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Cited by 251Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeural and Behavioral Psychology Studies

Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety

Open access
Marwood, Lindsey, Wise, Toby, Perkins, Adam M., Cleare, Anthony J.·2018·Neuroscience & Biobehavioral Reviews
DOI 10.1016/j.neubiorev.2018.09.022PMC PMC6267850
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Abstract

Understanding the neural mechanisms underlying psychological therapy could aid understanding of recovery processes and help target treatments. The dual-process model hypothesises that psychological therapy is associated with increased emotional-regulation in prefrontal brain regions and decreased implicit emotional-reactivity in limbic regions; however, research has yielded inconsistent findings. Meta-analyses of brain activity changes accompanying psychological therapy (22 studies, n = 352) and neural predictors of symptomatic improvement (11 studies, n = 293) in depression and anxiety were conducted using seed-based d mapping. Both resting-state and task-based studies were included, and analysed together and separately. The most robust findings were significant decreases in anterior cingulate/paracingulate gyrus, inferior frontal gyrus and insula activation after therapy. Cuneus activation was predictive of subsequent symptom change. The results are in agreement with neural models of improved emotional-reactivity following therapy as evidenced by decreased activity within the anterior cingulate and insula. We propose compensatory as well as corrective neural mechanisms of action underlie therapeutic efficacy, and suggest the dual-process model may be too simplistic to account fully for treatment mechanisms. More research on predictors of psychotherapeutic response is required to provide reliable predictors of response.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper reports AES-SDM meta-analyses of functional neuroimaging studies of psychotherapy in depression and anxiety. It found robust pre-to-post decreases in ACC, inferior frontal gyrus and insula, but only limited robust pre-treatment predictors of symptomatic improvement.

Key findings

  • In 22 longitudinal studies (n = 352 patients), psychological therapy was associated with significantly decreased activation post- versus pre-therapy in the left ACC/paracingulate gyri, right inferior frontal gyrus, and left inferior frontal gyrus/insula (all ps < .0001); these were the most robust results with no evidence of publication bias.
  • The prediction meta-analysis included 11 studies (n = 293 patients); only one cluster survived jackknife sensitivity analysis: greater baseline right cuneus cortex activation was associated with greater symptomatic improvement (p = .0004, peak MNI 10, −92, 14).
  • Other prediction clusters were not robust, and all prediction clusters showed evidence of publication bias in funnel plots, with an Egger’s regression trend for the decreased-activation cluster (t(1, 10) = −2.17, p = .055).
  • Subgroup analyses showed substantial task versus resting-state differences; decreased ACC activity post-therapy was common across both paradigms, while the only resting-state cluster surviving all robustness tests was the right middle frontal gyrus (p = .00005, peak 48, 34, 18).

Methods

  • Literature searches were conducted in Scopus, PubMed, and Medline for articles published before 24.07.2017; 33 articles were suitable for inclusion. Eligible studies used MRI, SPECT, or PET, included adults with DSM/ICD diagnoses of depression or anxiety disorders, reported whole-brain peak coordinates, and examined either pre-to-post therapy activation changes or pre-treatment predictors of symptom improvement.
  • Analyses used anisotropic effect-size seed-based d mapping (AES-SDM); voxels with p < .005 were considered significant, clusters with fewer than 10 voxels or peaks with AES-SDM Z-values < 1 were discarded, and jackknife sensitivity analysis, funnel plots, and Egger regression were used to assess robustness and publication bias.
  • Longitudinal and prediction meta-analyses were run separately, and task-based versus resting-state studies were analyzed separately where the number of studies permitted; meta-regressions for disorder, medication, or therapy type were not possible due to too few studies.

Limitations

  • The paper states that the literature is small, so between-study heterogeneity other than paradigm type could not be assessed through meta-regressions; included studies varied in paradigm, disorder, comorbidity, severity, therapy type, medication status, and imaging modality (fMRI, PET, SPECT), and anxiety disorders were over-represented compared with depression.
  • The paper states that only patient groups receiving therapy were included, so effects may partly reflect spontaneous remission or concomitant therapy rather than treatment alone; inclusion of placebo or wait-list control arms was not within scope.
  • The paper states that publication bias was evident in the prediction meta-analysis, and reliance on published peak coordinates does not provide the detail of statistical parametric maps or individual-level data; the text also makes evident that several longitudinal clusters were driven by only one or two studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.neubiorev.2018.09.022

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 60 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Psychological therapy is associated with decreased activation post- vs pre-therapy in limbic regions (insula and ACC).

