Emotion-focused therapy for bipolar disorder targets the amygdala

Summary: Bipolar patients who received emotion-focused therapy showed increased amygdala connectivity and activation after the intervention compared to those who received cognitive-behavioral therapy.

Source: Elsevier

A new study in Biological psychiatry: cognitive neurosciences and neuroimaging identifies a therapeutic tool focused on emotional awareness that increases the activation and connectivity of an emotion regulation center in the brain.

The therapy may be effective in the long-term treatment and prevention of relapses of bipolar disorder (BD).

Patients with BD experience alternating extreme mood states generally categorized by mania, depression, and impaired social functioning. The complex mechanisms of BD make it difficult to treat, often requiring concoction of drugs and behavioral interventions, which can take years for the provider and the patient to successfully personalize.

Led by Kristina Meyer, PhD, and Catherine Hindi Attar, PhD, at Charité – Universitätsmedizin Berlin, Berlin, Germany, researchers investigated the impact of two psychotherapeutic interventions on symptoms of BD and on the activation and the connectivity of the amygdala with other brain regions related to emotions. using functional magnetic resonance imaging (fMRI).

The amygdala – a pair of small bilateral regions of the brain’s limbic system – helps regulate emotions and detect salient stimuli. Research has shown that BD patients (outside of a manic episode) exhibit impaired amygdala activation and functional connectivity.

In one intervention, 28 patients underwent emotion-focused therapy where they were guided to perceive and label their emotions without avoidance or suppression. The second intervention, delivered to 31 participants, was a specific cognitive-behavioral therapy focused on the practice of social interventions.

Researchers recorded patients’ symptoms using a longitudinal assessment interview for 24 weeks before treatment as well as for six months throughout treatment, six months after treatment, and between six and 12 months after treatment. treatment.

The assessment produced separate weekly measures of mania and depression on a scale of 1 to 6 ranging from no symptoms (1) to psychotic symptoms or severe functional impairment (6). Seventeen participants from each treatment group underwent fMRI while performing an emotional face matching task, as did 32 healthy control subjects.

“Consistent with our expectations, patients participating in the emotion-focused therapy showed increased amygdala activation and connectivity after the intervention compared to patients receiving the cognitive-behavioral intervention, which may reflect a better emotional processing and an increased tolerance for negative emotions,” Dr. Meyer said.

In contrast, cognitive-behavioral intervention patients demonstrated increased activation of brain regions related to social function but not impaired amygdala activity.

Patients with BD experience alternating extreme mood states generally categorized by mania, depression, and impaired social functioning. Image is in public domain

“The results of this study suggest that different psychotherapeutic approaches unfold their beneficial effects through different neural pathways,” added lead author Felix Bermpohl, PhD, Charité – Universitätsmedizin Berlin.

Cameron Carter, MD, editor of Biological psychiatry: cognitive neurosciences and neuroimagingsaid of the work: “This study, which uses task-based fMRI to engage specific brain circuits affected by bipolar disorder before and after different forms of therapy, reveals new insights into their mechanisms of action in the brain. .

“The pattern of outcomes observed using this approach also provides a unique form of validation of the clinical approach used, linking the theoretical model motivating the emotion-focused intervention to its effects on the brain.”

About this bipolar disorder research news

Author: Eileen Leahy
Source: Elsevier
Contact: Eileen Leahy – Elsevier
Picture: Image is in public domain

Original research: Free access.
“Dare to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder. A Randomized Controlled Trial” by Kristina Meyer et al. Biological psychiatry: cognitive neurosciences and neuroimaging


Dare to feel: Emotion-focused psychotherapy increases amygdala activation and connectivity in euthymic bipolar disorder. A randomized controlled trial


In bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neuronal function of the emotional network. The present study investigated the effects of an emotion-focused psychotherapeutic intervention on amygdala reactivity and connectivity during emotional processing of the face in BD.


In a randomized controlled trial as part of the multicenter BipoLife project, euthymic BD patients received one of two interventions over six months: an emotion-focused intervention where patients were guided to correctly perceive and label their emotions (FEST , not = 28) or a specific cognitive-behavioral intervention (SEKT, not = 31). Before and after the interventions, functional magnetic resonance imaging (fMRI) was performed while the patients completed an emotional face matching paradigm (final sample of pre- and post-completer fMRI, SEKT: not = 17; PARTY : not = 17). Healthy controls (not = 32) were scanned twice after the same interval without receiving any intervention. Given FEST’s focus on emotion processing, we expected FEST to enhance amygdala activation and connectivity.


Clinically, both interventions stabilized patients’ euthymic states in terms of affective symptoms. At the neuronal level, FEST compared to SEKT increased amygdala activation and amygdala-insula connectivity after the time point compared to pre-intervention. In FEST, increased amygdala activation was associated with fewer depressive symptoms (r = 0.72) six months after surgery.


The enhanced activation and functional connectivity of the FEST amygdala relative to SEKT may represent a neural marker of enhanced emotion processing, supporting the FEST intervention as an effective tool in the prevention of BD relapses.

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