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

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

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Amygdala / physiopathology
  • Anger
  • Anxiety Disorders / physiopathology
  • Anxiety Disorders / therapy*
  • Case-Control Studies
  • Cognition
  • Cognitive Behavioral Therapy*
  • Cues
  • Emotions
  • Facial Expression
  • Fear
  • Female
  • Gyrus Cinguli / physiopathology*
  • Happiness
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Young Adult