Trends in Cognitive Sciences
Volume 14, Issue 9, September 2010, Pages 418-424
Journal home page for Trends in Cognitive Sciences

Review
Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings

https://doi.org/10.1016/j.tics.2010.06.007Get rights and content

In this review paper a modified cognitive neurophysiological model of Aaron T. Beck's cognitive formulation of anxiety and depression is proposed that provides an elaborated account of the cognitive and neural mediational processes of cognitive therapy (CT). Empirical evidence consistent with this model is discussed that indicates the effectiveness of cognitive therapy could be associated with reduced activation of the amygdalohippocampal subcortical regions implicated in the generation of negative emotion and increased activation of higher-order frontal regions involved in cognitive control of negative emotion. Future cognitive neuroscience research is needed on the unique brain substrates affected by CT and their role in facilitating symptom change. This future research would have important implications for improving the efficiency and efficacy of this treatment approach.

Section snippets

A cognitive approach to emotional disturbance

Major depressive disorder (MDD) and anxiety disorders (i.e. emotional disorders) are the most prevalent of all psychiatric conditions, accounting for a substantial proportion of the mental health disease burden in Western countries. MDD has an estimated lifetime prevalence of 17%, whereas anxiety disorders have an even higher lifetime prevalence of between 25 and 30% 1, 2. Both types of disorders have an early onset in adolescence and young adulthood, take a recurring or chronic lifetime

Cognitive mediation in treatment of anxiety and depression

CT is a complex therapeutic intervention that involves many components targeting various cognitive, behavioral, interpersonal and affective responses. Its primary mechanism of action is assumed to involve change in biased information processing (i.e. cognitive mediation). In fact there is now considerable evidence that CT produces change in negative cognition that precedes and predicts reductions in depressive and anxious symptoms 28, 29, 30, 31. Most studies report that CT produces significant

The neural basis of CT

Neuroimaging studies of CT provide new insights into its cognitive and neurophysiological mediators of change. In his review Linden [24] concluded that CT (or CBT) can lead to reduction in fronto-striato-thalamic activity for anxiety disorder but the findings are less consistent for depression. Across studies successful treatment with CT has been associated with both increases and decreases in prefrontal metabolism, although Linden suggested that CT for depression probably operates via change

Neurophysiological correlates of cognitive control

As discussed previously, treatment process research has shown that CT produces symptom change by correcting the maladaptive information processing biases that characterize anxiety and depression. Neuroimaging studies investigating the neural substrates of cognitive control of emotion shed light on the neurophysiological effects of specific therapeutic ingredients of CT such as cognitive restructuring that involves the reappraisal of emotional stimuli.

Neurophysiological research has shown that

Conclusion and future directions

In recent years considerable progress has been achieved in the development, evaluation and understanding of the change processes involved in the psychological treatment of clinical depression and the anxiety disorders. CT is a theory-derived, evidence-based psychotherapy for anxiety and depression that has been rigorously evaluated in numerous clinical trials. However, treatment process research that elucidates the mechanisms of therapeutic change in CT has lagged behind the advances attained

Glossary

Attentional cueing task
The presentation of emotional versus neutral cue stimuli (i.e. facial expressions) followed by a varying target probe (i.e. one or two dots) in which reaction time to shift attention away from invalid emotion cues when identifying probe type is considered an indicator of cognitive control over emotional stimuli.
Bottom-up processing
(also known as data-driven or associative processing). A primitive automatic, effortless, implicit and preconscious processing of information

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