Common Changes in Cerebral Blood Flow in Patients With Social Phobia Treated With Citalopram or Cognitive-Behavioral Therapy

Furmark, Tomas; Tillfors, Maria; Marteinsdóttir, Ína; Fischer, Håkan; Pissiota, Anna; Långström, Bengt; Fredrikson, Mats

doi:10.1001/archpsyc.59.5.425

Cited by 454 publications

(274 citation statements)

References 43 publications

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“…A PET study in patients with social phobia reported that, following successful psychotherapy or pharmacotherapy, the MTL was less activated during a public speaking task (Furmark et al. 2002). Comparable results were reported by Paquette et al.…”

Section: Discussionmentioning

confidence: 99%

“…Several PET and fMRI studies have shown that following successful psychotherapy or pharmacotherapy, visual associative cortical areas, including the insula, amygdala and MTL, are less activated during visual symptom provocation, while prefrontal cortical regions show increased activation (Furmark et al. 2002; Paquette et al. 2003; Sakamoto et al.…”

Section: Introductionmentioning

confidence: 99%

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CBT reduces CBF: cognitive‐behavioral therapy reduces cerebral blood flow in fear‐relevant brain regions in spider phobia

et al. 2016

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BackgroundImaging studies have provided evidence that cognitive‐behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion‐generating and modulatory regions. In this study, we use a data‐driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT.MethodsEight female patients with spider phobia were scanned before and 1 month after an exposure‐based group therapy for spider phobia. Each MRI session consisted of an ASL resting state measurement acquired before and after a symptom provocation task involving the showing of spider pictures in the scanner. The first ASL acquisition measured anticipatory anxiety and the second measured postprocessing of phobia‐relevant stimuli.ResultsCognitive‐behavioral therapy significantly reduced spider phobic symptoms in all patients. Symptom reduction during anticipatory anxiety was accompanied by reduced bilateral CBF in the parahippocampal gyrus, ventral anterior thalamus, Brodmann area 8, and the anterior cingulate cortex. During postprocessing of phobia‐relevant stimuli, patients showed reduced CBF in the bilateral insula, components of the motor cortex, and areas associated with language functions.ConclusionsLongitudinal CBF dynamics following CBT were in concordance with results from several studies using BOLD fMRI to investigate the effects of psychotherapy on brain activity. CBF can be quantified by ASL, with the principal advantage of sensitivity to slow variations in neural activity and task independence. Therefore, ASL may be a suitable method for monitoring and evaluating the efficacy of psychotherapy or pharmacotherapy approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CBT reduces CBF: cognitive‐behavioral therapy reduces cerebral blood flow in fear‐relevant brain regions in spider phobia

et al. 2016

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“…Treatment effects correlated positively with activation in the left superior temporal gyrus and superior/middle frontal gyrus. 75 Research has also shown the effects of psychotherapeutic intervention on CBF in depression, 76 obsessive-compulsive disorder, 77 panic disorder, 78 social phobia 79 and spider phobia. 80,81 In unipolar depression, 82 a prospective PET study revealed comparative results for psychotherapeutic (cognitive behavioural therapy) and pharmacologic (venlafaxine) treatment.…”

Section: Should Neuroimaging Studies Include Ptsd Patients Receiving mentioning

confidence: 99%

Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients?

Lanius

Brewin

Bremner

et al. 2010

jpn

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Background:In an attempt to avoid unknown influence, most neuroimaging studies examining the pathophysiology of posttraumatic stress disorder (PTSD) exclude patients taking medications. Here we review the empirical evidence for relevant medications having a confounding effect on task performance or cerebral blood flow (CBF) in this population. The evidence for potentially confounding effects of psychotherapy in PTSD are also discussed. Methods: The literature that we reviewed was obtained through a PubMed search from 1980 to 2009 using the search terms posttraumatic stress disorder, PTSD, psychotropic medications, neuroimaging, functional magnetic res onance imaging, positron emission tomography, cerebral blood flow, CBF, serotonin-specific reuptake blocker, benzodiazepine, ketamine, methamphetamine, lamotrigine and atypical antipsychotic agents. Results: The empirical evidence for relevant medications having a confounding effect on task performance or CBF in relevant areas remains sparse for most psychotropic medications among patients with PTSD. However, considerable evidence is accumulating for 2 of the most commonly prescribed medication classes (serotonin-specific reuptake inhibitors and benzodiazepines) in healthy controls. Compelling data for the potentially confounding effects on brain areas relevant to PTSD for psychotherapeutic interventions are also accumulating. Conclusion: Neuroimaging studies examining the pathophysiology of PTSD should ideally recruit both medicated (assuming that the medication treatment has not resulted in the remission of symptoms) and unmedicated participants, to allow the findings to be generalized with greater confidence to the entire population of patients with PTSD. More research is needed into the independent effects of medications on task performance and CBF in regions of interest in PTSD. Neuroimaging studies should also take into account whether patients are currently engaged in psychotherapeutic treatment.

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“…Effective treatments appear to alter these atypical patterns, in that they produce significant decreases in amygdala activity in anxious and MDD adults, as do pharmacological challenges in healthy adults (3,8,9,(15)(16)(17)(18). Studies of adults have found decreases in amygdala activation to relate to successful treatment of MDD (8,9) and social phobia (3,16,17).…”

mentioning

confidence: 99%

“…Studies of adults have found decreases in amygdala activation to relate to successful treatment of MDD (8,9) and social phobia (3,16,17). Whereas some studies have found decreased activation to be limited to the left amygdala (8), others have obtained evidence of bilateral decreases in activation in this region (9,16).…”

mentioning

confidence: 99%

fMRI predictors of treatment outcome in pediatric anxiety disorders

et al. 2006

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Common Changes in Cerebral Blood Flow in Patients With Social Phobia Treated With Citalopram or Cognitive-Behavioral Therapy

Abstract: Common sites of action for citalopram and cognitive-behavioral treatment of social anxiety were observed in the amygdala, hippocampus, and neighboring cortical areas, ie, brain regions subserving bodily defense reactions to threat.

Cited by 454 publications

References 43 publications

CBT reduces CBF: cognitive‐behavioral therapy reduces cerebral blood flow in fear‐relevant brain regions in spider phobia

CBT reduces CBF: cognitive‐behavioral therapy reduces cerebral blood flow in fear‐relevant brain regions in spider phobia

Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients?

fMRI predictors of treatment outcome in pediatric anxiety disorders

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