Neural correlates of explicit and implicit emotion processing in relation to treatment response in pediatric anxiety

Abstract

Background Approximately 40-45% of youth with anxiety disorders do not achieve remission (or a substantial reduction in symptoms) following treatment, highlighting the need to identify predictors of treatment response. Given the well-established link between attentional biases and anxiety disorders in youth and adults, the current study examined the neural correlates of directing attention toward and away from emotional faces in relation to pediatric anxiety treatment response. Method Prior to beginning treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline or cognitive behavior therapy (CBT), 37 youth (age 7-19 years) with generalized and/or social anxiety disorder completed a task with conditions that manipulated whether participants were instructed to match emotional faces (explicit emotion processing) or match shapes in the context of emotional face distractors (implicit emotion processing) during functional magnetic resonance imaging. Results Results revealed that reduced activation in superior frontal gyrus (SFG), encompassing the dorsal anterior cingulate cortex (ACC) and dorsomedial prefrontal cortex (PFC), during implicit processing of emotional faces predicted a greater reduction in anxiety severity pre-to-post treatment. Post-hoc analyses indicated that effects were not significantly moderated by type of treatment or anxiety type. Conclusions Findings suggest that less recruitment of SFG, including the dorsal ACC and dorsomedial PFC, during implicit emotion processing predicts a greater reduction in youth anxiety symptoms pre-to-post treatment. Youth who exhibit reduced activation in these areas while matching shapes in the context of emotional face distractors may have more to gain from CBT and SSRI treatment due to preexisting deficits in attentional control. These findings suggest neuroimaging may be a useful tool for predicting which youth are most likely to benefit from anxiety treatment.

Convergence of fMRI and ERP measures of emotional face processing in combat‐exposed U. S. military veterans

“…In addition, differences between the present results and prior work may reflect a combination of the different types of analyses used and the wider range of psychiatric symptomatology in the present sample. The face-matching task used here has been widely used in both the fMRI (e.g., Burkhouse et al, 2017;Hariri et al, 2002;Holz et al, 2017;Prater, Hosanagar, Klumpp, Angstadt, & Phan, 2013) and LPP (Kujawa et al, 2015;MacNamara et al, 2013 literatures, with shapes commonly employed as a control condition (as in the current study). As such, results reported here represent some of the first "crosstalk" between these otherwise relatively independent literatures.…”

“…The face‐matching task used here has been widely used in both the fMRI (e.g., Burkhouse et al, ; Hariri et al, ; Holz et al, ; Prater, Hosanagar, Klumpp, Angstadt, & Phan, ) and LPP (Kujawa et al, ; MacNamara et al, ) literatures, with shapes commonly employed as a control condition (as in the current study). As such, results reported here represent some of the first “crosstalk” between these otherwise relatively independent literatures.…”

Impact of pubertal timing and depression on error‐related brain activity in anxious youth

“…Participants were youth recruited through the University of Michigan and University of Illinois at Chicago. Patients were recruited through outpatient clinics at each university and healthy controls were recruited through the surrounding communities (Bunford et al, 2017; Burkhouse et al, 2017; Kujawa, MacNamara, Fitzgerald, Monk, & Phan, 2015; Kujawa, Swain, et al, 2016; Kujawa, Weinberg, et al, 2016). We have previously published ERN data from this sample of youth and a sample of young adults before and after treatment for anxiety (Kujawa, Weinberg, et al, 2016).…”

Social and Non-social Reward: A Preliminary Examination of Clinical Improvement and Neural Reactivity in Adolescents Treated With Behavioral Therapy for Anxiety and Depression

“…fMRI studies enrolling anxious vs. non-anxious youth evidenced increased striatal, frontal, and limbic reactivity during social and non-social reward tasks (e.g., Guyer et al, 2012; Benson et al, 2015; Jarcho et al, 2015); of note, these studies did not include a treatment component. To date, five reports citing data from four independent trials serve as the current literature base on neural predictors of response to psychosocial interventions targeting pediatric anxiety (McClure et al, 2007; Maslowsky et al, 2010; Kujawa et al, 2016; Burkhouse et al, 2017; White et al, 2017). Three studies incorporated fMRI data from baseline and follow-up (McClure et al, 2007; Maslowsky et al, 2010; White et al, 2017), while two representing the same trial utilized baseline data only (Kujawa et al, 2016; Burkhouse et al, 2017).…”

“…To date, five reports citing data from four independent trials serve as the current literature base on neural predictors of response to psychosocial interventions targeting pediatric anxiety (McClure et al, 2007; Maslowsky et al, 2010; Kujawa et al, 2016; Burkhouse et al, 2017; White et al, 2017). Three studies incorporated fMRI data from baseline and follow-up (McClure et al, 2007; Maslowsky et al, 2010; White et al, 2017), while two representing the same trial utilized baseline data only (Kujawa et al, 2016; Burkhouse et al, 2017). However, no investigations examined reward processing, specifically, as a neural predictor or mechanism of treatment response in this population.…”