Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up

Probably not a substantial claim: may not pass S3 (load-bearing).

Atypical recruitment of cortical regions, including dl/vl/mPFC and ACC, in SAD may be associated with emotion regulation deficits.

“Moreover, aberrant recruitment of cortical regions in SAD, including dorsolateral, ventrolateral, and medial prefrontal cortex (dl/vl/mPFC) and anterior cingulate cortex (ACC), may be linked to deficits in emotion regulation (Brühl, Delsignore, et al., 2014; Picó-Pérez, Radua, Steward, Menchón, & Soriano-Mas, 2017; Zilverstand, Parvaz, & Goldstein, 2017).”

• cites Brühl, Delsignore, et al., 2014 sourceSupported
• cites Picó-Pérez, Radua, Steward, Menchón, & Soriano-Mas, 2017 sourcePartly supported

  The Results (p. 14) and discussion (p. 15) link reduced dmPFC and vlPFC recruitment, including a cluster extending to the dorsal ACC, with altered emotion regulation in patients with mood and anxiety disorders. Social anxiety disorder was included among the studied diagnoses (p. 12), but the finding was not established specifically for SAD. The discussion (p. 15) explicitly says the meta-analysis did not find the expected dlPFC hypoactivation, so the cited paper does not support including dlPFC among its observed recruitment differences. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Zilverstand, Parvaz, & Goldstein, 2017 sourcePartly supported

  The Results (§3.2; page not provided) report reduced dlPFC, vlPFC, and dACC recruitment during emotion regulation in anxiety disorders, and the Discussion (§4.1) links the dACC finding to a possible regulatory deficit. The review includes SAD studies but reports these findings for anxiety disorders as a group, not specifically SAD; the cited passages also do not establish atypical mPFC recruitment. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Prior findings disagree about which prefrontal subregions are involved and whether activation is increased or decreased relative to healthy controls.

“However, findings have been inconsistent regarding the specific prefrontal sub-regions as well as direction of effects (both relatively increased (Brühl, Delsignore, et al., 2014; Goldin et al., 2009) or decreased activation (Zilverstand et al., 2017) compared to healthy individuals).”

• cites Brühl, Delsignore, et al., 2014 sourceSupported
• cites Goldin et al., 2009 sourceSupported
• cites Zilverstand et al., 2017 sourceSupported

Classified as probably not a substantial claim.

Changes in this circuitry have been proposed as mechanisms of treatment response.

“Changes in this circuitry have been implicated as mechanisms in treatment response (Goldin et al., 2013, 2014; Young et al., 2017).”

• cites Goldin et al., 2013, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Young et al., 2017 sourceSupported

Classified as probably not a substantial claim.

Neurobiological models propose that prefrontal cortex regions regulate emotional reactivity in the amygdala through top-down connectivity.

“Neurobiological models suggest that regions of the prefrontal cortex (PFC) are central to regulation of emotional reactivity in the amygdala through top-down connectivity (Berkman & Lieberman, 2009; Brühl, Delsignore, Komossa, & Weidt, 2014).”

• cites Berkman & Lieberman, 2009 sourceSupported
• cites Brühl, Delsignore, Komossa, & Weidt, 2014 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Dynamic causal modeling evidence indicates impaired bidirectional effective connectivity from the amygdala to vmPFC during perception of emotional cues.

“Additionally, evidence from dynamic causal modeling suggests impaired bidirectional effective connectivity from amygdala to vmPFC while perceiving emotional cues (Sladky, Höflich, et al., 2015).”

• cites Sladky, Höflich, et al., 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Amygdala hyper-reactivity to social or emotional cues is consistently linked to SAD pathophysiology, and its degree tracks symptom severity.

“In response to social or emotional stimuli, amygdala hyper-reactivity has been consistently implicated in the pathophysiology of SAD (Davies et al., 2017), the degree of which also corresponds with symptom severity (Goldin, Manber, Hakimi, Canli, & Gross, 2009).”

• cites Davies et al., 2017 sourceSupported
• cites Goldin, Manber, Hakimi, Canli, & Gross, 2009 sourceSupported

May combine two claims.

Discrepancies may partly reflect a focus on activation instead of functional connectivity between limbic and prefrontal regions, which may be a more reliable biomarker.

“Discrepancies may in part be due to examination of activation rather than patterns of functional connectivity between limbic and prefrontal regions, which may serve as a more reliable biomarker (Nord et al., 2019).”

• cites Nord et al., 2019 sourceSupported

May combine two claims.

Relative to healthy controls, people with SAD show atypical activity and connectivity between the amygdala and prefrontal regions.

“Compared to healthy individuals, individuals with SAD demonstrate aberrant activity in and connectivity between the amygdala and prefrontal regions (Freitas-Ferrari et al., 2010).”

• cites Freitas-Ferrari et al., 2010 sourcePartly supported

  The fMRI section reports greater amygdala activation in people with SAD than in healthy controls and notes alterations in prefrontal regions. The Discussion describes impaired amygdala–prefrontal communication as a possible feature of anxiety disorders generally, but does not establish altered connectivity between those regions in SAD relative to healthy controls. Page numbers are unavailable in our copy. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Functional connectivity studies report disrupted amygdala-prefrontal communication in SAD during rest, implicit emotion regulation, and explicit emotion regulation tasks.

“Functional connectivity studies have found that compared to healthy individuals, individuals with SAD demonstrate disrupted communication between the amygdala and prefrontal regions during resting state (vmPFC (Hahn et al., 2011)), as well as during implicit (vmPFC (Young et al., 2017)) and explicit emotion regulation tasks (dl/vlPFC (Goldin et al., 2009)).”

• cites Hahn et al., 2011 sourceNot checked — no full text of the source
• cites Young et al., 2017 sourceSupported
• cites Goldin et al., 2009 sourcePartly supported

  Goldin et al.’s Results and Discussion on emotion regulation report that healthy controls showed greater dorsolateral PFC activity than participants with SAD while regulating social threat. That supports a group difference during an explicit regulation task, but the reported BOLD activity does not establish disrupted functional connectivity or communication between the amygdala and prefrontal regions. The resting-state and implicit-task portions of the sentence are attributed to other citations, not Goldin et al. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Greater dmPFC activation and amygdala connectivity correspond to reappraisal success in healthy people and in SAD patients.

“Further, greater dmPFC activation and connectivity with the amygdala corresponded to reappraisal success in both healthy individuals (Banks, Eddy, Angstadt, Nathan, & Phan, 2007; Wager, Davidson, Hughes, Lindquist, & Ochsner, 2008) and patients with social anxiety disorder (Goldin et al., 2009).”

• cites Banks, Eddy, Angstadt, Nathan, & Phan, 2007 sourcePartly supported

  The Methods Participants section describes healthy volunteers, and the Results and Discussion link greater amygdala–dmPFC coupling during reappraisal to lower self-reported negative affect. The dmPFC association with success was only trend-level (P = 0.070), and the paper does not show that greater dmPFC activation itself corresponded to success. The citation to Banks et al. is attached to the healthy-individuals portion of the sentence, not the claim about patients with social anxiety disorder. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites Wager, Davidson, Hughes, Lindquist, & Ochsner, 2008 sourcePartly supported

  Results §2 reports that greater DMPFC activation was associated with reappraisal success, supporting that part of the claim about healthy individuals. Results §3 examines connectivity with the amygdala using vlPFC, not DMPFC, and finds that greater amygdala activity predicted reduced success. The social-anxiety-disorder finding is attributed to Goldin et al. in the citing sentence, not to Wager et al. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites Goldin et al., 2009 sourcePartly supported

  The Results > Emotion Regulation section reports that greater dorsomedial PFC activity during cognitive regulation was associated with reduced negative-emotion ratings in both SAD patients and healthy controls. It does not report that connectivity with the amygdala corresponded to regulation success. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The present findings fit a framework of emotion regulation along two dimensions: implicit-to-explicit goals and automatic-to-controlled processes.

“Our findings can be conceptualized within a recent framework of emotion regulation along two dimensions: the goal, ranging from implicit to explicit, and the change process, ranging from automatic to controlled (Braunstein, Gross, & Ochsner, 2017).”

• cites Braunstein, Gross, & Ochsner, 2017 sourceSupported

Classified as probably not a substantial claim.

A small number of studies have examined whether neural activation patterns predict long-term outcomes.

“A limited number of studies have examined whether patterns of neural activation predict long-term outcomes (Furmark et al., 2002; Månsson et al., 2015).”

• cites Furmark et al., 2002 sourceNot checked — no full text of the source
• cites Månsson et al., 2015 sourceSupported

May combine two claims.

The present findings matched this framework except for vlPFC, which is traditionally found during affect labeling in healthy controls and was implicated in short-term treatment response in the authors' prior analyses.

“Our findings were consistent with the exception of the vlPFC, which is traditionally found during affect labeling in healthy controls (Lieberman et al., 2007; Torre & Lieberman, 2018) and was implicated in short-term treatment response in our previous analyses (Young et al., 2017).”

• cites Lieberman et al., 2007 sourceNot checked — no full text of the source
• cites Torre & Lieberman, 2018 sourceNot checked — no full text of the source
• cites Young et al., 2017 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Healthy individuals using perspective-taking for emotion regulation engage the same anterior dmPFC region found here, and this engagement modulates amygdala activity.

“In particular, when using perspective-taking as an emotion regulation strategy, healthy individuals engaged the same anterior portion of the dmPFC found in the present study, which modulated amygdala activation (Gilead et al., 2016).”

• cites Gilead et al., 2016 sourcePartly supported

  The Results (page unavailable) identify an anterior mPFC cluster spanning the dmPFC and pgACC whose connectivity with the amygdala varied by perspective. But the Discussion (page unavailable) says participants did not explicitly try to regulate their emotions and describes top-down regulation as a suggestion, not an established causal effect. The source also cannot establish that its region is the same as one in the citing study. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Affect labeling, or naming emotions, is an effective emotion regulation strategy that reduces the intensity of reactions to labeled stimuli.

“Affect labeling, the process of naming emotions, has been demonstrated to be an effective emotion regulation strategy, resulting in reductions in the intensity of emotional reactions to labeled stimuli (Lieberman, Inagaki, Tabibnia, & Crockett, 2011).”

• cites Lieberman, Inagaki, Tabibnia, & Crockett, 2011 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The dACC may relate to survival goals, making it sensitive to social rejection, which is central to SAD.

“Relatedly, the dACC may relate to survival goals, making it sensitive to social rejection, a central component of social anxiety disorder (Lieberman & Eisenberger, 2015).”

• cites Lieberman & Eisenberger, 2015 sourcePartly supported

  The “Arbitrary vs. Survival Goal Conflicts” section proposes that the dACC responds to enduring survival-relevant goals and identifies social rejection as a threat to social connection, citing dACC activation in a meta-analysis of rejection studies. Our copy does not address social anxiety disorder or establish that social rejection is a central component of it. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

A reverse-inference meta-analysis found that dACC relates specifically to pain and distress-related emotions rather than conflict, salience, or executive processes.

“Historically, the ACC has been associated with a multitude of psychological functions; however, a reverse-inference meta-analysis indicated that the dACC specifically is related to pain and distress-related emotions rather than conflict, salience, or executive processes (Jahn, Nee, Alexander, & Brown, 2016; Lieberman & Eisenberger, 2015).”

• cites Jahn, Nee, Alexander, & Brown, 2016 sourcePartly supported

  The Introduction reports that Lieberman and Eisenberger’s reverse-inference meta-analysis associated the dACC preferentially with pain rather than cognitive-control terms such as conflict. It does not report a finding specific to distress-related emotions or a comparison with salience and executive processes. The Abstract also says Jahn et al.’s own experiment found cognitive effects extending into the dACC, so the claim’s unqualified exclusion of cognitive processes overstates this source. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Lieberman & Eisenberger, 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The dmPFC region found here partially overlaps with prior work, but more dorsal and posterior medial PFC regions are typically implicated in emotion regulation meta-analyses.

“Although the region of the dmPFC found in this study is partially overlapping with those mentioned above (e.g., Banks et al., 2007; Gilead et al., 2016; Wager et al., 2008), relatively more dorsal and posterior regions of the medial PFC (i.e., closer to the pre-supplementary motor area) are typically implicated in meta-analyses of emotion regulation (Buhle et al., 2014).”

• cites Buhle et al., 2014 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ACC is a hub in large-scale attention networks and has been implicated in modulating amygdala activation during emotional distraction.

“The ACC lies at the nexus of large scale networks involved in regulating attention to internal and external stimuli, and has been implicated in modulating amygdala activation in the presence of emotional distractors (Etkin, Egner, Peraza, Kandel, & Hirsch, 2006).”

• cites Etkin, Egner, Peraza, Kandel, & Hirsch, 2006 sourcePartly supported

  The Results report that greater rostral ACC activity predicted reduced amygdala activity during emotional-conflict resolution, supporting the claim about emotional distractors. The Introduction discusses ACC roles in cognitive and emotional processing, but does not establish that the ACC is a hub of large-scale networks regulating attention to internal and external stimuli. The indexed passages provide section labels but no page numbers. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

The analysis collapsed treatment groups because prior work found no group differences in immediate or follow-up clinical outcomes or in affect labeling functional connectivity.

“Given the lack of treatment group differences in both immediate and follow-up clinical outcomes (Craske et al., 2014), as well as functional connectivity in the affect labeling task (Young et al., 2017), the current analysis collapsed across treatment modality to create a combined sample.”

• cites Craske et al., 2014 sourceSupported
• cites Young et al., 2017 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Short-term connectivity changes during affect labeling after CBT or ACT were reported elsewhere; post-treatment symptom reduction corresponded with increased inverse right amygdala-right vlPFC and left amygdala-vmPFC connectivity, independent of treatment type.

“Short-term changes in functional connectivity during affect labeling by completion of cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) observed using data from the parent study have been reported elsewhere from (Young et al., 2017), with post-treatment symptom reduction corresponding to increased inverse connectivity between the right amygdala-right vlPFC and left”

• cites Young et al., 2017 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The dmPFC is implicated in social cognition, mentalizing, monitoring emotional states, and emotion regulation.

“The dmPFC, implicated in social cognition (Bzdok et al., 2013; Lieberman, Straccia, Meyer, Du, & Tan, 2019), mentalizing (Zaki & Ochsner, 2012), and monitoring one’s own and others’ emotional states (Ochsner et al., 2012), is thought to play a role in emotion regulation (Buhle et al., 2014; Ochsner & Gross, 2005).”

• cites Bzdok et al., 2013 sourceSupported
• cites Zaki & Ochsner, 2012 sourceNot checked — no full text of the source
• cites Ochsner et al., 2012 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The pre-central gyrus may relate to preparing motor responses to affective material.

“In the context of the emotional experience, the pre-central gyrus may relate to preparation of motor responses to affective material (Hardee et al., 2017).”

• cites Hardee et al., 2017 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Compared with healthy controls, SAD patients show greater fusiform gyrus activation to fearful faces and greater fusiform-amygdala connectivity, which tracks with greater social anxiety severity.

“Compared to healthy controls, patients with social anxiety disorder have demonstrated greater fusiform gyrus activation in response to fearful faces, as well as greater fusiform-amygdala connectivity, which corresponded with greater social anxiety severity (Frick, Howner, Fischer, Kristiansson, & Furmark, 2013).”

• cites Frick, Howner, Fischer, Kristiansson, & Furmark, 2013 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The fusiform gyrus is central to visual face perception and meta-analyses show it is hyper-reactive to negative emotional stimuli in SAD.

“The fusiform gyrus plays a central role in visual face perception (McCarthy, Puce, Gore, & Allison, 1997), and has been shown in a meta-analyses to be hyper-reactive to negative emotional stimuli in social anxiety disorder (Brühl, Delsignore, et al., 2014; Etkin & Wager, 2007).”

• cites McCarthy, Puce, Gore, & Allison, 1997 sourceNot checked — no full text of the source
• cites Brühl, Delsignore, et al., 2014 sourcePartly supported

  The ALE meta-analysis (section 3.2, Table 3; page unavailable) finds greater fusiform gyrus activation in SAD than in healthy controls. Section 4.2 links this finding to feared negative facial expressions, but presents that explanation as a possibility; the meta-analysis does not establish that the increased response is specific to negative emotional stimuli. The face-perception clause is attributed to McCarthy et al., not to this source. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites Etkin & Wager, 2007 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some evidence indicates that SAD patients show cerebellum hypo-activation during passive viewing and reappraisal of social stimuli compared with healthy controls, though amygdala connectivity has not been studied.

“There is some evidence that individuals with social anxiety demonstrate cerebellum hypo-activation during passive viewing (Nakao et al., 2011) and reappraisal of social stimuli (Ziv, Goldin, Jazaieri, Hahn, & Gross, 2013) compared to healthy controls, although studies have not investigated functional connectivity with the amygdala.”

• cites Nakao et al., 2011 sourceNot checked — no full text of the source
• cites Ziv, Goldin, Jazaieri, Hahn, & Gross, 2013 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Psychotropic medications such as SSRIs have been shown to enhance prefrontal down-regulation of the amygdala in healthy controls and depressed patients.

“As psychotropic medications, such as selective serotonin reuptake inhibitors, have been shown to enhance prefrontal down-regulation of the amygdala in healthy controls (Sladky, Spies, et al., 2015) and in depressed patients (Heller et al., 2013; Maslowsky et al., 2010), medication effects are an important consideration for future research on emotion regulation.”

• cites Sladky, Spies, et al., 2015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Heller et al., 2013 sourceCould not verify

  The Abstract and Discussion discuss sustained reward-circuit activity and well-being, not medication effects on prefrontal regulation of the amygdala. A References entry names a separate study of antidepressant treatment and fronto-striatal connectivity, but our copy does not report the claimed amygdala finding. Searches for SSRIs, medication, and prefrontal down-regulation found no supporting passage. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites Maslowsky et al., 2010 sourcePartly supported

  The fMRI Results (p. 10) report increased ventrolateral prefrontal activation after fluoxetine treatment relative to controls. But the treated participants were adolescents with generalized anxiety disorder, not depressed patients, and the study does not demonstrate prefrontal down-regulation of the amygdala. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Dynamic causal modeling evidence has shown bidirectional connectivity between the amygdala and orbitofrontal cortex and ventral PFC during emotional processing.

“Indeed, evidence from dynamic causal modeling has demonstrated bidirectional connectivity between the amygdala and orbitofrontal cortex and ventral PFC during emotional processing (Sladky, Höflich, et al., 2015).”

• cites Sladky, Höflich, et al., 2015 sourcePartly supported

  The Results > Intrinsic Connections (page unavailable) report significant connections in both directions between the amygdala and OFC during an emotional-face discrimination study. They do not establish bidirectional connectivity between the amygdala and an additional ventral PFC region; the other PFC region modeled was dorsolateral, and its direct connection to the amygdala was excluded. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For the present participants, the contrast between Affect Label and Gender Label conditions yielded no reliable difference in amygdala response (right t(22)=0.61, p=0.55; left t(22)=0.04, p=0.96), though the numerical trend was higher during Affect Label.

“In the current sample, a one-sample t-test revealed that there was not a significant difference in amygdala activation between the Affect Label versus Gender Label conditions (right amygdala: t(22)=0.61, p=0.55: left amygdala: t(22)=0.04, p=0.96), although the effect was in the same direction as Burklund et al. (2015) with greater amygdala activation during Affect Label compared to Gender Label.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Before treatment, left and right amygdala ROIs showed significant activation above implicit baseline during both Affect Label and Gender Label conditions.

“While amygdala activation was not significantly different between conditions, amygdala activation during both conditions was significantly greater than implicit baseline: one-sample t-tests confirmed significant activation at pre-treatment in the left and right amygdala ROI’s during the Affect Label (left amygdala: t(22)= 2.88, p = 0.009; right amygdala: t(22) = 4.25, p < 0.001) and Gender Label (”

Probably not a substantial claim: may not pass S3 (load-bearing).

Affect labeling is thought to reduce negative affect by putting feelings into words.

“Affect labeling is thought to serve as a form of incidental emotion regulation that reduces negative affect by “putting feelings into words.””

• cites Lieberman et al., 2007 sourceNot checked — no full text of the source

May combine two claims.

Baseline prediction studies cannot address treatment mechanisms; that requires testing whether neural changes during treatment predict follow-up outcomes.

“As noted, baseline prediction studies do not speak to treatment mechanisms, which requires investigation of whether changes in neural functioning throughout treatment predict outcomes at follow-up assessments.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Prior fMRI work shows that affect labeling versus gender labeling is typically linked to lower amygdala and higher prefrontal activation, and stronger connectivity between these regions, in healthy controls.

“Previous fMRI studies have shown that affect labeling (compared to a gender labeling control condition) is typically associated with reduced amygdala and enhanced prefrontal activation, as well as enhanced connectivity between these regions in healthy controls (Lieberman et al., 2007; Torre & Lieberman, 2018).”

• cites Lieberman et al., 2007 sourceNot checked — no full text of the source
• cites Torre & Lieberman, 2018 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Connectivity outliers greater than 2.5 standard deviations from the mean were removed.

“Connectivity estimate outliers, defined as greater than 2.5 standard deviations from the mean, were removed from analyses (n=1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Affect labeling is considered a hybrid implicit-controlled strategy with an implicit regulatory goal and controlled labeling processes.

“Affect labeling is considered a hybrid “implicit-controlled” strategy, characterized by an implicit regulatory goal (i.e. individuals do not intend to regulate when labeling) and engagement of controlled processes (i.e. the labeling itself is likely a controlled process).”

May combine two claims.

Changes in amygdala-dACC connectivity through treatment may reflect reduced coupling between threat-detection and social-distress regions during implicit emotion regulation, which relates to better follow-up outcomes.

“Changes in amygdala-dACC connectivity through treatment may reflect less coupling between threat-detection (Phelps & LeDoux, 2005) and social distress (Lieberman & Eisenberger, 2015) regions respectively during implicit emotion regulation, which in turn relate to superior outcomes at follow-up.”

• cites Phelps & LeDoux, 2005 sourceNot checked — no full text of the source
• cites Lieberman & Eisenberger, 2015 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Neural regions implicated in this class of emotion regulation strategies include posterior mPFC, dACC, and vlPFC.

“Neural regions implicated in this class of emotion regulation strategies include the posterior mPFC, dACC, and vlPFC.”

Classified as probably not a substantial claim.

The affect labeling task is commonly used as a laboratory measure of implicit emotion regulation independent of effort or intentionality.

“Participants completed the affect labeling task (Lieberman et al., 2007), commonly used in the laboratory as a measure of implicit emotion regulation independent of effort or intentionality (for a review see Torre & Lieberman, 2018).”

• cites Lieberman et al., 2007 sourceNot checked — no full text of the source
• cites Torre & Lieberman, 2018 sourceNot checked — no full text of the source

May combine two claims.

The PPI analysis used here cannot establish directionality within neural circuitry, so the two interpretations cannot be ranked.

“As the PPI analyses used here do not allow inference of directionality within neural circuitry, it is not possible to state which of these two interpretations is more likely.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Eligible patients were randomized to CBT, ACT, or a waitlist.

“Eligible patients were randomized to either receive one of two manualized psychotherapy treatments for anxiety (Cognitive Behavioral Therapy, n=40; or Acceptance and Commitment Therapy, n=34), which involved 12 weekly 1-hour individual therapy sessions, or to the wait list (WL; n=26).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Implicit regulation through affect labeling may engage processes shared by CBT and ACT.

“While cognitive behavioral therapy and acceptance and commitment therapy train explicit emotion regulation through different strategies, implicit regulation via affect labeling may tap into processes that are common across treatment types.”

Classified as probably not a substantial claim.

Participants completed two valid and reliable self-report social anxiety measures, the SIAS and SPS.

“Participants completed two valid and reliable self-report measures of social anxiety symptoms including the Social Interaction Anxiety Scale (SIAS (Mattick & Clarke, 1998)) and the Social Phobia Scale (SPS (Mattick & Clarke, 1998)).”

• cites Mattick & Clarke, 1998 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Whole-brain analyses were corrected for multiple comparisons using autocorrelation and 3dClustSim to account for non-Gaussian fMRI data.

“Whole-brain analyses were corrected for multiple comparisons using the autocorrelation (-acf) function in 3dFWHMx and 3dClustSim (two-tailed tests; AFNI version 19.0.15: http://afni.nimh.nih.gov/afni/) to account for the non-Gaussian nature of fMRI data (Eklund, Nichols, & Knutsson, 2016).”

• cites Eklund, Nichols, & Knutsson, 2016 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Mechanistic research requires evidence that change in a proposed mediator predicts later change in outcome measures.

“Mechanistic research informs questions about how treatments work and requires evidence for change in a purported mediator to predict subsequent change in measures of outcome.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants with noisy fMRI data at either scan were excluded using predefined global signal and motion thresholds.

“As in previous work, we excluded participants with noisy fMRI data at either pre- or post-treatment scans (defined as >10% of images with global signal intensity > 2.5 SD of the mean, or affected by motion more than 2.5mm in any direction; see Table 2).”

May combine two claims.

Only one PET study has used this approach, finding that reduced rCBF in bilateral amygdala, periaqueductal gray, and left thalamus during public speaking predicted responder status one year after SSRI or group CBT.

“To date, only one positron emission tomography (PET) study has taken this approach, finding that attenuation in bilateral amygdala, periaqueductal gray, and left thalamus regional cerebral blood flow (rCBF) during a public speaking task predicted responder status one year after treatment with either a selective serotonin reuptake inhibitor or cognitive behavioral group therapy (Furmark et al., 200”

• cites Furmark et al., 2002 sourceNot checked — no full text of the source

May combine two claims.

Pre-treatment connectivity, or connectivity change during Gender Labeling alone, does not fully account for the effects; change over time also matters.

“Further, we found that the direction of the relationship between functional connectivity and symptoms changed as a result of therapy, suggesting that pre-treatment functional connectivity, or changes in functional connectivity during Gender Labeling alone, are not solely driving the effects, but that change over time is also an important factor.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Whole-brain analyses included pre-treatment symptom composite as a covariate of no interest to control for pre-treatment severity.

“A one sample t-test was computed on the neural change scores with a covariate of interest (follow-up symptom change score) and a covariate of no interest (pre-treatment symptom composite score) to control for pre-treatment severity.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The symptom composite derived from the SIAS and SPS is a valid and reliable index covering cognitive, affective, and behavioral facets of social anxiety.

“A symptom composite score was calculated from the two self-report measures to create a valid and reliable index of symptoms that encompasses cognitive, affective, and behavioral facets of social anxiety.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Diagnostic evaluations used the ADIS-IV to assign diagnoses and clinical severity ratings, with scores of 4 or higher indicating clinically significant severity.

“Trained interviewers conducted diagnostic evaluations using the Anxiety Disorders Interview Schedule-IV (ADIS IV (Brown, Barlow, & DiNardo, 1994)) to assign diagnoses and clinical severity ratings (CSR), with ratings of 4 or higher indicating clinically significant severity.”

• cites Brown, Barlow, & DiNardo, 1994Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Weaker baseline dACC-amygdala functional connectivity during self-referential criticism predicted one-year treatment-responder status after internet-delivered CBT with attention bias modification.

“For example, weaker baseline dorsal anterior cingulate cortex (dACC)-amygdala functional connectivity in response to self-referential criticism predicted treatment-responder status one year after receiving internet-delivered CBT with attention bias modification (Månsson et al., 2015, 2017).”

• cites Månsson et al., 2015, 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The Affect Label versus Gender Label contrast isolates emotional verbal-linguistic processing while controlling for response selection, verbal processing, and emotion perception.

“This contrast examines emotional verbal-linguistic processing specifically while controlling for response selection, verbal processing, and emotion perception (Lieberman et al., 2007).”

• cites Lieberman et al., 2007 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Between post-treatment and 12-month follow-up, two participants changed psychotropic medication and three started new psychotherapy.

“From post-treatment to 12MFU, two participants changed psychotropic medication (one in CBT and one in ACT). Three began new psychotherapy (all three in the ACT group between 6MFU and 12MFU).”

Classified as probably not a substantial claim. May combine two claims.

Reduced amygdala-dACC coupling might mean the amygdala less easily triggers dACC subjective distress, leading to better long-term outcomes.

