Structural variations of neural regions implicated in fear responses have been well documented in the pathophysiology of anxiety and may play an important role in treatment response. We examined whether gray matter volume of three neural regions supporting fear and avoidance responses [bilateral amygdala, nucleus accumbens (NAcc), and ventromedial prefrontal cortex (PFC)] predicted cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) treatment outcome in two independent samples of patients with anxiety disorders. Study 1 consisted of 81 adults with anxiety disorders and Study 2 included 55 children and adolescents with anxiety disorders. In both studies, patients completed baseline structural MRI scans and received either CBT or SSRI treatment. Clinician-rated interviews of anxiety symptoms were assessed at baseline and posttreatment. Among the adult sample, greater pre-treatment bilateral NAcc volume was associated with a greater reduction in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment. Greater left NAcc volume also predicted greater decreases in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment among youth with current anxiety. Across studies, results were similar across treatments, and findings were maintained when adjusting for patient's age, sex, and total intracranial brain volume. We found no evidence for baseline amygdala or ventromedial PFC volume serving as treatment predictors across the two samples. Together, these findings provide promising support for the role of NAcc volume as an objective marker of anxiety treatment improvement that spans across development. Future studies should clarify the specific mechanisms through which NAcc volume exerts its therapeutic effects.

中文翻译：

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在两个独立样本中，伏核体积可作为 CBT 和 SSRI 治疗后焦虑症状改善的预测指标。


与恐惧反应有关的神经区域的结构变化已在焦虑的病理生理学中得到充分记录，并且可能在治疗反应中发挥重要作用。我们检查了支持恐惧和回避反应的三个神经区域的灰质体积 [双侧杏仁核、伏隔核 (NAcc) 和腹内侧前额叶皮质 (PFC)] 是否可以预测认知行为疗法 (CBT) 和选择性血清素再摄取抑制剂 (SSRI) 治疗焦虑症患者的两个独立样本的结果。研究 1 包括 81 名患有焦虑症的成年人，研究 2 包括 55 名患有焦虑症的儿童和青少年。在这两项研究中，患者完成了基线结构 MRI 扫描并接受了 CBT 或 SSRI 治疗。在基线和治疗后评估临床医生评定的焦虑症状访谈。在成人样本中，治疗前双侧 NAcc 体积越大，与 CBT 和 SSRI 治疗前后临床医生评价的焦虑症状的更大程度减少相关。左侧 NAcc 体积越大，也预示着目前患有焦虑症的青少年在 CBT 和 SSRI 治疗前后临床医生评定的焦虑症状会出现更大程度的减轻。各项研究中，不同治疗方法的结果相似，并且在调整患者的年龄、性别和颅内总脑容量后，结果仍保持不变。我们没有发现任何证据表明基线杏仁核或腹内侧 PFC 体积可作为两个样本的治疗预测因子。总之，这些发现为 NAcc 体积作为跨越发育过程的焦虑治疗改善的客观标志物的作用提供了有希望的支持。未来的研究应该阐明 NAcc 容量发挥治疗作用的具体机制。