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Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample
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Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample

Angela Fang, Bengi Baran, Jamie D Feusner, K Luan Phan, Clare C Beatty, Jessica Crane, Ryan J Jacoby, Dara S Manoach and Sabine Wilhelm
medRxiv : the preprint server for health sciences
Cold Spring Harbor Laboratory
09/02/2023
DOI: 10.1101/2023.08.30.23294878
PMCID: PMC10491350
PMID: 37693433
url
https://doi.org/10.1016/j.jpsychires.2024.01.018View
Published (Version of record)This article has now been published in a journal and has been peer-reviewed by subject experts. This version may differ significantly from the preprint version. Access restricted to faculty, staff and students
url
https://doi.org/10.1101/2023.08.30.23294878View
Preprint (Author's original)This preprint has not been evaluated by subject experts through peer review. Preprints may undergo extensive changes and/or become peer-reviewed journal articles. Open Access

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Abstract

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre- to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample. Twenty-seven patients with primary social anxiety disorder ( =14) and primary body dysmorphic disorder ( =13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex/precuneus that delineated a self-other functional network. At pre-treatment, stronger positive connectivity of the seed with the cerebellum, insula, middle occipital gyrus, postcentral gyrus, and precuneus/superior parietal lobule, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre- to post-treatment, greater anticorrelation between the seed and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding. Pre-treatment functional connectivity between regions involved in attentional salience, self-generated thoughts, and external attention predicted greater CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA. ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
 cognitive behavioral therapy social anxiety disorder prediction Resting state functional connectivity body dysmorphic disorder self-focused attention

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