title: Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder.
abstract: Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.
authors.affiliation: University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States. Electronic address: burklund@ucla.edu.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Burklund
authors.affiliation: University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
authors.forename: Jared B
authors.initials: JB
authors.lastname: Torre
authors.affiliation: University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lieberman
authors.affiliation: University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
authors.forename: Shelley E
authors.initials: SE
authors.lastname: Taylor
authors.affiliation: University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D015928:Cognitive Behavioral Therapy; D003463:Cues; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000072861:Phobia, Social / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012929:Psychological Distance; D055815:Young Adult
keywords: Amygdala; Anterior cingulate cortex; Rejection; Treatment prediction; fMRI