    “Psychological therapies resulted in decreased activation in limbic regions: insula and ACC.”
    • Also stated in: § Longitudinal results · plain
      “The most robust results, with no evidence of publication bias, were that psychological therapy was associated with significantly decreased activity post- compared to pre-therapy, in the left ACC/paracingulate gyri, the right inferior frontal gyrus and left inferior frontal gyrus/insula (all ps<.0001) (see Fig. 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychological therapy is associated with decreased prefrontal activation post- vs pre-therapy.

    “Decreased prefrontal activation was also found pre-to-post psychological therapy.”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychological therapy was associated with significantly increased activity post- vs pre-therapy in the right arcuate network posterior segment.

    “Right arcuate network, posterior segment2 | 40, -54, 22 | 1.02 | 0.0008 | 82 | –”
    Quote in the paperSubstantial claim
  • Findingown data

    Twenty-two longitudinal studies (n = 352 patients) met eligibility criteria and were included.

    “Twenty-two longitudinal studies (n = 352 patients) met eligibility criteria and were included in this analysis (see Table 1 for study details).”
    Quote in the paperSubstantial claim
  • Findingown data

    The right inferior network, right arcuate network, bilateral inferior frontal gyri and right middle frontal gyrus findings were only found in resting-state studies.

    “The right inferior network (p = .0003, peak coordinates: 22, −60, −8), right arcuate network (p = .0004, peak coordinates: 40, −60, 20), bilateral inferior frontal gyri and right middle frontal gyrus (p = .00005, peak coordinates: 48, 34, 18) findings were only found in resting-state studies.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 39
  • Classified as probably not a substantial claim. 30

  • May combine two claims.

    Findingown data

    Psychological therapy was associated with significantly decreased activity post- vs pre-therapy in the left inferior frontal gyrus/insula (p<.0001), with no evidence of publication bias.

    “The most robust results, with no evidence of publication bias, were that psychological therapy was associated with significantly decreased activity post- compared to pre-therapy, in the left ACC/paracingulate gyri, the right inferior frontal gyrus and left inferior frontal gyrus/insula (all ps<.0001) (see Fig. 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Psychological therapy was associated with significantly decreased activity post- vs pre-therapy in the right inferior frontal gyrus (p<.0001), with no evidence of publication bias.

    “The most robust results, with no evidence of publication bias, were that psychological therapy was associated with significantly decreased activity post- compared to pre-therapy, in the left ACC/paracingulate gyri, the right inferior frontal gyrus and left inferior frontal gyrus/insula (all ps<.0001) (see Fig. 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Scopus returned 3,559, PubMed 673 and Medline 958 results; 33 articles were suitable for inclusion.

    “Scopus returned 3,559, PubMed 673 and Medline 958 results. From these, 33 articles were suitable for inclusion in analyses (see Fig. 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Psychological therapy was associated with significantly decreased activity post- vs pre-therapy in the left ACC/paracingulate gyri (p<.0001), with no evidence of publication bias.

    “The most robust results, with no evidence of publication bias, were that psychological therapy was associated with significantly decreased activity post- compared to pre-therapy, in the left ACC/paracingulate gyri, the right inferior frontal gyrus and left inferior frontal gyrus/insula (all ps<.0001) (see Fig. 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The prediction studies comprised patient groups: PTSD (n=2), SAD (n=5), OCD (n=2), MDD (n=1), PD (n=1).

    “The studies comprised the following patient groups: PTSD (n = 2); SAD (n = 5); OCD (n = 2); MDD (n = 1) and PD (n = 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most robust task-based findings were precuneus increased activation (p=.0002) and ACC deactivation (p=.0001) post-therapy, with no signs of publication bias.

