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The purpose of this study is to determine whether neuroimaging-based markers of maladaptive self-focused processing are better predictors of treatment response to cognitive-behavioral therapy than behavioral markers.
First, the investigators propose to identify the neural correlates of self-focused processing. The investigators will assess baseline resting state connectivity within the default network, as well as regional brain activation using a well-validated event-related fMRI task that manipulates self-focused processing in patients with body dysmorphic and socially anxious symptoms, compared to healthy controls. This clinical sample was selected because such patients display heightened self-focused attention, and sampling individuals across these symptom dimensions will ensure greater variability on this dimension of maladaptive self-focused processing. Second, the investigators will examine the neural correlates of self-focused processing as a predictor of treatment response. Neuroimaging data will be acquired from patients with body dysmorphic and socially anxious symptoms during two scan sessions, before and after 12 weeks of individual cognitive behavioral therapy, and compared with healthy controls scanned twice at a 12 week interval. Finally, the investigators will compare the prediction of treatment response between neural measures and behavioral measures of self-focused processing. The investigators will assess the behavioral correlates of self-focused processing using a self-reference effect paradigm, and assess their relation to treatment response. If the investigators hypotheses are borne out, the investigators will have new targets for treatment, a method to identify promising candidates for treatment, and sensitive surrogate markers of treatment response.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cognitive-behavioral therapy | Experimental | Twelve weekly sessions of individual cognitive-behavioral therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cognitive-behavioral therapy | Behavioral | Twelve weekly sessions of individual cognitive-behavioral therapy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline clinical symptoms at 12 weeks | Evidence of symptom improvement as determined by clinician-administered assessment of body dysmorphic and socially anxious symptoms | Baseline and 12 weeks from baseline |
| Neural activation in the default mode network | Difference in regional brain activation in the default mode network in the Self vs. Other contrast (specifically in the medial prefrontal cortex, temporoparietal junction, posterior cingulate) during fMRI activation paradigm | Baseline and 12 weeks later |
| Resting state functional connectivity within the default mode network | Functional connectivity within the default mode network during resting state scan | Baseline and 12 weeks later |
| Response latencies during Self vs. Other conditions | Difference in average response latencies (in ms) during Self and Other conditions of a self-referential processing task | Baseline and 12 weeks later |
| Measure | Description | Time Frame |
|---|---|---|
| Word valence during Self vs. Other conditions | Number of positive and negative words endorsed during Self and Other task conditions | Baseline and 12 weeks later |
| Structural connectivity within the default mode network |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Angela Fang, Ph.D. | University of Washington | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Massachusetts General Hospital | Boston | Massachusetts | 02114 | United States | ||
| University of Washington |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38266332 | Derived | Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample. J Psychiatr Res. 2024 Mar;171:108-115. doi: 10.1016/j.jpsychires.2024.01.018. Epub 2024 Jan 16. | |
| 37693433 | Derived | Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample. medRxiv [Preprint]. 2023 Sep 2:2023.08.30.23294878. doi: 10.1101/2023.08.30.23294878. |
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| ID | Term |
|---|---|
| D000072861 | Phobia, Social |
| D057215 | Body Dysmorphic Disorders |
| ID | Term |
|---|---|
| D010698 | Phobic Disorders |
| D001008 | Anxiety Disorders |
| D001523 | Mental Disorders |
| D013001 | Somatoform Disorders |
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| ID | Term |
|---|---|
| D015928 | Cognitive Behavioral Therapy |
| ID | Term |
|---|---|
| D001521 | Behavior Therapy |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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White matter connectivity within the default mode network during DTI scan
| Baseline and 12 weeks later |
| Seattle |
| Washington |
| 98195 |
| United States |
| 34875086 | Derived | Fang A, Baran B, Beatty CC, Mosley J, Feusner JD, Phan KL, Wilhelm S, Manoach DS. Maladaptive self-focused attention and default mode network connectivity: a transdiagnostic investigation across social anxiety and body dysmorphic disorders. Soc Cogn Affect Neurosci. 2022 Jul 2;17(7):645-654. doi: 10.1093/scan/nsab130. |