“Reduced coupling between these regions might mean that the amygdala does not trigger the dACC subjective distress response as easily or often, thus conferring better long-term outcomes.”

May combine two claims.

Strengthened positive connectivity between pre- and post-central gyri and amygdala across treatment may reflect persistent physiological or motoric reactivity to emotional faces, predicting poorer outcomes.

“Strengthened positive connectivity between the pre- and post-central gyri and amygdala across the course of treatment may reflect persistent physiological reactivity or motoric responding to emotional faces, in turn predicting poorer outcomes.”

May combine two claims.

Changes in amygdala connectivity with sensorimotor and visual word/face processing areas may relate to sensitization to emotion-related cues, conferring poorer long-term outcomes.

“Conversely, changes in amygdala connectivity with sensorimotor and visual word/face processing areas may relate to sensitization to emotion-related cues, conferring poorer long-term outcomes.”

May combine two claims.

Poorer follow-up outcomes related to strengthened positive amygdala-fusiform connectivity, possibly reflecting sensitization to aversive faces across treatment.

“Our results are complementary, such poorer outcomes at follow up (no change or worsening of symptoms) related to strengthened positive amygdala-fusiform connectivity, perhaps reflecting sensitization to aversive stimuli (faces) across treatment.”

Classified as probably not a substantial claim. May combine two claims.

vlPFC regulation of amygdala responses may be important for immediate treatment response, while long-term benefit may depend on different neural mechanisms.

“It may be that whereas vlPFC regulation of amygdala responses may be important in immediate responses to treatment, long-term benefit may rely on a different set of neural mechanisms.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Three patients in the current study, all in the ACT group, began new psychotherapy between the 6- and 12-month follow-ups, which may have contributed to continued symptom improvement.

“Furthermore, three patients in the current study (all in the ACT group) began a new psychotherapy between the 6 and 12-month follow-up, which may have contributed to continued symptom improvement.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The possible impact of booster phone calls between follow-up periods cannot be ruled out as an explanation for symptom improvement.

“It is also important to note that the potential impact of booster phone calls between follow-up periods also cannot be ruled out as an explanation for symptom improvement.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals with social anxiety show decreased amygdala-posterior cingulate/precuneus connectivity while viewing facial expressions.

“Individuals with social anxiety have been found to exhibit decreased amygdala-posterior cingulate/precuneus connectivity while viewing facial expressions (Hahn et al., 2011).”

• cites Hahn et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The cerebellum, traditionally linked to motor coordination and behavior, has been theorized to play a role in emotion.

“The cerebellum, traditionally associated with motor coordination and behavior (Stein & Glickstein, 1992), has been theorized to play a role in emotion (Schutter & Van Honk, 2005).”

• cites Stein & Glickstein, 1992 sourceNot checked — no full text of the source
• cites Schutter & Van Honk, 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The effects were observed in a limited sample, and replication in a larger sample is warranted.

“However, it should be noted that effects were observed in a limited sample size and investigation of the replicability of these findings in a larger sample is warranted.”

May combine two claims.

Changes in amygdala connectivity with dmPFC and dACC through treatment may reflect strengthened emotion regulation, promoting lasting therapeutic success.

“Changes in amygdala connectivity with the dorsomedial prefrontal cortex and dorsal anterior cingulate through treatment may reflect strengthened emotion regulation, in turn promoting lasting therapeutic success.”

Classified as probably not a substantial claim.

The lingual gyrus, involved in visual word processing, is activated when verbalizing high-emotion words compared with neutral words.

“The lingual gyrus, involved in visual word processing, is also activated while verbalizing high-emotion words compared to neutral-emotion words (Isenberg et al., 1999).”

• cites Isenberg et al., 1999 sourceNot checked — no full text of the source

May combine two claims.

The study had a small sample size, partly from missing follow-up clinical data and excluded fMRI data due to motion, which prevented examining medication, additional psychotherapy, and comorbidity effects.

“One limitation of this study is the small sample size, in part due to missing clinical data at follow-up and excluded fMRI data due to motion, which prevented us from examining the effects of medication, additional psychotherapy, and comorbidities.”