Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder

Abstract

Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

“…In several other studies, in common with the results of the present study, ACT has been shown to be effective for reducing the symptoms of social anxiety disorder. 2,47,48 Yadavaia et al also showed that ACT is effective for improving psychological flexibility, 43 which is in line with the results of this study and previous studies. The main purpose of this study was to investigate the effectiveness of ACT at reducing the difficulty in emotion regulation of people with social anxiety disorder, which has been shown to be a major concern in their daily lives.…”

Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety

“…Anxiety disorders were over-represented compared to depression. Thirdly, we would expect that the specific neural changes occurring with therapy would differ according to the type of psychological therapy the patient received (for example as has been found with studies directly comparing different therapies ( Burklund et al, 2017 ; Månsson et al, 2013 ). Additionally, the studies varied on the concomitant psychotropic medication status of the patients (see Table 1 , Table 5 ) which reduced our ability to conclude that the neuroimaging effects are solely due to psychological therapy.…”

Transdiagnostic neural correlates of volitional emotion regulation in anxiety and depression

“…The failure to find group differences in the amygdala replicates prior work using a similarly crafted large, trans-diagnostic sample of GAD, SAD, and MDD participants during exposure to negative stimuli but outside the context of reappraisal . In addition, although numerous prior studies report overactive amygdala in response to varied negative stimuli (e.g., scenes, faces, and words), there are also number of studies that fail to find such effects in those with GAD and SAD (Blair et al, 2008;Burklund, Torre, Lieberman, Taylor, & Craske, 2017;Davies et al, 2017;Etkin, Prater, Hoeft, Menon, & Schatzberg, 2010;Mochcovitch, da Rocha Freire, Garcia, & Nardi, 2014;Nakao et al, 2011;Palm, Elliott, McKie, Deakin, & Anderson, 2011;Strawn et al, 2012;Whalen et al, 2008) or MDD (Almeida, Versace, Hassel, Kupfer, & Phillips, 2010;Beauregard et al, 2006;Davidson, Irwin, Anderle, & Kalin, 2003;Grimm et al, 2008;Irwin et al, 2004;Lawrence et al, 2004;Townsend et al, 2010). Lack of amygdala differentiation between patients and controls is also consistent with prior studies that did not find amygdala differences between HCs and those with GAD or HCs and those with MDD (Erk et al, 2010) during reappraisal specifically.…”

“…Torre, Lieberman, Taylor, & Craske, 2017;Davies et al, 2017;Etkin, Prater, Hoeft, Menon, & Schatzberg, 2010;Mochcovitch, da Rocha Freire, Garcia, & Nardi, 2014;Nakao et al, 2011;Palm, Elliott, McKie, Deakin, & Anderson, 2011;Strawn et al, 2012;Whalen et al, 2008) or MDD(Almeida, Versace, Hassel, Kupfer, & Phillips, 2010;Beauregard et al, 2006;Davidson, Irwin, Anderle, & Kalin, 2003; …”