Brain Scans Predict If Talk Therapy Will Work for Anxious Children
Researchers used an fMRI scan during their study on children and adolescents with pediatric anxiety disorder to see if they would respond to Cognitive Behavioral Therapy.
December 23, 2010 – Psychiatric medicine may be avoided for children with anxiety disorders if a brain scan shows they are likely to respond to “talk therapy,” according to neuroscientists from Georgetown’s Medical Center.
In a recent study at the center, brain scans showed that behavior in children and young adolescents naturally veers toward the egocentric.
“These results suggest that children develop introspection over time as their brains develop,” says the study’s first author, Stuart Washington, who graduated from the university in 2008 with a Ph.D. in biomedical neuroscience. “Before then they are somewhat egocentric, which is not to mean that they are negatively self-centered, but they think that everyone views the world in the same way they do. They lack perspective in that way.”
The researchers’ study, presented at the annual meeting of the Society for Neuroscience in San Diego this past fall, shows that children and adolescent ages 8 to 16 who expressed fear while looking at fearful faces are more likely to benefit from Cognitive Behavioral Therapy (CBT), also known as talk therapy.
Children and adolescents who showed fear when looking at happy faces on a screen inside an fMRI scanner had the least success with an eight-week course of CBT.
The Fear Center
“Anxiety and fear are intrinsically linked, so how the brain’s fear center responds would naturally affect how anxiety disorders manifest,” says the study’s lead author, Steve Rich, a fourth-year medical student.
Cognitive behavioral therapy proposes that thoughts cause feelings and behaviors, not external things such as people, situations and events.
“The impact on their responses to therapy was impressive,” Rich adds. “Past studies have shown that many people react to fearful faces with fear themselves, but our most robust finding indicated that some anxiety disorder patients have more anxiety towards happy faces than fearful ones.”
Analyzing Anxiety
The study enrolled 13 boys and 10 girls in this study, all diagnosed with pediatric anxiety disorder.
An fMRI is a type of brain scan that records changes in blood flow being used at each location in the brain, indicating different levels of activity. The Georgetown researchers focused on the amygdala, a part of the brain known to represent the emotion of fear.
The neuroscientists then correlated the different responses they observed 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 could benefit from talk therapy alone, and those that may require other therapy such as medication.
Rich says that one explanation for the results is that those patients who have greater anxiety toward happy faces than toward fearful ones have a subtly different disorder, one that is very similar but which does not respond to cognitive behavioral therapy.
“In this subset of patients, that support may actually elicit even more anxiety, thus alienating them from the therapist,” he says. “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.”
Georgetown University37th and O Streets, N.W., Washington D.C. 20057(202) 687.0100
Connect with us via: