Resting state amygdala-prefrontal connectivity predicts symptom change after cognitive behavioral therapy in generalized social anxiety disorder.
Resting state amygdala-prefrontal connectivity predicts symptom change after cognitive behavioral therapy in generalized social anxiety disorder.
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DOI：
10.1186/s13587-014-0014-5
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Phan KL
中科院分区：
文献类型：
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作者：
Klumpp H;Keutmann MK;Fitzgerald DA;Shankman SA;Phan KL
在休息和情绪处理过程中异常的杏仁核-前额叶相互作用与广泛性社交焦虑症（gSAD）的病理生理学有关，gSAD是一种常见的疾病，其特征是害怕潜在的审查。认知行为疗法（CBT）是gSAD和其他焦虑症的一线心理疗法。虽然CBT通常有效，但治疗反应存在很大的异质性。到目前为止，CBT治疗gSAD成功的预测因素包括杏仁核反应性降低和前额调节区（例如，前扣带皮层，“ACC”）。然而，研究还没有检查是否补药（即，杏仁核和这些前额叶区域的耦合也可以预测对CBT的反应。21例gSAD患者在12周CBT前接受静息态功能磁共振成像（fMRI）。总体而言，完成CBT后症状严重程度显著降低;然而，患者的症状变化程度差异很大。全脑体素方面的发现显示，CBT后的症状改善是由更大的右杏仁核-前膝前ACC（“pgACC”）连接和更大的左杏仁核-pgACC耦合包围内侧前额叶皮质预测的。为了支持其预测价值，左和右杏仁核-pgACC的受试者工作特征曲线下面积与治疗应答者相关。通过增强gSAD中静息态双侧杏仁核-前额耦合预测CBT后的改善。初步结果表明，可能是情绪调节的基础的基本电路的基线个体差异有助于CBT后症状变化的变化。研究结果提供了一种新的方法，可以使用生物学方法来预测谁最有可能从CBT中受益。特别地，偏离基于疾病相关刺激的神经预测器（例如，gSAD中的社会情绪刺激）允许开发反映焦虑和情绪障碍的神经生物学中的共性的生物标志物。
Aberrant amygdala-prefrontal interactions at rest and during emotion processing are implicated in the pathophysiology of generalized social anxiety disorder (gSAD), a common disorder characterized by fears of potential scrutiny. Cognitive behavioral therapy (CBT) is first-line psychotherapy for gSAD and other anxiety disorders. While CBT is generally effective, there is a great deal of heterogeneity in treatment response. To date, predictors of success in CBT for gSAD include reduced amygdala reactivity and increased activity in prefrontal regulatory regions (e.g., anterior cingulate cortex, “ACC”) during emotion processing. However, studies have not examined whether tonic (i.e., at rest) coupling of amygdala and these prefrontal regions also predict response to CBT. Twenty-one patients with gSAD participated in resting-state functional magnetic resonance imaging (fMRI) before 12 weeks of CBT. Overall, symptom severity was significantly reduced after completing CBT; however, the patients varied considerably in degree of symptom change. Whole-brain voxel-wise findings showed symptom improvement after CBT was predicted by greater right amygdala-pregenual ACC (“pgACC”) connectivity and greater left amygdala-pgACC coupling encompassing medial prefrontal cortex. In support of their predictive value, area under receiver operating characteristic curve was significant for the left and right amygdala-pgACC in relation to treatment responders. Improvement after CBT was predicted by enhanced resting-state bilateral amygdala-prefrontal coupling in gSAD. Preliminary results suggest baseline individual differences in a fundamental circuitry that may underlie emotion regulation contributed to variation in symptom change after CBT. Findings offer a new approach towards using a biological measure to foretell who will most likely benefit from CBT. In particular, the departure from neural predictors based on illness-relevant stimuli (e.g., socio-emotional stimuli in gSAD) permits the development of biomarkers that reflect commonalities in the neurobiology of anxiety and mood disorders.