Cognitive Behavioral Therapy Changes Brain Structure In Social Anxiety Disorder

Successful treatment of social anxiety disorder changes brain structures that are involved in processing and regulating emotions, a study conducted by researchers from the University of Zurich, Zurich University Hospital and the University Hospital of Psychiatry Zurich suggests.

Around one in ten people are affected by social anxiety disorder during their lifetime. Social anxiety disorder is defined as when fears and anxiety in social situations significantly impair everyday life and cause intense suffering. Talking in front of a larger group can be one typical feared situation.

The study investigated structural brain changes in patients suffering from social anxiety disorder after a specific ten-week course of cognitive behavioral therapy (CBT).

Social Anxiety Disorder

In patients suffering from social anxiety disorder, the regulation of excessive anxiety by frontal and lateral brain areas is impaired. Strategies aimed at regulating emotions should restore the balance between cortical and subcortical brain areas.

These strategies are practised in cognitive behavioral therapy, a central therapy for social anxiety disorder. The study from Zurich investigated structural brain changes in patients suffering from social anxiety disorder after a specific ten-week course of CBT.

Using surface-based morphometry, and diffusion tensor imaging the participants’ brains were examined before and after CBT.

“We were able to show that structural changes occur in brain areas linked to self control and emotion regulation,”

says Annette Brühl, head physician at the Center for Depression, Anxiety Disorders and Psychotherapy at the University Hospital of Psychiatry Zurich (PUK).

Cognitive Behavioral Therapy

The more successful the treatment, the more pronounced the brain changes. The research group was also able to demonstrate that brain areas involved in processing emotions were more interconnected after the treatment.

Significant volume reduction, pre- to post-treatment, was observed in the left inferior parietal cortex. There was also a positive partial correlation between treatment success, as evidenced by reductions in the Liebowitz Social Anxiety Scale, and reductions in cortical volume in the bilateral dorsomedial prefrontal cortex.

In cognitive behavioral group therapy, patients learn and apply new strategies aimed at dealing with social anxiety disorder. Based on specific examples, the group discusses explanatory models and identifies starting points for changes. Through self-observation, role plays or video recordings, alternative viewpoints can be developed.

V R Steiger, A B Brühl, S Weidt, A Delsignore, M Rufer, L Jäncke, U Herwig and J Hänggi
Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study
Molecular Psychiatry , (6 December 2016) | doi:10.1038/mp.2016.217

Image: Decrease in the thickness of the cerebral cortex after psychotherapy in the left parietal cortex (marked in red) Credit: UZH

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