title: Treatment for social anxiety disorder alters functional connectivity in emotion regulation neural circuitry.
abstract: Social anxiety disorder (SAD) is characterized at a neurobiological level by disrupted activity in emotion regulation neural circuitry. Previous work has demonstrated amygdala hyperreactivity and disrupted prefrontal responses to social cues in individuals with SAD (Kim et al., 2011). While exposure-based psychological treatments effectively reduce SAD symptoms, not all individuals respond to treatment. Better understanding of the neural mechanisms involved offers the potential to improve treatment efficacy. In this study, we investigated functional connectivity in emotion regulation neural circuitry in a randomized controlled treatment trial for SAD. Participants with SAD underwent fMRI scanning while performing an implicit emotion regulation task prior to treatment (n=62). Following 12 weeks of cognitive behavioral therapy, acceptance and commitment therapy, or wait-list, participants completed a second scan (n=42). Psychophysiological interaction analyses using amygdala seed regions demonstrated differences between SAD and healthy control participants (HC; n=16) in right amygdala-vmPFC connectivity. SAD participants demonstrated more negative amygdala-to-vmPFC connectivity, compared to HC participants, an effect that was correlated with SAD symptom severity. Post-treatment symptom reduction was correlated with altered amygdala-to-vm/vlPFC connectivity, independent of treatment type. Greater symptom reduction was associated with more negative amygdala-to-vm/vlPFC connectivity. These findings suggest that effective psychological treatment for SAD enhances amygdala-prefrontal functional connectivity.
authors.affiliation: Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Young
authors.affiliation: Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Burklund
authors.affiliation: Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
authors.forename: Jared B
authors.initials: JB
authors.lastname: Torre
authors.affiliation: Department of Psychology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Darby
authors.initials: D
authors.lastname: Saxbe
authors.affiliation: Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lieberman
authors.affiliation: Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. Electronic address: craske@psych.ucla.edu.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000072861:Phobia, Social / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACT; Amygdala; CBT; FMRI; Prefrontal cortex; Psychophysiological interactions; Randomized controlled trial