Nav: Home

Quick evaluation can predict whether drugs, talk therapy work better for anxiety patients

December 07, 2017

Clinicians and patients often struggle to find the right treatment for anxiety, sometimes cycling through various therapies for months before the patient begins to feel their symptoms improve.

Now, researchers at the University of Illinois at Chicago have found that a brief test that can be performed in the office can help determine whether an antidepressant or a form of talk therapy, called cognitive behavioral therapy or CBT, would be better at relieving symptoms of anxiety in individual patients. Their findings are reported in the journal Neuropsychopharmacology.

Selective serotonin reuptake inhibitors (SSRIs) and CBT are two often-used, first-line treatment options for anxiety. SSRIs are believed to relieve anxiety symptoms by modifying the transmission of serotonin in the brain. CBT helps patients modify dysfunctional thoughts and behaviors and encourages them to develop new cognitive and behavioral techniques to manage mood and anxiety symptoms. Both are generally and equally effective for treating anxiety, but who responds to one versus the other remains a mystery. In previous research, Stephanie Gorka, assistant professor of psychiatry in the UIC College of Medicine and lead author on the paper, showed that higher electrical activity in the brain in response to committing an error - known as error-related negativity or ERN - was associated with greater symptoms of anxiety.

"People with anxiety disorders tend to show an exaggerated neural response to their own mistakes," said Gorka. "This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder."

ERN can be measured using electroencephalography, or EEG, which records electrical signals from the brain through the scalp. A cap embedded with electrodes can pick up these signals. A larger ERN signal reflects an enhanced brain response when a mistake is made.

To elicit errors, participants in Gorka's study wore an EEG cap while they performed a task that required them to quickly and accurately indicate the direction of a center arrow embedded within a string of arrows on a computer screen. A new screen would appear each time the participant indicated the direction of the center arrow using a button. "The task is a bit harder than it sounds and the pace picks up, which inevitably leads to mistakes," Gorka said.

Gorka and colleagues recruited 60 adult volunteers with anxiety disorders and 26 healthy participants with no history of mental health problems. All participants completed the arrow task while undergoing EEG. Next, participants with anxiety disorders were randomized to take an SSRI every day for 12 weeks, or to 12 weekly sessions of CBT delivered by a psychotherapist. After treatment, all participants completed the arrow task again to assess whether there were changes in neural reactivity related to making mistakes.

The researchers found that an enhanced ERN at the beginning of treatment was associated with greater reduction in anxiety for participants who received CBT, but not for those who received SSRIs. In fact, participants prescribed SSRIs had even more enhanced ERN at the end of the 12-week treatment period.

"We found that ERN can help predict which patients will achieve better outcomes with cognitive behavioral therapy, and that information is very useful because that CBT is a time-intensive, less-available resource and because SSRIs can be associated with side effects, it's good to know that a patient will do better on CBT to reduce the exposure to potential side effects," Gorka said.

"Using EEG to measure ERN before deciding on a treatment give us a simple and objective way to help more people get the right treatment the first time around," said Dr. K. Luan Phan, professor of psychiatry in the UIC College of Medicine and a senior author on the paper. "Patients tend to leave treatment when the first attempt fails to reduce their symptoms. Once people drop out, we lose the opportunity to take care of them, and ultimately these patients continue to suffer from their anxiety," continued Phan, who holds the University of Illinois Center on Depression and Resilience Professorship.

Gorka thinks that participants with enhanced ERN do better with CBT because they respond well to the structured learning that occurs in the context of individual therapy. "CBT is all about learning new techniques for reducing anxiety and learning to reframe overly negative ideas or feelings. People highly attuned to their own behavior, as evidenced by their enhanced ERN, might just be more receptive and attentive to the lessons learned through CBT," she said.

The total time for set up and arrow task completion is less than 30 minutes, and because EEG equipment is relatively cheap, portable and available, Gorka thinks that it can be easily incorporated into practitioners' office settings and decision-making process when it comes to determining treatment.
-end-
Heide Klumpp, Jennifer Francis, Scott Langenecker, Stewart Shankman, Scott Mariouw, Dr. Olusola Ajilore, Kaveh Afshar, and Amy Kennedy, of UIC and Michelle Craske of the University of California, Los Angeles, are co-authors on the paper.

This research was supported by grant R01 MH101497 from the National Institute of Mental Health and by grant UL1RR029879 from the University of Illinois at Chicago Center for Clinical and Translational Sciences.

University of Illinois at Chicago

Related Brain Articles:

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.
Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.
Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.
Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.
BRAIN Initiative tool may transform how scientists study brain structure and function
Researchers have developed a high-tech support system that can keep a large mammalian brain from rapidly decomposing in the hours after death, enabling study of certain molecular and cellular functions.
Wiring diagram of the brain provides a clearer picture of brain scan data
In a study published today in the journal BRAIN, neuroscientists led by Michael D.
Blue Brain Project releases first-ever digital 3D brain cell atlas
The Blue Brain Cell Atlas is like ''going from hand-drawn maps to Google Earth'' -- providing previously unavailable information on major cell types, numbers and positions in all 737 brain regions.
Landmark study reveals no benefit to costly and risky brain cooling after brain injury
A landmark study, led by Monash University researchers, has definitively found that the practice of cooling the body and brain in patients who have recently received a severe traumatic brain injury, has no impact on the patient's long-term outcome.
Brain cells called astrocytes have unexpected role in brain 'plasticity'
Researchers from the Salk Institute have shown that astrocytes -- long-overlooked supportive cells in the brain -- help to enable the brain's plasticity, a new role for astrocytes that was not previously known.
Largest brain study of 62,454 scans identifies drivers of brain aging
In the largest known brain imaging study, scientists from Amen Clinics (Costa Mesa, CA), Google, John's Hopkins University, University of California, Los Angeles and the University of California, San Francisco evaluated 62,454 brain SPECT (single photon emission computed tomography) scans of more than 30,000 individuals from 9 months old to 105 years of age to investigate factors that accelerate brain aging.
More Brain News and Brain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#555 Coronavirus
It's everywhere, and it felt disingenuous for us here at Science for the People to avoid it, so here is our episode on Coronavirus. It's ok to give this one a skip if this isn't what you want to listen to right now. Check out the links below for other great podcasts mentioned in the intro. Host Rachelle Saunders gets us up to date on what the Coronavirus is, how it spreads, and what we know and don't know with Dr Jason Kindrachuk, Assistant Professor in the Department of Medical Microbiology and infectious diseases at the University of Manitoba. And...
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.