Abstract
Anterior cingulate cortex (ACC) response during attentional control in the context of task-irrelevant emotional faces is a promising biomarker of cognitive behavioral therapy (CBT) outcome in patients with social anxiety disorder (SAD). However, it is unclear whether this biomarker extends to major depressive disorder (MDD) and is specific to CBT outcome. In the current study, 72 unmedicated patients with SAD (n = 39) or MDD (n = 33) completed a validated emotional interference paradigm during functional magnetic resonance imaging before treatment. Participants viewed letter strings superimposed on task-irrelevant threat and neutral faces under low perceptual load (high interference) and high perceptual load (low interference). Biomarkers comprised anatomy-based rostral ACC (rACC) and dorsal ACC (dACC) response to task-irrelevant threat (>neutral) faces under low and high perceptual load. Patients were randomly assigned to 12 weeks of CBT or supportive therapy (ST) (ClinicalTrials.gov identifier: NCT03175068). Clinician-administered measures of social anxiety and depression severity were obtained at baseline and every 2 weeks throughout treatment (7 assessments total) by an assessor blinded to the treatment arm. A composite symptom severity score was submitted to latent growth curve models. Results showed more baseline rACC activity to task-irrelevant threat>neutral faces under low, but not high, perceptual load predicted steeper trajectories of symptom improvement throughout CBT or ST. Post-hoc analyses indicated this effect was driven by subgenual ACC (sgACC) activation. Findings indicate ACC activity during attentional control may be a transdiagnostic neural predictor of general psychotherapy outcome.
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Funding
This work was supported by NIH/NIMH R01-MH112705 (HK), NIH/NIMH T32-MH067631 (CF), and the Center for Clinical and Translational Research (CCTS) UL1RR029879.
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CF contributed to data analysis, manuscript writing, and interpretation of results. JJ contributed to the collection and analysis of neuroimaging data. RB assisted with the analytic approach. JD performed psychotherapy and contributed to manśuscript preparation. GRM performed psychotherapy and contributed to manuscript preparation. OA reviewed the medical history of patients and contributed to manuscript preparation. SAS contributed to the interpretation of findings and manuscript preparation. SAL contributed to the interpretation of findings and manuscript preparation. MGC oversaw treatment fidelity, adherence, and manuscript preparation. KLP contributed to the interpretation of findings and manuscript preparation. HK contributed to study conception, manuscript writing, and interpretation of results. All authors contributed to and approved the final manuscript.
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Feurer, C., Jimmy, J., Bhaumik, R. et al. Anterior cingulate cortex activation during attentional control as a transdiagnostic marker of psychotherapy response: a randomized clinical trial. Neuropsychopharmacol. 47, 1350–1357 (2022). https://doi.org/10.1038/s41386-021-01211-2
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DOI: https://doi.org/10.1038/s41386-021-01211-2
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