fMRI predictors of treatment outcome in pediatric anxiety disorders

McClure, Erin B.; Adler, Abby; Monk, Christopher S.; Cameron, Jennifer; Smith, Samantha G.; Nelson, Eric E.; Leibenluft, Ellen; Ernst, Monique; Pine, Daniel S.

doi:10.1007/s00213-006-0542-9

Cited by 150 publications

(122 citation statements)

References 45 publications

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“…Also, participants with deficits in incidental emotion regulation benefited more overall, regardless of group, in terms of skin conductance during recovery. The findings for heart rate during anticipation and recovery and for skin conductance during recovery support the compensation hypothesis, which suggests that those with deficits will benefit more from an intervention that compensates that deficit, and are consistent with previous research showing that physiological activation (Davies et al, 2015;McClure et al, 2007) and emotional reactivity during a behavioral task (Niles et al, 2013) predict greater improvement following treatment. These findings are of particular interest because participants with more difficulty regulating emotion show decreased connectivity between areas of the PFC and the amygdala (Banks, Eddy, Angstadt, Nathan, & Phan, 2007).…”

Section: Discussionsupporting

confidence: 88%

“…Recent studies on depression and suicidality treatment have found support for both capitalization (Cheavens, Strunk, Lazarus, & Goldstein, 2012) and compensation (Wingate, Van Orden, JoinerJr., Williams, & David, 2005). Studies examining amygdala activation (McClure et al, 2007), emotional reactivity to evocative images (Niles, Mesri, Burklund, Lieberman, & Craske, 2013), and heart rate variability (Davies, Niles, Pittig, Arch, & Craske, 2015) as predictors of treatment outcome for anxiety patients, support a compensation model, with superior outcomes for patients with greater reactivity at baseline. We aimed to evaluate whether affect labeling would most benefit those with a deficit or with a strength in affect labeling at baseline.…”

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confidence: 99%

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Affect labeling enhances exposure effectiveness for public speaking anxiety

Niles

Craske

Lieberman

et al. 2015

Behaviour Research and Therapy

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a b s t r a c tExposure is an effective treatment for anxiety but many patients do not respond fully. Affect labeling (labeling emotional experience) attenuates emotional responding. The current project examined whether affect labeling enhances exposure effectiveness in participants with public speaking anxiety. Participants were randomized to exposure with or without affect labeling. Physiological arousal and selfreported fear were assessed before and after exposure and compared between groups. Consistent with hypotheses, participants assigned to Affect Labeling, especially those who used more labels during exposure, showed greater reduction in physiological activation than Control participants. No effect was found for self-report measures. Also, greater emotion regulation deficits at baseline predicted more benefit in physiological arousal from exposure combined with affect labeling than exposure alone. The current research provides evidence that behavioral strategies that target prefrontal-amygdala circuitry can improve treatment effectiveness for anxiety and these effects are particularly pronounced for patients with the greatest deficits in emotion regulation.

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Affect labeling enhances exposure effectiveness for public speaking anxiety

Niles

Craske

Lieberman

et al. 2015

Behaviour Research and Therapy

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Section: Introductionmentioning

confidence: 71%

“…Consistent with this, activation in the amydala, involved in signaling the presence of threat, has been shown to predict response to treatment in anxiety (McClure et al, 2007a;Whalen et al, 2008); however, results have been inconsistent. Less amygdala reactivity in adults with GAD predicted better response to venlafaxine (Whalen et al, 2008), yet greater amygdala activation predicted better response to CBT or fluoxetine in anxious youth (McClure et al, 2007a), and other studies have failed to find amygdala effects (Doehrmann et al, 2013;Klumpp et al, 2013;Nitschke et al, 2009). Other work has indicated that greater activation to threatening faces in visual processing regions (ie, occipital and temporal gyri) involved in detecting and appraising emotional cues predicted better response to CBT among adults with social anxiety disorder (Doehrmann et al, 2013;Klumpp et al, 2013), possibly indicating greater initial threat reactivity which can be modified by treatment.…”

Section: Introductionmentioning

confidence: 71%

“…Only one previous fMRI study has examined predictors of treatment response in anxious youth, with analyses limited to amygdala activation to threat (McClure et al, 2007a). Given the relatively high prevalence of anxiety disorders in children and adolescents (Costello et al, 2005;Merikangas et al, 2010) and evidence that the neural circuitry involved in emotional processing develops into young adulthood (Monk, 2008), evaluating neural predictors of treatment response among youth is essential.…”

Section: Introductionmentioning

confidence: 99%

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Prefrontal Reactivity to Social Signals of Threat as a Predictor of Treatment Response in Anxious Youth

Kujawa

Swain

Hanna

et al. 2015

Neuropsychopharmacol

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Neuroimaging has shown promise as a tool to predict likelihood of treatment response in adult anxiety disorders, with potential implications for clinical decision-making. Despite the relatively high prevalence and emergence of anxiety disorders in youth, very little work has evaluated neural predictors of response to treatment. The goal of the current study was to examine brain function during emotional face processing as a predictor of response to treatment in children and adolescents (age 7-19 years; N = 41) with generalized, social, and/ or separation anxiety disorder. Prior to beginning treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline or cognitive behavior therapy (CBT), participants completed an emotional faces matching task during functional magnetic resonance imaging (fMRI). Whole brain responses to threatening (ie, angry and fearful) and happy faces were examined as predictors of change in anxiety severity following treatment. Greater activation in inferior and superior frontal gyri, including dorsolateral prefrontal cortex and ventrolateral prefrontal cortex, as well as precentral/postcentral gyri during processing of threatening faces predicted greater response to CBT and SSRI treatment. For processing of happy faces, activation in postcentral gyrus was a significant predictor of treatment response. Post-hoc analyses indicated that effects were not significantly moderated by type of treatment. Findings suggest that greater activation in prefrontal regions involved in appraising and regulating responses to social signals of threat predict better response to SSRI and CBT treatment in anxious youth and that neuroimaging may be a useful tool for predicting how youth will respond to treatment.

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Disorders of Childhood and Adolescence

Mash

Wolfe

2012

Handbook of Psychology, Second Edition

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fMRI predictors of treatment outcome in pediatric anxiety disorders

Cited by 150 publications

References 45 publications

Affect labeling enhances exposure effectiveness for public speaking anxiety

Affect labeling enhances exposure effectiveness for public speaking anxiety

Prefrontal Reactivity to Social Signals of Threat as a Predictor of Treatment Response in Anxious Youth

Disorders of Childhood and Adolescence

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