Psychotherapy in Social Anxiety Disorder and alterations in neural processing (PANDA)

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Social Anxiety Disorder (SAD) is characterized by an intense fear of negative social evaluation due to embarrassing or humiliating behavior. Without adequate treatment, the course of SAD is often chronic and leads to a significant reduction in quality of life. Negative self-beliefs play a key role for the development and maintenance of SAD symptoms. On a neurobiological level, SAD is associated with a hyperreactivity of the salience network and a dysregulation of the executive control network. While effects of a cognitive behavioral therapy (CBT) have been evaluated by several meta-analyses, research on psychological and neurobiological mechanisms of CBT is still sparse. In the proposed study, a psychological change model of CBT will be tested in 80 patients with SAD and associated with neurobiological mechanisms. Specifically, we will investigate CBT-associated changes in negative self-beliefs and fear of social evaluation on a behavioral and neural level by means of functional Magnetic Resonance Imaging. For the first time, a paradigm on negative self-beliefs will be tested in combination with a paradigm on executive functions in a social-evaluative situation before and after CBT. Thus, we will be able to test assumptions on CBT-induced changes in effective (directional) fronto-limbic connectivity (top-down and bottom-up modulations) by means of Dynamic Causal Modelling for the first time. Furthermore, we will investigate if CBT-non-response can be predicted by abnormally high connectivity from Amygdala to Anterior Cingulate Cortex. An improved understanding of neurobiological mechanisms of CBT and the prediction of CBT outcome may explain underlying causal mechanisms for CBT-non-response and may contribute to the development of more effective and individualized treatment strategies for SAD.