What the study found
The review found that baseline neural activity during emotion regulation was often linked to treatment response in internalizing disorders such as depressive and anxiety disorders. In general, lower pre-treatment activity in medial and lateral prefrontal cortices during explicit regulation tasks was associated with greater symptom improvement, while higher baseline activity in prefrontal and anterior cingulate regions during implicit regulation tasks was often associated with greater symptom improvement.
Why the authors say this matters
The authors conclude that neural predictors of treatment outcome may contribute to precision medicine, meaning treatment could be better matched to patients. They also suggest that these predictors may help improve treatment outcomes in internalizing disorders.
What the researchers tested
This was a narrative review of functional magnetic resonance imaging studies, or fMRI studies that measure brain activity. The review examined studies of explicit emotion regulation, such as cognitive reappraisal or effortful regulation, and implicit emotion regulation, such as automatic regulation, in relation to treatment response for negative stimuli in internalizing disorders.
What worked and what didn't
Across the reviewed studies, treatments mostly included cognitive behavioral therapy, exposure therapy, and/or pharmacotherapy. For explicit regulation, pre-treatment activity in medial and lateral prefrontal cortices frequently predicted treatment response, and lower baseline activity was generally linked to greater symptom improvement. For implicit regulation, predictors often involved prefrontal cortical regions and the anterior cingulate cortex, with more baseline activity generally predicting greater symptom improvement; findings in other regions, including the amygdala, were less consistent.
What to keep in mind
The review notes substantial gaps in the literature. Most explicit regulation studies focused on cognitive reappraisal, and most studies involved major depressive disorder, anxiety disorders, and posttraumatic stress disorder, with insufficient representation of other internalizing disorders.
Key points
- Baseline brain activity during emotion regulation was often associated with treatment response.
- Lower pre-treatment activity in medial and lateral prefrontal cortices during explicit regulation was generally linked to greater symptom improvement.
- Higher baseline activity in prefrontal and anterior cingulate regions during implicit regulation was generally linked to greater symptom improvement.
- Most reviewed studies examined cognitive behavioral therapy, exposure therapy, and/or pharmacotherapy.
- The literature was limited by a heavy focus on cognitive reappraisal and a few internalizing disorders.
Disclosure
- Research title:
- Neural activity predicted treatment response in internalizing disorders
- Authors:
- Heide Klumpp, Delaney K. Davey, Scott A. Langenecker
- Institutions:
- Edward Hines, Jr. VA Hospital, The Ohio State University, University of Illinois Chicago, University of Illinois Chicago
- Publication date:
- 2026-03-07
- OpenAlex record:
- View
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