认知行为疗法对抑郁症和焦虑障碍治疗中脑激活影响的激活可能性估计meta分析

Activation Likelihood Estimation Meta-Analysis of the Effects of Cognitive Behavioral Therapy on Brain Activation in the Treatment of Depression and Anxiety Disorders

认知行为疗法对抑郁症和焦虑障碍治疗中脑激活影响的激活可能性估计meta分析

Authors: Junjie Ren, Lijun Ma, Wanxin Wu, Juan Qiu, Zhuo Zhang, Yuxi Hong, Zushen Wang, Xinyu Hou, Jia Jin, Weixuan Hu, Yanran Wu, Xiaowei Chen, Jinyi Luo, Chuan Fan, Kai Wang, Xiaoming Li

Source:Depression And Anxiety

DOI:10.1155/da/3557367

Abstract

Background:Cognitive behavioral therapy (CBT) stands as a highly efficacious psychological treatment for both anxiety and depressive disorders. Nonetheless, scholarly debates persist regarding the specificities of brain area activation during CBT treatment for these disorders.

Methodology:Utilizing activation likelihood estimation (ALE) analysis, this study aims to discern the neurobiological similarities and disparities between CBT's effects on anxiety and depressive disorders by examining functional brain areas.

Results:A total of 22 articles, encompassing 443 patients, were included in the meta-analysis. Our results show that in the resting state, patients with depression treated with CBT resulted in increased activation of the right and left ventral anterior cingulate cortex (vACC), left parahippocampal gyrus (PG), right subgyral, left inferior temporal gyrus (ITG), and right inferior occipital gyrus (IOG), whereas patients with anxiety disorders had increased activation of the right and left superior frontal gyrus (SFG) and decreased activation of the caudate after treatment. In the task state, increased activation of the right PG, right orbital frontal lobe, and right dorsal anterior cingulate cortex (dACC) was mainly observed after treatment in patients with anxiety disorders, and the left lentiform nucleus (LN), left dorsal entorhinal cortex, and right caudate activation were decreased. For depressive disorders, no consistent activation patterns emerged in the task state, likely due to limited studies or heterogeneity in task paradigms across included studies.

Conclusion:CBT's efficacy relies on both shared (e.g., vACC-mediated emotion regulation and cognitive control) and distinct neural mechanisms (fear-circuit modulation in anxiety vs. memory-network enhancement in depression), informing biomarker-driven treatment personalization.

Keywords:anxiety disorders; cognitive behavioral therapy; depressive disorders; meta-analysis.

摘要

背景：认知行为疗法（CBT）是治疗焦虑和抑郁障碍的高效心理治疗方法。然而，关于CBT治疗这些障碍时脑区激活的具体特征，学术界仍存在争议。

方法：本研究采用激活可能性估计（ALE）分析，通过考察功能性脑区，旨在揭示CBT对焦虑和抑郁障碍影响的神经生物学相似性和差异。

结果：本研究纳入了22篇文献，共涉及443名患者。结果显示，在静息状态下，接受CBT治疗的抑郁症患者右侧和左侧腹侧前扣带回皮层（vACC）、左侧海马旁回（PG）、 右侧亚颞叶回、左侧下颞叶回（ITG）和右侧下枕叶回（IOG）的激活程度增加，而焦虑障碍患者在治疗后右侧和左侧上额叶回（SFG）的激活程度增加，尾状核的激活程度降低。在任务状态下，焦虑障碍患者治疗后主要观察到右侧PG、右侧眶额叶和右侧背侧前扣带回皮层（dACC）的激活增强，而左侧 lentiform 核（LN）、左侧背侧海马旁回皮层和右侧尾状核的激活则减少。对于抑郁障碍，任务状态下未出现一致的激活模式，这可能由于纳入研究中任务范式的不一致性或研究数量有限。

结论：CBT的疗效依赖于共同的神经机制（如vACC介导的情感调节和认知控制）和特异性神经机制（焦虑中的恐惧回路调节与抑郁中的记忆网络增强），这为基于生物标志物的治疗个性化提供了依据。

关键词：焦虑障碍；认知行为疗法；抑郁障碍；meta分析。