Experts say a brain scan can predict which kids with anxiety disorders will respond to one form of psychotherapy. As a consequence, Georgetown University neuroscientists say the use of psychiatric medication is not necessary for certain children.
Their study, presented at the annual meeting of the Society for Neuroscience in San Diego, utilized functional Magentic Resonance Imaging (fMRI) to map regions of brain activity. The results showed that children and adolescents, ages 8 to 16, who show fear when looking at happy faces on a screen were those who had least success with an eight-week course of cognitive-behavioral therapy.
Conversely, children who showed fear while looking at fearful faces benefitted from the treatment, the researchers found.
Their study, presented at the annual meeting of the Society for Neuroscience in San Diego, utilized functional Magentic Resonance Imaging (fMRI) to map regions of brain activity. The results showed that children and adolescents, ages 8 to 16, who show fear when looking at happy faces on a screen were those who had least success with an eight-week course of cognitive-behavioral therapy.
Conversely, children who showed fear while looking at fearful faces benefitted from the treatment, the researchers found.
The study enrolled 13 boys and 10 girls in this study, all of whom had been diagnosed with pediatric anxiety disorder.
While inside the fMRI machine, the participants were shown pictures of faces that expressed certain emotions strongly.
“The questions we were trying to answer were: What emotions make people afraid when they witness them on others’ faces, and does that pattern predict response to talk therapy,” Rich says.
An fMRI records changes in blood flow in the brain, thus showing levels of activity. In this study, the researchers zeroed in on the amygdala, a brain structure involved in fear responses.
They then correlated the differing responses they saw in the amygdala with outcomes from an eight-week course in cognitive-behavioral therapy.
The researchers found a significant correlation, indicating that pre-treatment fMRI can be used to select patients who likely do well with psychotherapy alone, and those that may require other therapy, such as medication.
Rich said that one explanation for the results is that those patients who have greater anxiety towards happy faces than towards fearful ones have a subtly different disorder, one that is very similar but cannot be treated by cognitive-behavioral therapy.
“In this subset of patients, that support may actually elicit even more anxiety, thus alienating them from the therapist,” he said.
“Further study is required to determine whether this is indeed a unique disease subtype, or whether a modified approach to cognitive-behavioral therapy that requires the therapist to stay completely neutral could make therapy more effective for these patients.”
Rich and his co-authors do not expect that every pediatric anxiety disorder patient should receive an fMRI diagnosis.
“fMRI is expensive, and this study does not by any means suggest that it should be used as a universal screening tool,” he said.
“Even so, once the field develops further, our results suggest that neuroimaging studies like fMRI may be able to help us understand why a given patient might not be responding to the first-line treatment. In other words, when routine care is not enough, we can focus on the nuances of the individual.”
Source: Georgetown University Medical Center
http://psychcentral.com
While inside the fMRI machine, the participants were shown pictures of faces that expressed certain emotions strongly.
“The questions we were trying to answer were: What emotions make people afraid when they witness them on others’ faces, and does that pattern predict response to talk therapy,” Rich says.
An fMRI records changes in blood flow in the brain, thus showing levels of activity. In this study, the researchers zeroed in on the amygdala, a brain structure involved in fear responses.
They then correlated the differing responses they saw in the amygdala with outcomes from an eight-week course in cognitive-behavioral therapy.
The researchers found a significant correlation, indicating that pre-treatment fMRI can be used to select patients who likely do well with psychotherapy alone, and those that may require other therapy, such as medication.
Rich said that one explanation for the results is that those patients who have greater anxiety towards happy faces than towards fearful ones have a subtly different disorder, one that is very similar but cannot be treated by cognitive-behavioral therapy.
“In this subset of patients, that support may actually elicit even more anxiety, thus alienating them from the therapist,” he said.
“Further study is required to determine whether this is indeed a unique disease subtype, or whether a modified approach to cognitive-behavioral therapy that requires the therapist to stay completely neutral could make therapy more effective for these patients.”
Rich and his co-authors do not expect that every pediatric anxiety disorder patient should receive an fMRI diagnosis.
“fMRI is expensive, and this study does not by any means suggest that it should be used as a universal screening tool,” he said.
“Even so, once the field develops further, our results suggest that neuroimaging studies like fMRI may be able to help us understand why a given patient might not be responding to the first-line treatment. In other words, when routine care is not enough, we can focus on the nuances of the individual.”
Source: Georgetown University Medical Center
http://psychcentral.com
