title: Prefrontal Reactivity to Social Signals of Threat as a Predictor of Treatment Response in Anxious Youth.
abstract: Neuroimaging has shown promise as a tool to predict likelihood of treatment response in adult anxiety disorders, with potential implications for clinical decision-making. Despite the relatively high prevalence and emergence of anxiety disorders in youth, very little work has evaluated neural predictors of response to treatment. The goal of the current study was to examine brain function during emotional face processing as a predictor of response to treatment in children and adolescents (age 7-19 years; N=41) with generalized, social, and/or separation anxiety disorder. Prior to beginning treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline or cognitive behavior therapy (CBT), participants completed an emotional faces matching task during functional magnetic resonance imaging (fMRI). Whole brain responses to threatening (ie, angry and fearful) and happy faces were examined as predictors of change in anxiety severity following treatment. Greater activation in inferior and superior frontal gyri, including dorsolateral prefrontal cortex and ventrolateral prefrontal cortex, as well as precentral/postcentral gyri during processing of threatening faces predicted greater response to CBT and SSRI treatment. For processing of happy faces, activation in postcentral gyrus was a significant predictor of treatment response. Post-hoc analyses indicated that effects were not significantly moderated by type of treatment. Findings suggest that greater activation in prefrontal regions involved in appraising and regulating responses to social signals of threat predict better response to SSRI and CBT treatment in anxious youth and that neuroimaging may be a useful tool for predicting how youth will respond to treatment.
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Autumn
authors.initials: A
authors.lastname: Kujawa
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Swain
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Gregory L
authors.identifier: 0000-0002-0742-6990
authors.initials: GL
authors.lastname: Hanna
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Koschmann
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: David
authors.initials: D
authors.lastname: Simpson
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Connolly
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Kate D
authors.initials: KD
authors.lastname: Fitzgerald
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.|Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Monk
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.|Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA.|Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois, USA.|Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: K Luan
authors.initials: KL
authors.lastname: Phan
mesh_terms: D000293:Adolescent; D000786:Anger; D001010:Anxiety, Separation / Q000503:physiopathology* / Q000628:therapy*; D001921:Brain / Q000503:physiopathology; D001931:Brain Mapping; D002648:Child; D015928:Cognitive Behavioral Therapy; D005149:Facial Expression; D000066499:Facial Recognition; D005239:Fear; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000072861:Phobia, Social / Q000503:physiopathology* / Q000628:therapy*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D012938:Social Perception; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline