Brain Scans Help Predict Treatment For Social Anxiety Disorder

Brain scans of patients with social anxiety disorder can help determine if cognitive behavioral therapy (CBT) could be an effective treatment option, suggests researchers from MIT, Boston University (BU), and Massachusetts General Hospital (MGH) in the Archives of General Psychiatry.

Either CBT or medications are normally used to treat social anxiety, but scientists have not been able to identify which of these treatments will suit a particular individual best.

By looking at photos of faces and measuring brain activity, the usefulness of therapy could be determined before the sessions even start, according to the team.

With about 15 million people in the United States struggling with the disorder, authors believe these findings will help doctors decide which treatment is right for each patient.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," said John Gabrieli, lead author, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, and a member of the McGovern Institute for Brain Research.

Choosing The Right Treatment

CBT is known for changing the thought and behavior patterns that give the sufferer anxiety, such as feelings of intense fear in social settings that impair their ability to act normally. Some patients have anxiety because they think that others are watching them, however, the therapy shows that their beliefs are false and no one is judging them.

The current study is part of a larger one that MGH and BU conducted recently on cognitive behavioral therapy for social anxiety.

Gabrieli explained:

"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."

Although some patients find the idea of taking pills easier than going to therapy, it is not an effective method of treatment. Some doctors, on the other hand, are currently making decisions about treatment based on what their patient's insurance covers or because of potential drug side effects.

"From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli commented.

In order to image patients' brains before and after treatment, functional magnetic resonance imaging (fMRI) was used. Imaging has never before been used as a way to predict a patient's reactions to a certain treatment, although some imaging studies have shown brain differences between patients with nueropyschiatric disorders and their healthy counterparts.

Measuring Differences in Brain Activity

Experts in the new study had subjects look at images of angry or neutral faces, in order to identify differences in brain activity as they observed. Social anxiety levels were tested after undergoing 12 weeks of CBT.

Results showed that those who benefited the most from therapy were the individuals who had shown a greater difference in activity in high-level visual processing areas during the face-response task.

It is unclear why activity in brain regions involved with visual processing would be a good indicator of treatment outcomes, according to Gabrieli. He believes it could be because the patients who received more benefits were those whose brains were already adept at separating different types of experiences.

The authors are carrying out further research to determine if brain scans can predict differences in response between cognitive behavioral therapy and drug treatments.

Gabrieli concluded:

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome of therapy. The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."