Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder

Abstract

Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain's adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure–function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood–oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected PFWE=0.02) and BOLD responsivity (PFWE=0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (PFWE=0.04), and CBT-induced reduction of amygdala GM volume (pre–post) correlated positively with reduced anticipatory anxiety after treatment (PFWE⩽0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (PFWE=0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.

Using neuroscience as an outcome measure for behavioral interventions in Autism spectrum disorders (ASD): A review

“…Modulation of brain activity with cognitive behavioral therapy (CBT) has been reported in panic disorder using a variety of neuroscience methods (Kircher et al, 2013;Prasko et al, 2004;Sakai et al, 2006;Seo, Choi, Chung, Rho, & Chae, 2014;Straube, Glauer, Dilger, Mentzel, Miltner, 2006;Mansson et al, 2016-for a review of studies completed through 2014 see Yang, Kircher, & Straube 2014). Three studies using resting state paradigms found converging evidence that CBT modulates brain activity in frontal regions in individuals with panic disorder (Prasko et al, 2004;Sakai et al, 2006;Seo et al, 2014).…”

“…Recently, Mansson et al (2016) completed a randomized control trial (RCT) designed to investigate the effects of cognitive behavioral therapy (CBT) on changes in brain structure and function in response to self-referential criticism in individuals with social anxiety disorder. Participants were randomly assigned to either CBT or an attention bias modification control treatment.…”

“…Many candidates have been proposed, such as imbalance of excitatory/inhibitory neurotransmitters (Rubenstein & Merzenich, 2003;Yizhar et al, 2011), or selective dysfunction in the reward system in response to social information (Dawson, 2008;Stavropoulos & Carver, 2014), but no theory has been definitively accepted by the scientific community, perhaps because there are insufficient combinations of large-scale studies and replications. Conversely, the research community is largely in agreement that anxiety involves dysfunction in the amygdala and hippocampus, and anterior cingulate cortex, as these areas play a central role in the expression of fear (Mansson et al, 2016). There remains a need for additional research on these disorders, because aspects of both depression and anxiety remain elusive.…”

Verbal Exposure for Irrational Fears: New Directions in Research and Applications

“…Feared stimuli and threat perception capitalize on neural pathways involved in processing of future time reference. If we can find methods of shifting of the processing of threat perception triggered by feared stimuli from future reference related neural pathways to past or present related neural pathways; it can then exploit inbuilt neuroplasticity and resolve the conditions of irrational fears [10].…”

Hjärnan formas av psykologisk behandling

“…Moreover, the individuals with SAD were compared to healthy controls to evaluate indices of psychopathology in SAD and putative normalisation effects of CBT (Månsson et al, 2016).…”