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Review
. 2020 Jun 15:271:207-214.
doi: 10.1016/j.jad.2020.04.001. Epub 2020 Apr 13.

Change in neural response during emotion regulation is associated with symptom reduction in cognitive behavioral therapy for anxiety disorders

J Bomyea  1 , T M Ball  2 , A N Simmons  3 , L Campbell-Sills  4 , M P Paulus  5 , M B Stein  6
Affiliations
Review

Change in neural response during emotion regulation is associated with symptom reduction in cognitive behavioral therapy for anxiety disorders

J Bomyea et al. J Affect Disord. .

Abstract

Background: Anxiety disorders are debilitating conditions that can be treated with cognitive behavioral therapy (CBT). Increased understanding of the neurobiological correlates of CBT may inform treatment improvements and personalization. Prior neuroimaging studies point to treatment-related changes in anterior cingulate, insula, and other prefrontal regions during emotional processing, yet to date the impact of CBT on neural substrates of "top down" emotion regulation remains understudied. We examined the relationship between symptom changes assessed over the course of CBT treatment sessions and pre- to post-treatment neural change during an emotion regulation task.

Method: In the current study, a sample of 30 participants with panic disorder or generalized anxiety disorder completed a reappraisal-based emotion regulation task while undergoing fMRI before and after completing CBT.

Results: Reduced activation in the parahippocampal gyrus was observed from pre- to post-treatment during periods of reducing versus maintaining emotion. Parahippocampal activation was associated with change in symptoms over the course of treatment and post-treatment responder status. Results suggest that, from pre- to post-CBT, participants demonstrated downregulation of neural responses during effortful cognitive emotion regulation.

Limitations: Effects were not observed in frontoparietal systems as would be hypothesized based on prior literature, suggesting that treatment-related change could occur outside of fronto-parietal and limbic regions that are central to most models of neural functioning in anxiety disorders.

Conclusions: Continued work is needed to better understand how CBT affects cognitive control and memory processes that are hypothesized to support reappraisal as a strategy for emotion regulation.

Keywords: Anxiety; Cognitive behavioral therapy; Emotion regulation; Reappraisal; fMRI.

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Conflict of interest statement

Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Figures

Figure 1.
Figure 1.
Change in neural activation in right parahippocampal region from pre- to post-treatment in responders and non-responders
Figure 2.
Figure 2.
Relationship between change in activation in the parahippocampal region and change in OASIS severity scores from pre- to post-treatment
Figure 3.
Figure 3.
Neural activation during reappraise and maintain (vs. baseline) from pre- to post-treatment
See this image and copyright information in PMC

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