Format

Send to

Choose Destination
J Affect Disord. 2014 Dec;169:76-85. doi: 10.1016/j.jad.2014.07.031. Epub 2014 Aug 7.

Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions.

Author information

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.

KEYWORDS:

Amygdala; CBT; GAD; Imaging; Psychotherapy

PMID:
25171782
PMCID:
PMC4172549
DOI:
10.1016/j.jad.2014.07.031
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center