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

2014 ◽  
Vol 44 (14) ◽  
pp. 3109-3121 ◽  
Author(s):  
H. Klumpp ◽  
D. A. Fitzgerald ◽  
M. Angstadt ◽  
D. Post ◽  
K. L. Phan
Keyword(s):  
Prefrontal Cortex ◽  
Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Attentional Control ◽  
Behavioral Therapy ◽  
Emotion Processing ◽  
Anterior Cingulate ◽  
Emotional Faces ◽  
Pre Treatment ◽  
Treatment Activity

BackgroundIndividuals 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.MethodDuring 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.ResultsWhole-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.ConclusionsCBT 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.

Directed threat imagery in generalized anxiety disorder

2017 ◽  
Vol 48 (4) ◽  
pp. 617-628 ◽  
Author(s):  
C. Buff ◽  
C. Schmidt ◽  
L. Brinkmann ◽  
B. Gathmann ◽  
S. Tupak ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Emotional Reactivity ◽  
Behavioral Therapy ◽  
Brain Activity ◽  
Neural Correlates ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Initial Exposure

BackgroundWorrying has been suggested to prevent emotional and elaborative processing of fears. In cognitive-behavioral therapy (CBT), generalized anxiety disorder (GAD) patients are exposed to their fears during the method of directed threat imagery by inducing emotional reactivity. However, studies investigating neural correlates of directed threat imagery and emotional reactivity in GAD patients are lacking. The present functional magnetic resonance imaging (fMRI) study aimed at delineating neural correlates of directed threat imagery in GAD patients.MethodNineteen GAD patients and 19 healthy controls (HC) were exposed to narrative scripts of either disorder-related or neutral content and were encouraged to imagine it as vividly as possible.ResultsRating results showed that GAD patients experienced disorder-related scripts as more anxiety inducing and arousing than HC. These results were also reflected in fMRI data: Disorder-related v. neutral scripts elicited elevated activity in the amygdala, dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and the thalamus as well as reduced activity in the ventromedial prefrontal cortex/subgenual anterior cingulate cortex in GAD patients relative to HC.ConclusionThe present study presents the first behavioral and neural evidence for emotional reactivity during directed threat imagery in GAD. The brain activity pattern suggests an involvement of a fear processing network as a neural correlate of initial exposure during directed imagery in CBT in GAD.

scholarly journals Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy

PLoS ONE ◽  
2019 ◽  
Vol 14 (11) ◽  
pp. e0225603 ◽  
Author(s):  
Jens Högström ◽  
Martina Nordh ◽  
Miriam Larson Lindal ◽  
Ebba Taylor ◽  
Eva Serlachius ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Visual Attention ◽  
Cognitive Behavioral Therapy ◽  
Social Anxiety Disorder ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Emotional Faces

Neurobiological correlates of social anxiety disorder: an update

CNS Spectrums ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 100-111 ◽  
Author(s):  
Donatella Marazziti ◽  
Marianna Abelli ◽  
Stefano Baroni ◽  
Barbara Carpita ◽  
Carla E. Ramacciotti ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Anterior Cingulate ◽  
Therapeutic Interventions ◽  
Future Research ◽  
Special Focus ◽  
Brain Areas ◽  
Wide Range

Social anxiety disorder (SAD) is a condition characterized by pervasiveness and impairment in social functioning, with a prevalence in the general population between 1.9% and 12.1%. The most consistent findings on its neurobiological underpinnings involve a wide range of neurotransmitters (serotonin, norepinephrine, glutamate, and GABA) and neuropeptides (oxytocin), but no comprehensive hypothesis is yet available. In particular, oxytocin is becoming increasingly established as a “prosocial neuropeptide” and, as such, is a major focus of current research, with a great range of therapeutic applications including SAD treatment. Specifically, the amygdala plays a pivotal role in conditioning and processing of fear, and exaggerated amygdala responses in SAD patients have been observed during various social-emotional stimuli. In addition to the amygdala, other brain areas of interest in SAD-related circuitry are represented by the medial prefrontal cortex, dorsal raphe, striatum, locus coeruleus, prefrontal cortex, insular cortex, and anterior cingulate cortex. The aim of this review is to provide an update on neurobiological correlates of SAD, with a special focus on neurotransmitters and brain areas possibly involved, and suggestions for future research that could lead to more specific therapeutic interventions.

scholarly journals Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder

2021 ◽  
Vol 10 (5) ◽  
pp. 915
Author(s):  
Hyu Seok Jeong ◽  
Jee Hyun Lee ◽  
Hesun Erin Kim ◽  
Jae-Jin Kim
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Cognitive Behavioral Therapy ◽  
Social Anxiety Disorder ◽  
Behavioral Therapy ◽  
Early Termination ◽  
Cognitive Behavioral ◽  
Significant Group ◽  
Extension Group

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.

scholarly journals New Developments in Emotion-Focused Therapy for Social Anxiety Disorder

2020 ◽  
Vol 9 (9) ◽  
pp. 2918
Author(s):  
Ben Shahar
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Skill Learning ◽  
Great Promise ◽  
Empirically Supported Treatment ◽  
Emotion Focused Therapy ◽  
Empirically Supported

Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.

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