DOI: 10.3724/SP.J.1042.2019.00522

Advances in Psychological Science (心理科学进展) 2019/27:3 PP.522-532

The biological mechanism of cognitive behavioral therapy

At present the biological mechanisms of cognitive behavioral therapy are not clear and need to explore. This paper will discuss the biological mechanisms of cognitive behavioral therapy from four aspects of brain function, neuroelectrophysiology, neuroendocrine system and immunity, heredity and epigenetics, involving multiple mechanisms. Combining the results of psychology, physiology and heredity, this paper proposes that the biological integration mechanism of cognitive behavioral therapy is a multi-disciplinary integration model which develops from micro, middle and macro levels. Moreover, the limitations of the present results of previous studies are also discussed and a new direction for exploring the biological mechanism of cognitive behavioral therapy are provided. We intend to establish a foundation for promoting the development of cognitive behavioral therapy.

Key words:CBT,event-related potentials,neuroendocrine system,pro-inflammatory cytokines,epigenetics

ReleaseDate:2019-03-01 06:48:06

Beck, J. S. (2013). 认知疗法:基础与应用:第2版 (张怡, 孙凌, 王辰怡 译). 北京:中国轻工业出版社.

胡格, 穆祥, 段慧琴, 杨佐君, 高立云. (2003). 免疫、神经和内分泌系统间的关系. 动物医学进展, 24(1), 5-7.

刘艳丽, 许远理. (2012). 情绪、情绪调节的ERPs晚正成分研究进展. 心理研究, 5, 14-18.

李蕊, 陈珍珠, 沈彦婷, 田飞, 葛芹玉. (2016). 抑郁症相关基因甲基化的研究进展. 生命的化学, (2), 219-224.

闵文蛟, 黄雨兰, 汪瑾宇, 邹志礼, 何影, 徐理, 周波. (2017). 惊恐障碍患者临床特征与神经内分泌轴关系的研究. 实用医院临床杂志, 14(1), 46-48.

王洪明, 孙学礼, 胡峻梅, 姚静. (2013). 健康成人神经心理与神经内分泌功能的相关性研究. 四川医学, 34(2), 185-187.

徐丽丽, 张兰, 马秀云, 朱秀杰, 朱菊红. (2016). 抑郁症神经内分泌及细胞因子的研究进展. 中国医学创新, 13(34), 138-141.

杨宏宇, 林文娟. (2005). 正负性情绪的神经内分泌和免疫反应研究进展. 心理科学, 28(4), 926-928.

易芳, 俞宏辉. (2008). 生态心理学——心理学研究模式的转向. 心理学探新, 28(1), 16-20.

詹光杰, 奚耕思. (2006). 负性情绪的生物学基础. 现代生物医学进展, 6(7), 73-75.

张晓. (2015). 认知行为治疗焦虑症的疗效分析. 临床医药文献电子杂志, 2(16), 3375-3378.

张帆, 雍武, 邵枫, 王玮文. (2014). 中枢肥大细胞在脑功能和行为调节中的作用. 心理科学进展, 22(10), 1597-1607.

曾敏怡, 卢宁. (2017). 强迫症脑成像研究进展. 华西医学, (12), 1950-1954.

郑佳威, 吴玺宏, 李量. (2007). 外侧杏仁核在恐惧性条件化学习和记忆中的作用. 生理科学进展, 38(3), 269-273.

周敏, 胡治国. (2014). 抑郁症患者自我相关加工的fMRI研究现状. 中国医学影像技术, 30(1), 149-152.

Abelson, J. L., Liberzon, I., Young, E. A., & Khan, S. (2005). Cognitive modulation of the endocrine stress response to a pharmacological challenge in normal and panic disorder subjects. Archives of General Psychiatry, 62(6), 668-675.

Abramovitch, A., & Cooperman, A. (2015). The cognitive neuropsychology of obsessive-compulsive disorder:A critical review. Journal of Obsessive-Compulsive and Related Disorders, 5, 24-36.

Abelson, J. L., Khan, S., Liberzon, I., Erickson, T. M., & Young, E. A. (2008). Effects of perceived control and cognitive coping on endocrine stress responses to pharmacological activation. Biological Psychiatry, 64(8), 701-707.

Beck, A. T. (2008). The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry, 165(8), 969-977.

Blechert, J., Wilhelm, F. H., Williams, H., Braams, B. R., Jou, J., & Gross, J. J. (2015). Reappraisal facilitates extinction in healthy and socially anxious individuals. Journal of Behavior Therapy and Experimental Psychiatry, 46, 141-150.

Bunford, N., Kujawa, A., Fitzgerald, K. D., Swain, J. E., Hanna, G. L., Koschmann, E.,... Phan, K. L. (2017). Neural reactivity to angry faces predicts treatment response in pediatric anxiety. Journal of Abnormal Child Psychology, 45(2), 385-395.

Burkhouse, K. L., Kujawa, A., Kennedy, A. E., Shankman, S. A., Langenecker, S. A., Phan, K. L., & Klumpp, H. (2016). Neural reactivity to reward as a predictor of cognitive behavioral therapy response in anxiety and depression. Depress Anxiety, 33(4), 281-288.

DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample:a follow-up study. Behaviour Research and Therapy, 51(2), 82-86.

Dowlati, Y., Herrmann, N., Swardfager, W., Liu, H., Sham, L., Reim, E. K., & Lanctôt, K. L. (2010). A meta-analysis of cytokines in major depression. Biological Psychiatry, 67(5), 446-457.

Endrass, T., Klawohn, J., Schuster, F., & Kathmann, N. (2008). Overactive performance monitoring in obsessive-compulsive disorder:ERP evidence from correct and erroneous reactions. Neuropsychologia, 46(7), 1877-1887.

Etkin, A., Mager, T. D. (2007). Functional neuroimaging of anxiety:A meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), 1476-1488.

Feng, L., Xia, Y., Garcia, G. E., Hwang, D., & Wilson, C. B. (1995). Involvement of reactive oxygen intermediates in cyclooxygenase-2 expression induced by interleukin-1, tumor necrosis factor-alpha, and lipopolysaccharide. Journal of Clinical Investigation, 95(4), 1669-1675.

Fraser, S. A., Kroenke, K., Callahan, C. M., Hui, S. L., Williams, J. W., Jr., & Unützer, J. (2004). Low yield of thyroid-stimulating hormone testing in elderly patients with depression. General Hospital Psychiatry, 26(4), 302-309.

Fonzo, G. A., Ramsawh, H. J., Flagan, T. M., Sullivan, S. G., Simmons, A. N., Paulus, M. P., & Stein, M. B. (2014). Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions. Journal of Affective Disorders, 169, 76-85.

Fu, C. H. Y., Williams, S. C. R., Cleare, A. J., Scott, J., Mitterschiffthaler, M. T., Walsh, N. D.,... Murray, R. M. (2008). Neural responses to sad facial expressions in major depression following cognitive behavioral therapy. Biological Psychiatry, 64(6), 505-512.

Gazal, M., Souza, L. D., Fucolo, B. A., Wiener, C. D., Silva, R. A., Pinheiro, R. T.,... Kaster, M. P. (2013). The impact of cognitive behavioral therapy on IL-6 levels in unmedicated women experiencing the first episode of depression:A pilot study. Psychiatry Research, 209(3), 742-745.

Gárate, I., Garcia-Bueno, B., Madrigal, J. L. M., Caso, J. R., Alou, L., Gomez-Lus, M. L.,... Leza, J. C. (2013). Stress-induced neuroinflammation:Role of the Toll-like receptor-4 pathway. Biological Psychiatry, 73(1), 32-43.

Ghashghaei, H. T., Hilgetag, C. C., & Barbas, H. (2007). Sequence of information processing for emotions based on the anatomic dialogue between prefrontal cortex and amygdala. NeuroImage, 34(3), 905-923.

Hänsel, A., Hong, S., Cámara, R. J., & von Känel, R. (2010). Inflammation as a psychophysiological biomarker in chronic psychosocial stress. Neuroscience & Biobehavioral Reviews, 35(1), 115-121.

Helen, M., & David, K. (2015). The evolution of cognitive-behavioral therapy for psychosis. Psychology Research & Behavior Management, 8, 63-69.

Hum, K. M., Manassis, K., & Lewis, M. D. (2013). Neurophysiological markers that predict and track treatment outcomes in childhood anxiety. Journal of Abnormal Child Psychology, 41(8), 1243-1255.

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders:An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337-346.

Kéri, S., Szabó, C., & Kelemen, O. (2014). Expression of toll-like receptors in peripheral blood mononuclear cells and response to cognitive-behavioral therapy in major depressive disorder. Brain Behavior and Immunity, 40, 235-243.

Kircher, T., Arolt, V., Jansen, A., Pyka, M., Reinhardt, I., Kellermann, T.,... Straube, B. (2013). Effect of cognitive-behavioral therapy on neural correlates of fear conditioning in panic disorder. Biological Psychiatry, 73(1), 93-101.

Klumpp, H., Keutmann, M. K., Fitzgerald, D. A., Shankman, S. A., & Phan, K. L. (2014). Resting state amygdala-prefrontal connectivity predicts symptom change after cognitive behavioral therapy in generalized social anxiety disorder. Biology of Mood & Anxiety Disorders, 4(1), 14.

Landecker, H., & Panofsky, A. (2013). From social structure to gene regulation, and back:A critical introduction to environmental epigenetics for sociology. Annual Review of Sociology, 39(39), 333-357.

Lasselin, J., Kemani, M. K., Kanstrup, M., Olsson, G. L., Axelsson, J., Andreasson, A.,... Wicksell, R. K. (2016). Low-grade inflammation may moderate the effect of behavioral treatment for chronic pain in adults. Journal of Behavioral Medicine, 39(5), 916-924.

Levy-Gigi, E., Szabó, C., Kelemen, O., & Kéri, S. (2013). Association among clinical response, hippocampal volume, and FKBP5 gene expression in individuals with posttraumatic stress disorder receiving cognitive behavioral therapy. Biological Psychiatry, 74(11), 793-800.

Linden, D. E. (2006). How psychotherapy changes the brain——The contribution of functional neuroimaging. Molecular Psychiatry, 11(6), 528-538.

Lissek, S., & Rabin, S. R. (2010). Overgeneralization of conditioned fear as a pathogenic marker of panic disorder. American Journal of Psychiatry, 167(1), 47-55.

Li, P., Yang, X., Greenshaw, A. J., Li, S., Luo, J., Han, H.,... Li, Z. (2018). The effects of cognitive behavioral therapy on resting-state functional brain network in drug-naive patients with obsessive-compulsive disorder. Brain & Behavior, 8(5), e00963.

Liu, Y., Ho, R. C., & Mak, A. (2012). Interleukin (IL)-6, tumour necrosis factor alpha (TNF-alpha) and soluble interleukin-2 receptors (sIL-2R) are elevated in patients with major depressive disorder:A meta-analysis and meta-regression. Journal of Affective Disorders, 139(3), 230-239.

Lueken, U., Straube, B., Konrad, C., Wittchen, H. U., Ströhle, A., Wittmann, A.,... Kircher, T. (2013). Neural substrates of treatment response to cognitive-behavioral therapy in panic disorder with agoraphobia. American Journal of Psychiatry, 170(11), 1345-1355.

Maslowsky, J., Mogg, K., Bradley, B. P., McClure-Tone, E., Ernst, M., Pine, D. S., & Monk, C. S. (2010). A preliminary investigation of neural correlates of treatment in adolescents with generalized anxiety disorder. Journal of Child and Adolescent Psychopharmacology, 20(2), 105-111.

Månsson, K. N. T., Carlbring, P., Frick, A., Engman, J., Olsson, C-J., Bodlund, O.,... Andersson, G. (2013). Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder. Psychiatry Research:Neuroimaging, 214(3), 229-237.

Meloni, M. (2014). The social brain meets the reactive genome:Neuroscience, epigenetics and the new social biology. Frontiers in Human Neuroscience, 8, 309.

Milad, M. R., & Quirk, G. J. (2012). Fear extinction as a model for translational neuroscience:Ten years of progress. Annual Review of Psychology, 63, 129-151.

Milad, M. R., Quirk, G. J., Pitman, R. K., Orr, S. P., Fischl, B., & Rauch, S. L. (2007). A role for the human dorsal anterior cingulate cortex in fear expression. Biological Psychiatry, 62(10), 1191-1194.

Moody, T. D., Morfini, F., Cheng, G., Sheen, C., Tadayonnejad, R., Reggente, N.,... Feusner, J. D. (2017). Mechanisms of cognitive-behavioral therapy for obsessive-compulsive disorder involve robust and extensive increases in brain network connectivity. Translational Psychiatry, 7(9), e1230.

Morgieve, M., N'Diaye, K., Haynes, W. I., Granger, B., Clair, A. H., Pelissolo, A., & Mallet, L. (2014). Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging. Psychological Medicine, 44(7), 1461-1473.

Moreira, F. P., Cardoso Tde, A., Mondin, T. C., Souza, L. D. M., Silva, R., Jansen, K.,... Wiener, C. D. (2015). The effect of proinflammatory cytokines in cognitive behavioral therapy. Journal of Neuroimmunology, 285, 143-146.

Nolen-hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424.

O'Neill, J., Gorbis, E., Feusner, J. D., Yip, J. C., Chang, S., Maidment, K. M.,... Saxena, S. (2013). Effects of intensive cognitive-behavioral therapy on cingulate neurochemistry in obsessive-compulsive disorder. Journal of Psychiatric Research, 47(4), 494-504.

O'Neill, J., Piacentini, J., Chang, S., Ly, R., Lai, T. M., Armstrong, C. C.,... Nurmi, E. L. (2017). Glutamate in pediatric obsessive-compulsive disorder and response to cognitive behavioral therapy:Randomized clinical trial. Neuropsychopharmacology, 42(12), 2414-2422.

O'Neill, J., Piacentini, J. C., Chang, S., Levitt, J. G., Rozenman, M., Bergman, L.,... McCracken, J. T. (2012). MRSI correlates of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 36(1), 161-168.

Prazeres, A. M., Souza, W. F., & Fontenelle, L. F. (2007). Cognitive-behavior therapy for obsessive-compulsive disorder:A systematic review of the last decade. RevistaBrasileira de Psiquiatria, 29(3), 262-270.

Proudfit, G. H. (2015). The reward positivity:From basic research on reward to a biomarker for depression. Psychophysiology, 52(4), 449-459.

Proudfit, G. H., Bress, J. N., Foti, D., Kujawa, A., & Klein, D. N. (2015). Depression and event-related potentials:Emotional disengagement and reward insensitivity. Current Opinion in Psychology, 4, 110-113.

Ritchey, M., Dolcos, F., Eddington, K. M., Strauman, T. J., & Cabeza, R. (2011). Neural correlates of emotional processing in depression:Changes with cognitive behavioral therapy and predictors of treatment response. Journal of Psychiatric Research, 45(5), 577-587.

Roberts, S., Lester, K. J., Hudson, J. L., Rapee, R. M., Creswell, C., Cooper, P. J.,... Eley, T. C. (2014). Serotonin transporter methylation and response to cognitive behaviour therapy in children with anxiety disorders. Translational Psychiatry, 4(9), e444.

Rosner, R., Bartl, H., Pfoh, G., Kotoucova, M., & Hagl, M. (2015). Efficacy of an integrative CBT for prolonged grief disorder:A long-term follow-up. Journal of Affective Disorders, 183, 106-112.

Sehlmeyer, C., Schöning, S., Zwitserlood, P., Pfleiderer, B., Kircher, T., Arolt, V., & Konrad, C. (2009). Human fear conditioning and extinction in neuroimaging:A systematic review. Plos One, 4(6), e5865.

Seidel, E-M., Satterthwaite, T. D., Eickhoff, S. B., Schneider, F., Gur, R. C., Wolf, D. H.,... Derntl, B. (2012). Neural correlates of depressive realism-An fMRI study on causal attribution in depression. Journal of Affective Disorders, 138(3), 268-276.

Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169-191.

Simons, R. L., Man, K. L., Beach, S. R. H., Cutrona, C. E., & Philibert, R. A. (2017). Methylation of the oxytocin receptor gene mediates the effect of adversity on negative schemas and depression. Development and Psychopathology, 29(3), 725-736.

Stange, J. P., MacNamara, A., Barnas, O., Kennedy, A. E., Hajcak, G., Phan, K. L., & Klumpp, H. (2017). Neural markers of attention to aversive pictures predict response to cognitive behavioral therapy in anxiety and depression. Biological Psychology, 123, 269-277.

Szabó, C., Kelemen, O., & Kéri, S. (2014). Changes in FKBP5 expression and memory functions during cognitive-behavioral therapy in posttraumatic stress disorder:A preliminary study. Neuroscience Letters, 569, 116-120.

Thase, M. E., Dube, S., Bowler, K., Howland, R. H., Myers, J. E., Friedman, E., & Jarrett, D. B. (1996). Hypothalamic-pituitary-adrenocortical activity and response to cognitive behavior therapy in unmedicated, hospitalized depressed patients. American Journal of Psychiatry, 153(7), 886-891.

Touma, C., Gassen, N. C., Herrmann, L., Cheung-Flynn, J., Büll, D. R., Ionescu, I. A.,... Rein, T. (2011). FK506 binding protein 5 shapes stress responsiveness:Modulation of neuroendocrine reactivity and coping behavior. Biological Psychiatry, 70(10), 928-936.

van IJzendoorn. M. H., Caspers, K., Bakermans-Kranenburg, M. J., Beach, S. R. H., & Philibert, R. (2010). Methylation matters:interaction between methylation density and serotonin transporter genotype predicts unresolved loss or trauma. Biological Psychiatry, 68(5), 405-407.

Walters, J. T., Rujescu, D., Franke, B., Giegling, I., Vasquez, A. A., Hargreaves, A.,... Owen, M. J. (2013). The role of the major histocompatibility complex region in cognition and brain structure:A schizophrenia GWAS follow-up. American Journal of Psychiatry, 170(8), 877-885.

Xu, J., Qin, W., Liu, B., Jiang, T., & Yu, C. (2016). Interactions of genetic variants reveal inverse modulation patterns of dopamine system on brain gray matter volume and resting-state functional connectivity in healthy young adults. Brain Structure and Function, 221(8), 3891-3901.

Yoshimura, S., Okamoto, Y., Onoda, K., Matsunaga, M., Okada, G., Kunisato, Y.,... Yamawaki, S. (2014). Cognitive behavioral therapy for depression changes medial prefrontal and ventral anterior cingulate cortex activity associated with self-referential processing. Social Cognitive and Affective Neuroscience, 9(4), 487-493.

Yuan, M., Zhu, H., Qiu, C., Meng, Y., Yan, Z., Jing, S.,... Liu, S. (2016). Group cognitive behavioral therapy modulates the resting-state functional connectivity of amygdala-related network in patients with generalized social anxiety disorder. BMC Psychiatry, 16(1), 198.

Zhao, W., Luo, L., Li, Q., & Kendrick, K. M. (2013). What can psychiatric disorders tell us about neural processing of the self? Frontiers in Human Neuroscience, 7(7), 485.

Zhou, M., & Hu, Z-G. (2014). Status of fMRI studies on abnormalities of self-related processing in depression. Chinese Journal of Medical Imaging Technology, 30(1), 149-152.

Ziegler, C., Richter, J., Mahr, M., Gajewska, A., Schiele, M. A., Gehrmann, A.,... Domschke, K. (2016). MAOA gene hypomethylation in panic disorder-reversibility of an epigenetic risk pattern by psychotherapy. Translational Psychiatry, 6(4), e773.