title: Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging.
abstract: BACKGROUND
  Current behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD.
  
  
  OBJECTIVE
  To measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT).
  
  
  METHODS
  Functional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli.
  
  
  METHODS
  Patients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology.
  
  
  METHODS
  Thirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD.
  
  
  METHODS
  Brain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT.
  
  
  METHODS
  Whole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure.
  
  
  RESULTS
  Pretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline.
  
  
  CONCLUSIONS
  The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.
authors.affiliation: McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. oldoe@mit.edu
authors.forename: Oliver
authors.initials: O
authors.lastname: Doehrmann
authors.forename: Satrajit S
authors.initials: SS
authors.lastname: Ghosh
authors.forename: Frida E
authors.initials: FE
authors.lastname: Polli
authors.forename: Gretchen O
authors.initials: GO
authors.lastname: Reynolds
authors.forename: Franziska
authors.initials: F
authors.lastname: Horn
authors.forename: Anisha
authors.initials: A
authors.lastname: Keshavan
authors.forename: Christina
authors.initials: C
authors.lastname: Triantafyllou
authors.forename: Zeynep M
authors.initials: ZM
authors.lastname: Saygin
authors.forename: Susan
authors.initials: S
authors.lastname: Whitfield-Gabrieli
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Hofmann
authors.forename: Mark
authors.initials: M
authors.lastname: Pollack
authors.forename: John D
authors.initials: JD
authors.lastname: Gabrieli
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D015415:Biomarkers; D001921:Brain / Q000503:physiopathology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000628:therapy; D011237:Predictive Value of Tests; D011615:Psychotherapy, Group / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers