title: Neural correlates of procedural variants in cognitive-behavioral therapy: a randomized, controlled multicenter FMRI study.
abstract: BACKGROUND
  Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus self-guided (T-) exposure on the neural correlates of fear conditioning in PD/AG.
  
  
  METHODS
  In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T-, n = 20).
  
  
  RESULTS
  The interaction of diagnosis (PD/AG, HS), treatment group (T+, T-), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2).
  
  
  CONCLUSIONS
  After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.
authors: Department of Psychiatry and Psychotherapy, Philipps University Marburg, Marburg, Germany.
authors: Benjamin
authors: B
authors: Straube
authors: Ulrike
authors: U
authors: Lueken
authors: Andreas
authors: A
authors: Jansen
authors: Carsten
authors: C
authors: Konrad
authors: Andrew T
authors: AT
authors: Gloster
authors: Alexander L
authors: AL
authors: Gerlach
authors: Andreas
authors: A
authors: Ströhle
authors: André
authors: A
authors: Wittmann
authors: Bettina
authors: B
authors: Pfleiderer
authors: Siegfried
authors: S
authors: Gauggel
authors: Ulrich
authors: U
authors: Wittchen
authors: Volker
authors: V
authors: Arolt
authors: Tilo
authors: T
authors: Kircher
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000503:physiopathology* / Q000628:therapy*; D002540:Cerebral Cortex / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003213:Conditioning, Psychological / Q000502:physiology; D005239:Fear / Q000502:physiology; D005260:Female; D006624:Hippocampus / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome