Brain Imaging Provides Social Anxiety Therapy Route

Internal Medicine World Report, November 2014,

Analyzing the brain patterns of social anxiety disorder (SAD) patients, Massachusetts Institute of Technology (MIT), Boston University (BU), and Massachusetts General Hospital (MGH), neuroscientists uncovered a method to pinpoint which candidates will benefit from cognitive behavioral therapy (CBT).

Analyzing the brain patterns of social anxiety disorder (SAD) patients, Massachusetts Institute of Technology (MIT), Boston University (BU), and Massachusetts General Hospital (MGH), neuroscientists uncovered a method to pinpoint which candidates will benefit from cognitive behavioral therapy (CBT).

Experiencing debilitating symptoms, SAD patients’ symptoms heavily affect how they function every day and in society. CBT — a possible treatment – aimed to modify thought processes which induced anxiety. However, doctors consider using CBT based on several factors such as difficulty taking pills versus attending therapy, possible side effects, and insurance eligibility, an MIT statement mentioned.

“From a science perspective there’s very little evidence about which treatment is optimal for a person,” John Gabrieli, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, a member of the McGovern Institute for Brain Research, and senior author of the study said.

Part of larger MGH and BU research on social anxiety, their JAMA Psychiatry study compared 39 non-medicated SAD patients’ functional Magnetic Resonance Imaging (fMRI) scans before and after undergoing 12 weeks of CBT. While undergoing fMRIs, the researchers subjected the participants to angry and neutral faces or emotional and neutral scenes, and analyzed their brain activity.

“This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment,” said Gabrieli.

In doing so, the neuroscientists noted that subjects who exhibited high-level visual processing in their higher-order visual cortex regions during the face-response activity, benefitted the most from CBT.

“Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline,” the investigators reported.

While the mechanism fueling this trend is unknown to researchers, Gabrieli hypothesized that successful CBT patients were already able to categorize varying experiences.

“The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient,” the authors determined.

Moving forward, the team plans to study if brain scans can also identify variations between CBT and drug treatments.