Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: randomized clinical trial.
OBJECTIVE
Cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) is thought to enhance cognitive reappraisal in patients with SAD. Such improvements should be evident in cognitive reappraisal-related prefrontal cortex responses.


OBJECTIVE
To determine whether CBT for SAD modifies cognitive reappraisal-related prefrontal cortex neural signal magnitude and timing when implementing cognitive reappraisal with negative self-beliefs. DESIGN Randomized clinical trial of CBT for SAD vs wait-list control group during a study that enrolled patients from 2007 to 2010.


METHODS
University psychology department.


METHODS
Seventy-five patients with generalized SAD randomly assigned to CBT or wait list.


METHODS
Sixteen sessions of individual CBT for SAD.


METHODS
Negative emotion ratings and functional magnetic resonance imaging blood oxygen-level dependent signal when reacting to and cognitively reappraising negative self-beliefs embedded in autobiographical social anxiety situations. RESULTS During reactivity trials, compared with wait list, CBT produced (1) greater reduction in negative emotion ratings and (2) greater blood oxygen-level dependent signal magnitude in the medial prefrontal cortex. During cognitive reappraisal trials, compared with wait list, CBT produced (3) greater reduction in negative emotion ratings, (4) greater blood oxygen level-dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (5) earlier temporal onset of dorsomedial prefrontal cortex activity, and (6) greater dorsomedial prefrontal cortex-amygdala inverse functional connectivity.


CONCLUSIONS
Modulation of cognitive reappraisal-related brain responses, timing, and functional connectivity may be important brain changes that contribute to the effectiveness of CBT for social anxiety. This study demonstrates that clinically applied neuroscience investigations can elucidate neurobiological mechanisms of change in psychiatric conditions.


BACKGROUND
clinicaltrials.gov Identifier: NCT00380731.
Department of Psychology, Stanford University, Stanford, California.
Philippe R
PR
Goldin
Michal
M
Ziv
Hooria
H
Jazaieri
Kevin
K
Hahn
Richard
R
Heimberg
James J
JJ
Gross
D001008:Anxiety Disorders / Q000503:physiopathology* / Q000628:therapy*; D001931:Brain Mapping; D003071:Cognition / Q000502:physiology; D015928:Cognitive Behavioral Therapy; D004644:Emotions / Q000502:physiology*; D006801:Humans; D017397:Prefrontal Cortex / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology