Neural response during attentional control and emotion processing predicts improvement after cognitive behavioral therapy in generalized social anxiety disorder.
Neural response during attentional control and emotion processing predicts improvement after cognitive behavioral therapy in generalized social anxiety disorder.
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DOI：
10.1017/s0033291714000567
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发表时间：
2014-10
影响因子：
6.9
通讯作者：
Phan, K. L.
中科院分区：
文献类型：
--
作者：
Klumpp, H.;Fitzgerald, D. A.;Angstadt, M.;Post, D.;Phan, K. L.
广泛性社交焦虑症(GSAD)患者对显著刺激表现出注意偏向，治疗后症状改善的患者注意偏向减弱，表明偏向机制调节治疗成功。因此，涉及注意控制社会情绪信号的区域(如前扣带回皮质、前额叶背外侧皮质)的治疗前活动可能预测认知行为疗法(CBT)的反应，CBT是GSAD的循证心理疗法。在功能磁共振成像期间，21名患有GSAD的参与者在同一视野内观看了由三个几何形状(圆形、矩形或三角形)组成的图像，以及三个面孔(愤怒、恐惧或高兴)。对注意力控制进行评估的是“匹配形状”的指令，它将注意力从脸部转移开，这与“匹配脸部”形成对比，后者将注意力引导到情感面孔上。全脑体素分析表明，在背侧前扣带回皮质和背侧内侧前额叶皮质存在情绪面孔干扰物的情况下，通过增强治疗前的活动可以预测症状的改善。此外，在情绪处理过程中，杏仁核的活动减少和/或内侧眶前回的活动增加预示着CBT的成功。CBT反应通过治疗前额叶区域和杏仁核的活动来预测。活动的方向表明，在情绪分心因素存在的情况下，注意力控制完好无损、对情绪面孔的调节能力和/或对此类面孔的反应较少的人更有可能从CBT中受益。研究结果表明，在注意控制和情绪处理的背景下，基线神经活动可能是描述CBT发挥作用的机制的一步。
Individuals with generalized social anxiety disorder (gSAD) exhibit attentional bias to salient stimuli, which is reduced in patients whose symptoms improve after treatment, indicating that mechanisms of bias mediate treatment success. Therefore, pre-treatment activity in regions implicated in attentional control over socio-emotional signals (e.g. anterior cingulate cortex, dorsolateral prefrontal cortex) may predict response to cognitive behavioral therapy (CBT), evidence-based psychotherapy for gSAD. During functional magnetic resonance imaging, 21 participants with gSAD viewed images comprising a trio of geometric shapes (circles, rectangles or triangles) alongside a trio of faces (angry, fearful or happy) within the same field of view. Attentional control was evaluated with the instruction to ‘match shapes’, directing attention away from faces, which was contrasted with ‘match faces’, whereby attention was directed to emotional faces. Whole-brain voxel-wise analyses showed that symptom improvement was predicted by enhanced pre-treatment activity in the presence of emotional face distractors in the dorsal anterior cingulate cortex and dorsal medial pre-frontal cortex. Additionally, CBT success was foretold by less activity in the amygdala and/or increased activity in the medial orbitofrontal gyrus during emotion processing. CBT response was predicted by pre-treatment activity in prefrontal regions and the amygdala. The direction of activity suggests that individuals with intact attentional control in the presence of emotional distractors, regulatory capacity over emotional faces and/or less reactivity to such faces are more likely to benefit from CBT. Findings indicate that baseline neural activity in the context of attentional control and emotion processing may serve as a step towards delineating mechanisms by which CBT exerts its effects.