Brain Correlates of Self-Focused Processing

Massachusetts General Hospital89 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Social Phobia Body Dysmorphic Disorder

Interventions

Cognitive-behavioral therapyBEHAVIORAL

Twelve weekly sessions of individual cognitive-behavioral therapy

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Men and women, age 18-45 * For patients: treatment-seeking individuals presenting with at least moderate levels of social anxiety/body dysmorphic symptoms, and a score of at least 1 SD above the mean on the public self-consciousness scale of the Self-Consciousness Scale- Revised * For healthy controls only: no current or lifetime history of psychiatric disorders, and score of below 1 SD of mean on the SCS-R * Right-handed, as determined by the Handedness Inventory * Fluent in English, and willing to provide informed consent Exclusion Criteria: * Positive MR screen * History of head injury, neurological disorder, or neurosurgical procedure * Active suicidal or homicidal ideation * Current or past manic/hypomanic episode or psychotic symptoms * Active alcohol and substance dependence (as assessed by the SCID-5-RV * Current use of psychotropic medications, except antidepressants taken at a stable dose for 2 weeks, to maximize generalizability of sample * Current CBT and/or formal mindfulness/meditation training * History of more than 10 sessions of CBT and formal mindfulness/meditation training

Locations (2)

Massachusetts General Hospital

Boston, Massachusetts, United States

University of Washington

Seattle, Washington, United States

Outcomes

Primary Outcomes

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

Time frame: 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