Quick evaluation can predict whether drugs, talk therapy work better for anxiety patients

December 7, 2017 by Sharon Parmet, University of Illinois at Chicago

Clinicians and patients often struggle to find the right treatment for anxiety, sometimes cycling through various therapies for months before the patient begins to feel their symptoms improve.

Now, researchers at the University of Illinois at Chicago have found that a brief test that can be performed in the office can help determine whether an antidepressant or a form of talk therapy, called cognitive behavioral therapy or CBT, would be better at relieving symptoms of in individual patients. Their findings are reported in the journal Neuropsychopharmacology.

Selective serotonin reuptake inhibitors (SSRIs) and CBT are two often-used, first-line treatment options for anxiety. SSRIs are believed to relieve anxiety symptoms by modifying the transmission of serotonin in the brain. CBT helps patients modify dysfunctional thoughts and behaviors and encourages them to develop new cognitive and behavioral techniques to manage mood and . Both are generally and equally effective for treating anxiety, but who responds to one versus the other remains a mystery. In previous research, Stephanie Gorka, assistant professor of psychiatry in the UIC College of Medicine and lead author on the paper, showed that higher electrical activity in the brain in response to committing an error - known as error-related negativity or ERN - was associated with greater symptoms of anxiety.

"People with tend to show an exaggerated neural response to their own mistakes," said Gorka. "This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder."

ERN can be measured using electroencephalography, or EEG, which records electrical signals from the brain through the scalp. A cap embedded with electrodes can pick up these signals. A larger ERN signal reflects an enhanced brain response when a mistake is made.

To elicit errors, participants in Gorka's study wore an EEG cap while they performed a task that required them to quickly and accurately indicate the direction of a center arrow embedded within a string of arrows on a computer screen. A new screen would appear each time the participant indicated the direction of the center arrow using a button. "The task is a bit harder than it sounds and the pace picks up, which inevitably leads to mistakes," Gorka said.

Gorka and colleagues recruited 60 adult volunteers with anxiety disorders and 26 healthy participants with no history of mental health problems. All participants completed the arrow task while undergoing EEG. Next, participants with anxiety disorders were randomized to take an SSRI every day for 12 weeks, or to 12 weekly sessions of CBT delivered by a psychotherapist. After treatment, all participants completed the arrow task again to assess whether there were changes in neural reactivity related to making mistakes.

The researchers found that an enhanced ERN at the beginning of treatment was associated with greater reduction in anxiety for participants who received CBT, but not for those who received SSRIs. In fact, participants prescribed SSRIs had even more enhanced ERN at the end of the 12-week treatment period.

"We found that ERN can help predict which patients will achieve better outcomes with , and that information is very useful because that CBT is a time-intensive, less-available resource and because SSRIs can be associated with side effects, it's good to know that a patient will do better on CBT to reduce the exposure to potential side effects," Gorka said.

"Using EEG to measure ERN before deciding on a treatment give us a simple and objective way to help more people get the right treatment the first time around," said Dr. K. Luan Phan, professor of psychiatry in the UIC College of Medicine and a senior author on the paper. "Patients tend to leave treatment when the first attempt fails to reduce their symptoms. Once people drop out, we lose the opportunity to take care of them, and ultimately these continue to suffer from their anxiety," continued Phan, who holds the University of Illinois Center on Depression and Resilience Professorship.

Gorka thinks that with enhanced ERN do better with CBT because they respond well to the structured learning that occurs in the context of individual therapy. "CBT is all about learning new techniques for reducing anxiety and learning to reframe overly negative ideas or feelings. People highly attuned to their own behavior, as evidenced by their enhanced ERN, might just be more receptive and attentive to the lessons learned through CBT," she said.

The total time for set up and arrow task completion is less than 30 minutes, and because EEG equipment is relatively cheap, portable and available, Gorka thinks that it can be easily incorporated into practitioners' office settings and decision-making process when it comes to determining .

Explore further: CBT, SSRIs effectively cut anxiety symptoms in childhood

More information: Stephanie M Gorka et al, Error-Related Brain Activity as a Treatment Moderator and Index of Symptom Change during Cognitive-Behavioral Therapy or Selective Serotonin Reuptake Inhibitors, Neuropsychopharmacology (2017). DOI: 10.1038/npp.2017.289

Related Stories

CBT, SSRIs effectively cut anxiety symptoms in childhood

September 5, 2017
(HealthDay)—Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective for reducing symptoms of anxiety in childhood, according to a review published online Aug. 31 in JAMA Pediatrics.

Fear of the unknown common to many anxiety disorders

November 18, 2016
Several anxiety disorders, including panic disorder, social anxiety disorder and specific phobias, share a common underlying trait: increased sensitivity to uncertain threat, or fear of the unknown, report researchers from ...

Interventions for anxiety may help people with autism spectrum disorder

August 30, 2017
A new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reports that anxiety occurring in autism spectrum disorder (ASD) shares similar brain mechanisms as anxiety alone. Led by Drs. John Herrington ...

Managing anxiety

November 2, 2017
(HealthDay)—A little bit of stress can motivate you, but too much might cause an anxiety disorder that can prevent you from living your life to the fullest.

Patients' expectations influence effectiveness of SSRI antidepressants

October 3, 2017
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety but their superiority over placebo has been questioned, generating considerable debate among researchers and clinicians. In ...

Severe anxiety best treated with drugs and therapy

October 3, 2017
Children and teens with severe anxiety need both behavioral therapy and medication for the best chance of improvement, a new Yale-led analysis has found.

Recommended for you

We start caring about our reputations as early as kindergarten

March 20, 2018
Kindergarteners don't use social media, but they do care about their public image. Research suggests that by the time kids go to elementary school, they're thinking critically about their reputation. In a Review published ...

Social media use at age 10 could reduce wellbeing of adolescent girls

March 19, 2018
Social media use may have different effects on wellbeing in adolescent boys and girls, according to research published in the open access journal BMC Public Health.

We can read each other's emotions from surprisingly tiny changes in facial color, study finds

March 19, 2018
Our faces broadcast our feelings in living color—even when we don't move a muscle.

Study with infants suggests language not necessary for reasoning ability

March 16, 2018
A team of researchers from Spain, Hungary and Poland has found via a study with infants that language may not be a necessity for the ability to reason. In their paper published in the journal Science, the group describes ...

Hep C compounds alcoholism's effect on brain volume

March 16, 2018
(HealthDay)—Alcohol dependence has deleterious effects on frontal cortical volumes that are compounded by hepatitis C virus (HCV) infection and drug dependence, according to a study published online March 14 in JAMA Psychiatry.

Study casts doubt on ketamine nasal sprays for depression

March 16, 2018
Researchers from the Black Dog Institute and UNSW Sydney have questioned the efficacy and safety of intranasal ketamine for depression, with their pilot trial stopped early due to poor side effects in patients.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.