Integrating Core Conflictual Relationship Themes in neurobiological assessment of interpersonal processes in psychotherapy

Interpersonal processes are a key target in counselling and psychotherapy. It is of paramount importance to sharpen their assessment using integrated methods. Hence, this methodological paper describes how fields of research in psychotherapy and neuroimaging can be integrated into one novel complementary neurobehavioural paradigm that can be applied to enhance our understanding of interpersonal processes in psychotherapy. To illustrate this integration, we present selected data from a pre–post pilot study where the authors assessed interpersonal processes in brief treatment for borderline personality disorder using the core conflictual relationship theme, functional magnetic resonance imaging (fMRI) and outcome questionnaires. To do so, they measured individual changes in neural activity using an fMRI task pre‐ and post‐treatment where clients gave feedback on the emotional valence of sentences extracted from their own Relationship Anecdotes Paradigm interviews mixed with neutral ones. In this paper, using data from two participants of said study, we discuss how to implement this methodology and what can be achieved in terms of results

EFFECT OF ELECTROCONVULSIVE THERAPY FOR MAJOR DEPRESSION ON BRAIN VOLUME AND MICROSTRUCTURAL PROPERTIES

Major depressive disorder (MDD) affects worldwide more than 300 million individuals and is the second contributor to the Years Lived with Disability (DALY). Despite a large therapeutic arsenal, significant number of patients does not recover sufficiently swift from a depressive episode and suffer for a prolonged period of time. For these patients, electroconvulsive therapy (ECT) is the most efficient somatic treatment though its precise mechanism of action is still unknown. Pre-clinical studies indicate that neuroplasticity, and in particular neurogenesis in the hippocampus (HP), are possibly related to the treatment effect. This notion is also supported by human studies that consistently demonstrate hippocampal volume increases in patients undergoing ECT. In the first part of my project, I sought answering the question whether the observed grey matter (GM) volume increase related to ECT are differentially distributed along HPs longitudinal axis with a predominant effect on the anterior “limbic” portion of the HP. To this aim, 9 MDD patients treated with ECT were scanned before and after ECT. According to our hypothesis, we found a strong spatial effect of ECT induced GM volume change along the main HP axis indicating that the anterior part of the HP is more strongly affected by ECT. Individuals’ clinical outcome was associated with volume changes in the anterior and not in the posterior HP. This study shows that the effect of ECT is not uniform but depends on the position along the longitudinal axis of the HP and indicates the importance of the anterior HP for the mechanism of action of ECT. In the second part of my project, I tried to address some potential bias in current computational anatomy studies that have limited the straightforward neurobiological interpretation of the observed ECT induced brain changes. Indeed, volume estimation based on T1-weighted contrast is not only influenced my macrostructural changes of brain anatomy but is also influenced by microstructural properties of the brain tissue (the water, myelin and iron content). Therefore, we used advanced MRI acquisition in a new sample of 9 patients to perform a quantitative investigation of the contribution of GM volume, water, myelin and iron to the plasticity occurring during a treatment of ECT. We observed increase of GM volume in the HP and in the anterior cingulate without notable change in microstructural properties. We also found that a widespread pattern of regions including the medial prefrontal cortex, the bilateral HP, the bilateral striatum, and the precuneus were associated with clinical outcome. Interestingly, in the medial PFC we found a large contribution of water and myelin content but no contribution of GM volume, which means that classical morphometric studies would be blind to this association. My findings indicate the potential of quantitative MRI to enhance our understanding of the biological processes underlying the therapeutic effects of ECT in MDD patients. -- La dépression majeure affecte 300 millions d’individus et est le deuxième contributeur aux nombres d’années de vie corrigées de l’incapacité (DALY) au niveau mondial. Malgré un grand arsenal thérapeutique, un nombre important de patients ne répondent pas suffisamment