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Functional magnetic resonance imaging (fMRI) of the brain can predict whether children with anxiety disorders (ADs) will respond to cognitive behavioral therapy (CBT).

Results of a small study in which children with ADs underwent functional MRI of the amygdala while being shown images of adult faces expressing specific emotions showed those who exhibited fear when looking at the happy faces were least likely to respond to an 8-week course of CBT without medication. In contrast, their counterparts who showed fear while looking at fearful faces benefited from the treatment.

The findings were presented November 14 at the Society for Neuroscience 2010 Annual Meeting in San Diego, California.

"Anxiety and fear are intrinsically linked, so how the brain's fear center responds would naturally affect how [ADs] manifest," lead study author J. Stephen Rich, a fourth-year medical student at the Georgetown University School of Medicine in Arlington, Virginia, said in a release.

Although previous research has shown that many people react with fear to fearful faces, "our most robust finding indicated that some [AD] patients have more anxiety towards happy faces than fearful ones," he added.

The investigators note that these findings could potentially help clinicians in deciding which patients would respond well with CBT alone and which ones may need additional therapy, including medication.

"The number 1 takeaway is that, even though patients with a given psychiatric disorder may behave similarly, sometimes the biological basis of that behavior may be very different," Mr. Rich told Medscape Medical News.

"With neuroimaging tools like functional MRI (fMRI), we can better understand that biology in each individual patient and may one day be able to tailor our treatment based on it," he added.

Future Screening Tool?

For the study, the investigators enrolled 23 children (13 boys and 10 girls) between the ages of 8 and 16 years who had been diagnosed as having a pediatric AD.

After showing 32 face pictures (8 each of happy, fearful, angry, and neutral) to the participants and recording the brain scans before treatment, the investigators correlated the responses with CBT outcomes, based on the standardized Clinical Global Impression of Improvement.

The investigators report that, to their knowledge, this is the first trial "to attempt to study CBT treatment outcome independent of other treatment modalities (although others have studied other treatment modalities and combined treatments more generally)."

They note 1 explanation for the main findings is that those with a greater anxiety toward happy faces may have a subtly different disorder — one that elicits even more anxiety with CBT.

"Further study is required to determine whether this is indeed a unique disease subtype or whether a modified approach to [CBT] that requires the therapist to stay completely neutral could make therapy more effective for these patients," said Mr. Rich.

However, he stressed that he and his coinvestigators do not recommend that every child with AD receive an functional MRI (fMRI) diagnosis at this time, especially because of its expense.

"Even so, once the field develops further, our results suggest that neuroimaging studies like functional MRI may be able to help us understand why a given patient might not be responding to the first-line treatment," said Mr. Rich.

"In other words, when routine care is not enough, we can focus on the nuances of the individual."

Source: Medscape

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