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Published Online: 21 January 2021

Association of Neural Reward Circuitry Function With Response to Psychotherapy in Youths With Anxiety Disorders

Stefanie L. Sequeira, M.S., Jennifer S. Silk, Ph.D., Cecile D. Ladouceur, Ph.D., Jamie L. Hanson, Ph.D., Neal D. Ryan, M.D., Judith K. Morgan, Ph.D., Dana L. McMakin, Ph.D., Philip C. Kendall, Ph.D., Ronald E. Dahl, M.D., and Erika E. Forbes, Ph.D. [email protected]Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 178, Number 4
https://doi.org/10.1176/appi.ajp.2020.20010094
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Abstract

Objective:

Identifying neural correlates of response to psychological treatment may inform targets for interventions designed to treat psychiatric disorders. This study examined the extent to which baseline functioning in reward circuitry is associated with response to psychotherapy in youths with anxiety disorders.

Methods:

A randomized clinical trial of cognitive-behavioral therapy compared with supportive therapy was conducted in youths with anxiety disorders. Before treatment, 72 youths (9–14 years old) with anxiety disorders and 37 group-matched healthy comparison youths completed a monetary reward functional MRI task. Treatment response was defined categorically as at least a 35% reduction in diagnostician-rated anxiety severity from pre- to posttreatment assessment. Pretreatment neural activation in the striatum and medial prefrontal cortex (mPFC) during monetary wins relative to losses was examined in relation to treatment response.

Results:

Responders, nonresponders, and healthy youths differed significantly in mPFC activation to rewards versus losses at baseline. Youths with anxiety exhibited higher mPFC activity relative to healthy youths, although this may have been driven by differences in depressive symptoms. Planned comparisons between treatment responders (N=48) and nonresponders (N=24) also revealed greater pretreatment neural activation in a cluster encompassing the subgenual anterior cingulate cortex and nucleus accumbens among responders.

Conclusions:

Striatal activation to reward receipt may not differentiate youths with anxiety from healthy youths. However, higher striatal responsivity to rewards may allow youths with anxiety to improve during treatment, potentially through greater engagement in therapy. Function in reward circuitry may guide development of treatments for youths with anxiety.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 178 • Number 4 • April 01, 2021
Pages: 343 - 351
PubMed: 33472390

History

Received: 28 January 2020
Revision received: 5 June 2020
Revision received: 23 October 2020
Accepted: 2 November 2020
Published online: 21 January 2021
Published in print: April 01, 2021

Keywords

  1. Anxiety Disorders
  2. Child/Adolescent Psychiatry
  3. Neuroimaging
  4. Psychotherapy

Authors

Affiliations

Stefanie L. Sequeira, M.S.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Jennifer S. Silk, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Cecile D. Ladouceur, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Jamie L. Hanson, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Neal D. Ryan, M.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Judith K. Morgan, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Dana L. McMakin, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Philip C. Kendall, Ph.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Ronald E. Dahl, M.D.
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Erika E. Forbes, Ph.D. [email protected]
Department of Psychology (Sequeira, Silk, Hanson) and Department of Psychiatry (Ladouceur, Ryan, Morgan, Forbes), University of Pittsburgh, Pittsburgh; Department of Psychology, Florida International University, Miami (McMakin); Department of Psychology, Temple University, Philadelphia (Kendall); School of Public Health, University of California, Berkeley (Dahl).
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Notes

Send correspondence to Dr. Forbes ([email protected]).

Funding Information

Supported by NIMH grant P50 MH080215. Support for research participant recruitment was also provided by the Clinical and Translational Science Institute at the University of Pittsburgh (NIH/NCRR/CTSA grant UL1 RR024153).Dr. Ryan has served on an advisory panel for Axsome Therapeutics. Dr. Kendall receives royalties from the sale of materials related to the treatment of anxiety in youths. Dr. Forbes has received an honorarium from the Association for Psychological Science and consulting fees from Case Western Reserve University, Brown University, and Otsuka/Durham VA. The other authors report no financial relationships with commercial interests.

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