Department of Psychology, Stanford University, Stanford, California.
JAMA Psychiatry. 2013 Oct;70(10):1048-56. doi: 10.1001/jamapsychiatry.2013.234.
Cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) is thought to enhance cognitive reappraisal in patients with SAD. Such improvements should be evident in cognitive reappraisal-related prefrontal cortex responses.
To determine whether CBT for SAD modifies cognitive reappraisal-related prefrontal cortex neural signal magnitude and timing when implementing cognitive reappraisal with negative self-beliefs. DESIGN Randomized clinical trial of CBT for SAD vs wait-list control group during a study that enrolled patients from 2007 to 2010.
University psychology department.
Seventy-five patients with generalized SAD randomly assigned to CBT or wait list.
Sixteen sessions of individual CBT for SAD.
Negative emotion ratings and functional magnetic resonance imaging blood oxygen-level dependent signal when reacting to and cognitively reappraising negative self-beliefs embedded in autobiographical social anxiety situations. RESULTS During reactivity trials, compared with wait list, CBT produced (1) greater reduction in negative emotion ratings and (2) greater blood oxygen-level dependent signal magnitude in the medial prefrontal cortex. During cognitive reappraisal trials, compared with wait list, CBT produced (3) greater reduction in negative emotion ratings, (4) greater blood oxygen level-dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (5) earlier temporal onset of dorsomedial prefrontal cortex activity, and (6) greater dorsomedial prefrontal cortex-amygdala inverse functional connectivity.
Modulation of cognitive reappraisal-related brain responses, timing, and functional connectivity may be important brain changes that contribute to the effectiveness of CBT for social anxiety. This study demonstrates that clinically applied neuroscience investigations can elucidate neurobiological mechanisms of change in psychiatric conditions.
clinicaltrials.gov Identifier: NCT00380731.
认知行为疗法（CBT）被认为可以增强社交焦虑障碍（SAD）患者的认知重评。这种改善应该在与认知重评相关的前额叶皮层反应中得到体现。
确定认知行为治疗（CBT）是否会改变 SAD 患者在实施与消极自我信念相关的认知重评时与认知重评相关的前额叶皮层神经信号的幅度和时间。
2007 年至 2010 年期间进行的一项研究，将 SAD 的 CBT 与候补对照组进行随机临床试验。
大学心理学系。
75 名患有广泛性 SAD 的患者被随机分配到 CBT 或候补名单组。
16 次个体 CBT 治疗 SAD。
对嵌入自传体社交焦虑情境的消极自我信念的反应和认知重评时的消极情绪评分和功能磁共振成像血氧水平依赖信号。
与候补名单相比，在反应性试验中，CBT 产生了（1）负性情绪评分的更大降低，（2）内侧前额叶皮层的血氧水平依赖信号幅度的更大增加。在认知重评试验中，与候补名单相比，CBT 产生了（3）负性情绪评分的更大降低，（4）背外侧和背内侧前额叶皮层的血氧水平依赖信号幅度的更大增加，（5）背内侧前额叶皮层活动的时间更早开始，以及（6）背内侧前额叶皮层-杏仁核的反向功能连接性更大。
认知重评相关大脑反应、时间和功能连接的调节可能是导致 CBT 对社交焦虑有效性的重要大脑变化。这项研究表明，临床应用神经科学研究可以阐明精神疾病变化的神经生物学机制。
clinicaltrials.gov 标识符：NCT00380731。
