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Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder
Stockholm University, Faculty of Social Sciences, Department of Psychology.
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2013 (English)In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, Vol. 214, no 3, 229-237 p.Article in journal (Refereed) Published
Abstract [en]

Randomized controlled trials have yielded promising results for internet-delivered cognitive behavior therapy (iCBT) for patients with social anxiety disorder (SAD). The present study investigated anxiety-related neural changes after iCBT for SAD. The amygdala is a critical hub in the neural fear network, receptive to change using emotion regulation strategies and a putative target for iCBT. Twenty-two subjects were included in pre- and post-treatment functional magnetic resonance imaging at 3T assessing neural changes during an affective face processing task. Treatment outcome was assessed using social anxiety self-reports and the Clinical Global Impression-Improvement (CGI-I) scale. ICBT yielded better outcome than ABM (66% vs. 25% CGI-I responders). A significant differential activation of the left amygdala was found with relatively decreased reactivity after iCBT. Changes in the amygdala were related to a behavioral measure of social anxiety. Functional connectivity analysis in the iCBT group showed that the amygdala attenuation was associated with increased activity in the medial orbitofrontal cortex and decreased activity in the right ventrolateral and dorsolateral (dlPFC) cortices. Treatment-induced neural changes with iCBT were consistent with previously reported studies on regular CBT and emotion regulation in general.

Place, publisher, year, edition, pages
2013. Vol. 214, no 3, 229-237 p.
Keyword [en]
amygdala, cognitive behavior therapy, dlPFC, fMRI, mOFC, vlPFC
National Category
Psychology Neurosciences
Research subject
URN: urn:nbn:se:su:diva-96831DOI: 10.1016/j.pscychresns.2013.08.012ISI: 000327531600008OAI: diva2:667828

This study was supported by Grants to three co-authors: Gerhard Andersson (Linköping University), Tomas Furmark (Swedish Research Council) and Per Carlbring (Swedish Council for Working Life and Social Research, FAS 2009–0222). We are grateful to the staff of the Umeå Functional Brain Imaging Centre (UFBI) for providing excellent research conditions. Carl-Johan Uckelstam contributed as a cognitive behavior therapist. We also like to thank Ahmad R. Hariri for providing the experimental paradigm and to Mats Fredrikson for valuable comments on the manuscript.

Available from: 2013-11-27 Created: 2013-11-27 Last updated: 2014-01-03Bibliographically approved

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