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Psychotherapy for social anxiety disorder and changes in neural activity (PANDA)

Social anxiety disorder (SAD) is characterised by an intense fear of being the centre of attention or of behaving in an embarrassing or humiliating way. Without adequate treatment, SAD is often chronic and leads to a significant reduction in quality of life. A key role in the development and maintenance of the symptoms of SAD is played by negative self-referential basic beliefs. On a neurobiological level, SAD is characterised by hyperreactivity of the salience network with simultaneous dysregulation of the executive control network. While treatment effects of cognitive behavioural therapy (CBT) in SAD have already been investigated in several meta-analyses, the psychological and neuronal mechanisms of action have not yet been sufficiently researched.
In the planned randomised controlled research project, a psychological effect model of CBT in 80 patients with SAD will be tested and linked to neurobiological mechanisms. In particular, CBT-associated changes in self-related basic beliefs and in the fear of observation and evaluation at the behavioural and neurobiological level are investigated by means of functional magnetic resonance imaging. For the first time in this project a paradigm on negative self-referential basic beliefs in combination with a paradigm on executive functions during a social-evaluative situation before and after CBT is implemented. For the first time, it can be tested whether assumptions about therapy-induced changes in effective (directed) fronto-limbic connectivity (top-down and bottom-up modulations) can be proven using dynamic causal modelling and whether a significantly deviating connectivity from the amygdala to the anterior cingulate cortex predicts a CBT non-response. A better understanding of the neurobiological mechanisms of action of CBT and their prediction could provide an explanation to therapy response or non-response and help develop more precise and effective treatment strategies for SAD.