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

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 pre-frontal 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.

EEG source activity during processing of neutral stimuli in subjects with anxiety disorders

“…Hyperactivity of higher visual areas and associative areas (superior and inferior parietal lobule, supramarginal gyrus, precuneus, middle temporal gyrus) in the study group could be explained by effect of compensation of anxiety related disruption of cognitive function. Similar compensatory activity of parietal cortex was previously showed in the subjects with anxiety disorders (Etkin et al 2010, Klumpp et al 2014.…”

“…In the analysis we showed that there was an increase in electrical activity of parietal cortex during N1 wave after any kind of stimuli and in the cuneus after target stimulus. This result indicates that people with anxiety disorders have stronger activation of structures responsible for allocation of attention and discrimination of visual stimuli (Brühl et al 2014, Klumpp et al 2014.…”

“…It has been previously presented that anterior cingulate cortex is involved in attentional and emotional processes, detection of relevant stimuli and it is important part of cortico-subcortical loop involved in fear conditioning (Eser et al 2009, Javanmard et al 1999, Jensen et al 2003, Ketter et al 1996, Klumpp et al 2014, Phelps et al 2004, Schunck et al 2006, Servan-Schreiber et al 1998, Straube et al 2010. It was shown that anterior cingulate cortex is involved in pathophysiology of anxiety disorder, usually manifested by elevated activity (Bremner et al 2005, Brühl et al 2014, Dilger and Straube 2003, Klumpp et al 2014, Kopřivova et al 2011, Lorberbaum et al 2004, McClure et al 2007, Monk et al 2008, Nitschke et al 2009, Saxena and Rauch 2000, Straube et al 2004a, 2004b, Wright et al 2003, although it was also shown that after exposition of incongruent stimulus subjects with anxiety disorders had smaller activity in anterior cingulate cortex (Etkin et al 2010). The increase of activity in anterior cingulate cortex and anterior part of insula in subjects with anxiety disorders often correlates with elevated activity in amygdala (Brühl et al 2014, Shin andLiberzon 2010).…”

“…The influence of anxiety on cognitive functions is reflected also in psychopathology: an excessive reaction to stimuli and concentration difficulties are symptoms of the majority of anxiety disorders. Impaired performance can be compensated by increasing effort and involvement of additional cognitive resources, which was shown in the bioelectrical studies, especially using visual evoked potentials that are markers of attention and information processing (Egloff and Hock 2001, Eysenck et al 2007, Klumpp et al 2014.…”

Attention Control and Attention to Emotional Stimuli in Anxious Children Before and After Cognitive Behavioral Therapy

“…Empirical research with adults supports an association between anxiety disorders and impaired attention control, as indexed by greater interference of task-irrelevant distractors on the performance of a primary reaction-time (RT) task (Pacheco-Unguetti et al 2011). Furthermore, results from a recent neuroimaging study suggested that the effect of CBT on anxiety symptoms may depend on neural mechanisms underlying attention control, as pre-treatment dorsal prefrontal activity during an attention control manipulation was associated with greater response to CBT in socially anxious patients (Klumpp et al 2014). Other research with adults suggests that interventions such as mindfulness meditation training can produce both improvement in attention control (i.e., reduced distractibility) and reduction in anxiety and other negative mood symptoms (Tang et al 2007).…”