Wednesday, January 24, 2024

Cognitive-Behavioral Therapy May Reduce Overactivity in Some Brain Regions in Anxious Youth

Cognitive-behavioral therapy (CBT) may normalize activity in some parts of the brain that are overactive in youth with anxiety disorders, suggests a report published today in The American Journal of Psychiatry. After three months of CBT, youth with anxiety showed reduced activity in frontal and parietal brain regions (areas known to be involved with attention and emotional regulation).

“Understanding the brain circuitry underpinning feelings of severe anxiety and determining which circuits normalize and which do not as anxiety symptoms improve with CBT is critical for advancing treatment and making it more effective for all children,” said lead author Simone Haller, Ph.D., of the National Institute of Mental Health in a press release.

Haller and colleagues used functional MRI (fMRI) to analyze brain activity in 69 youth who were not taking medications (41% males, average age 13 years) and had been diagnosed with anxiety disorder. The youth underwent an fMRI at the start of the study as well as after 12 weeks of CBT. The researchers evaluated changes in the youth’s anxiety weekly using the Pediatric Anxiety Rating Scale and the Clinical Global Impressions Scale improvement scale.

After 12 weeks of therapy, 66% of youth with anxiety experienced a clinically significant decline in anxiety symptoms, Haller and colleagues reported.

The researchers compared the fMRI scans collected from youth with anxiety before and after CBT treatment; they also compared the fMRI scans with those from similarly aged youth who did not have anxiety. A second sample of 87 youth who were identified as high-risk for anxiety but received no treatment also underwent brain scans. 

Before CBT treatment, youth with anxiety disorder displayed hyperactivation in multiple brain regions, including the fronto-parietal network, compared with the youth without anxiety. After treatment, the activity in the fronto-parietal network declined to “levels comparable to (or lower than) those observed in healthy control youths,” the researchers wrote. In contrast, the sample of untreated youth at risk for anxiety continued to show fronto-parietal hyperactivity. “This provides preliminary evidence that the brain changes in children with anxiety were driven by CBT and that they may offer a reliable neural marker of anxiety treatment,” the NIMH release stated.

The researchers noted that several regions, including the right amygdala, remained hyperactive in youth with anxiety after treatment. (The amygdala plays a central role in controlling fear response.)

“While CBT is the current gold-standard intervention for pediatric anxiety, response rates are variable, leaving a large portion of treated youth with significant symptoms following treatment,” Haller and colleagues wrote. “Clinical outcomes may be improved by targeting fronto-parietal attention circuits and complementing CBT with adjunctive interventions that have a direct impact on subcortical structures.”

For related information, see the Psychiatric News article “Pediatric Anxiety Can Be Treated—The Challenge is to Recognize It.”

(Image: Getty Images/iStock/Hank Grebe)

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