Gregory A Fonzo1, Holly J Ramsawh2, Taru M Flagan2, Sarah G Sullivan2, Alan N Simmons3, Martin P Paulus4, Murray B Stein5. 1. San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA. Electronic address: gfonzo@ucsd.edu. 2. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA. 3. VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center of Excellence in Stress and Mental Health, San Diego, CA, USA. 4. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326, USA. 5. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA.
Abstract
BACKGROUND: The neural processes underlying the benefits of cognitive behavioral treatment (CBT) for generalized anxiety disorder (GAD) are not well understood. METHODS: Twenty-one (n=21) adults with a principal diagnosis of GAD and eleven (n=11) non-anxious healthy controls (HC) underwent functional magnetic resonance imaging while completing a facial emotion processing task. Responses to threat-related emotionality (i.e., the contrast of fear and angry vs. happy faces) were assessed at pretreatment and again following 10 sessions of CBT in the GAD group and a comparable waiting period in the HC group. RESULTS: At pretreatment, GAD participants displayed blunted responses in the amygdala, insula, and anterior cingulate to the happy face-processing comparison condition, and greater amygdalo-insular connectivity. CBT was associated with attenuated amygdalar and subgenual anterior cingulate activation to fear/angry faces and heightened insular responses to the happy face comparison condition, but had no apparent effects on connectivity. Pre-treatment abnormalities and treatment-related changes were not associated with symptoms of worry. LIMITATIONS: There was no active control condition (e.g., treatment waitlist) for comparison of treatment effects. CONCLUSIONS: Taken together, these results provide evidence for a dual-process psychotherapeutic model of neural systems changes in GAD in which cingulo-amygdalar reactivity to threat-cues is attenuated while insular responses to positive facial emotions are potentiated. Future work is needed to determine the clinical implications of these changes and their specificity to CBT.
BACKGROUND: The neural processes underlying the benefits of cognitive behavioral treatment (CBT) for generalized anxiety disorder (GAD) are not well understood. METHODS: Twenty-one (n=21) adults with a principal diagnosis of GAD and eleven (n=11) non-anxious healthy controls (HC) underwent functional magnetic resonance imaging while completing a facial emotion processing task. Responses to threat-related emotionality (i.e., the contrast of fear and angry vs. happy faces) were assessed at pretreatment and again following 10 sessions of CBT in the GAD group and a comparable waiting period in the HC group. RESULTS: At pretreatment, GAD participants displayed blunted responses in the amygdala, insula, and anterior cingulate to the happy face-processing comparison condition, and greater amygdalo-insular connectivity. CBT was associated with attenuated amygdalar and subgenual anterior cingulate activation to fear/angry faces and heightened insular responses to the happy face comparison condition, but had no apparent effects on connectivity. Pre-treatment abnormalities and treatment-related changes were not associated with symptoms of worry. LIMITATIONS: There was no active control condition (e.g., treatment waitlist) for comparison of treatment effects. CONCLUSIONS: Taken together, these results provide evidence for a dual-process psychotherapeutic model of neural systems changes in GAD in which cingulo-amygdalar reactivity to threat-cues is attenuated while insular responses to positive facial emotions are potentiated. Future work is needed to determine the clinical implications of these changes and their specificity to CBT.
Authors: Laura Campbell-Sills; Alan N Simmons; Kathryn L Lovero; Alexis A Rochlin; Martin P Paulus; Murray B Stein Journal: Neuroimage Date: 2010-07-29 Impact factor: 6.556
Authors: Gregory A Fonzo; Alan N Simmons; Steven R Thorp; Sonya B Norman; Martin P Paulus; Murray B Stein Journal: Biol Psychiatry Date: 2010-06-22 Impact factor: 13.382
Authors: Tomas Furmark; Maria Tillfors; Ina Marteinsdottir; Håkan Fischer; Anna Pissiota; Bengt Långström; Mats Fredrikson Journal: Arch Gen Psychiatry Date: 2002-05
Authors: Sonya B Norman; Laura Campbell-Sills; Carla A Hitchcock; Sarah Sullivan; Alexis Rochlin; Kendall C Wilkins; Murray B Stein Journal: J Psychiatr Res Date: 2010-07-07 Impact factor: 4.791
Authors: Carmen Andreescu; James J Gross; Eric Lenze; Kathryn Dunfee Edelman; Sara Snyder; Costin Tanase; Howard Aizenstein Journal: Depress Anxiety Date: 2011-03 Impact factor: 6.505
Authors: Elizabeth A Flook; Joseph R Luchsinger; Marisa M Silveri; Danny G Winder; Margaret M Benningfield; Jennifer Urbano Blackford Journal: Addict Biol Date: 2020-01-28 Impact factor: 4.280
Authors: Chloe U Wallis; Rudolf N Cardinal; Laith Alexander; Angela C Roberts; Hannah F Clarke Journal: Proc Natl Acad Sci U S A Date: 2017-05-01 Impact factor: 11.205