Lack of evidence for predictive utility from resting state fMRI data for individual exposure-based cognitive behavioral therapy outcomes: A machine learning study in two large multi-site samples in anxiety disorders

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Kevin Hilbert - , Humboldt University of Berlin, HMU Health and Medical University (Joint first author)
  • Joscha Böhnlein - , University of Münster (Joint first author)
  • Charlotte Meinke - , Humboldt University of Berlin (Author)
  • Alice V. Chavanne - , Humboldt University of Berlin, École normale supérieure Paris-Saclay (Author)
  • Till Langhammer - , Humboldt University of Berlin (Author)
  • Lara Stumpe - , University of Münster (Author)
  • Nils Winter - , University of Münster (Author)
  • Ramona Leenings - , University of Münster (Author)
  • Dirk Adolph - , Ruhr University Bochum (Author)
  • Volker Arolt - , University of Münster (Author)
  • Sophie Bischoff - , Charité – Universitätsmedizin Berlin (Author)
  • Jan C. Cwik - , University of Cologne (Author)
  • Jürgen Deckert - , University Hospital of Würzburg (Author)
  • Katharina Domschke - , University Medical Center Freiburg (Author)
  • Thomas Fydrich - , Humboldt University of Berlin (Author)
  • Bettina Gathmann - , University of Münster (Author)
  • Alfons O. Hamm - , University of Greifswald (Author)
  • Ingmar Heinig - , Chair of Clinical Psychology and Behavioral Neuroscience (Author)
  • Martin J. Herrmann - , University of Würzburg (Author)
  • Maike Hollandt - , University of Greifswald (Author)
  • Jürgen Hoyer - , Chair of Behavioral Psychotherapy (Author)
  • Markus Junghöfer - , University of Münster (Author)
  • Tilo Kircher - , University of Marburg (Author)
  • Katja Koelkebeck - , University of Duisburg-Essen (Author)
  • Martin Lotze - , University of Greifswald (Author)
  • Jürgen Margraf - , Ruhr University Bochum (Author)
  • Jennifer L.M. Mumm - , Charité – Universitätsmedizin Berlin (Author)
  • Peter Neudeck - , Protect-AD Study Site Cologne, Chemnitz University of Technology (Author)
  • Paul Pauli - , University of Würzburg (Author)
  • Andre Pittig - , University of Göttingen (Author)
  • Jens Plag - , Charité – Universitätsmedizin Berlin, Alexianer St. Hedwig Hospital (Author)
  • Jan Richter - , University of Greifswald, University of Hildesheim (Author)
  • Isabelle C. Ridderbusch - , University of Marburg (Author)
  • Winfried Rief - , University of Marburg (Author)
  • Silvia Schneider - , Ruhr University Bochum (Author)
  • Hanna Schwarzmeier - , University of Würzburg (Author)
  • Fabian R. Seeger - , University of Würzburg (Author)
  • Niklas Siminski - , University of Würzburg (Author)
  • Benjamin Straube - , University of Marburg (Author)
  • Thomas Straube - , University Osnabruck (Author)
  • Andreas Ströhle - , Charité – Universitätsmedizin Berlin (Author)
  • Hans-Ulrich Wittchen - , Ludwig Maximilian University of Munich (Author)
  • Adrian Wroblewski - , University of Marburg (Author)
  • Yunbo Yang - , University of Marburg (Author)
  • Kati Roesmann - , University of Münster, University Osnabruck (Author)
  • Elisabeth J. Leehr - , University of Münster (Author)
  • Udo Dannlowski - , University of Münster (Author)
  • Ulrike Lueken - , Humboldt University of Berlin, German Center for Mental Health (DZPG) (Author)

Abstract

Data-based predictions of individual Cognitive Behavioral Therapy (CBT) treatment response are a fundamental step towards precision medicine. Past studies demonstrated only moderate prediction accuracy (i.e. ability to discriminate between responders and non-responders of a given treatment) when using clinical routine data such as demographic and questionnaire data, while neuroimaging data achieved superior prediction accuracy. However, these studies may be considerably biased due to very limited sample sizes and bias-prone methodology. Adequately powered and cross-validated samples are a prerequisite to evaluate predictive performance and to identify the most promising predictors. We therefore analyzed resting state functional magnet resonance imaging (rs-fMRI) data from two large clinical trials to test whether functional neuroimaging data continues to provide good prediction accuracy in much larger samples. Data came from two distinct German multicenter studies on exposure-based CBT for anxiety disorders, the Protect-AD and SpiderVR studies. We separately and independently preprocessed baseline rs-fMRI data from n = 220 patients (Protect-AD) and n = 190 patients (SpiderVR) and extracted a variety of features, including ROI-to-ROI and edge-functional connectivity, sliding-windows, and graph measures. Including these features in sophisticated machine learning pipelines, we found that predictions of individual outcomes never significantly differed from chance level, even when conducting a range of exploratory post-hoc analyses. Moreover, resting state data never provided prediction accuracy beyond the sociodemographic and clinical data. The analyses were independent of each other in terms of selecting methods to process resting state data for prediction input as well as in the used parameters of the machine learning pipelines, corroborating the external validity of the results. These similar findings in two independent studies, analyzed separately, urge caution regarding the interpretation of promising prediction results based on neuroimaging data from small samples and emphasizes that some of the prediction accuracies from previous studies may result from overestimation due to homogeneous data and weak cross-validation schemes. The promise of resting-state neuroimaging data to play an important role in the prediction of CBT treatment outcomes in patients with anxiety disorders remains yet to be delivered.

Details

Original languageEnglish
Article number120639
Number of pages10
JournalNeuroImage
Volume295
Publication statusPublished - 15 Jul 2024
Peer-reviewedYes

External IDs

PubMed 38796977
ORCID /0000-0002-1697-6732/work/173516019
ORCID /0000-0002-7762-4327/work/173516630

Keywords

ASJC Scopus subject areas

Keywords

  • Anxiety disorders, Cognitive behavioral therapy, Machine learning, Outcome prediction, Precision psychotherapy, Resting state