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

Background: Behavioral Activation (BA) as part of cognitive behavioral therapy effectively treats some individuals with major depressive disorder, and its putative mechanism is through targeting reward-related processes. Here we examine how BA may influence these processes in adolescents with depressive disorders.Method:We examined a total of 64 adolescent patients with major depressive disorder (18 adolescents receiving 13 weekly sessions of BA psychotherapy vs. 46 adolescents with depression who did not receive psychotherapy). We collected clinical questionnaires and neural responses to reward anticipation and consumption with the Monetary Incentive Delay (MID) task. Results: Depression 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). The BA group also demonstrated a greater increase in consummatory contrast over time in clusters within the right nucleus accumbens and left putamen (p < 0.01, alpha < 0.025, cluster size > 17). In a cross-lagged analysis, increased anticipatory contrast in the left nucleus accumbens, right caudate, and putamen preceded reduction in clinical symptoms.Conclusions: We provide evidence that BA may modulate the reward processing system and that changes in reward processing during therapy precede symptom improvement. This highlights the potential of BA as a treatment and a tool for studying the role of reward processing in depression.