title: NEURAL REACTIVITY TO REWARD AS A PREDICTOR OF COGNITIVE BEHAVIORAL THERAPY RESPONSE IN ANXIETY AND DEPRESSION.
abstract: BACKGROUND
  Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety and depression; however, response to CBT is heterogeneous across patients and many remain symptomatic after therapy, raising the need to identify prospective predictors for treatment planning. Altered neural processing of reward has been implicated in both depression and anxiety, and improving hedonic capacity is a goal of CBT. However, little is known about how neural response to reward relates to CBT outcomes in depression and anxiety. The current study used the reward positivity (RewP) event-related potential (ERP) component to examine whether neural reactivity to reward would predict CBT response in a sample of patients with anxiety without depression (n = 30) and comorbid anxiety and depression (CAD, n = 22).
  
  
  METHODS
  Participants completed a guessing reward ERP paradigm before completing 12 weeks of standard CBT.
  
  
  RESULTS
  The majority of the sample (68%; 35 out of 52 patients) responded to treatment, and those with a reduced RewP at baseline were more likely to respond to treatment. A reduced RewP was also associated with a greater pre-to-post CBT reduction in depressive symptoms among individuals with CAD, but not among individuals with pure anxiety.
  
  
  CONCLUSIONS
  CBT may be most beneficial in reducing depressive symptoms for individuals who demonstrate decreased reward reactivity prior to treatment. CBT may target reward brain function, leading to greater improvement in symptoms. These effects may be strongest, and therefore most meaningful, for individuals with reward-processing deficits prior to treatment.
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Burkhouse
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Autumn
authors.initials: A
authors.lastname: Kujawa
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.|Mental Health Service, Jesse Brown VA Medical Center, Chicago, Illinois.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kennedy
authors.affiliation: Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Stewart A
authors.initials: SA
authors.lastname: Shankman
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Langenecker
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.|Mental Health Service, Jesse Brown VA Medical Center, Chicago, Illinois.|Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: K Luan
authors.initials: KL
authors.lastname: Phan
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.|Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Heide
authors.initials: H
authors.lastname: Klumpp
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012201:Reward; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: anxiety; cognitive behavioral therapy; depression; event-related potentials; reward