AGP：大脑扫描有助治疗社交恐惧症

2012年9月7日 讯 /生物谷BIOON/ --近日，麻省理工学院的神经科学家发现，对社交恐惧症患者进行大脑扫描可以帮助判断认知行为治疗（cognitive behavioral therapy）是否对其有效。

社交恐惧症（social anxiety disorder）的治疗方法有认知行为治疗和药物治疗。然而，对于某一病人来说哪种治疗方法更好尚无法判断。研究表明，患者观察面部表情不同的照片时的大脑活动可告诉我们答案。相关论文发表在新一期的Archives of General Psychiatry杂志上。

社交恐惧症又名社交焦虑症，是一种对任何社交或公开场合感到强烈恐惧或忧虑的精神疾病。患者对于在陌生人面前或可能被别人仔细观察的社交或表演场合，有一种显著且持久的恐惧，害怕自己的行为或紧张的表现会引起羞辱或难堪。有些患者对参加聚会、打电话、到商店购物、或询问权威人士都感到困难。

认知行为治疗的目的是改变导致恐惧的想法和行为，患者需要通过学习改变他人在注视或评价自己的想法。

目前医生通常根据药物的副作用、患者的保险等因素决定治疗方法。论文作者Gabrieli说，"从科学角度来说，基本无证据可以表明患者采用哪种治疗方法更好。"

此项研究中，在治疗前和治疗后，研究者在患者观察面部表情生气或平静的照片时对患者大脑进行功能性核磁共振成像（fMRI，functional magnetic resonance imaging）。在12周的认知行为治疗之后，检测患者的社交恐惧水平。结果发现，认知行为治疗可明显改善观察照片时大脑高层视觉处理区（high-level visual processing areas）活动有显著变化的患者。

Gabrieli说，尚不清楚为何与视觉处理有关的大脑区域会做出这一指示，或许能够区分不同经历的患者更能从认知行为治疗中获益。

编译自Predicting How Patients Respond to Therapy: Brain Scans Could Help Doctors Choose Treatments for People With Social Anxiety Disorder

doi:10.1001/2013.jamapsychiatry.5
PMC:
PMID:

Predicting Treatment Response in Social Anxiety Disorder From Functional Magnetic Resonance Imaging

Oliver Doehrmann, PhD; Satrajit S. Ghosh, PhD; Frida E. Polli, PhD; Gretchen O. Reynolds, BA; Franziska Horn, BSc; Anisha Keshavan, BSc; Christina Triantafyllou, PhD; Zeynep M. Saygin, PhD; Susan Whitfield-Gabrieli, PhD; Stefan G. Hofmann, PhD; Mark Pollack, MD; John D. Gabrieli, PhD

Context  Current behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD.

Objective  To measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT).

Design  Functional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli.

Setting  Patients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology.

Patients  Thirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD.

Interventions  Brain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT.

Main Outcome Measures  Whole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure.

Results  Pretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline.

Conclusions  The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.