aux traitements et souffrent pour une période prolongée. Pour ces patients, l’électro- convulsivothérapie (ECT) est le meilleur traitement dans cette situation bien que son mécanisme d’action soit mal compris. Des études pré-cliniques indiquent que la neuroplasticité, et en particulier la neurogenèse dans l’hippocampe (HP), sont des élément clé du mécanisme d’action de l’ECT. Cette hypothèse est aussi supportée par des études cliniques qui ont démontré e manière consistente que le volume de l’HP est augmenté chez les patients recevant de l’ECT. Dans la première partie de ma recherche, j’ai cherché à répondre à la question de savoir si l’augmentation de volume de matière grise causé par l’ECT est distribuée de manière différentielle le long de l’axe longitudinal de l’HP, avec l’hypothèse que l’effet est prédominant sur la partie antérieure ou « limbique » de l’HP. Dans ce but, 9 patients traités par ECT ont été scannés avant et après l’ECT. En accord avec notre hypothèse, nous avons trouvé une forte dépendance spatiale du changement de volume lié à l’ECT par rapport à la position le long de l’axe longitudinal de l’HP, la partie antérieure de l’HP étant la plus susceptible aux effets de l’ECT. De plus, nous avons trouvé que l’état clinique était associé avec la plasticité dans la partie antérieure mais pas postérieure de l’HP. Cette étude met en avant le fait que l’effet de l’ECT n’est pas uniforme mais dépend de la position le long de l’axe longitudinal de l’HP. Ceci indique le rôle tout particulier de l’hippocampe antérieur dans le mécanisme d’action de l’ECT. Dans la seconde partie de mon projet, j’ai tenté d’adresser certains biais potentiels dans les études actuelle d’anatomie computationnelle qui limitent l’interprétation neurobiologique des changements de volume observés après un traitement d’ECT. En effet, les contrastes pondérés en T1 sont aussi influencés par les propriétés microstructurelles du tissu cérébral (le contenu en eau, myéline et fer). Par conséquent, nous avons utilisé des acquisitions d’imagerie par résonance magnétique (IRM) avancées dans un nouvel échantillon de 9 patients afin de faire une investigation quantitative de la contribution de la matière grise, de l’eau, de la myéline et du fer à la plasticité qui a lieu lors d’un traitement d’ECT. Nous avons observé une augmentation de la matière grise dans l’HP et le cortex cingulaire antérieur sans changement notable au niveau des propriétés microstructurelles. Nous avons aussi trouvé qu’un large nombre de régions incluant le cortex préfrontal médial, les HP, le striatum ventral et le précuneus était associé avec le changement d’état clinique. Dans le cortex préfrontal médial, il y avait une grande contribution de l’eau et de la myéline sans contribution notable de la matière grise, ce qui signifie que les études morphométriques classiques n’auraient pas détecté cette association. Ceci indique le potentiel de l’IRM quantitatif afin de mieux comprendre les processus associés aux bénéfices thérapeutiques de l’ECT sur la dépression

A social and physical stressor increases later punishment in healthy males

Existing literature suggests that stress in early life can influence or trigger later aggressive and punishment behaviors during social interactions. However, only a few human studies have addressed this link in controlled experimental settings. Here, we assessed the impact of biological and behavioral markers of stress on economic and social interactions in healthy men using a between-group design. The Socially Evaluated Cold Pressor Test (i.e., supervised hand immersion into cold water) was applied to one group of participants (n = 19), while a second group underwent the Warm Water Test (n = 21). After the stressor or control procedure, all participants played the Inequality Game, a paradigm in which they could engage in punishment, cooperative, or aggressive behaviors towards a fair and an unfair counterpart player. Compared to the control condition, participants in the stress condition engaged in more punishment behaviors towards the unfair player and less cooperative behaviors towards both players. Critically, higher levels of cortisol in the stress group were associated with more punishment behaviors towards the unfair player. In contrast, aggressive behavior did not differ between participants in the stress vs. control condition. Overall, our findings showed that situationally induced stress might facilitate punishment behaviors in provoking situations. Further research should elucidate the role of inter-individual variables that may encourage or prevent stress-related punishment in social contexts