    “The most robust findings were the precuneus increased activation (p = .0002, peak coordinates: 6, −56, 38) and ACC deactivation (p = .0001, peak coordinates: −8, 44, −2) post-therapy, which showed no signs of publication bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Due to few studies (n=5), the only resting-state cluster meeting criteria for robustness, surviving all jackknife iterations, was the right middle frontal gyrus (p=.00005, peak coordinates 48, 34, 18).

    “Due to few studies meeting eligibility for this analysis (n = 5), the only cluster meeting our criteria for robustness, surviving all iterations of the jackknife sensitivity analysis, was the right middle frontal gyrus (p = .00005, peak coordinates 48, 34, 18).”
    Quote in the paperSubstantial claim

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

    Findingnone given

    Anxiety disorders were over-represented compared to depression.

    “Anxiety disorders were over-represented compared to depression.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The literature is relatively small.

    “although the literature is relatively small”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Patients in the included studies were typically in the moderate to severe range of severity, most therapies were cognitive and/or behavioral in nature, and a negative emotional scanning paradigm was primarily used.

    “patients in the included studies were typically in the moderate to severe range of severity, most therapies were cognitive and/or behavioral in nature, and a negative emotional scanning paradigm was primarily used.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Prefrontal areas are involved in executive control and emotional regulation and have an inhibitory effect on limbic regions (amygdala, insula, hippocampus, ACC), which are associated with intrinsic emotional reactivity.

    “Prefrontal areas are involved in executive control (Owen et al., 2005) and emotional regulation processes (Ochsner and Gross, 2005), and have an inhibitory effect on limbic brain regions such as the amygdala, insula, hippocampus and anterior cingulate cortex (ACC), which are associated with intrinsic emotional reactivity (Drevets and Raichle, 1998; Phillips et al., 2003).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Owen et al., 2005 source

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    • cites Ochsner and Gross, 2005 source

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    • cites Drevets and Raichle, 1998 source

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

    Premisecitation

    The dual-process model of emotion regulation involves top-down prefrontal controlled processes and bottom-up automatic limbic activation.

    “These findings align with a dual-process model of emotion regulation with top-down prefrontal controlled processes and bottom-up, automatic limbic activation (Barrett et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barrett et al., 2004 source

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  • Classified as probably not a substantial claim.

    Premisecitation

    Psychological therapies for depression act to regulate emotional control processes by increasing prefrontal emotional regulation activation, which has a top-down effect on limbic activation.

    “DeRubeis et al. proposed that psychological therapies for depression act to regulate emotional control processes by increasing activation in prefrontal emotional regulation systems which in turn have a top-down effect on limbic activation (DeRubeis et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites DeRubeis et al., 2008 source

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  • May combine two claims.

    Premisecitation

    Hyper-prefrontal activation has been associated with ruminative thinking and intrusiveness of traumatic memories, which would be expected to reduce with therapy.

    “Theoretically, this is not entirely unexpected as hyper-prefrontal activation has been associated with ruminative thinking (Goldapple et al., 2004) and the intrusiveness of traumatic memories (Lindauer et al., 2008) which would be expected to reduce with therapy.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Goldapple et al., 2004 source

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    • cites Lindauer et al., 2008 source

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

    Premisecitation

    An equivalent model of psychological therapy action has been proposed for anxiety disorders.

    “An equivalent model in anxiety disorders has been proposed (Etkin et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Etkin et al., 2005 source

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  • May combine two claims.

    Study design and conductown data

    All regions in the longitudinal meta-analysis survived sensitivity analysis and Eggers regression (all ps>.05), though some showed signs of publication bias in visual inspection of funnel plots.

    “All regions survived sensitivity analysis and Eggers regression (all ps>.05), though some regions showed signs of publication bias in visual inspection of funnel plots.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    To ensure no overlap between studies, when multiple studies reported the same patient group, the largest sample or the study with scanning closest to therapy completion was included.

    “To ensure no overlap between studies, in the case of multiple studies reporting the same patient group, we included the largest sample or, in studies following up the same participant group at a range of time points post-therapy, the study reporting scanning at the time-point closest to therapy completion.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Only whole brain results were included; studies using ROI or machine learning only were excluded.

