Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study

Abstract

Social anxiety disorder (SAD) is characterized by fears of social and performance situations. Cognitive behavioral group therapy (CBGT) has in general positive effects on symptoms, distress and avoidance in SAD. Prior studies found increased cortical volumes and decreased fractional anisotropy (FA) in SAD compared with healthy controls (HCs). Thirty-three participants diagnosed with SAD attended in a 10-week CBGT and were scanned before and after therapy. We applied three neuroimaging methods-surface-based morphometry, diffusion tensor imaging and network-based statistics-each with specific longitudinal processing protocols, to investigate CBGT-induced structural brain alterations of the gray and white matter (WM). Surface-based morphometry revealed a significant cortical volume reduction (pre- to post-treatment) in the left inferior parietal cortex, as well as a positive partial correlation between treatment success (indexed by reductions in Liebowitz Social Anxiety Scale) and reductions in cortical volume in bilateral dorsomedial prefrontal cortex. Diffusion tensor imaging analysis revealed a significant increase in FA in bilateral uncinate fasciculus and right inferior longitudinal fasciculus. Network-based statistics revealed a significant increase of structural connectivity in a frontolimbic network. No partial correlations with treatment success have been found in WM analyses. For, we believe, the first time, we present a distinctive pattern of longitudinal structural brain changes after CBGT measured with three established magnetic resonance imaging analyzing techniques. Our findings are in line with previous cross-sectional, unimodal SAD studies and extent them by highlighting anatomical brain alterations that point toward the level of HCs in parallel with a reduction in SAD symptomatology.

Gray Matter Structural Alterations in Social Anxiety Disorder: A Voxel-Based Meta-Analysis

“…The data from structural and functional MRI studies (increased thickness and increased activity) in SAD were rather consistent and pointed in a common direction for some brain regions such as in the prefrontal and temporal cortex ( 15 ). Reductions in the prefrontal and parieto-occipital GMV have been associated with treatment response after cognitive behavior therapy for SAD patients ( 26 , 27 ). Additionally, larger GMVs in SAD patients might reflect a lack of synaptic pruning in an individual.…”

“…However, one study reported increased bilateral amygdala and left hippocampus volumes in treatment-naive socially anxious participants compared with controls in an ROI analysis ( 18 ). Morphometry studies revealed SAD-related GMV reduction in the bilateral superior temporal, the left inferior parietal and cerebellar cortex following cognitive behavioral group therapy ( 27 ) or treatment with escitalopram ( 24 ), without correlations of anatomical changes with clinical course ( 15 ). Considering that only current drug-free status has been taken into consideration in our study, it is difficult to attribute the finding to direct effects of the medication itself or fully exclude pharmacological-specific sequelae unrelated to SAD.…”

“…Moreover, treatment studies revealed significant GMV alterations following medication treatment ( 24 , 25 ), suggesting the influence of psychotropic medication on the GMV alterations in SAD. The reduced GMVs in the prefrontal, parieto-occipital regions and amygdala were observed for SAD patients after effective cognitive behavior therapy ( 26 , 27 ). Finally, regarding SAD-related alterations in regional GMV, support vector machine (SVM) analyses of gray matter correctly classified SAD participants only when using the whole brain search volume ( 28 ).…”

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder

“…6 Ten weeks of cognitive behavioural group therapy reduced grey matter volume in parieto-occipital and prefrontal regions and increased fractional anisotropy in the uncinate and inferior longitudinal fasciculus and structural connectivity in a frontolimbic network in patients with social anxiety disorder. 7 In contrast, 16 weeks of brief eclectic psychotherapy showed no effect on the (para-)hippocampus and amygdala in patients with posttraumatic stress disorder. 8 However, to our knowledge, no study to date has investigated the effects of psychotherapy on the brain structure of patients with borderline personality disorder (BPD).…”

The optimistic brain: Trait optimism mediates the influence of resting‐state brain activity and connectivity on anxiety in late adolescence

“…Furthermore, the structural variances of the PFC regions (e.g., the OFC, the medial PFC, the lateral PFC and the anterior cingulate cortex) are found to be linked with anxious symptoms among both clinical and healthy samples (Blackmon et al, ; Brühl et al, b; Ducharme et al, ; Shang et al, ; Spampinato, Wood, De Simone, & Grafman, ; Syal et al, ; Talati et al, ). Finally, some evidence has shown that cognitive behavioral therapy can change PFC function and structure, which, in turn, reduces anxious symptoms in patients with anxiety disorder (Kircher et al, ; Klumpp, Fitzgerald, & Phan, ; Steiger et al, ). Given these findings and the predictive ability of trait optimism for anxiety, trait optimism might mediate the influence of PFC regions (e.g., the OFC, the medial PFC and anterior cingulate cortex) on anxiety.…”