Objective:

Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT.

Methods:

Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response.

Results:

Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes.

Conclusions:

Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.

中文翻译：

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通过认知行为疗法使未接受药物治疗的焦虑症儿科患者额顶叶激活正常化

客观的：

焦虑症在青少年中普遍存在，并且常常造成严重损害。认知行为疗法（CBT）是一种有效的一线治疗方法。作者研究了与 CBT 后症状变化相关的大脑机制。

方法：

被诊断患有焦虑症的未接受药物治疗的青少年接受了 12 周的 CBT，这是两项随机临床试验的一部分，旨在测试辅助计算机认知训练的效果。在这两项试验中，参与者在治疗前后的功能性核磁共振成像中完成了威胁处理任务。年龄匹配的健康对照青少年在同一时间段内完成了两次扫描。样本的平均年龄为13.20岁（SD=2.68）；41% 为男性（患有焦虑症的青少年，N=69；健康对照青少年，N=62）。另一个样本包括有焦虑气质风险的青少年（N = 87；平均年龄，10.51 岁 [SD = 0.43]；41% 男性），用于测试在没有治疗的情况下与焦虑相关的神经差异的稳定性。使用基于任务的血氧水平依赖性反应检查全脑区域激活变化（阈值p<0.001）。

结果：

在治疗之前，与健康对照儿童相比，焦虑症患者在所有任务条件下都表现出额顶叶注意力网络和边缘区域激活的改变。额顶叶过度活跃在治疗过程中恢复正常，而边缘系统反应在治疗后仍然升高。在高危样本中，随着时间的推移，显示出与焦虑稳定相关的区域和显示出治疗相关变化的区域之间出现了重叠的簇。

结论：

对于未接受药物治疗的儿科焦虑症患者，进行 CBT 后，额顶叶网络的激活可能会恢复正常。边缘区域可能不太容易受到急性认知行为疗法的影响。高危样本的研究结果表明，与治疗相关的变化可能不仅仅归因于时间的流逝。