Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder

• Published in: Psychiatry research Vol. 214; no. 3; pp. 229 - 237
• Main Authors: Månsson, Kristoffer N.T, Carlbring, Per, Frick, Andreas, Engman, Jonas, Olsson, Carl-Johan, Bodlund, Owe, Furmark, Tomas, Andersson, Gerhard
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 2013; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Amygdala; Amygdala - physiology; Amygdala - physiopathology; Anxiety Disorders - physiopathology; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Anxiety disorders. Neuroses; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive behavior therapy; Cognitive Therapy; dlPFC; Emotions; Facial Expression; Female; fMRI; Humans; Internet; Magnetic Resonance Imaging; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; mOFC; Phobia; Phobic Disorders - physiopathology; Phobic Disorders - psychology; Phobic Disorders - therapy; Psychiatry; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; psykologi; Radiology; Treatment Outcome; Treatments; vlPFC; Young Adult; fMRI; Amygdala; Cognitive behavior therapy; mOFC; dlPFC; vlPFC; Affect affectivity; Social phobia; Central nervous system; Anxiety disorder; Encephalon; Dorsolateral prefrontal cortex; Functional magnetic resonance imaging; Behavior therapy; Amygdaloid nucleus; Ventrolateral prefrontal cortex; Human; Orbitofrontal cortex; Cognitive therapy; Basal ganglion; Nuclear magnetic resonance imaging; Treatment; Medical imagery; Internet; Functional imaging
• ISSN: 0925-4927; 0165-1781; 1872-7123; 1872-7506; 1872-7506
• DOI: 10.1016/j.pscychresns.2013.08.012

Abstract Randomized controlled trials have yielded promising results for internet-delivered cognitive behavior therapy (iCBT) for patients with social anxiety disorder (SAD). The present study investigated anxiety-related neural changes after iCBT for SAD. The amygdala is a critical hub in the neural fear network, receptive to change using emotion regulation strategies and a putative target for iCBT. Twenty-two subjects were included in pre- and post-treatment functional magnetic resonance imaging at 3T assessing neural changes during an affective face processing task. Treatment outcome was assessed using social anxiety self-reports and the Clinical Global Impression-Improvement (CGI-I) scale. ICBT yielded better outcome than ABM (66% vs. 25% CGI-I responders). A significant differential activation of the left amygdala was found with relatively decreased reactivity after iCBT. Changes in the amygdala were related to a behavioral measure of social anxiety. Functional connectivity analysis in the iCBT group showed that the amygdala attenuation was associated with increased activity in the medial orbitofrontal cortex and decreased activity in the right ventrolateral and dorsolateral (dlPFC) cortices. Treatment-induced neural changes with iCBT were consistent with previously reported studies on regular CBT and emotion regulation in general.