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Methods: A small sample of substance misusing schizophrenia outpatients randomized to either CET (n = 10) or usual care (n = 4) completed an emotional faces n-back task during functional magnetic resonance imaging (fMRI) after completing 18 months of treatment. A 2 (CET vs. usual care) x 3 (happy, fearful, neutral) general linear model was used to investigate post-treatment group differences in fronto-limbic and striatal regional brain activation during the regulation of emotion.
Results: Compared to participants in usual care, CET participants displayed significantly greater activation in prefrontal networks involved in the regulation of emotion, including the right dorsolateral prefrontal (DLPFC), bilateral orbitofrontal, and right anterior cingulate cortices during the emotional faces n-back task. Greater activation favoring CET was also observed in limbic and striatal subcortical regions of the bilateral caudate, right putamen, and right insular cortex. No significant interactions were observed regarding group and emotional valence. Greater activation in the right DLPFC (Boardman Area 9) was significantly associated with lower negative (pr = -.70, p = .011) and depressive symptoms (pr = -.61, p = .034) following treatment completion. Lower negative symptoms was also significantly associated with greater activation in all other regions following treatment completion (all pr < -.67, all p < .035), with the exception of the right anterior cingulate and the right DLPFC (Boardman Area 46). .
Conclusions: CET may contribute to neuroplasticity in fronto-limbic and striatal brain regions that can support the regulation of emotion in people with schizophrenia who misuse substances. These preliminary results highlight the potential of psychosocial interventions to influence brain function in schizophrenia.