Neural response during attentional control and emotion processing predicts improvement after cognitive behavioral therapy in generalized social anxiety disorder
Open accessAbstract
Background: Individuals with generalized social anxiety disorder (gSAD) exhibit attentional bias to salient stimuli, which is reduced in patients whose symptoms improve after treatment, indicating that mechanisms of bias mediate treatment success. Therefore, pre-treatment activity in regions implicated in attentional control over socio-emotional signals (e.g. anterior cingulate cortex, dorsolateral prefrontal cortex) may predict response to cognitive behavioral therapy (CBT), evidence-based psychotherapy for gSAD. Method: During functional magnetic resonance imaging, 21 participants with gSAD viewed images comprising a trio of geometric shapes (circles, rectangles or triangles) alongside a trio of faces (angry, fearful or happy) within the same field of view. Attentional control was evaluated with the instruction to ‘match shapes’, directing attention away from faces, which was contrasted with ‘match faces’, whereby attention was directed to emotional faces. Results: Whole-brain voxel-wise analyses showed that symptom improvement was predicted by enhanced pre-treatment activity in the presence of emotional face distractors in the dorsal anterior cingulate cortex and dorsal medial prefrontal cortex. Additionally, CBT success was foretold by less activity in the amygdala and/or increased activity in the medial orbitofrontal gyrus during emotion processing. Conclusions: CBT response was predicted by pre-treatment activity in prefrontal regions and the amygdala. The direction of activity suggests that individuals with intact attentional control in the presence of emotional distractors, regulatory capacity over emotional faces and/or less reactivity to such faces are more likely to benefit from CBT. Findings indicate that baseline neural activity in the context of attentional control and emotion processing may serve as a step towards delineating mechanisms by which CBT exerts its effects.
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Greater symptom reduction following cognitive behavioral therapy is associated with greater pre-treatment neural responses to emotional stimuli within anterior cingulate cortex, dorsomedial/ventromedial prefrontal cortex, and occipital and parietal areas.
“greater symptom reduction following CBT was associated with greater pre-treatment neural responses to emotional stimuli (emotional faces or rejecting statements) within the anterior cingulate cortex (ACC), dm/vmPFC and areas of occipital and parietal lobe (dACC and dmPFC; Burklund et al., 2017; Doehrmann et al., 2013; Klumpp et al., 2014; Klumpp et al., 2013)”
From Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder. (2019) · cites this paper as Klumpp et al., 2014
The Discussion (page not provided) links greater CBT improvement to higher pre-treatment dorsal ACC and dmPFC activity during attentional control in the presence of emotional faces, and to higher vmPFC activity during emotion perception. It does not report the claimed positive association in occipital and parietal areas; instead, it says its visual-region finding was limited to the inferior temporal gyrus, where less activity predicted improvement. (LLM, conf=0.89)
Experimental — accuracy not yet measuredPre-treatment neural activity in amygdala, dACC, prefrontal, occipital, and temporal regions during simple perceptual matching tasks has predicted CBT responses in SAD participants.
“A handful of emerging studies have found that pre-treatment neural activity in amygdala, dACC, prefrontal, occipital, and temporal regions during simple perceptual matching tasks has predicted responses to CBT in SAD participants (Doehrmann et al., 2013; Klumpp et al., 2013, 2014).”
From Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder (2017) · cites this paper as Klumpp et al., 2014
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).”
From Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder. (2019) · cites this paper as Klumpp et al., 2014
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References 86 · Cited by 75
Research works printed but not linked: 1
- Hope DA Heimberg RG Turk CL 2006 Managing Social Anxiety: A Cognitive–Behavioral Therapy Approach Oxford University Press New York
- Authors
- Klumpp, H., Fitzgerald, D. A., Angstadt, M., Post, D., & Phan, K. L.
- Affiliations
- University of Illinois Chicago (US)
- University of Michigan (US)
- Corresponding author
- Klumpp, H.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-03-21
- Volume
- 44
- Issue
- 14
- Pages
- 3109-3121
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4376309
- OpenAlex
- W2170184275
- Cited by
- 75
- References
- 86
- Citations by year
- 2026: 5 · 2025: 3 · 2023: 6 · 2022: 13 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 10 · 2017: 6 · 2016: 11 · 2015: 6 · 2014: 3
- FWCI
- 12.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Michigan
- National Institutes of Health
- Medical School, University of Michigan
- National Institute of Mental Health (MH076198, MH093679, K23MH093679, K23MH076198)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Face Recognition and Perception
- Keywords
- generalized social anxiety disorder, cognitive behavioral therapy, treatment response prediction, attentional bias, attentional control, emotional processing, dorsal anterior cingulate cortex, dorsomedial prefrontal cortex, amygdala
- MeSH terms
- Adult, Amygdala, Attention, Emotions, Facial Expression, Female, Humans, Magnetic Resonance Imaging, Male, Phobic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Prefrontal Cortex, Young Adult, Executive Function
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