Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder.
Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder.
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DOI：
10.1016/j.pscychresns.2016.12.012
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发表时间：
2017-03-30
期刊：
影响因子：
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通讯作者：
Craske MG
中科院分区：
文献类型：
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作者：
Burklund LJ;Torre JB;Lieberman MD;Taylor SE;Craske MG
以前的研究经常强调，在社交焦虑症(SAD)中，情绪区域的多动与简单、静态的社交威胁线索有关。使用更自然的范式研究SAD的神经生物学可以进一步揭示潜在的机制以及这些机制如何与临床结果相关。我们使用功能磁共振成像来研究SAD患者(N=70)和健康对照组(HC；N=17)对新的动态排斥刺激的反应，以及这些反应是否可以预测认知行为治疗(CBT)或接受承诺治疗(ACT)后的治疗结果。与中性社会刺激相比，HC和SAD组都报告了对拒绝的更大痛苦。在神经水平上，HCS在社会痛/排斥区域，包括背侧前扣带回皮质和前脑岛，对排斥刺激表现出更大的激活。SAD组证明了一种不同的模式，这些排斥区域没有差异，杏仁核和其他区域对中性刺激的激活相对更大。与中性刺激相比，扣带回前皮质和杏仁核对排斥反应的更大反应预示着CBT结果更好。相反，注重感觉的后岛叶的活动增强可以预测ACT的反应。
Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.