Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder—A Randomized Controlled Trial

Research output: Contribution to journalResearch articleContributedpeer-review


  • Kristina Meyer - , Charité – Universitätsmedizin Berlin (Author)
  • Catherine Hindi Attar - , Charité – Universitätsmedizin Berlin (Author)
  • Jana Fiebig - , Charité – Universitätsmedizin Berlin (Author)
  • Thomas Stamm - , Charité – Universitätsmedizin Berlin, Brandenburg Medical School Theodor Fontane (Author)
  • Tyler R. Bassett - , University Hospital Carl Gustav Carus Dresden (Author)
  • Michael Bauer - , Department of Psychiatry and Psychotherapy (Author)
  • Udo Dannlowski - , University of Münster (Author)
  • Thomas Ethofer - , University Hospital Tübingen, University of Tübingen (Author)
  • Irina Falkenberg - , University of Marburg (Author)
  • Andreas Jansen - , University of Marburg (Author)
  • Georg Juckel - , Ruhr University Bochum (Author)
  • Tilo Kircher - , University of Marburg (Author)
  • Christoph Mulert - , University of Hamburg, Justus Liebig University Giessen (Author)
  • Gregor Leicht - , University of Hamburg (Author)
  • Anne Rau - , University Hospital Tübingen (Author)
  • Jonas Rauh - , University of Hamburg (Author)
  • Dirk Ritter - , Department of Psychiatry and Psychotherapy (Author)
  • Philipp Ritter - , Department of Psychiatry and Psychotherapy (Author)
  • Sarah Trost - , University of Göttingen, Universitäre Altersmedizin FELIX PLATTER (Author)
  • Christoph Vogelbacher - , University of Marburg (Author)
  • Henrik Walter - , Charité – Universitätsmedizin Berlin (Author)
  • Sarah Wolter - , University of Göttingen, Otto von Guericke University Magdeburg (Author)
  • Martin Hautzinger - , University of Tübingen (Author)
  • Felix Bermpohl - , Charité – Universitätsmedizin Berlin (Author)


Background: In bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neural function of the emotion network. The present study investigated the effects of an emotion-centered psychotherapeutic intervention on amygdala responsivity and connectivity during emotional face processing in BD. Methods: In a randomized controlled trial within the multicentric BipoLife project, euthymic patients with BD received one of two interventions over 6 months: an unstructured, emotion-focused intervention (FEST), where patients were guided to adequately perceive and label their emotions (n = 28), or a specific, structured, cognitive behavioral intervention (SEKT) (n = 31). Before and after interventions, functional magnetic resonance imaging was conducted while patients completed an emotional face-matching paradigm (final functional magnetic resonance imaging sample of patients completing both measurements: SEKT, n = 17; FEST, n = 17). Healthy control subjects (n = 32) were scanned twice after the same interval without receiving any intervention. Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala activation and connectivity. Results: Clinically, both interventions stabilized patients’ euthymic states in terms of affective symptoms. At the neural level, FEST versus SEKT increased amygdala activation and amygdala-insula connectivity at postintervention relative to preintervention time point. In FEST, the increase in amygdala activation was associated with fewer depressive symptoms (r = 0.72) 6 months after intervention. Conclusions: Enhanced activation and functional connectivity of the amygdala after FEST versus SEKT may represent a neural marker of improved emotion processing, supporting the FEST intervention as an effective tool in relapse prevention in patients with BD.


Original languageEnglish
Pages (from-to)750-759
Number of pages10
JournalBiological Psychiatry: Cognitive Neuroscience and Neuroimaging
Issue number7
Publication statusPublished - Jul 2023

External IDs

PubMed 36898634
ORCID /0000-0003-4286-5830/work/149796286
ORCID /0000-0002-2666-859X/work/149797559



  • Amygdala, Bipolar disorder, Emotion processing, Euthymia, Psychotherapy, fMRI, Bipolar Disorder, Humans, Brain Mapping, Emotions/physiology, Neural Pathways