Background
Cognitive behavioral therapy (CBT) is an effective treatment for emotional disorders
such as anxiety or depression, but the mechanisms underlying successful intervention
are far from understood. Although it has been a long-held view that psychopharmacological
approaches work by directly targeting automatic emotional information processing in
the brain, it is usually postulated that psychological treatments affect these processes
only over time, through changes in more conscious thought cycles. This study explored
the role of early changes in emotional information processing in CBT action.
Methods
Twenty-eight untreated patients with panic disorder were randomized to a single session
of exposure-based CBT or waiting group. Emotional information processing was measured
on the day after intervention with an attentional visual probe task, and clinical
symptoms were assessed on the day after intervention and at 4-week follow-up.
Results
Vigilance for threat information was decreased in the treated group, compared with
the waiting group, the day after intervention, before reductions in clinical symptoms.
The magnitude of this early effect on threat vigilance predicted therapeutic response
after 4 weeks.
Conclusions
Cognitive behavioral therapy rapidly affects automatic processing, and these early
effects are predictive of later therapeutic change. Such results suggest very fast
action on automatic processes mediating threat sensitivity, and they provide an early
marker of treatment response. Furthermore, these findings challenge the notion that
psychological treatments work directly on conscious thought processes before automatic
information processing and imply a greater similarity between early effects of pharmacological
and psychological treatments for anxiety than previously thought.
Key Words
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Article info
Publication history
Published online: March 18, 2013
Accepted:
February 4,
2013
Received in revised form:
February 4,
2013
Received:
September 5,
2012
Identification
Copyright
© 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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- Threat-Related Attention Bias in the Early Stages of Cognitive-Behavior Therapy Action for Panic DisorderBiological PsychiatryVol. 73Issue 11
- PreviewCognitive theories of anxiety propose that information-processing biases play a pivotal role in the etiology and maintenance of anxiety disorders (1). Along with the application of conditioning principles derived from learning theories, such cognitive models inspired the development of cognitive-behavioral therapy (CBT), now considered the first-line treatment for anxiety disorders (2,3). But although extensive evidence indicates that automatic attention is biased toward threatening information in anxious individuals (4), such threat-related attention biases were typically thought to be outside the realm of the direct therapeutic effects of CBT, which focuses primarily on the modification of thoughts, interpretations, and beliefs (3).
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