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Neural response during attentional control and emotion processing predicts improvement after cognitive behavioral therapy in generalized social anxiety disorder

Published online by Cambridge University Press:  21 March 2014

H. Klumpp ,
D. A. Fitzgerald ,
M. Angstadt ,
D. Post  and
K. L. Phan
H. Klumpp*
Affiliation:
Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
D. A. Fitzgerald
Affiliation:
Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, USA
M. Angstadt
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
D. Post
Affiliation:
Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
K. L. Phan
Affiliation:
Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, USA
*
* Address for correspondence: H. Klumpp, Ph.D., Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL 606 08USA. (Email: hklumpp@psych.uic.edu)
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Abstract

Background

Individuals with generalized social anxiety disorder (gSAD) exhibit attentional bias to salient stimuli, which is reduced in patients whose symptoms improve after treatment, indicating that mechanisms of bias mediate treatment success. Therefore, pre-treatment activity in regions implicated in attentional control over socio-emotional signals (e.g. anterior cingulate cortex, dorsolateral prefrontal cortex) may predict response to cognitive behavioral therapy (CBT), evidence-based psychotherapy for gSAD.

Method

During functional magnetic resonance imaging, 21 participants with gSAD viewed images comprising a trio of geometric shapes (circles, rectangles or triangles) alongside a trio of faces (angry, fearful or happy) within the same field of view. Attentional control was evaluated with the instruction to ‘match shapes’, directing attention away from faces, which was contrasted with ‘match faces’, whereby attention was directed to emotional faces.

Results

Whole-brain voxel-wise analyses showed that symptom improvement was predicted by enhanced pre-treatment activity in the presence of emotional face distractors in the dorsal anterior cingulate cortex and dorsal medial prefrontal cortex. Additionally, CBT success was foretold by less activity in the amygdala and/or increased activity in the medial orbitofrontal gyrus during emotion processing.

Conclusions

CBT response was predicted by pre-treatment activity in prefrontal regions and the amygdala. The direction of activity suggests that individuals with intact attentional control in the presence of emotional distractors, regulatory capacity over emotional faces and/or less reactivity to such faces are more likely to benefit from CBT. Findings indicate that baseline neural activity in the context of attentional control and emotion processing may serve as a step towards delineating mechanisms by which CBT exerts its effects.

Keywords

Attentional controlbrain imagingneural predictorspsychotherapysocial anxiety
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 3109 - 3121
Copyright
Copyright © Cambridge University Press 2014 

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