    “Only whole brain results were included. Articles that used a region of interest (ROI) or machine learning approach only, did not apply consistent statistical thresholds throughout the brain (for example, regional resting-state analysis methods such as seed-based analyses), or did not report peak coordinates in stereotactic space were excluded.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The potential effect of paradigm type was examined by simple linear models and repeating standard AES-SDM meta-analyses in subgroups.

    “The potential effect of paradigm type (task versus resting state scans) was examined by simple linear models and repeating standard AES-SDM meta-analyses in subgroups.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Only adult samples were included; child, adolescent or geriatric populations were excluded to minimise neurodevelopmental and neurodegeneration confounders.

    “Only adult samples were suitable; studies focused on child, adolescent or geriatric populations were excluded to minimise the effect of neurodevelopmental and neurodegeneration confounders.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    A jackknife sensitivity analysis was conducted to assess the contribution of individual studies, and results were excluded if they did not remain significant in 10% or more of iterations.

    “To determine the most robust results and explore the influence of outliers, a jackknife sensitivity analysis was conducted to assess the contribution of individual studies to the overall results. This repeats the analyses removing one study per iteration. Results were excluded that did not remain significant in 10% or more of iterations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Voxels with p<.005 were considered significant, but clusters with fewer than 10 voxels or peaks with AES-SDM Z-values <1 were discarded to reduce false positive rate.

    “As suggested by Radua and Mataix-Cols (2012), voxels with a p-value <.005 were considered as significant, but those from clusters with fewer than 10 voxels or peaks with AES-SDM Z-values <1 were discarded to reduce the false positive rate.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Radua and Mataix-Cols (2012)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    AES-SDM permits analysis of heterogeneity between studies via meta-regressions and addresses between-study heterogeneity by reconstructing both positive and negative maps in the same image.

    “AES-SDM also has the advantage of permitting analysis of heterogeneity between studies via meta-regressions, and addresses between-study heterogeneity by counteracting the effects of studies reporting opposite activation findings in the same region by reconstructing both positive and negative maps in the same image (Radua et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Radua et al., 2012

      Not checked in the free run.

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

    Study design and conductcitation

    Publication bias was assessed by visual inspection of funnel plots and an Egger regression test.

    “To assess publication bias, funnel plots of effect size estimates of peak voxels were visually inspected and an Egger regression test implemented to examine funnel plot asymmetry (Egger et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Egger et al., 1997 source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Standard AES-SDM meta-analyses were conducted separately for task-based and resting-state studies and a meta-regression controlled for paradigm type where the number of studies permitted.

    “In order to control for any possible differences observed between these two study types, standard AES-SDM meta-analyses were conducted separately for task-based and resting-state studies and a meta-regression conducted controlling for paradigm type to increase methodological homogeneity where the number of studies permitted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    In task-based longitudinal analysis, all but one region survived jackknife analysis criteria; the right temporal pole/middle temporal gyrus did not.

    “Regarding task-based longitudinal analysis, all but one region survived jackknife analysis criteria (the right temporal pole/middle temporal gyrus, p = .003, peak coordinates: −46, 4, −34, see Table 3).”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The analysis method used is improved and has various strengths compared to other neuroimaging meta-analytical techniques.

    “we used an improved analysis method which has various strengths compared to other neuroimaging meta-analytical techniques (Radua et al., 2014)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Radua et al., 2014 source

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    Premisereasoning

    The present study provides the largest and most up-to-date summary of the literature.

    “the present study provides the largest and most up-to-date summary of the literature.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The ACC region is involved in both emotional processing and regulation and has been linked to self-referential processing and cognitive and attentional control with strong connections to both limbic and prefrontal brain regions.

    “This region is involved in both emotional processing and regulation and has been linked to self-referential processing and cognitive and attentional control with strong connections to both limbic and prefrontal brain regions (Pizzagalli, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pizzagalli, 2011 source

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  • Classified as probably not a substantial claim.

    Premisecitation

    The most consistent finding in a systematic review on brain activation changes with CBT is decreased dorsal ACC activity.

