Boosting the ToM network: Specific psychotherapy increases neural correlates of affective theory of mind in euthymic bipolar disorder

Objectives: Impairments in social cognitive processes are discussed as a vulnerability factor for bipolar disorder (BD). Previous studies demonstrated aberrant neural activation in brain areas related to theory of mind (ToM) and impaired affective ToM (aToM) task performance in BD. However, it is yet unknown whether successful psychotherapy of BD influences neuroimaging markers of aToM.Methods: In the present study conducted within the multicentric randomized controlled trial of the BipoLife consortium, euthymic BD patients underwent two group interventions: a specific, cognitive-behavioral intervention (SEKT, n = 31) encompassing psychoeducation and the training of self-management, impulse regulation, and ToM and social skills versus a supportive, unstructured, 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. Because ToM skills were trained in SEKT, we expected an increased ToM network activation in SEKT relative to FEST post intervention. Results: Both treatments were effective in stabilizing patients’ euthymic state in terms of affective symptoms, life satisfaction and global functioning. Confirming our expectations, patients who had completed SEKT showed an increased neural activation within four regions of the ToM brain network, the bilateral temporoparietal junction (TPJ), the posterior cingulate cortex (PCC), and the precuneus, whereas FEST patients did not. Conclusions: The stabilizing effect of SEKT on clinical outcomes went along with a boost in neural activation of the ToM network, while FEST possibly exerted its positive effect by other, yet unexplored routes.

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Neural Correlates of Theory of Mind Are Preserved in Young Women With Anorexia Nervosa

Frontiers in Psychology ◽

10.3389/fpsyg.2020.568073 ◽

2020 ◽

Vol 11 ◽

Author(s):

Monica Leslie ◽

Daniel Halls ◽

Jenni Leppanen ◽

Felicity Sedgewick ◽

Katherine Smith ◽

...

Keyword(s):

Anorexia Nervosa ◽

Prefrontal Cortex ◽

Theory Of Mind ◽

Social Interactions ◽

Young Women ◽

Inferior Frontal Gyrus ◽

Reliability And Validity ◽

Neural Correlates ◽

Neural Activation ◽

Neural Basis

People with anorexia nervosa (AN) commonly exhibit social difficulties, which may be related to problems with understanding the perspectives of others, commonly known as Theory of Mind (ToM) processing. However, there is a dearth of literature investigating the neural basis of these differences in ToM and at what age they emerge. This study aimed to test for differences in the neural correlates of ToM processes in young women with AN, and young women weight-restored (WR) from AN, as compared to healthy control participants (HC). Based on previous findings in AN, we hypothesized that young women with current or prior AN, as compared to HCs, would exhibit a reduced neural response in the medial prefrontal cortex (mPFC), the inferior frontal gyrus, and the temporo-parietal junction (TPJ) whilst completing a ToM task. We recruited 73 young women with AN, 45 WR young women, and 70 young women without a history of AN to take part in the current study. Whilst undergoing a functional magnetic resonance imaging (fMRI) scan, participants completed the Frith-Happé task, which is a commonly used measure of ToM with demonstrated reliability and validity in adult populations. In this task, participants viewed the movements of triangles, which depicted either action movements, simple interactions, or complex social interactions. Viewing trials with more complex social interactions in the Frith-Happé task was associated with increased brain activation in regions including the right TPJ, the bilateral mPFC, the cerebellum, and the dorsolateral prefrontal cortex. There were no group differences in neural activation in response to the ToM contrast. Overall, these results suggest that the neural basis of spontaneous mentalizing is preserved in most young women with AN.

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Group-based psychosocial intervention for bipolar disorder: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.058263 ◽

2010 ◽

Vol 196 (5) ◽

pp. 383-388 ◽

Cited By ~ 69

Author(s):

David Castle ◽

Carolynne White ◽

James Chamberlain ◽

Michael Berk ◽

Lesley Berk ◽

...

