Individuals who exhibit greater brain activity in response to angry facial expressions may be more likely to benefit from cognitive behavioral therapy (CBT), according to new neuroimaging research. The findings, published in Psychological Medicine, could help mental health professionals choose the most effective treatments for patients with anxiety disorders and depression.

As a licensed psychologist, I am continuously reminded of the pervasiveness of depression and anxiety disorders, which commonly co-occur and are frequently associated with interpersonal difficulties that substantively reduce quality of life. Fortunately, CBT for anxiety and depression can help, said study author Heide Klumpp, an associate professor and director of the Clinical Cognitive Affective Neuroscience Lab at the University of Illinois at Chicago.

However, people differ in the extent to which they benefit from CBT which focuses on changing thoughts and behaviors to better manage negative emotions. Symptoms and demographic information are not good predictors of response to CBT.

Yet, accumulating data from neuroimaging studies suggests brain regions that underlie facial expressions, an important interpersonal signal, may predict individual differences in CBT outcome, Klumpp said. Developing brain-based profiles to help determine who is and who is not likely to benefit from CBT could aid in guiding which treatments a person should receive from an assortment of treatments with different mechanisms of action.

In the study, 90 individuals with depression and/or anxiety completed an emotion recognition task as the researchers used functional magnetic resonance imaging (fMRI) to record their brain activity. The procedure was conducted twice: Once before and once after 12 weeks of CBT.

The researchers found that patients who had shown a greater activity in a particular brain region during the emotion recognition task tended to experience the greatest improvement after treatment.

Following CBT, about half of the participants with depression and/or an anxiety were considered to be responders as they experienced more than a 50% reduction in symptom severity,Klumpp told PsyPost.

A data-driven classification approach identified two brain-based subtypes.The subtype characterized by more brain activity to angry faces in a visual area (i.e., superior occipital gyrus)before CBTconsisted of more responders than the subtype representing less brain activity in the region, despite subtypes having similar levels of depression and anxietybeforetreatment. After completing CBT, the difference in brain activity between subtypes remained and the one with less brain response to angry faces had more anxiety and depression symptoms, Klumpp explained.

Angry faces can signal interpersonal aggression that may be encountered relatively frequently.Findings suggest it is possible to identify distinct brain-based subgroups that have clinical implications; here, individuals with more reactivity to angry facial expressions in a visual processing region are more likely to benefit from the skills learned in CBT.

The findings are a step toward improving the ability to choose the most effective treatments for psychiatric disorders. Klumpp was also involved in research indicating that activity in other brain regions, such as the insula and amygdala, can help predict treatment outcomes as well.

But as with any study, the new research includes some caveats.

The number of participants in the study was relatively small so it will be necessary to replicate findings in a larger sample, Klumpp said. Since CBT was not compared to an alternative treatment such as medication and there was no waitlist (i.e., no treatment) group, we cannot conclude findings are unique to CBT.

Also, the processing of emotional facial expressions involves an array of brain regions that are part of large networks, thus, it would be important for future studies to examine the clinical utility of neural network-based approaches.

Lastly, it cannot be assumed that the patient subtypes represent abnormal brain activity, Klumpp noted. Indeed, anxiety and depression symptoms range from nonexistent to severe as opposed to all-or-none. Therefore, it could be useful to identify brain-based groups that capture meaningful divisions along a mental health continuum before treatment and then evaluate their response to a treatment or combination of interventions to tailor treatments to the individual to increase therapeutic gains.

The study, Brain response to emotional faces in anxiety and depression: neural predictors of cognitive behavioral therapy outcome and predictor-based subgroups following therapy, was authored by Heide Klumpp, Jagan Jimmy, Katie L. Burkhouse, Runa Bhaumik, Jennifer Francis, Michelle G. Craske, K. Luan Phan and Olusola Ajilore.

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Study uncovers neural predictors of cognitive behavioral therapy outcome for patients with anxiety and dep ... - PsyPost