Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders

J Neuropsychiatry Clin Neurosci. 2009 Spring;21(2):114-25. doi: 10.1176/jnp.2009.21.2.114.


This systematic review aims to investigate neurobiological changes related to cognitive-behavioral therapy (CBT) in anxiety disorders detected through neuroimaging techniques and to identify predictors of response to treatment. Cognitive-behavioral therapy modified the neural circuits involved in the regulation of negative emotions and fear extinction in judged treatment responders. The only study on predictors of response to treatment was regarding obsessive-compulsive disorder and showed higher pretreatment regional metabolic activity in the left orbitofrontal cortex associated with a better response to behavioral therapy. Despite methodological limitations, neuroimaging studies revealed that CBT was able to change dysfunctions of the nervous system.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anxiety Disorders / pathology*
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Brain / pathology*
  • Brain Mapping / methods
  • Cognitive Behavioral Therapy / methods*
  • Diagnostic Imaging / methods*
  • Humans