title: Functional neuroimaging of psychotherapeutic processes in anxiety and depression: from mechanisms to predictions.
abstract: OBJECTIVE
  The review provides an update of functional neuroimaging studies that identify neural processes underlying psychotherapy and predict outcomes following psychotherapeutic treatment in anxiety and depressive disorders. Following current developments in this field, studies were classified as 'mechanistic' or 'predictor' studies (i.e., informing neurobiological models about putative mechanisms versus aiming to provide predictive information).
  
  
  RESULTS
  Mechanistic evidence points toward a dual-process model of psychotherapy in anxiety disorders with abnormally increased limbic activation being decreased, while prefrontal activity is increased. Partly overlapping findings are reported for depression, albeit with a stronger focus on prefrontal activation following treatment. No studies directly comparing neural pathways of psychotherapy between anxiety and depression were detected. Consensus is accumulating for an overarching role of the anterior cingulate cortex in modulating treatment response across disorders. When aiming to quantify clinical utility, the need for single-subject predictions is increasingly recognized and predictions based on machine learning approaches show high translational potential.
  
  
  CONCLUSIONS
  Present findings encourage the search for predictors providing clinically meaningful information for single patients. However, independent validation as a crucial prerequisite for clinical use is still needed. Identifying nonresponders a priori creates the need for alternative treatment options that can be developed based on an improved understanding of those neural mechanisms underlying effective interventions.
authors.affiliation: aDepartment of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Würzburg, WürzburgbDepartment of Cognitive Psychology II, Goethe-University Frankfurt, Frankfurt a.M., Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lueken
authors.forename: Tim
authors.initials: T
authors.lastname: Hahn
mesh_terms: D001007:Anxiety / Q000503:physiopathology / Q000628:therapy*; D001008:Anxiety Disorders / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D003863:Depression / Q000503:physiopathology / Q000628:therapy*; D003866:Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D059907:Functional Neuroimaging; D006801:Humans; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods