Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety

Abstract

Exposure-based cognitive-behaviour therapy (CBT) for anxiety disorders is an effective intervention, but the brain mechanisms driving recovery are largely unknown. In this experimental medicine study, we investigated to what degree CBT affects neural markers of anxiety at an early stage of treatment, to identify dynamic mechanistic changes which might be crucial in the process of recovery as opposed to those seen following full treatment completion. In a randomised controlled trial, unmedicated patients with panic disorder either received four weekly sessions of exposure-based CBT (N = 14) or were allocated to a waiting group (N = 14). Symptom severity was measured before and after the intervention. During functional magnetic resonance imaging (fMRI), patients performed an emotion regulation task, either viewing negative images naturally, or intentionally down-regulating negative affect using previously taught strategies. Four-session CBT led to marked reductions in symptoms and 71% of patients reached recovery status (versus 7% in the control group). This intervention normalised brain hyperactivation previously seen in panic disorder, particularly in areas linked to threat monitoring, fear memory, and maladaptive emotion regulation, such as amygdala, dorsomedial and dorsolateral prefrontal cortex, and temporal gyrus. Our findings suggest that optimal treatment doses for panic disorder might be much lower than previously thought. Furthermore, this is the first study to show that neural markers of anxiety change very early during CBT, highlighting potential neural mechanisms that might drive clinical recovery. Such knowledge is important for the development of more compact combination treatments targeting these mechanisms more effectively. (Neural Effects of Cognitive-behaviour Therapy in Panic Disorder; clinicaltrials.gov; NCT03251235)

In search of convergent regional brain abnormality in cognitive emotion regulation: a transdiagnostic neuroimaging meta-analysis

“…19 (Fitzgerald et al, 2017b) Non-significant results 20 (Schmitt et al, 2016) Non-significant results 21 (Light et al, 2011) Non-significant results 22 (Yip et al, 2018) Non-significant results 23 (Hilland et al, 2018) Lacking healthy controls 24 Lacking healthy controls Table S1. List of excluded studies with reasons 25 (Contreras-Rodríguez et al, 2020) Lacking healthy controls 26 (Fitzgerald et al, 2019) Lacking healthy controls 27 (Schmitgen et al, 2019) Lacking healthy controls 28 (Gorka et al, 2019) Lacking healthy controls 29 (Klumpp et al, 2017b) Lacking healthy controls 30 (Fonzo et al, 2017b) Lacking healthy controls 31 (Fonzo et al, 2017a) Lacking healthy controls 32 (Klumpp et al, 2017a) Lacking healthy controls 33 (Reinecke et al, 2018) Lacking healthy controls 34 (Klumpp et al, 2017c) Lacking healthy controls 35 (Goldin et al, 2014) Lacking healthy controls 36 (Reinecke et al, 2014) Lacking healthy controls 37 (Brühl et al, 2013) Lacking healthy controls 38 (Goldin et al, 2013a) Lacking healthy controls 39 (Heller et al, 2013) Lacking healthy controls 40 (Goldin et al, 2013b) Lacking healthy controls 41 (Hermann et al, 2009) Lacking healthy controls 42 (Kanske et al, 2015) Non-whole-brain analysis 43 (Rabinak et al, 2014) Non-whole-brain analysis 44 (Kanske et al, 2012) Non-whole-brain analysis 45 (Lang et al, 2012) Non-whole-brain analysis 46 (Erk et al, 2010) Non-whole-brain analysis 47 (Douw et al, 2020) Non-whole-brain analysis 48 (Klumpp et al, 2019) Non-whole-brain analysis 49 (Jacob et al, 2019) Non-whole-brain analysis 50 (Young et al, 2019) Non-whole-brain analysis 51 (Zhang et al, 2018) Non-whole-brain analysis 52 …”

Resting-state functional connectivity of the amygdala subregions in unmedicated patients with obsessive–compulsive disorder before and after cognitive behavioural therapy

“…More importantly, these neural changes adjusted by CBT could also help patients with anxiety disorders reduce their clinical symptoms. 58,59 Taken together, our findings suggest that CBT modulates emotional processing in patients with OCD by integrating visual and emotional signals related to higher cognitive processes such as reapprais al, 60 and by decreasing the perceptual bias toward threatening stimuli that may easily induce symptoms.…”

Support Group as a Management Modality for Burning Mouth Syndrome: A Randomized Prospective Study

“…The implication of these changes for future health has become an important topic of psychoneuroimmunological research [28]. Studies have shown that cognitive behavioral therapy can lead to normalization of stress-induced neural activity in individuals with a range of anxiety disorders already very early in treatment and relative to a control group [29][30][31][32]. According to emerging evidence, the outburst of the COVID-19 pandemic has triggered worsening of anxiety, sleep quality, and pain intensity in BMS patients [33].…”