Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample.

Background: Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.
Methods: Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network.
Results: At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.
Conclusions: Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.
Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
Competing Interests: Declaration of competing interest J.D.F. receives consultation fees from NOCD, Inc. R.J.J. has received salary and research support from the International OCD Foundation, the Charles A. King Trust Postdoctoral Research Fellowship Program (Bank of America, N.A., Co-Trustees), the Harvard University Mind Brain Behavior Initiative, the Harvard University Department of Psychiatry Livingston Fellowship Award, and the Harvard University Pershing Square Fund for Research on the Foundations of Human Behavior, and the National Institute of Mental Health (NIMH; K23 MH120351). She is also paid as a faculty member of the Massachusetts General Hospital Psychiatry Academy for filming role plays for course content and for moderating the course discussion boards. She receives book royalties from Hogrefe Publishing. S.W. is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. She has received royalties from Guilford Publications, New Harbinger Publications, Springer, and Oxford University Press. Dr. Wilhelm has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation, the Tourette Association of America, and the Centers for Disease Control and Prevention. In addition, she received honoraria for her role on the Scientific Advisory Board for One-Mind (PsyberGuide), Koa Health, Inc, and Noom, Inc. Dr. Wilhelm has received research and salary support from Koa Health, Inc. No other co-authors have any declarations of interest.
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