Keyword(s):

Bipolar Disorder ◽

Controlled Trial ◽

Psychosocial Interventions ◽

Post Intervention ◽

Treatment As Usual ◽

Face To Face ◽

Telephone Interviews ◽

Naturalistic Setting ◽

Reduced Rate ◽

Randomised Controlled

BackgroundPsychosocial interventions have the potential to enhance relapse prevention in bipolar disorder.AimsTo evaluate a manualised group-based intervention for people with bipolar disorder in a naturalistic setting.MethodEighty-four participants were randomised to receive the group-based intervention (a 12-week programme plus three booster sessions) or treatment as usual, and followed up with monthly telephone interviews (for 9 months post-intervention) and face-to-face interviews (at baseline, 3 months and 12 months).ResultsParticipants who received the group-based intervention were significantly less likely to have a relapse of any type and spent less time unwell. There was a reduced rate of relapse in the treatment group for pooled relapses of any type (hazard ratio 0.43, 95% CI 0.20–0.95; t343 = −2.09, P = 0.04).ConclusionsThis study suggests that the group-based intervention reduces relapse risk in bipolar disorder.

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Try to see it my way – Examining the relationship between visual perspective taking and theory of mind in frontotemporal dementia

10.31234/osf.io/crdjh ◽

2021 ◽

Author(s):

Cherie Strikwerda-Brown ◽

Rebekah Ahmed ◽

Olivier Piguet ◽

Muireann Irish

Keyword(s):

Theory Of Mind ◽

Frontotemporal Dementia ◽

Real World ◽

Perspective Taking ◽

Inferior Frontal Gyrus ◽

Neural Correlates ◽

Visual Perspective ◽

Temporoparietal Junction ◽

Visual Perspective Taking ◽

World Perspective

The behavioural variant of frontotemporal dementia (bvFTD) is characterised by pronounced alterations in social functioning, including the understanding of others’ thoughts and feelings via theory of mind. The emergence of such impairments in other social disorders such as autism and schizophrenia is suggested to reflect an inability to imagine the other person’s visual perspective of the world. To our knowledge, this hypothesis is yet to be explored in bvFTD. Here, we sought to examine the capacity for different forms of perspective taking, including visual perspective taking and theory of mind in bvFTD, and to establish their inter-relationships and underlying neural correlates. Fifteen bvFTD patients and 15 healthy Controls completed a comprehensive battery of perspective taking measures, comprising Level 1 (‘what’) and Level 2 (‘how’) visual perspective taking tasks, a cartoon task capturing theory of mind, and a questionnaire assessing perspective taking in daily life. Compared with Controls, bvFTD patients displayed significant impairments across all perspective taking measures. These perspective taking impairments, however, were not correlated with one another in bvFTD. Moreover, controlling for visual perspective taking performance did not ameliorate the deficits in theory of mind or real-world perspective taking. Region-of-interest voxel-based morphometry analyses suggested distinct neural correlates for visual perspective taking (inferior frontal gyrus) versus theory of mind (medial prefrontal cortex, precuneus), which appeared to partially overlap with those implicated in real-world perspective taking (inferior frontal gyrus, precuneus, temporoparietal junction). Despite pervasive impairments in all aspects of perspective taking in bvFTD, our findings suggest that these deficits may reflect distinct underlying processes. Future studies manipulating discrete aspects of the tasks will help to clarify the neurocognitive mechanisms of, and relationships between different forms of perspective taking in bvFTD, along with their real-world implications.

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Neural correlates of theory of mind in typically-developing youth: Influence of sex, age and callous-unemotional traits

Scientific Reports ◽

10.1038/s41598-019-52261-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Yidian Gao ◽

Jack C. Rogers ◽

Ruth Pauli ◽

Roberta Clanton ◽

Rosalind Baker ◽

...

Keyword(s):

Theory Of Mind ◽

Neural Correlates ◽

Typically Developing ◽

Temporoparietal Junction ◽

Callous Unemotional ◽

Callous Unemotional Traits ◽

Brain Responses ◽

Unemotional Traits ◽

Understanding Emotions ◽

Behavioral Evidence

Abstract Theory of mind (ToM), or the ability to infer and predict the intentions, thoughts and beliefs of others, involves cognitive perspective taking (cognitive ToM/cToM) and understanding emotions (affective ToM/aToM). While behavioral evidence indicates that ToM is influenced by sex and age, no study has examined the influence of these variables on the neural correlates of cToM and aToM in late childhood/adolescence. Using fMRI with 35 typically-developing youths (aged 9–18 years, 12 males), we investigated the influence of sex and age on the neural correlates of cToM and aToM. We also examined how callous-unemotional traits, indexing a lack of empathy, were related to brain responses during aToM. Across both conditions, we found convergent activity in ToM network regions, such as superior temporal sulcus/temporoparietal junction (TPJ) and precuneus across males and females, but males recruited the left TPJ significantly more than females during cToM. During aToM, age was negatively correlated with brain responses in frontal, temporal and posterior midline regions, while callous-unemotional traits were positively correlated with right anterior insula responses. These results provide the first evidence in youth that sex influences the neural correlates of cToM, while age and callous-unemotional traits are specifically related to brain responses during aToM.

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Theory of Mind Deficits and Their Influence on Functional Impairment in Remitted Phase of Bipolar Disorder

Indian Journal of Psychological Medicine ◽

10.1177/0253717620930315 ◽

2020 ◽

pp. 025371762093031

Author(s):

Pradeep Palaniappan ◽

Krishnapriya Easwaran

Keyword(s):

Bipolar Disorder ◽

Theory Of Mind ◽

Functional Impairment ◽

Second Order ◽

Or Education ◽

Global Functioning ◽

First Order ◽

Significant Difference ◽

Depressive Episodes ◽

Illness Variables

Background: Functional impairment has been convincingly established in the euthymic/ remitted phase of bipolar disorder (BD). Though deficits in social cognition, especially theory of mind (ToM), predict functional impairment, the association has not been consistently proven. Methods: Thirty remitted subjects with BD (as per DSM 5) and 30 age- and gender-matched healthy controls were screened for eligibility and the sociodemographic details and ToM scores, that is, first-order ToM, second-order ToM, and Faux pas, were collected. In subjects with BD, functioning was assessed using Functioning Assessment Short Test (FAST) and illness variables were collected. Results: No significant difference was found in occupation or education between the groups. Remitted subjects with BD had statistically significant deficits in all domains of ToM, that is, first-order ToM ( r = 0.65), second-order ToM ( r = 0.69), and Faux pas ( r = 0.75). Significant correlations existed between first-order ToM and FAST total score, as well as second-order ToM and FAST total score, but the correlations dropped after controlling for duration of illness and number of depressive episodes. Quantile regression analysis showed that the only factors which predicted global functional impairment was a higher number of episodes ( βτ= –0.45, SE = 3.51, t = 0.13, P = 0.04), while all other illness variables and ToM failed to predict the global functioning. Conclusion: Though there seems to be an association between ToM and functioning, only illness variables predicted functional impairment in subjects with BD. We need prospective studies to delineate the contributors to functional impairment.

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Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063102 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3102

Author(s):

Sanne P.A. Rasing ◽

Yvonne A.J. Stikkelbroek ◽

Wouter den Hollander ◽

Heleen Riper ◽

Maja Deković ◽

...

Keyword(s):

Depressive Symptoms ◽

Depressive Disorders ◽

Controlled Trial ◽

Post Intervention ◽

Global Functioning ◽

Treatment As Usual ◽

Face To Face ◽

Quasi Experimental ◽

Secondary Outcomes

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice.

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Theory of Mind, pragmatics and the brain

Pragmatics & Cognition ◽

10.1075/pc.19010.enr ◽

2019 ◽

Vol 26 (1) ◽

pp. 5-38 ◽

Cited By ~ 6

Author(s):

Ivan Enrici ◽

Bruno G. Bara ◽

Mauro Adenzato

Keyword(s):

Theory Of Mind ◽

Mental States ◽

Brain Regions ◽

Brain Network ◽

Written Language ◽

Human Communication ◽

Temporoparietal Junction ◽

Communicative Intention ◽

Right Temporoparietal Junction

Abstract Theory of Mind (ToM) is a neurocognitive system that allows the perceiver to attribute mental states, such as intentions, beliefs, or feelings, to others’ actions. The aim of the present work is to analyse the engagement of the ToM system in communication, in particular, in communicative intention processing. To this aim, we propose an Intention Processing Network (IPN) with its own principles and mechanisms, that is, a brain network differentially engaged according to the complex intertwining of the context, goal, and action involved. According to our IPN model, a set of brain regions of the ToM system (i.e. left and right temporoparietal junction, precuneus, and medial prefrontal cortex) are differentially involved in comprehending different types of intention, such as private or social intentions. We provide independent and convergent evidence on the role of the IPN model in communicative intention processing and we show that the engagement of the IPN does not depend upon the communicative means used, that is, written language, auditory language, or gesture. Evidence deriving from different experimental paradigms, including neuroimaging, lesion, neurodegenerative, and brain stimulation studies are discussed. In our view, this evidence establishes a link between ToM and pragmatics studies and suggests the role of intention processing as a core feature of human communication.

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