    “a recently published systematic review on brain activation changes with CBT summarising that the most consistent finding is decreased dorsal ACC activity (Franklin et al., 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Franklin et al., 2016 source

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    Study design and conductnone given

    The approach to identify studies was thorough and conservative, identifying only the most robust studies within the heterogeneous literature fitting eligibility criteria.

    “implemented a thorough and conservative approach to identify only the most robust studies within this heterogeneous literature fitting our eligibility criteria.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The dlPFC is associated with attentional control and emotional regulation.

    “this region also being associated with attentional control and emotional regulation (Hofmann et al., 2012; Kane and Engle, 2002; Owen et al., 2005; Wager and Smith, 2003).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Hofmann et al., 2012 source

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    • cites Kane and Engle, 2002

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    • cites Owen et al., 2005 source

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  • May combine two claims.

    Interpretationown data

    The results appear to show brain activation changes that are consistent across psychological therapies and are trans-diagnostic.

    “the results appear to show brain activation changes which are consistent across psychological therapies and are trans-diagnostic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings do not signify that there are no activation changes specific to types of psychological therapy or able to differentiate between disorders and their subtypes.

    “these findings do not signify that there are not activation changes that are specific to types of psychological therapy or able to differentiate between disorders and their subtypes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Ma's meta-analysis of antidepressants included 60 studies (n = 1,569) and found decreased activation in ACC, amygdala and thalamus with antidepressant medication and increased activation in dlPFC.

    “Ma conducted a meta-analysis of the neural correlates of antidepressants which included 60 studies (n = 1,569) (Ma, 2015) and found decreased activation in the ACC, amygdala and thalamus with antidepressant medication and increased activation in the dlPFC.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ma, 2015

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  • Classified as probably not a substantial claim.

    Premisecitation

    The dual-process model ignores that psychodynamic therapy aims to regulate emotional states through resolution of early childhood parental interactions and challenging negative representation of self and others in relationships.

    “They highlighted that the dual-process model ignores that psychodynamic therapy aims to regulate emotional states, not only by strengthening executive control but through the resolution of early childhood parental interactions and challenging negative representation of the self and others in relationships.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Messina et al., 2016 source

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

    Premisecitation

    The IFG is a key region involved in emotional regulation and inhibition.

    “which is a key region involved in emotional regulation and inhibition (Aron et al., 2003, 2004)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Aron et al., 2003 source

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    • cites Aron et al., 2004 source

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    Premisecitation

    One should expect direct changes in default mode network and implicit emotional regulation regions involved in self-referential processing.

    “They therefore postulated that one should expect direct changes in default mode network and implicit emotional regulation regions which are involved in self-referential processing.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Messina et al., 2016 source

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    Premisecitation

    Messina et al. proposed an alternative neural model of action of psychological therapy, focusing on psychodynamic therapy models.

    “Messina et al. proposed an alternative neural model of action of psychological therapy, albeit with a focus on psychodynamic therapy models (Messina et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Messina et al., 2016 source

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  • May combine two claims.

    Interpretationreasoning

    The lack of dlPFC involvement could be due to an insufficient number of studies and inconsistency between designs of included studies.

    “This could be due to an insufficient number of studies in our meta-analyses to demonstrate this effect and an inconsistency between the designs of included studies.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    The dual-process model may be too simplistic as it ignores compensatory changes in functioning.

    “However, the model may be too simplistic as it ignores any compensatory changes in functioning that may be occurring.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Involvement of the PFC in affective disorders may be complex and not attributable to a single region.

    “which suggests involvement of the PFC in affective disorders may be complex and not attributable to a single region (Fitzgerald et al., 2006; Thomas and Elliott, 2009).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Fitzgerald et al., 2006 source

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    • cites Thomas and Elliott, 2009

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

    Interpretationreasoning

    Their model may also be applicable to other psychological therapies which place importance on challenging negative self-views.

    “Their model may also be applicable to other psychological therapies which also place importance on challenging negative self-views.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The cuneus forms part of the DMN, which has been found to be abnormally activated in depression.

