title: Emotion regulation related neural predictors of cognitive behavioral therapy response in social anxiety disorder.
abstract: Social anxiety disorder (SAD) is characterized by aberrant prefrontal activity during reappraisal, an adaptive cognitive approach aimed at downregulating the automatic response evoked by a negative event. Cognitive behavioral therapy (CBT) is first-line psychotherapy for SAD, however, many remain symptomatic after treatment indicating baseline individual differences in neurofunctional activity may factor into CBT outcome. An emotion regulation strategy practiced in CBT is cognitive restructuring, a proxy for reappraisal. Therefore, neural response during reappraisal may serve as a brain-based predictor of CBT success. Prior to 12weeks of individual CBT, 34 patients with SAD completed a validated emotion regulation task during fMRI. Task instructions included 'Reappraise,' that is, use a cognitive approach to reduce affective state to a negative image, which was contrasted with looking at a negative image ('Look'). Regression results for Reappraise (vs. Look) revealed greater reduction in symptom severity was predicted by less pre-CBT activation in the dorsolateral prefrontal cortex (DLPFC). Regarding predictive validity, DLPFC significantly classified responder status. Post-hoc analysis revealed DLPFC activity, but not demographic data, baseline clinical measures, or reappraisal-related affective state during fMRI, significantly accounted for the variance in symptom reduction. Findings indicate patients with SAD are more likely to benefit from CBT if there is less pre-treatment DLPFC recruitment, a region strongly implicated in emotion regulation. Patients with reduced baseline frontal activation when reappraising negative stimuli may be especially helped by explicit cognitive interventions. Further research is necessary to establish DLPFC as a stable brain-based marker of treatment outcome.
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, United States. Electronic address: hklumpp@psych.uic.edu.
authors.forename: Heide
authors.initials: H
authors.lastname: Klumpp
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Julia
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, United States.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kennedy
authors.affiliation: Department of Psychology, University of Illinois at Chicago, United States.
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, IL, United States; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Langenecker
authors.affiliation: Stanford University, Department of Psychology, Stanford, CA, United States.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gross
authors.affiliation: Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, United States.
authors.forename: K Luan
authors.initials: KL
authors.lastname: Phan
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D015928:Cognitive Behavioral Therapy; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D000072861:Phobia, Social / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen