Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder.

May combine two claims.

The role of amygdala activation in predicting treatment response is unclear, with one study finding decreased pre-treatment amygdala reactivity predicted symptom reduction and another finding increased reactivity.

“The role of amygdala activation in predicting treatment response remains unclear. Symptom reduction was predicted by decreased pre-treatment amygdala reactivity in one study (Klumpp et al., 2014) and increased reactivity in another (Burklund et al., 2017).”

• cites Klumpp et al., 2014 sourceSupported
• cites Burklund et al., 2017 sourceSupported

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

Participants completed an affect labeling task as a measure of implicit emotion regulation and an explicit emotion regulation task measuring responses during regulation of social cues.

“Participants completed an affect labeling task (a measure of implicit emotion regulation; Burklund et al., 2014b) and an explicit emotion regulation task (measuring responses during regulation of social cues; Burklund et al., 2017).”

• cites Burklund et al., 2014bNot matched

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

• cites Burklund et al., 2017 sourceSupported

May combine two claims.

In comparisons of individuals with social anxiety disorder to healthy individuals, deficits in regulatory connectivity were observed only when cognitive load was low, with no group differences in high cognitive load.

“Comparing individuals with SAD to healthy individuals, deficits in regulatory connectivity were observed only when cognitive load was low. There were no group differences observed in the high cognitive load condition, suggesting that regulatory capacity was impacted by attentional demands for all individuals.”

• cites Minkova et al., 2017 sourceSupported

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

The primary limitation of this work was the sample size, although it is consistent with prior studies in this field.

“The primary limitation of this work was the sample size, although it is consistent with prior studies in this field (Doehrmann et al., 2013; Whitfield-Gabrieli et al., 2016).”

• cites Doehrmann et al., 2013 sourceSupported
• cites Whitfield-Gabrieli et al., 2016 sourceNot checked — no full text of the source

May combine two claims.

Data were collected in the context of a high-quality randomized controlled trial using manualized treatment interventions with high therapist adherence to protocol and validity in assessment methods.

“First, data were collected in the context of a high-quality randomized controlled trial using manualized treatment interventions with a high level of therapist adherence to protocol and validity in assessment methods (Craske et al., 2014).”

• cites Craske et al., 2014 sourceSupported

May combine two claims.

The study used a treatment completer analysis rather than an intent-to-treat analysis, which has been criticized due to exclusion of data from individuals who did not fully comply or complete treatment.

“In addition, we used a ‘treatment completer’ analysis, rather than an ‘intent-to-treat’ analysis, which has been criticized due to the exclusion of data from individuals who did not fully comply or did not complete treatment (Gupta, 2011).”

• cites Gupta, 2011 sourceSupported

May combine two claims.

The response rate in this study of 47% is typical when a clinically significant change index is used, whereas other studies have reported higher response rates to cognitive behavioral therapy for social anxiety disorder.

“It should be noted that whereas other studies have reported higher response rates to CBT for SAD, the response rate in this study (47%) is typical when a CSCI is used (Loerinc et al., 2015).”

• cites Loerinc et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

There were no significant connectivity by treatment group interactions and no significant connectivity main effects on the explicit emotion regulation task, with all p values greater than .05.

“There were no significant connectivity × treatment group interactions in moderator analyses and no significant connectivity main effects in predictor analyses on this task (all p > .05).”

May combine two claims.

Among non-responders, none moved into the non-clinical diagnostic range on the Anxiety Disorders Interview Schedule, all retained a clinical severity rating of 4 or higher, although 9 participants achieved significant reductions in self-reported symptomatology on the symptom composite.

“Of the non-responders, none of the participants moved into the non-clinical diagnostic range on the ADIS (all retained a CSR ≥ 4), although 9 (3 CBT, 6 ACT) achieved significant reductions in self-reported symptomatology on the symptom composite measure.”

May combine two claims.

The expected moderation effect that connectivity during reappraisal would predict cognitive behavioral therapy response and connectivity during acceptance would predict acceptance and commitment therapy response was not significant.

“It might be expected that connectivity during reappraisal would predict treatment responses to CBT and connectivity during acceptance would predict treatment response to ACT. However, this moderation effect was not significant in the current analyses.”

May combine two claims.

Of 34 participants, 16 achieved clinically significant change on the clinically significant change index and 18 did not.

“Of the 34 participants included in the analyses, 16 achieved clinically significant change on the CSCI, 18 did not.”

May combine two claims.

Response rates were comparable across treatment conditions, with eight participants in each group achieving responder status.

“Response rates were comparable across treatment conditions with eight participants in each group achieving responder status.”

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

Existing work has identified self-report, clinician assessment, or task performance characteristics that predict responses to cognitive behavioral therapy for anxiety disorders.

“Existing work in this domain has begun to identify a set of characteristics, determined by self-report, clinician assessment or task performance, that are predictive of responses to Cognitive Behavioral Therapy (CBT) for anxiety disorders (Schneider et al., 2015).”

• cites Schneider et al., 2015 sourceNot checked — no full text of the source

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

Many patients with social anxiety disorder do not respond to psychological treatment, with as many as 55% failing to respond or retaining residual symptoms or impairment.

“Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment.”

• Also stated in: § Introduction · plain

  “a large number of patients (as many as 55%; Loerinc et al., 2015) fail to respond to treatment, or retain residual symptoms or impairment following treatment.”

• cites Loerinc et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

Most existing studies have assessed pre-treatment neural activation rather than connectivity and focused on emotional reactivity rather than regulation.

“Most existing studies have assessed pre-treatment measures of neural activation rather than connectivity and focused on emotional reactivity, rather than regulation.”

Probably not a substantial claim: may not pass S4 (based).

