Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2018 Jun 8;84(Pt A):250-256. doi: 10.1016/j.pnpbp.2018.03.013. Epub 2018 Mar 10.
Research suggests that individuals with anxiety have difficulty ignoring threat distractors when completing tasks with competing stimuli. Studies examining the neural correlates of these emotional processing difficulties in youth anxiety highlight reduced recruitment of regions associated with goal-directed attention, such as the anterior cingulate cortex (ACC). In the current study, we examined neural activation during an emotional conflict task in youth with anxiety disorders before and after treatment.
Twenty-five youth (ages 9-19 years) with generalized, separation, and/or social anxiety disorder and 25 healthy controls underwent 2 functional magnetic resonance imaging scans approximately 13 weeks apart. At each scan, participants completed a task in which they matched shapes in the context of emotional distractors (happy and threatening faces). Between scans, anxious youth were treated with the selective serotonin reuptake inhibitor (SSRI) sertraline or cognitive behavior therapy (CBT).
Prior to treatment, anxious youth exhibited reduced activation of the medial prefrontal cortex, encompassing the rostral ACC, when matching shapes in the context of threat distractors relative to healthy controls. Activation in this region increased in anxious youth after treatment, but remained unchanged in the healthy control group. Increases in rostral ACC activation were related to greater reductions in social anxiety and avoidance symptoms following treatment.
Effective treatments for pediatric anxiety may enhance rostral ACC response during attempts to filter out threat-relevant stimuli. Enhanced recruitment of this region may constitute one manner in which CBT and SSRI treatment reduce youth anxiety symptoms, particularly social anxiety and avoidance.
研究表明，焦虑个体在完成有竞争刺激的任务时，难以忽略威胁性干扰物。研究青少年焦虑情绪处理困难的神经相关性的研究强调，与目标导向注意力相关的区域（如前扣带皮层，ACC）的招募减少。在目前的研究中，我们在治疗前后检查了焦虑障碍青少年在情绪冲突任务中的神经激活。
25 名（9-19 岁）广泛性、分离性和/或社交焦虑障碍的青少年和 25 名健康对照者接受了大约 13 周的两次功能磁共振成像扫描。在每次扫描中，参与者完成了一项任务，即在情绪干扰物（快乐和威胁面孔）的背景下匹配形状。在扫描之间，焦虑的青少年接受选择性 5-羟色胺再摄取抑制剂（SSRI）舍曲林或认知行为治疗（CBT）的治疗。
在治疗前，与健康对照组相比，焦虑的青少年在匹配威胁性干扰物背景下的形状时，内侧前额叶皮层（包括前扣带皮层）的激活减少。在治疗后，该区域的激活在焦虑的青少年中增加，但在健康对照组中没有变化。前扣带皮层激活的增加与治疗后社交焦虑和回避症状的更大减轻有关。
儿童焦虑的有效治疗方法可能会增强前扣带皮层在试图过滤出与威胁相关的刺激时的反应。该区域的募集增加可能构成 CBT 和 SSRI 治疗减轻青少年焦虑症状（特别是社交焦虑和回避）的一种方式。
