Emotion regulation related neural predictors of cognitive behavioral therapy response in social anxiety disorder
Open accessAbstract
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.
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fMRI studies of pretreatment brain predictors have reported that lesser rostral anterior cingulate cortex and lesser left DLPFC activity during reappraisal of negative images, inverse connectivity between amygdala and right VLPFC during affect labeling, greater occipitotemporal activation to angry vs neutral faces, and dorsal ACC activation during self-referential criticism are associated with响应
“fMRI studies of pretreatment brain predictors have reported that lesser rostral anterior cingulate cortex and lesser left DLPFC activity during reappraisal of negative images, 42,43 inverse connectivity between amygdala and right VLPFC during affect labeling, 44 greater occipitotemporal activation to angry vs neutral faces, 45 and dorsal ACC activation 46 during self-referential criticism are”
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“Reappraisal is an antecedent form of regulation directed at cognitively changing a situation to alter its emotional significance; it is considered an adaptive, explicit regulation approach known to engender social support and psychological well-being (Gross and John, 2003).”
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“, “reframing”) an aversive stimulus to decrease the negative affect evoked by it (Webb et al., 2012), an approach that generally echoes cognitive strategies employed in CBT, for example, generating alternative appraisals to negate negative beliefs (Hofmann, 2004; Hope et al.”
Cognitive Reappraisal of Emotion: A Meta-Analysis of Human Neuroimaging Studies
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“The clinical implication is that pre-CBT variation in frontal activity during reappraise may interact with CBT outcome as this cognitive approach is a proxy to the interventions practiced in CBT (e.g., cognitive restructuring) (Arch and Craske, 2009).”
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- Authors
- Klumpp, H., Roberts, J., Kennedy, A. E., Shankman, S. A., Langenecker, S. A., Gross, J. J., & Phan, K. L.
- Affiliations
- University of Illinois Chicago (US)
- Stanford University (US)
- Corresponding author
- Klumpp, Heide
- ORCID
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 75
- Pages
- 106-112
- ISSN
- 0278-5846 (ISSN-L)
- PMC
- PMC9278876
- OpenAlex
- W2581558860
- Cited by
- 34
- References
- 19
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 7 · 2017: 4
- FWCI
- 7.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH (K23MH093679, R01MH101497)
- Brain & Behavior Research Foundation
- Center for Clinical and Translational Research (UL1RR029879)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- social anxiety disorder, cognitive behavioral therapy, emotion regulation, cognitive reappraisal, dorsolateral prefrontal cortex, treatment response prediction, neural predictors, cognitive restructuring, symptom severity reduction, individual differences
- MeSH terms
- Phobia, Social, Adolescent, Adult, Brain Mapping, Emotions, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Oxygen, Psychiatric Status Rating Scales, ROC Curve, Cognitive Behavioral Therapy, Treatment Outcome, Prefrontal Cortex, Young Adult
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