aDepartment of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of KoreabSuicide and School Mental Health Institute, Hallym University, 176 bun-gil, Gwanpyoung-ro, Dongan-gu, Anyang, Kyunggi-do 14066, Republic of KoreacDepartment of Biomedical Engineering, Hanyang University, 222 Wangsipri-ro, Sungdong-gu, Seoul 04763, Republic of KoreadDepartment of Neurology, Memory and Aging Center, University of California San Francisco, 2130 Fulton Street, San Francisco, CA 94117-1080, USAeDepartment of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of KoreafDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul 03080, Republic of Korea
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The purpose of this study was to investigate the neural correlates of cognitive-behavioral therapy (CBT) for externalizing behavior problems in perpetrators of school bullying using assessments of brain activity and behavior. Twenty-five adolescent bullies participated in an 8-session intervention. Prior to and after participation, 24 adolescents were evaluated using the Child Behavior Checklist (CBCL) and 23 completed resting-state functional magnetic resonance imaging. Changes in the fractional amplitude of low-frequency fluctuations (fALFF) and scores on the CBCL were analyzed. We also compared the identified changes into 2 groups (low and high delinquency) differentiated by a cutoff of 65 points on the delinquency subscale of the CBCL. Following the intervention, participants exhibited improvement in the subscores of the CBCL and decreases in the fALFF of the inferior parietal lobule, lingual, interior frontal and middle occipital gyrus. A positive correlation was observed between changes in the CBCL externalizing behavior scores and fALFF of the inferior frontal gyrus. The high delinquency group showed a greater decrease in delinquency and externalizing CBCL subscores across time than did the low delinquency group. The high delinquency group had more areas that showed change in fALFF post-intervention than did the low delinquency group. A positive correlation was observed between changes in the CBCL delinquency scores and fALFF of the precentral gyrus in the high delinquency group. The results indicate that this CBT for externalizing behavior problems in bullies had more positive effects on delinquent behavior in adolescents with high levels of delinquency, and these changes were associated with functional changes in brain activity.Trial registration: ClinicalTrials.gov identifier: NCT02670876HighlightsSchool bullying is a universal phenomenon that has significant negative effects on mental health for both the perpetrator and victim.We conducted cognitive-behavioral therapy targeting cognitive distortions related to externalizing problems commonly found in bullies.The purpose of this study was to investigate the effects and neural correlates of this intervention on externalizing problems.We found a positive effect on externalizing problems and this was associated with changes in spontaneous neural activity in related brain regions.Further studies that include large homogeneous samples and well-controlled designs are warranted.