Predicting how patients respond to therapySeptember 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.
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
Even moderate picky eating can have negative effects on children's health
Picky eating among children is a common but burdensome problem that can result in poor nutrition for kids, family conflict, and frustrated parents.
Attention-control video game curbs combat vets' PTSD symptoms
A computerized attention-control training program significantly reduced combat veterans' preoccupation with - or avoidance of -- threat and attendant PTSD symptoms.
Doing good deeds helps socially anxious people relax
Being busy with acts of kindness can help people who suffer from social anxiety to mingle more easily. This is the opinion of Canadian researchers Jennifer Trew of Simon Fraser University and Lynn Alden of the University of British Columbia, in a study published in Springer's journal Motivation and Emotion.
Individuals with social phobia have too much serotonin -- not too little
Previous studies have led researchers to believe that individuals with social anxiety disorder/ social phobia have too low levels of the neurotransmitter serotonin.
Animals' presence may ease social anxiety in kids with autism
Animals' presence may ease social anxiety in kids with autism NIH-funded study could have implications for treatment
Nail biters, beware: Teeth grinding is next
Anxiety disorders affect approximately one in six adult Americans, according to the National Institute of Mental Health.
Discovery may open door for treating fragile X carriers
Fragile X syndrome, an inherited cause of autism and intellectual disability, can have consequences even for carriers of the disorder who don't have full-blown symptoms.
Scientists create the sensation of invisibility
The power of invisibility has long fascinated man and inspired the works of many great authors and philosophers.
How oxytocin makes a mom: Hormone teaches maternal brain to respond to offspring's needs
Neuroscientists at NYU Langone Medical Center have discovered how the powerful brain hormone oxytocin acts on individual brain cells to prompt specific social behaviors - findings that could lead to a better understanding of how oxytocin and other hormones could be used to treat behavioral problems resulting from disease or trauma to the brain.
Link between social anxiety and drug use offers opportunities for more effective treatment
A team led by Case Western Reserve researchers has identified a potentially powerful approach to lowering relapse rates among the ranks of those addicted to illegal drugs or alcohol.
More Social Anxiety Current Events and Social Anxiety News Articles