    “The cuneus forms part of the DMN, which has been found to be abnormally activated in depression (Greicius et al., 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Greicius et al., 2009 source

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  • May combine two claims.

    Study design and conductnone given

    There is inconsistency between study results and too few published studies to determine further robust predictors of symptomatic improvement with psychological therapy.

    “However, there is inconsistency between study results and too few published studies at present to determine further robust predictors of symptomatic improvement with psychological therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Lueken and Hahn's systematic review, the direction of predictive effects of ACC activity was dependent on the type of functional imaging paradigm used and on the specific psychological treatment received.

    “Lueken and Hahn (2016) note in their systematic review that the direction of predictive effects of ACC activity was dependent both on the type of functional imaging paradigm used and on the specific psychological treatment received (Lueken and Hahn, 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lueken and Hahn, 2016

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    Study design and conductreasoning

    We controlled for resting-state versus task-based methodology to increase specificity in findings.

    “Although we did control for resting-state versus task-based methodology to increase specificity in findings”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Adopting inclusive eligibility criteria for paradigm type increased power and allowed greater generalisability of global results to broad neurobiological models.

    “By adopting inclusive eligibility criteria for paradigm type, this will have increased power given the paucity of research in this field and allowed greater generalisability of global results to broad neurobiological models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The present literature is small, meaning the influence of between-study heterogeneity, other than paradigm type, could not be assessed through meta-regressions.

    “The present literature is small meaning the influence of between study heterogeneity, other than paradigm type, could not be assessed through meta-regressions.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The right cuneus cortex (extrastriate region) has been implicated in response inhibition, particularly involving motor reactions.

    “This extrastriate region has been implicated in response inhibition in particular those involving motor reactions (Booth et al., 2005; Matthews et al., 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Booth et al., 2005 source

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    • cites Matthews et al., 2005 source

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    Interpretationreasoning

    It is plausible that findings from the various modalities could differ considerably.

    “Therefore, it is plausible that findings from the various modalities could differ considerably.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: SPECT, PET and fMRI differ in their measurement of brain activity, including temporal and spatial resolution.

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

    Study design and conductnone given

    Our reliance on including only peak co-ordinates reported in published papers does not provide the level of detail that statistical parametric maps or individual-level data would.

    “our reliance on including only peak co-ordinates reported in published papers does not provide the level of detail that statistical parametric maps or individual-level data would.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The studies varied on the concomitant psychotropic medication status of the patients, which reduced our ability to conclude that the neuroimaging effects are solely due to psychological therapy.

    “the studies varied on the concomitant psychotropic medication status of the patients (see Table 1, Table 5) which reduced our ability to conclude that the neuroimaging effects are solely due to psychological therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    All included PET and SPECT studies used radiotracers to measure regional brain glucose metabolism, which is the measurement most related to fMRI BOLD signal.

    “all included PET and SPECT studies used radiotracers to measure regional brain glucose metabolism, which is the measurement most related to fMRI BOLD signal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Most studies required patients to have been on medication for an adequate trial (typically 6 or more weeks) and medication to be kept stable for the duration of the study.

    “most studies required patients to have been on the medication for an adequate trial (typically 6 or more weeks) and the medication to be kept stable for the duration of the study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Despite considerable variability in study designs, commonalities did emerge, and we were able to demonstrate some consistent findings.

    “Despite considerable variability in study designs which these meta-analyses illustrate, commonalities did emerge, and we were able to demonstrate some consistent findings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Effects are unlikely to be solely attributable to the treatment under investigation and may in part be due to spontaneous remission or concomitant therapy.

    “effects are unlikely to be solely attributable to the treatment under investigation and may in part be due to spontaneous remission or concomitant therapy.”
    Quote in the paperSubstantial claim
57 of 57

  • The paper relies on this without support.

    Meta-analyses in the field of neuroimaging provide an effective way to determine consistencies across datasets with improved statistical power.

    “Meta-analyses in the field of neuroimaging provide an effective way to determine consistencies across datasets with improved statistical power.”

  • The paper relies on this without support.

    Depression and anxiety disorders have overlapping symptoms.

