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Wednesday, November 9, 2022

Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies

Schrammen E, Roesmann K, Rosenbaum D, et al.
Neuroscience and Biobehavioral Reviews. 2022 


Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.


• We conducted a coordinate-based meta-analysis of studies assessing fMRI pre- and post-therapy in anxiety disorders.

• Our results are based on whole-brain findings and include more than 50% original statistical maps.

• From pre to post, activation decreased in the insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex.

• Subgroup-analysis for CBT and exposure revealed an additional cluster of activation decrease in the supplementary motor area.