper relies on this without support.

    CBT is commonly conceptualized to target emotion regulation processes.

    “which CBT is commonly conceptualized to target”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Responses in pre- and subgenual cingulate and adjacent ventral medial prefrontal cortex (vmPFC) have been associated with response to cognitive behavioral therapy, antidepressant medication, and repetitive transcranial magnetic stimulation (rTMS).

    “In particular, responses in pre- and subgenual cingulate and adjacent ventral medial prefrontal cortex (vmPFC) have been associated with response to cognitive behavioral therapy (Ritchey et al, 2011; Siegle et al, 2006), antidepressant medication (Davidson et al, 2003; Kennedy et al, 2001, 2007; Mayberg et al, 1997; Pizzagalli et al, 2001), and repetitive transcranial magnetic stimulation (rTMS) (”

    From Resting-state cortico-thalamic-striatal connectivity predicts response to dorsomedial prefrontal rTMS in major depressive disorder (2014) · cites this paper as Ritchey et al, 2011

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(14) = 6.2reported p < .001 · recomputed p < .001

    “t(14) = 6.20, p < .001”

  • ConsistentF(2, 50) = 329.05reported p < .001 · recomputed p < .001

    “F(2, 50) = 329.05, p < .001”

  • ConsistentF(1, 25) = 0.04reported p = .84 · recomputed p = .843

    “F(1, 25) = .04, p = .84”

  • ConsistentF(2, 50) = 0.86reported p = .43 · recomputed p = .429

    “F(2, 50) = .86, p = .43”

  • ConsistentF(2, 10) = 52.48reported p < .001 · recomputed p < .001

    “F(2, 10) = 52.48, p < .001”

  • ConsistentF(1, 5) = 1.24reported p = .32 · recomputed p = .316

    “F(1, 5) = 1.24, p = .32”

  • ConsistentF(2, 10) = 3.33reported p = .08 · recomputed p = .078

    “F(2, 10) = 3.33, p = .08”

  • ConsistentF(2, 50) = 5.14reported p = .01 · recomputed p = .009

    “F(2, 50) = 5.14, p = .01”

  • ConsistentF(1, 25) = 0.03reported p = .88 · recomputed p = .864

    “F(1, 25) = .03, p = .88”

  • ConsistentF(2, 50) = 1.86reported p = .17 · recomputed p = .166

    “F(2, 50) = 1.86, p = .17”

  • ConsistentF(2, 10) = 2.25reported p = .16 · recomputed p = .156

    “F(2, 10) = 2.25, p = .16”

  • ConsistentF(1, 5) = 0.2reported p = .67 · recomputed p = .673

    “F(1, 5) = .20, p = .67”

  • ConsistentF(2, 10) = 4.04reported p = .052 · recomputed p = .052

    “F(2, 10) = 4.04, p = .052”

13 of 13

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

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Authors
Ritchey, M., Dolcos, F., Eddington, K. M., Strauman, T. J., & Cabeza, R.
Affiliations
  • Duke University (US)
  • University of Illinois Urbana-Champaign (US)
  • University of North Carolina at Greensboro (US)
Corresponding author
  • Ritchey, Maureen
  • Dolcos, Florin
  • Eddington, Kari M.
ORCID
Venue
Journal of Psychiatric Research
Publisher
Elsevier BV
Published
2011-05
Volume
45
Issue
5
Pages
577-587
ISSN
0022-3956 (ISSN-L)
DOI
10.1016/j.jpsychires.2010.09.007
PMC
PMC3042483
OpenAlex
W2098818989
Cited by
320
References
74
Citations by year
2026: 13 · 2025: 13 · 2024: 18 · 2023: 18 · 2022: 19 · 2021: 41 · 2020: 10 · 2019: 19 · 2018: 18 · 2017: 29 · 2016: 21 · 2015: 25 · 2014: 18 · 2013: 21 · 2012: 24
FWCI
23.87
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Psychiatric Research (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
Funders
  • National Institute of Mental Health (F31MH085384, F32MH064261, 5F32MH64261, R24MH067447, MH067447)
  • National Institute of Neurological Disorders and Stroke (P01NS041328, NS41328)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
major depressive disorder, emotional processing, cognitive behavioral therapy, treatment response prediction, ventromedial prefrontal cortex, anterior temporal lobe, amygdala, caudate nucleus, hippocampus, valence effects, emotion regulation, neural correlates of depression
MeSH terms
Adult, Brain, Brain Mapping, Depression, Emotions, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Neuropsychological Tests, Oxygen, Photic Stimulation, Predictive Value of Tests, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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