Neural predictors of cognitive-behavior therapy outcome in anxiety-related disorders: a meta-analysis of task-based fMRI studies

2022 ◽  
pp. 1-9
Author(s):  
Maria Picó-Pérez ◽  
Miquel A. Fullana ◽  
Anton Albajes-Eizagirre ◽  
Daniel Vega ◽  
Josep Marco-Pallarés ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Meta Analysis ◽  
Inferior Frontal Gyrus ◽  
Anterior Cingulate ◽  
Cognitive Behavior ◽  
Brain Response ◽  
Dorsal Anterior Cingulate Cortex ◽  
Compulsive Disorder

Abstract Background Cognitive-behavior therapy (CBT) is a well-established first-line intervention for anxiety-related disorders, including specific phobia, social anxiety disorder, panic disorder/agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Several neural predictors of CBT outcome for anxiety-related disorders have been proposed, but previous results are inconsistent. Methods We conducted a systematic review and meta-analysis of task-based functional magnetic resonance imaging (fMRI) studies investigating whole-brain predictors of CBT outcome in anxiety-related disorders (17 studies, n = 442). Results Across different tasks, we observed that brain response in a network of regions involved in salience and interoception processing, encompassing fronto-insular (the right inferior frontal gyrus-anterior insular cortex) and fronto-limbic (the dorsomedial prefrontal cortex-dorsal anterior cingulate cortex) cortices was strongly associated with a positive CBT outcome. Conclusions Our results suggest that there are robust neural predictors of CBT outcome in anxiety-related disorders that may eventually lead (probably in combination with other data) to develop personalized approaches for the treatment of these mental disorders.

Therapist–Patient Alliance, Patient–Therapist Alliance, Mutual Therapeutic Alliance, Therapist–Patient Concordance, and Outcome of CBT in GAD

2008 ◽  
Vol 22 (1) ◽  
pp. 68-79 ◽  
Author(s):  
Christin Langhoff ◽  
Thomas Baer ◽  
Doris Zubraegel ◽  
Michael Linden
Keyword(s):  
Anxiety Disorder ◽  
Therapeutic Alliance ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Therapeutic Process ◽  
Generalized Anxiety ◽  
Cognitive Behavior ◽  
Process And Outcome ◽  
Observer Ratings ◽  
Hamilton Anxiety Scale

The therapeutic alliance is seen as an important dimension in any type of psychotherapy. But patient, therapist, or observers can have different views on the therapeutic alliance. The question is which perspective best represents the therapeutic alliance, and what are the differences between these alternative views. In the present study, the therapist–patient alliance (TPA, the view of the therapist), patient–therapist alliance (PTA, the view of the patient), and mutual therapeutic alliance (MTA, the view of an observer) were measured simultaneously in cognitive behavior therapy of patients suffering from generalized anxiety disorder. Additionally, the concordance between patient and therapist ratings (TPC) was calculated. Cognitive behavior therapists attained high positive scores in all perspectives for all dimensions of the therapeutic alliance, such as empathy, cooperation, transparency, focusing, and assurance of progress. Correlations were consistently higher for ratings between therapist and patient than between observer and patient. A relation with outcome (Hamilton Anxiety Scale) was only found for observer ratings. It was concluded that cognitive behavior therapists can achieve good alliances with their patients. Different perspectives on the therapeutic alliance should be distinguished and taken into account separately in studies on the therapeutic process and outcome.

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