    “Both disorders were included due to high levels of comorbidity between the conditions (Brown et al., 2001; Kaufman and Charney, 2000), overlapping symptoms, both responding to similar therapies (Ressler and Mayberg, 2007), and the same theory being used to model therapeutic response across disorders (Messina et al., 2013).”

  • The authors state this as an assumption.

    The dual-process model hypothesises that antidepressants act more directly on the emotional, limbic network whereas psychological therapies primarily target prefrontal function by increasing inhibitory executive function.

    “These results fit the dual-process model which hypothesises that antidepressants act more directly on the emotional, limbic network whereas psychological therapies primarily target prefrontal function by increasing inhibitory executive function.”

  • The paper relies on this without support.

    CBT improves emotional regulation by challenging negative cognitions and improving conscious emotional regulation.

    “CBT is proposed to improve emotional regulation by challenging negative cognitions and improving conscious emotional regulation.”

  • The paper relies on this without support.

    SPECT, PET and fMRI differ in their measurement of brain activity, including temporal and spatial resolution.

    “These methods differ in their measurement of brain activity, including temporal and spatial resolution.”

  • The paper relies on this without support.

    The neural effects of psychological therapy are vastly understudied compared to those of antidepressants.

    “The neural effects of psychological therapy are vastly understudied compared to those of antidepressants.”
6 of 6

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?

  • Psychotherapy is an alternative and effective means of treating mental illness that alters activity within neural circuits by harnessing the brain's inherent capacity for experience-dependent plasticity.

    “Psychotherapy is an alternative and effective means of treating mental illness that alters activity within neural circuits by harnessing the brain’s inherent capacity for experience-dependent plasticity [57].”

    From Translational opportunities for circuit-based social neuroscience: advancing 21st century psychiatry (2021) · cites this paper as [57]

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Precuneus finding is said to lack publication bias despite its funnel plot

    Major

    The task-based results describe the precuneus finding as showing no signs of publication bias, whereas the note for that cluster in Table 3 says its funnel plot showed signs of publication bias.

  • Left inferior frontal/insula cluster is called robust despite not passing all robustness tests

    Minor

    The results call this one of the most robust clusters with no evidence of publication bias, but Table 2 marks only the ACC and right inferior frontal clusters as surviving all robustness and publication-bias tests. The left inferior frontal/insula cluster is not marked.

  • Longitudinal meta-analysis is said to show no publication bias despite reported signs

    Minor

    The limitations section says the longitudinal meta-analysis showed no evidence of publication bias. Table 2, however, reports funnel-plot evidence or signs of publication bias in several longitudinal clusters.

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The citation lists haven’t been fetched yet

References 94 · Cited by 251

Authors
Marwood, L., Wise, T., Perkins, A. M., & Cleare, A. J.
Affiliations
  • King's College London (GB)
  • Wellcome Centre for Human Neuroimaging (GB)
Corresponding author
Marwood, Lindsey
ORCID
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2018-12
Volume
95
Pages
61-72
ISSN
0149-7634 (ISSN-L)
DOI
10.1016/j.neubiorev.2018.09.022
PMC
PMC6267850
OpenAlex
W2892807301
Cited by
251
References
94
Citations by year
2026: 24 · 2025: 23 · 2024: 102 · 2023: 24 · 2022: 23 · 2021: 24 · 2020: 17 · 2019: 14
FWCI
2.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
  • MPG.PuRe (Max Planck Society) (submittedVersion)
Funders
  • joint Medical Research Council / Institute of Psychiatry, Psychology and Neuroscience PhD studentship
  • National Institute of Health Research (NIHR) PhD studentship
  • NIHR Mental Health Biomedical Research Centre at the South London and Maudsley National Health Service Foundation Trust and King’s College London
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords
psychotherapy response, depression, anxiety, dual-process models, emotion regulation, emotional reactivity, anterior cingulate cortex, insula, inferior frontal gyrus, cuneus, seed-based d mapping, predictors of treatment response, compensatory neural mechanisms
MeSH terms
Anxiety, Anxiety Disorders, Brain, Depression, Depressive Disorder, Humans, Psychotherapy, Treatment Outcome, Neuroimaging

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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