Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder-A Randomized Controlled Trial

Kristina Meyer; Catherine Hindi Attar; Jana Fiebig; Thomas Stamm; Tyler R Bassett; Michael Bauer; Udo Dannlowski; Thomas Ethofer; Irina Falkenberg; Andreas Jansen; Georg Juckel; Tilo Kircher; Christoph Mulert; Gregor Leicht; Anne Rau; Jonas Rauh; Dirk Ritter; Philipp Ritter; Sarah Trost; Christoph Vogelbacher; Henrik Walter; Sarah Wolter; Martin Hautzinger; Felix Bermpohl

doi:10.1016/j.bpsc.2023.02.008

Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder-A Randomized Controlled Trial

Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Jul;8(7):750-759. doi: 10.1016/j.bpsc.2023.02.008. Epub 2023 Mar 8.

Authors

Kristina Meyer¹, Catherine Hindi Attar², Jana Fiebig², Thomas Stamm³, Tyler R Bassett⁴, Michael Bauer⁴, Udo Dannlowski⁵, Thomas Ethofer⁶, Irina Falkenberg⁷, Andreas Jansen⁸, Georg Juckel⁹, Tilo Kircher⁷, Christoph Mulert¹⁰, Gregor Leicht¹¹, Anne Rau¹², Jonas Rauh¹¹, Dirk Ritter⁴, Philipp Ritter⁴, Sarah Trost¹³, Christoph Vogelbacher¹⁴, Henrik Walter², Sarah Wolter¹⁵, Martin Hautzinger¹⁶, Felix Bermpohl²

Affiliations

¹ Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: kristina.meyer@charite.de.
² Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
⁴ Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
⁵ Institute for Translational Psychiatry, University of Münster, Münster, Germany.
⁶ University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Clinic for Radiology Tübingen, Tübingen, Germany.
⁷ Department of Psychiatry and Psychotherapy, University of Marburg, Germany.
⁸ Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany.
⁹ Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany.
¹⁰ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany.
¹¹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹² University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany.
¹³ Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Geriatric Psychiatry, Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland.
¹⁴ Translational Clinical Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
¹⁵ Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
¹⁶ Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany.

PMID: 36898634
DOI: 10.1016/j.bpsc.2023.02.008

Abstract

Background: In bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neural function of the emotion network. The present study investigated the effects of an emotion-centered psychotherapeutic intervention on amygdala responsivity and connectivity during emotional face processing in BD.

Methods: In a randomized controlled trial within the multicentric BipoLife project, euthymic patients with BD received one of two interventions over 6 months: an unstructured, emotion-focused intervention (FEST), where patients were guided to adequately perceive and label their emotions (n = 28), or a specific, structured, cognitive behavioral intervention (SEKT) (n = 31). Before and after interventions, functional magnetic resonance imaging was conducted while patients completed an emotional face-matching paradigm (final functional magnetic resonance imaging sample of patients completing both measurements: SEKT, n = 17; FEST, n = 17). Healthy control subjects (n = 32) were scanned twice after the same interval without receiving any intervention. Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala activation and connectivity.

Results: Clinically, both interventions stabilized patients' euthymic states in terms of affective symptoms. At the neural level, FEST versus SEKT increased amygdala activation and amygdala-insula connectivity at postintervention relative to preintervention time point. In FEST, the increase in amygdala activation was associated with fewer depressive symptoms (r = 0.72) 6 months after intervention.

Conclusions: Enhanced activation and functional connectivity of the amygdala after FEST versus SEKT may represent a neural marker of improved emotion processing, supporting the FEST intervention as an effective tool in relapse prevention in patients with BD.

Keywords: Amygdala; Bipolar disorder; Emotion processing; Euthymia; Psychotherapy; fMRI.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Amygdala
Bipolar Disorder*
Brain Mapping
Emotions / physiology
Humans
Neural Pathways
Psychotherapy