No prior studies have assessed the role of emotion regulation in predicting treatment response.

“No prior studies have assessed the role of emotion regulation in predicting treatment response.”

May combine two claims.

Greater symptom reduction following cognitive behavioral therapy for social anxiety disorder was associated with stronger pre-treatment amygdala-anterior cingulate connectivity, stronger amygdala connectivity with caudate and putamen, and reduced amygdala connectivity with central sulcus and right temporo-occipital cluster.

“greater symptom reduction following CBT for SAD was associated with stronger pre-treatment amygdala-ACC connectivity, stronger amygdala connectivity with caudate and putamen, and reduced amygdala connectivity with central sulcus and right temporo-occipital cluster.”

• cites Whitfield-Gabrieli et al., 2016 sourceNot checked — no full text of the source

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

Differences in cognitive load between the affect labeling and explicit regulation tasks may have impacted engagement of regulatory circuitry.

“Alternatively, it is plausible that differences in cognitive load between the affect labeling and explicit regulation tasks impacted engagement of regulatory circuitry.”

May combine two claims.

Findings support a role for activation and connectivity in emotional processing neural circuitry in predicting treatment response, with directions and locations varying across task design.

“In general, these findings support a role for activation and connectivity among neural circuitry involved in emotional processing in predicting treatment response, albeit with specific directions and locations of effects varying across task design.”

Classified as probably not a substantial claim.

The study used leave-one-out k-fold cross-validation to estimate the regression model's predictive utility for unseen data.

“To estimate the predictive value of the regression model for unseen data, we used leave-one-out k-fold cross validation.”

Classified as probably not a substantial claim.

Diagnostic evaluations were conducted using the Anxiety Disorders Interview Schedule-IV by trained interviewers.

“Diagnostic evaluations were conducted using the Anxiety Disorders Interview Schedule-IV (ADIS IV; Brown et al., 1994) by trained interviewers.”

• cites Brown et al., 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). May combine two claims.

Both cognitive behavioral therapy and acceptance and commitment therapy focus on improving emotion regulation, though through different approaches.

“Both CBT and ACT focus on improving emotion regulation, albeit through different approaches.”

• cites Craske, 2010Not matched

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

• cites Hayes et al., 1999Not 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).

Cognitive behavioral therapy teaches reappraisal, the intentional re-framing of negative or unpleasant thoughts or experiences.

“CBT teaches ‘reappraisal’, the intentional re-framing of negative or unpleasant thoughts or experiences (Craske, 2010).”

• cites Craske, 2010Not matched

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

May combine two claims.

The affect labeling and explicit regulation tasks differ in intentionality: reappraisal or acceptance intentionally reduces emotional reactivity, while affect labeling involves recognizing an emotional cue, a more incidental form of regulation.

“The goal of reappraisal or acceptance (explicit task) is to intentionally reduce emotional reactivity, while affect labeling simply involves recognizing an emotional cue, a more incidental form of regulation (Burklund et al., 2014b).”

• cites Burklund et al., 2014bNot matched

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

Classified as probably not a substantial claim.

The use of the clinically significant change index as a measure of treatment responder status provides a reliable and conservative index, ensuring a clinically meaningful definition.

“Second, the use of the CSCI as a measure of treatment responder status provides a reliable and conservative index, ensuring a clinically meaningful definition of this term.”

• cites Loerinc et al., 2015 sourceNot checked — no full text of the source

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

The additional cognitive load of the explicit regulation task may reduce regulatory capacity among all individuals, masking individual differences in the tendency to engage regulatory circuitry.

“Therefore, the additional cognitive load of the explicit regulation task may reduce regulatory capacity among all individuals, masking individual differences in the tendency to engage regulatory circuitry.”

May combine two claims.

The study's small sample size limited statistical power to detect significant moderation effects, and the results should be interpreted as preliminary.

“The primary limitation of this work was the small sample size which limited the power to detect significant moderation effects, and results should be interpreted as preliminary.”

• Also stated in: § Limitations · plain

  “We had limited power to detect significant moderators of treatment response, such as baseline capacity to engage emotion regulation neural circuitry during instructed reappraisal predicting better outcomes to CBT over ACT.”

• Also stated in: § Discussion · hedged

  “However, it should be noted that the current sample size may be too small to sufficiently assess treatment-moderator effects and that with a larger sample, neural moderators of treatment response may be observed.”

Classified as probably not a substantial claim.

A more robust measure of treatment response can be obtained using the clinically significant change index.

“A more robust measure of treatment response can be obtained through use of a ‘clinically significant change index’ (CSCI) (Loerinc et al., 2015).”

• cites Loerinc et al., 2015 sourceNot checked — no full text of the source

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

Previous studies have primarily correlated responses with self-reported symptoms following treatment or categorized treatment responders as those showing greatest symptom reduction.

“previous studies have primarily correlated responses with self-reported symptoms following treatment, or categorized ‘treatment-responders’ as those showing greatest symptom reduction.”

May combine two claims.

Connectivity during affect labeling reflects a generalized tendency to engage regulatory circuitry when faced with emotional stimuli, whereas connectivity during explicit regulation reflects intentional engagement of this circuitry.

“We suggest that connectivity during affect labeling reflects a generalized tendency to engage regulatory circuitry when faced with emotional stimuli, whereas connectivity during explicit regulation reflects intentional engagement of this circuitry.”

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

Acceptance and commitment therapy promotes acceptance, the acknowledgement that emotional experiences are fleeting and can be viewed with perspective.

“ACT promotes ‘acceptance’, the acknowledgement that emotional experiences are fleeting and can be viewed with a sense of perspective (Hayes et al., 1999).”

• cites Hayes et al., 1999Not matched

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