***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Affective facial processing is an important component of interpersonal relationships . The neural substrate has been examined following treatment with antidepressant medication but not with psychological therapies . The present study investigated the neural correlates of implicit processing of sad facial expressions in depression pretreatment and posttreatment with cognitive behavioral therapy ( CBT ) . METHODS The patient group consisted of 16 medication-free subjects ( mean age 40 years ) with a DSM-IV diagnosis of acute unipolar major depression , and the comparison group were 16 matched healthy volunteers . Subjects participated in a prospect i ve study with functional magnetic resonance imaging ( fMRI ) at weeks 0 and 16 . During the fMRI scans , subjects performed an affect recognition task with facial stimuli morphed to display varying intensities of sadness . Patients received 16 sessions of CBT . Functional magnetic resonance imaging data were analyzed for the mean activation and differential response to variable intensity ( load-response ) of facial affect processing . RESULTS During an acute depressive episode , patients showed elevated amygdala-hippocampal activity relative to healthy individuals . Baseline dorsal anterior cingulate activity in patients showed a significant relationship with subsequent clinical response . CONCLUSIONS These data provide further support for elevated amygdala activity in depression and suggest that anterior cingulate activity may be a predictor of treatment response to both pharmacotherapy and CBT Major depressive disorder ( MDD ) is characterized by the presence of disturbances in emotional processing . However , the neural correlates of these alterations , and how they may be affected by therapeutic interventions , remain unclear . The present study addressed these issues in a preliminary investigation using functional magnetic resonance imaging ( fMRI ) to examine neural responses to positive , negative , and neutral pictures in unmedicated MDD patients ( N = 22 ) versus controls ( N = 14 ) . After this initial scan , MDD patients were treated with cognitive behavioral therapy ( CBT ) and scanned again after treatment . Within regions that showed pre-treatment differences between patients and controls , we tested the association between pre-treatment activity and subsequent treatment response as well as activity changes from pre- to post-treatment . This study yielded three main findings . First , prior to treatment and relative to controls , patients exhibited overall reduced activity in the ventromedial prefrontal cortex ( PFC ) , diminished discrimination between emotional and neutral items in the amygdala , cau date , and hippocampus , and enhanced responses to negative versus positive stimuli in the left anterior temporal lobe ( ATL ) and right dorsolateral PFC . Second , CBT-related symptom improvement in MDD patients was predicted by increased activity at baseline in ventromedial PFC as well as the valence effects in the ATL and dorsolateral PFC . Third , from pre- to post-treatment , MDD patients exhibited overall increases in ventromedial PFC activation , enhanced arousal responses in the amygdala , cau date , and hippocampus , and a reversal of valence effects in the ATL . The study was limited by the relatively small sample that was able to complete both scan sessions , as well as an inability to determine the influence of comorbid disorders within the current sample . Nevertheless , components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response , possibly reflecting improvements in emotion regulation processes in response to CBT BACKGROUND Functional brain imaging studies in major depression have suggested abnormalities of areas , including the frontal cortex , cingulate gyrus , basal ganglia , and temporal cortex . We hypothesized that venlafaxine hydrochloride and interpersonal psychotherapy ( IPT ) might each alter brain blood flow in some or all of these areas on sequential single photon emission computed tomography ( SPECT ) scans . METHODS Twenty-eight men and women aged 30 to 53 years with a DSM-IV major depressive episode , a 17-item Hamilton Rating Scale for Depression ( HAM-D ) rating of 18 or higher , and antidepressant-naive for at least 6 months were studied . After baseline (99m)technetium-hexa-methyl-propylene-amine-oxime scan , 1-T magnetic resonance imaging , and psychometric ratings , patients were assigned to different treatments . Thirteen patients had 1-hour weekly sessions of IPT from the same supervised therapist ( E.M. ) . Fifteen patients took 37.5 mg twice-daily of venlafaxine hydrochloride . Single-photon emission computed tomography scans and ratings were repeated at 6 weeks . RESULTS Both treatment groups improved substantially , more so with venlafaxine ( mean [ SD ] HAM-D scores at pretreatment : IPT , 22.7 [ 2.7 ] , and venlafaxine , 22.4 [ 3.1 ] ; and posttreatment : IPT , 16.2 [ 7.1 ] , and venlafaxine , 10.9 [ 8.6 ] ) . No patients had structural brain abnormalities . On analysis with statistical parametric mapping 96 , the venlafaxine group showed right posterior temporal and right basal ganglia activation ( P = .01 ) , while the IPT group had limbic right posterior cingulate and right basal ganglia activation ( P = .01 ) . CONCLUSIONS This preliminary investigation has shown limbic blood flow increase with IPT yet not venlafaxine , while both treatments demonstrated increased basal ganglia blood flow . This was , however , a short trial with a small sample , no control group , and different symptom reduction in the 2 groups BACKGROUND Pill-taking , expectations and therapeutic alliance may account for much of the benefit of medication and placebo treatment for major depressive disorder ( MDD ) . Aims To examine the effects of medication , placebo and supportive care on treatment outcome , and the relationships of expectations and therapeutic alliance to improvement . METHOD A total of 88 participants were r and omised to 8 weeks of treatment with supportive care alone or combined with double-blind treatment with placebo or antidepressant medication .  Expectations of medication effectiveness , general treatment effectiveness and therapeutic alliance were measured ( trial registration at Clinical Trials.gov : NCT00200902 ) . RESULTS Medication or placebo plus supportive care were not significantly different but had significantly better outcome than supportive care alone . Therapeutic alliance predicted response to medication and placebo ; expectations of medication effectiveness at enrolment predicted only placebo response . CONCLUSIONS Pill treatment yielded better outcome than supportive care alone . Medication expectations uniquely predicted placebo treatment outcome and were formed by time of enrolment , suggesting that they were shaped by prior experiences outside the clinical trial The relationship between therapeutic alliance and treatment outcome was examined for depressed out patients who received interpersonal psychotherapy , cognitive-behavior therapy , imipramine with clinical management , or placebo with clinical management .  Clinical raters scored videotapes of early , middle , and late therapy sessions for 225 cases ( 619 sessions ) . Outcome was assessed from patients ' and clinical evaluators ' perspectives and from depressive symptomatology . Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy .  Ratings of patient contribution to the alliance were significantly related to treatment outcome ; ratings of therapist contribution to the alliance and outcome were not significantly linked . These results indicate that the therapeutic alliance is a common factor with significant influence on outcome Several studies have reported low brain serotonin transporter ( SERT ) binding in individuals with major depression . We hypothesized that the SERT st and ardized uptake ratio ( SUR ) values using [ ( 123 ) I]-ADAM single photon emission computed tomography would increase in depressed subjects who responded to cognitive behavior therapy ( CBT )  compared to CBT nonresponders . [ ( 123 ) I]-ADAM scans were acquired before and after 12 weeks of CBT from 20 depressed subjects and on two occasions 12 weeks apart from 10 nondepressed , healthy volunteers . The primary outcome measure was change over time in SUR values in the midbrain , medial temporal lobe , and basal ganglia regions . Depressed subjects demonstrated low pretreatment mean SUR values that significantly increased over time in the midbrain ( P = .011 ) , right medial temporal lobe ( P = .008 ) , and left medial temporal lobe ( P = .000 ) regions . Treatment responders showed a significant increase over time in SUR values in left medial temporal lobe ( P = .029 ) and right medial temporal lobe ( P = .007 ) regions . Partial and nonresponder subjects also showed a significant increase over time in SUR values in the left medial temporal region ( P = .040 ) ( vs. healthy volunteers ) , but to a lesser degree . The findings suggest that low pretreatment SERT binding may increase over time in some depressed individuals who experience symptom improvement 
    Output:
    
The meta- analysis revealed a significant group by time effect in left rostral anterior cingulate , in which patients showed increased activity following psychotherapy while healthy controls showed a decrease at follow up .
Longitudinal treatment effects revealed reduced left pre central cortical activity in major depression .
Findings could be indicative of improvements in emotion responsivity that may be achieved following psychotherapy