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Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study

Molecular Psychiatry volume 22, pages 1164–1171 (2017)Cite this article

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Abstract

Social anxiety disorder (SAD) is characterized by fears of social and performance situations. Cognitive behavioral group therapy (CBGT) has in general positive effects on symptoms, distress and avoidance in SAD. Prior studies found increased cortical volumes and decreased fractional anisotropy (FA) in SAD compared with healthy controls (HCs). Thirty-three participants diagnosed with SAD attended in a 10-week CBGT and were scanned before and after therapy. We applied three neuroimaging methods–surface-based morphometry, diffusion tensor imaging and network-based statistics–each with specific longitudinal processing protocols, to investigate CBGT-induced structural brain alterations of the gray and white matter (WM). Surface-based morphometry revealed a significant cortical volume reduction (pre- to post-treatment) in the left inferior parietal cortex, as well as a positive partial correlation between treatment success (indexed by reductions in Liebowitz Social Anxiety Scale) and reductions in cortical volume in bilateral dorsomedial prefrontal cortex. Diffusion tensor imaging analysis revealed a significant increase in FA in bilateral uncinate fasciculus and right inferior longitudinal fasciculus. Network-based statistics revealed a significant increase of structural connectivity in a frontolimbic network. No partial correlations with treatment success have been found in WM analyses. For, we believe, the first time, we present a distinctive pattern of longitudinal structural brain changes after CBGT measured with three established magnetic resonance imaging analyzing techniques. Our findings are in line with previous cross-sectional, unimodal SAD studies and extent them by highlighting anatomical brain alterations that point toward the level of HCs in parallel with a reduction in SAD symptomatology.

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Acknowledgements

This study was funded by two Swiss National Science Foundation (SNSF) grants 320030_133009 and 320030_146972. We thank Hansruedi Baetschmann for the usage of his MATLAB scripts that support the network-based statistic (NBS) tool. We would like to thank all participants of our SAD group for their attendance in our study. Furthermore, we would like to thank to all clinicians and all the members of our research groups for collecting and quality controlling the neuroimaging data.

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Authors and Affiliations

  1. Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland

    V R Steiger, L Jäncke & J Hänggi

  2. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland

    V R Steiger, A B Brühl & U Herwig

  3. Behavioural and Cognitive Neuroscience Institute and Department of Psychiatry, University of Cambridge, Cambridge, UK

    A B Brühl

  4. Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland

    S Weidt, A Delsignore & M Rufer

  5. Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    L Jäncke

  6. International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland

    L Jäncke

  7. University Research Priority Program (URPP) 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland

    L Jäncke

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  1. V R Steiger
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Correspondence to V R Steiger.

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Steiger, V., Brühl, A., Weidt, S. et al. Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study. Mol Psychiatry 22, 1164–1171 (2017). https://doi.org/10.1038/mp.2016.217

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