A novel psychotherapy based on traditional Chinese culture and its effectiveness on depression

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Abstract Submission 

Yifan Liao^1,2,3, Qinglin Gao^1,4, Tianjun Liu⁵, Chaogan Yan⁶

¹CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China, ²Department of Psychology, University of Chinese Academy of Sciences, Beijing , China, ³International Big-Data Center for Depression Research, Institute of Psychology, CAS, Beijing , China, ⁴International Big-Data Center for Depression Research, Institute of Psychology, CAS, Beijing, China, ⁵MET Research Institute, Beijing, China, ⁶Chinese Academy of Sciences, Beijing, China

Yifan Liao  
CAS Key Laboratory of Behavioral Science, Institute of Psychology|Department of Psychology, University of Chinese Academy of Sciences|International Big-Data Center for Depression Research, Institute of Psychology, CAS
Beijing, China|Beijing , China|Beijing , China

Qinglin Gao  
CAS Key Laboratory of Behavioral Science, Institute of Psychology|International Big-Data Center for Depression Research, Institute of Psychology, CAS
Beijing, China|Beijing, China

Tianjun Liu  
MET Research Institute
Beijing, China

Chaogan Yan  
Chinese Academy of Sciences
Beijing, China

Moving to "Kong" Therapy (MKT) is a unique therapeutic approach rooted in traditional Chinese philosophy and medical theory, while retaining the structure of Western psychotherapies. The technique involves a simple 10-step framework (Fig.1) where therapists guide patients to visualize their target symptoms as symbolic objects and place them in a personalized "container". These symbols are then moved mentally across different distances until they gradually fade and disappear. The process helps to reduce the negative impact of the symptoms by leading the patient to a state of "Kong"- an infinite psychological space free of troubles (Tao, 2022). This innovative approach offers a promising alternative for treating various mental health conditions, including depression, anxiety, stress disorder, and chronic pain (Liu, 2019). Despite the remarkable clinical performance of MKT in Chinese medical practice, its effectiveness remains phenomenological, awaiting empirical evidence and well-designed experiments to investigate the neurocognitive mechanisms underlying this novel therapeutic technique. In this study, we examined the effectiveness of MKT on major depressive disorder (MDD) using multiple methods, including resting-state fMRI (R-fMRI), questionnaires, and clinical interviews. We expect to reveal the therapeutic mechanisms of MKT and improve the clinical practice of MDD treatment.

Twenty-one MDD patients (15 females; mean age=26.5 years, range 21 to 34) were randomly assigned to an intervention group (received 8 weeks of MKT immediately after baseline, n=12) or a wait-list group (waited for 8 weeks before receiving the 8-week MKT, n=9). Participants completed clinical interviews, R-fMRI scans, and self-reported questionnaires (e.g., Beck Depression Inventory-II, BDI-II) before and after the MKT treatment. Depression and anxiety symptoms were assessed by experienced independent evaluators using the 17-item Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). Brain imaging data were preprocessed with DPABISurf (Yan, 2021) before brain network construction with DPABINet (Yan, 2016). Paired-sample t-tests were conducted to examine the symptomatic, behavioral, and functional connectivity (FC) changes pre- and post-intervention of all participants.

Our results revealed significant improvement in clinical symptoms among the participants after 8 weeks of MET, as demonstrated by a significant reduction in the HAMD score (t=4.94, p<.001), HAMA score (t=3.89, p<.001), BDI score (t=4.01, p<.001), and the Insomnia Severity Index (ISI) score (t=3.81, p<0.01). The patients also reported greater self-efficiency after MET, as evidenced by a significantly higher score (t=-3.55, p<0.01) on the General Self-Efficiency Scale (GSES) (Fig.2A). The functional network analysis revealed a significant decrease in FC across the whole brain posttreatment (p< 0.001, uncorrected). This tendency of reducing FC is similar to the effect of 8-week antidepressant treatment for MDD patients, as shown in our previous work (Li, 2022). Some increases were also observed in between-network FC for DMN-SC, DMN-LN, and within DMN (Fig.2B), suggesting that DMN may play a pivotal role in the therapeutic mechanism of MET on MDD treatment.

In conclusion, the study initiatively provided empirical evidence for the effectiveness of MKT in treating MDD, showing significant improvements in clinical symptoms and changes in functional brain connectivity, particularly involving the DMN. Future research should focus on larger sample sizes, alternative neuroimaging methodologies (e.g., multi-modal imaging), and cross-cultural applicability to validate and generalize the findings. The findings of this study could open doors to cross-cultural collaborations and provide insights into the development of culturally sensitive and more effective mental health interventions.

Psychiatric (eg. Depression, Anxiety, Schizophrenia) ¹

Connectivity (eg. functional, effective, structural)

fMRI Connectivity and Network Modeling ²

Task-Independent and Resting-State Analysis

Affective Disorders

FUNCTIONAL MRI

Psychiatric Disorders

Therapy

Treatment

Other - Major depressive disorder, Resting-state fMRI, Functional network connectivity, Culturally sensitive intervention