Anterior cingulate cortex activity as a candidate biomarker for treatment selection in social anxiety disorder

Andreas Frick; Jonas Engman; Kurt Wahlstedt; Malin Gingnell; Mats Fredrikson; Tomas Furmark

doi:10.1192/bjo.2018.15

Anterior cingulate cortex activity as a candidate biomarker for treatment selection in social anxiety disorder

BJPsych Open. 2018 May 11;4(3):157-159. doi: 10.1192/bjo.2018.15. eCollection 2018.

Authors

Andreas Frick¹, Jonas Engman², Kurt Wahlstedt², Malin Gingnell³, Mats Fredrikson⁴, Tomas Furmark²

Affiliations

¹ Department of Psychology, Uppsala University, Sweden and Department of Psychology, Stockholm University, Sweden.
² Department of Psychology, Uppsala University, Sweden.
³ Department of Psychology, Uppsala University, Sweden and Department of Neuroscience, Uppsala University, Sweden.
⁴ Department of Psychology, Uppsala University, Sweden and Department of Clinical Neuroscience, Karolinska Institutet, Sweden.

Abstract

We aimed to identify biomarkers to guide the decision to add selective serotonin reuptake inhibitors (SSRI) to psychological treatment for social anxiety disorder (SAD). Forty-eight patients with SAD underwent functional magnetic resonance imaging and collection of clinical and demographic variables before treatment with cognitive-behavioural therapy, combined on a double-blind basis with either escitalopram or placebo for 9 weeks. Pre-treatment neural reactivity to aversive faces in the dorsal anterior cingulate cortex (ACC), but not clinical/demographic variables, moderated clinical outcomes. Cross-validated individual-level predictions accurately identified 81% of responders/non-responders. Dorsal ACC reactivity is thus a potential biomarker for SAD treatment selection.

Declaration of interest: None.

Keywords: Functional magnetic resonance imaging; anxiety; cognitive–behavioural therapy; prediction; selective serotonin reuptake inhibitors; social phobia.