Towards Personalized, Brain-Based Behavioral Intervention for Transdiagnostic Anxiety: Transient Neural Responses to Negative Images Predict Outcomes Following a Targeted Computer-Based Intervention

• Published in: Journal of consulting and clinical psychology 2018-12, Vol.86 (12), p.1031-1045
• Main Authors: Price, Rebecca B, Cummings, Logan, Gilchrist, Danielle, Graur, Simona, Banihashemi, Layla, Kuo, Susan S, Siegle, Greg J
• Format: Article
• Language: English
• Subjects: Adult; Anxiety; Anxiety Disorders - physiopathology; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Attention - physiology; Attentional Bias; Behavior modification; Behavior Therapy; Behavior Therapy - methods; Brain; Brain - diagnostic imaging; Brain - physiopathology; Clinical outcomes; Cognitive behavioral therapy; Comorbidity; Computer Assisted Therapy; Computer based modeling; Cortex; Deployment; Disability; Female; Functional Magnetic Resonance Imaging; Human; Humans; Individual differences; Individuality; Intervention; Magnetic Resonance Imaging - methods; Male; Medical imaging; Morbidity; Neurocognition; Pattern recognition; Personalization; Precision medicine; Predictive Value of Tests; Public health; Therapy, Computer-Assisted - methods; Threat; Treatment Outcome; Treatment Outcomes
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000309

Objective: Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information. Method: Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat. Results: Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy. Conclusions: Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse). What is the public health significance of this article? This study suggests that a translational computer-based treatment targeting attentional patterns works best for those anxiety patients showing a specific, relevant profile of brain responses. This information might help in developing a process-based framework for matching patients to treatments across many anxiety diagnoses.