A new study suggests brain scans can predict if an individual with social anxiety disorder will benefit from cognitive-behavioral therapy.
Social anxiety disorder is usually treated with either cognitive-behavioral therapy or medications although the decision to use a particular modality is often based on the preference of a provider.
The choice of therapy can be hit or miss as providers are unable to predict which modality will be most efficacious for a particular individual.
The new MIT study discovered that the odds for a successful intervention can be improved by measuring patients’ brain activity as they looked at photos of faces, before the therapy sessions began.
Researchers believe the new insight may help doctors choose more effective treatments for social anxiety disorder, which is estimated to affect around 15 million people in the United States.
“Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them,” said John Gabrieli, Ph.D., senior author of the paper.
Experts say that sufferers of social anxiety disorder experience intense fear in social situations that interferes with their ability to function in daily life.
Cognitive-behavioral therapy aims to change the thought and behavior patterns that lead to anxiety. For social anxiety disorder patients, that might include learning to reverse the belief that others are watching or judging them.
Use of cognitive-behavioral therapy for social anxiety has received considerable research attention as the current paper is part of a larger study by Massachusetts General Hospital and Boston University.
“This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment,” Gabrieli said.
Currently doctors might choose a treatment based on factors such as ease of taking pills versus going to therapy, the possibility of drug side effects, or what the patient’s insurance will cover.
“From a science perspective, there’s very little evidence about which treatment is optimal for a person,” Gabrieli said.
The researchers used functional magnetic resonance imaging (fMRI) to image the brains of patients before and after treatment.
There have been many imaging studies showing brain differences between healthy people and patients with neuropsychiatric disorders, but so far imaging has not been established as a way to predict patients’ responses to particular treatments.
In the new study, the researchers measured differences in brain activity as patients looked at images of angry or neutral faces. After 12 weeks of cognitive-behavioral therapy, patients’ social anxiety levels were tested.
The researchers found that patients who had shown a greater difference in activity in high-level visual processing areas during the face-response task showed the most improvement after therapy.
Gabrieli said it’s unclear why activity in brain regions involved with visual processing would be a good predictor of treatment outcome. One possibility is that patients who benefited more were those whose brains were already adept at segregating different types of experiences, Gabrieli said.
A follow-up study is planned to investigate whether brain scans can predict differences in response between cognitive behavioral therapy and drug treatment.
“Right now, all by itself, we’re just giving somebody encouraging or discouraging news about the likely outcome” of therapy, Gabrieli said. “The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices.”
The findings are published in the journal Archives of General Psychiatry.