Original Article

Citation: Translational Psychiatry (2017) 7, e1001; doi:10.1038/tp.2016.263
Published online 17 January 2017

There is a Corrigendum (15 August 2017) associated with this article.

Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery
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L Mason1, E Peters1,2, S C Williams3 and V Kumari1,2

  1. 1Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  2. 2South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
  3. 3Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Correspondence: Dr L Mason, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Henry Wellcome Building, Denmark Hill, London SE5 8BB, UK. E-mail: Liam.Mason@kcl.ac.uk or LiamMason0@gmail.com

Received 6 June 2016; Revised 7 October 2016; Accepted 13 November 2016

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Abstract

Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.