Throughout the 1980s and into the 90s, cognitive behavioral therapy gained acceptance as the therapy of choice for many mental health care patients, including those with social anxiety disorder (SAD). The fear of being judged by others and humiliated – social anxiety disorder is the third most prevalent psychiatric disorder in America (depression and alcohol dependence claim the first two positions). Cognitive behavioral therapy is generally an effective form of treatment that addresses both the underlying causes of social anxiety disorder as well as its connection to other related mental health problems including alcoholism, eating disorders and depression.
Cognitive Behavioral Therapy Pros and Cons
The science of cognitive behavioral therapy is essentially the same as that of school or college learning. Students learn new information in class and then through repetition, begin to think, act and feel differently about the topics and lessons. By the same token, SAD patients learn new information and skills in therapy and through the same repetition, begin to find relief from their symptoms. The learning process for both school and cognitive behavioral therapy relates to altered memory processes and physiological changes in the neural pathways of the brain.
The problem with cognitive behavioral therapy is its misconception as a “unified” therapy promising to produce the same results for every patient struggling with a psychological issue such as social phobia. On the contrary, patients often respond differently to the same form of treatment – and the only way to gauge the success of cognitive behavioral therapy is for the patient to experience it.
The Dawn of Personalized Treatment
A new study designed to predict the success of cognitive behavioral therapy in SAD patients introduces brain imaging technology to bring “personalized” treatment to patients for the first time.
Lead study author John D. Gabrieli, Ph.D, and colleagues used functional magnetic resonance imaging (fMRI) to compare the brain images of 39 patients with social anxiety disorder both before and after a 12-week course of cognitive behavioral therapy. Researchers presented patients with photos of both angry and neutral faces, as angry faces that convey disapproval often prompt negative connotations in SAD patients, triggering an excessive fear response.
Before and after 12 weeks of cognitive behavioral therapy, researchers compared brain images to patient scores on the Liebowitz Social Anxiety Scale – a conventional clinical measure commonly used with SAD patients. The study found a correlation between the strength of brain reactions to angry faces and the effectiveness of cognitive behavioral therapy. The stronger the brain reaction, the more cognitive behavioral therapy benefited the patient.
This is the first study of its kind to use neuroimaging to predict the treatment response in SAD patients. Neuromarkers may become a practical clinical tool to help mental health professionals select the optimal treatment for individual patients. In fact, scientists currently use the same neuromarkers in other areas of mental illness – to better predict the likelihood of relapse in drug addiction and also the onset of psychosis in schizophrenia.
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