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Brain scans help to predict success of social anxiety therapy

Functional MRI results predicted positive treatment responses to cognitive behavioral therapy for patients with social anxiety, according to researchers.

Two current standard approaches to treating social anxiety disorder include cognitive behavioral therapy (CBT) and pharmacotherapy. However, both approaches are only moderately effective, leaving a large number of patients symptomatic after the initial intervention.

“Although such treatments are superior to placebo on average, no reliable predictor of treatment response has been identified,” the researchers wrote.

Oliver Doehrmann, PhD, of the McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research in Cambridge, Mass., and colleagues collected neuroimaging data from 39 patients who were being treated for anxiety disorder at Boston University or Massachusetts General Hospital. Patients were not receiving medication for the illness during the study period.

Doehrmann and colleagues measured the brain activity of patients as they looked at images of angry or neutral faces. Afterward, patients underwent 12 weeks of CBT. Severity of social anxiety was assessed using theLiebowitz Social Anxiety Scale immediately before and after 12-week CBT treatment.

The researchers hypothesized that the degree of patients’ responses to stimuli from social content such as the neutral or angry faces would predict changes in the severity of their social anxiety after CBT treatment. The researchers hypothesized that the degree of patients’ responses to stimuli from social content such as the neutral or angry faces would predict changes in the severity of their social anxiety after CBT treatment.

Patients who exhibited greater differences in the brain’s visual cortex during the face-response task showed the most improvement after therapy, according to the researchers (P=.005). Also, patients’ social anxiety scores were reduced significantly after CBT (P<.001).

“A fundamental goal of CBT is to enhance emotion regulation in [social anxiety disorder], so perhaps CBT was particularly successful in patients with superior emotion regulation capacities, which was correlated with already stronger responses to angry faces in visual regions,” the researchers wrote. “Thus, patients with particularly low responses to angry faces might have benefited less from treatment because of poorer emotion regulation capacities.”

Disclosure: See the study for a full list of financial disclosures.