title: Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder.
abstract: Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain's adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure-function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood-oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected P(FWE) = 0.02) and BOLD responsivity (P(FWE) = 0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (P(FWE)=0.04), and CBT-induced reduction of amygdala GM volume (pre-post) correlated positively with reduced anticipatory anxiety after treatment (P(FWE) ⩽ 0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (P(FWE) = 0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.
authors.affiliation: Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.|Department of Adult Psychiatry, PRIMA Barn och Vuxenpsykiatri, Stockholm, Sweden.
authors.forename: K N T
authors.initials: KN
authors.lastname: Månsson
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden.|Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Salami
authors.affiliation: Department of Psychology, Uppsala University, Uppsala, Sweden.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-2516-9075
authors.initials: A
authors.lastname: Frick
authors.affiliation: Department of Psychology, Stockholm University, Stockholm, Sweden.
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-2172-8813
authors.initials: P
authors.lastname: Carlbring
authors.affiliation: Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.|Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Psychology, Uppsala University, Uppsala, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Furmark
authors.affiliation: Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden.|CEDAR, Center for Demographic and Aging Research, Umeå University, Umeå, Sweden.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Boraxbekk
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
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