Boosting the Theory of Mind Network: Specific Psychotherapy Increases Neural Correlates of Affective Theory of Mind in Euthymic Bipolar Disorder

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; Dirk Ritter; Philipp Ritter; Sarah Trost; Christoph Vogelbacher; Henrik Walter; Sarah Wolter; Martin Hautzinger; Felix Bermpohl

doi:10.1016/j.bpsc.2022.08.013

Boosting the Theory of Mind Network: Specific Psychotherapy Increases Neural Correlates of Affective Theory of Mind in Euthymic Bipolar Disorder

Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 May;8(5):572-580. doi: 10.1016/j.bpsc.2022.08.013. Epub 2022 Sep 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 Rau⁶, Dirk Ritter⁴, Philipp Ritter⁴, Sarah Trost¹², Christoph Vogelbacher⁷, Henrik Walter², Sarah Wolter¹³, Martin Hautzinger⁶, Felix Bermpohl²

Affiliations

¹ Department of Psychiatry and Neurosciences, CCM, 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, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ Department of Psychiatry and Neurosciences, CCM, 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, Dresden, Germany.
⁵ Institute for Translational Psychiatry, University of Münster, Münster, Germany.
⁶ Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany.
⁷ Department of Psychiatry, University of Marburg, Marburg, Germany.
⁸ Department of Psychiatry, University of Marburg, Marburg, Germany; Core-Facility Brain Imaging, Faculty of Medicine, University of Marburg, Marburg, Germany.
⁹ Department of Psychiatry, Ruhr University Bochum, LWL, University Hospital, Bochum, Germany.
¹⁰ Center for Psychiatry, Justus Liebig University, Giessen, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany.
¹¹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹² Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland.
¹³ Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.

PMID: 36087699
DOI: 10.1016/j.bpsc.2022.08.013

Abstract

Background: In bipolar disorder, impaired affective theory of mind (aToM) performance and aberrant neural activation in the ToM brain network partly explain social functioning impairments. However, it is not yet known whether psychotherapy of bipolar disorder influences neuroimaging markers of aToM.

Methods: In this study, conducted within the multicentric randomized controlled trial of the BipoLife consortium, patients with euthymic bipolar disorder underwent 2 group interventions over 6 months (mean = 28.45 weeks): 1) a specific, cognitive behavioral intervention (specific psychotherapeutic intervention [SEKT]) (n = 31) targeting impulse regulation, ToM, and social skills and 2) an emotion-focused intervention (FEST) (n = 28). To compare the effect of SEKT and FEST on neural correlates of aToM, patients performed an aToM task during functional magnetic resonance imaging before and after interventions (final functional magnetic resonance imaging sample of pre- and postcompleters, SEKT: n = 16; FEST: n = 17). Healthy control subjects (n = 32) were scanned twice with the same time interval. Because ToM was trained in SEKT, we expected an increased ToM network activation in SEKT relative to FEST postintervention.

Results: Both treatments effectively stabilized patients' euthymic state in terms of affective symptoms, life satisfaction, and global functioning. Confirming our expectations, SEKT patients showed increased neural activation within regions of the ToM network, bilateral temporoparietal junction, posterior cingulate cortex, and precuneus, whereas FEST patients did not.

Conclusions: The stabilizing effect of SEKT on clinical outcomes went along with increased neural activation of the ToM network, while FEST possibly exerted its positive effect by other, yet unexplored routes.

Trial registration: ClinicalTrials.gov NCT02506322.

Keywords: Bipolar Disorder; Neural correlates of Psychotherapy; Social cognition; Theory of Mind; ToM network; fMRI.

Publication types

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

MeSH terms

Bipolar Disorder*
Brain
Cyclothymic Disorder
Humans
Psychotherapy
Theory of Mind* / physiology

Associated data

ClinicalTrials.gov/NCT02506322
DRKS/DRKS00006013