Neural Reward Circuitry and Response to Behavioral Activation Psychological Treatment in Youth with Major Depressive Disorder

Behavioral Activation (BA) as part of cognitive behavioral therapy is an effective treatment for some individuals with major depressive disorder (MDD) and is hypothesized to operate through engagement of reward-related processes. However, evidence linking BA to modulation of reward circuitry, particularly during adolescence, remains limited. The present non-randomized open-label trial examined whether adolescents receiving BA, compared to those not receiving psychotherapy, show differential longitudinal changes in reward-related neural activity and depressive symptoms. Sixty-four adolescents with MDD were assessed longitudinally, including 18 adolescents who received 13 weekly sessions of BA psychotherapy and 46 adolescents with MDD who did not receive psychotherapy. Depressive symptoms were assessed using clinical questionnaires, and neural responses to reward anticipation and consumption were measured using the Monetary Incentive Delay (MID) task during functional MRI. Depressive symptoms decreased by approximately 1 point per month more in the BA group than the non-BA group (0.03 points per day, 95% CI = -0.06 – -0.01, p = 0.008). Longitudinal neuroimaging analyses revealed greater increases over time in the consummatory contrast in the BA group relative to the non-BA group in clusters within the right nucleus accumbens and left putamen (p < 0.01, alpha < 0.025, cluster size > 17). These findings indicate that BA is associated with longitudinal changes in both depressive symptoms and reward-related neural activity in adolescents with depression. These findings support that BA is an effective treatment and a useful tool for exploring reward-related neural changes in Major Depressive Disorder.