University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
Psychiatry Res Neuroimaging. 2017 Mar 30;261:52-64. doi: 10.1016/j.pscychresns.2016.12.012. Epub 2016 Dec 28.
Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.
先前的研究常常强调社交焦虑症(SAD)患者对简单、静态的社交威胁线索的情绪区域过度活跃。使用更自然的范式研究 SAD 的神经生物学可以进一步揭示潜在的机制以及这些机制与临床结果的关系。我们使用 fMRI 研究了 SAD 患者(N=70)和健康对照组(HC;N=17)对新颖动态拒绝刺激的反应,以及这些反应是否可以预测认知行为治疗(CBT)或接受和承诺治疗(ACT)后的治疗效果。HC 和 SAD 组报告说,与中性社会刺激相比,他们对拒绝的痛苦更大。在神经水平上,与中性刺激相比,HC 组在社会痛苦/拒绝区域(包括背侧前扣带皮层和前岛叶)表现出更大的激活。SAD 组表现出不同的模式,拒绝区域没有差异,对中性刺激的杏仁核和其他区域的激活相对较大。与中性刺激相比,前扣带皮层和杏仁核对拒绝刺激的反应越大,CBT 效果越好。相比之下,感觉聚焦后岛叶的活动增强预测了 ACT 的反应。