Grant Report on Anxiety-CBT: Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety

Abstract

In the following grant report, we describe initial and planned work supported by our National Institute of Mental Health R01-funded, Research Domain Criteria (RDoc) informed project, "Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety". This project examines response to cognitive behavioral therapy (CBT) in a large sample of anxiety-affected and low-anxious youth ages 7 to 18 years using multiple levels of analysis, including brain imaging, behavioral performance, and clinical measures. The primary goal of the project is to understand how brain-behavioral markers of anxiety-relevant constructs, namely acute threat, cognitive control, and their interaction, associate with CBT response in youth with clinically significant anxiety. A secondary goal is to determine whether child age influences how these markers predict, and/or change, across varying degrees of CBT response. Now in its fourth year, data from this project has informed the examination of (1) baseline (i.e., pre-CBT) anxiety severity as a function of brain-behavioral measures of cognitive control, and (2) clinical characteristics of youth and parents that associate with anxiety severity and/or predict response to CBT. Analysis of brain-behavioral markers before and after CBT will assess mechanisms of CBT effect, and will be conducted once the data collection in the full sample has been completed. This knowledge will help guide the treatment of clinically anxious youth by informing for whom and how does CBT work.

Keywords: Research Domain Criteria; acute threat; anxiety; cognitive behavioral therapy; cognitive control; emotion processing; fMRI.

Figure 1.

Examples of conditions of the MSIT task.

Figure 2.

EFSAT task procedure.

Figure 3.

Error-related brain activations associated with anxiety symptom severity across subjects. Data are presented at a peak threshold of p < 0.005 uncorrected and cluster-wise threshold of p < 0.05 (corrected for false discovery rate). The color bar shows t score. A, anterior; P, posterior; L, left; R, right; pMFC, posterior medial frontal cortex; x, y, MNI coordinates.