title: Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions.
abstract: BACKGROUND
  The neural processes underlying the benefits of cognitive behavioral treatment (CBT) for generalized anxiety disorder (GAD) are not well understood.
  
  
  METHODS
  Twenty-one (n=21) adults with a principal diagnosis of GAD and eleven (n=11) non-anxious healthy controls (HC) underwent functional magnetic resonance imaging while completing a facial emotion processing task. Responses to threat-related emotionality (i.e., the contrast of fear and angry vs. happy faces) were assessed at pretreatment and again following 10 sessions of CBT in the GAD group and a comparable waiting period in the HC group.
  
  
  RESULTS
  At pretreatment, GAD participants displayed blunted responses in the amygdala, insula, and anterior cingulate to the happy face-processing comparison condition, and greater amygdalo-insular connectivity. CBT was associated with attenuated amygdalar and subgenual anterior cingulate activation to fear/angry faces and heightened insular responses to the happy face comparison condition, but had no apparent effects on connectivity. Pre-treatment abnormalities and treatment-related changes were not associated with symptoms of worry.
  
  
  CONCLUSIONS
  There was no active control condition (e.g., treatment waitlist) for comparison of treatment effects.
  
  
  CONCLUSIONS
  Taken together, these results provide evidence for a dual-process psychotherapeutic model of neural systems changes in GAD in which cingulo-amygdalar reactivity to threat-cues is attenuated while insular responses to positive facial emotions are potentiated. Future work is needed to determine the clinical implications of these changes and their specificity to CBT.
authors.affiliation: San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA. Electronic address: gfonzo@ucsd.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Fonzo
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Ramsawh
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Taru M
authors.initials: TM
authors.lastname: Flagan
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Sullivan
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center of Excellence in Stress and Mental Health, San Diego, CA, USA.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Simmons
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology; D000786:Anger; D001008:Anxiety Disorders / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003463:Cues; D004644:Emotions; D005149:Facial Expression; D005239:Fear; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006240:Happiness; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Amygdala; CBT; GAD; Imaging; Psychotherapy