---

Predicting how patients respond to therapy

September 07, 2012

Brain scans could help doctors choose treatments for people with social anxiety disorder

CAMBRIDGE, MA -- A new study led by MIT neuroscientists has found that brain scans of patients with social anxiety disorder can help predict whether they will benefit from cognitive behavioral therapy.

Social anxiety is usually treated with either cognitive behavioral therapy or medications. However, it is currently impossible to predict which treatment will work best for a particular patient. The team of researchers from MIT, Boston University (BU) and Massachusetts General Hospital (MGH) found that the effectiveness of therapy could be predicted by measuring patients' brain activity as they looked at photos of faces, before the therapy sessions began.

The findings, published this week in the Archives of General Psychiatry, may help doctors choose more effective treatments for social anxiety disorder, which is estimated to affect around 15 million people in the United States.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," says 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 paper.

Lead authors of the paper are MIT postdoc Oliver Doehrmann and Satrajit Ghosh, a research scientist in the McGovern Institute.

Choosing treatments

Sufferers of social anxiety disorder experience intense fear in social situations that interferes with their ability to function in daily life. Cognitive behavioral therapy aims to change the thought and behavior patterns that lead to anxiety. For social anxiety disorder patients, that might include learning to reverse the belief that others are watching or judging them.

The new paper is part of a larger study that MGH and BU ran recently on cognitive behavioral therapy for social anxiety, led by Mark Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at MGH, and Stefan Hofmann, director of the Social Anxiety Program at BU.

"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," Gabrieli says.

Currently doctors might choose a treatment based on factors such as ease of taking pills versus going to therapy, the possibility of drug side effects, or what the patient's insurance will cover. "From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli says.

The researchers used functional magnetic resonance imaging (fMRI) to image the brains of patients before and after treatment. There have been many imaging studies showing brain differences between healthy people and patients with neuropsychiatric disorders, but so far imaging has not been established as a way to predict patients' responses to particular treatments.

Measuring brain activity

In the new study, the researchers measured differences in brain activity as patients looked at images of angry or neutral faces. After 12 weeks of cognitive behavioral therapy, patients' social anxiety levels were tested. The researchers found that patients who had shown a greater difference in activity in high-level visual processing areas during the face-response task showed the most improvement after therapy.

Gabrieli says it's unclear why activity in brain regions involved with visual processing would be a good predictor of treatment outcome. One possibility is that patients who benefited more were those whose brains were already adept at segregating different types of experiences, Gabrieli says.

The researchers are now planning a follow-up study to investigate whether brain scans can predict differences in response between cognitive behavioral therapy and drug treatment.

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome" of therapy, Gabrieli says. "The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."

###

The research was funded by the Poitras Center for Affective Disorders Research and the National Institute of Mental Health.

Massachusetts Institute of Technology

Related Social Anxiety Current Events and Social Anxiety News Articles

To suppress or to explore? Emotional strategy may influence anxiety
When trouble approaches, what do you do? Run for the hills? Hide? Pretend it isn't there? Or do you focus on the promise of rain in those looming dark clouds?

Reframing stress: Stage fright can be your friend
Fear of public speaking tops death and spiders as the nation's number one phobia. But new research shows that learning to rethink the way we view our shaky hands, pounding heart, and sweaty palms can help people perform better both mentally and physically.

Do I know you? Memory patterns help us recall the social webs we weave, finds new Cornell study
With a dizzying number of ties in our social networks - that your Aunt Alice is a neighbor of Muhammad who is married to Natasha who is your wife's boss - it's a wonder we remember any of it.

Persistent Negative Attitude Can Undo Effectiveness of Exposure Therapy for Phobias
Because confronting fear won't always make it go away, researchers suggest that people with phobias must alter memory-driven negative attitudes about feared objects or events to achieve a more lasting recovery from what scares them the most.

Genetic defect causing fragile X-related disorders more common than thought
A single genetic defect on the X chromosome that can result in a wide array of conditions - from learning and emotional difficulties to primary ovarian insufficiency in women and tremors in middle-aged men - occurs at a much greater frequency than previously thought, research led by the UC Davis MIND Institute has found.

Is that nervous feeling social anxiety disorder, or is it simply a case of being shy?
Most people are faced with embarrassment or humiliation at some point in their lives. Maybe they get nervous before a big presentation to the bosses at work. Maybe they get a bit anxious thinking about approaching an attractive stranger at a party. But where is the line between normal shyness and social anxiety disorder?

Trickle-Down Anxiety: Study Examines Parental Behaviors that Create Anxious Children
Parents with social anxiety disorder are more likely than parents with other forms of anxiety to engage in behaviors that put their children at high risk for developing angst of their own, according to a small study of parent-child pairs conducted at Johns Hopkins Children's Center.

Male Ontario students show declines in fighting; females show elevated bullying and mental distress
An ongoing survey of Ontario students in grades 7 to 12 conducted for the Centre for Addiction and Mental Health (CAMH) shows that while the majority of students have healthy relationships and report overall good mental and physical health, some negative trends, especially among girls, have raised concerns.

Research at UH finds cognitive-behavioral therapy effective in combatting anxiety disorders
Whether it is a phobia like a fear of flying, public speaking or spiders, or a diagnosis such as obsessive compulsive disorder, new research finds patients suffering from anxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) in conjunction with a "transdiagnostic" approach - a model that allows therapists to apply one set of principles across anxiety disorders.

Avatars may help children with social anxiety overcome fears
A principal standing in the hallway says, "You are one of my favorite students!" In class, a smart girl says, "You are the nicest person in our class!"

---

More Social Anxiety Current Events and Social Anxiety News Articles

---