Neurobiological Aspects of Cognitive-Behavioral Therapy With Anxiety Disorders(Invited Article)

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The focus of this article was on providing updates on the neurocircuitry of anxiety disorder, partly with the aim of providing a clinical foundation for approaching the symptoms and cognitive-behavioral therapy of these conditions. Both animal and clinical studies indicate that the amygdala and paralimbic structures play an important role in conditioned fear, and hyperactivation of the limbic system is characteristic of a number of different anxiety disorders. Paralimbic regions such as anterior cingulate appears to play a key role in the interface of cognition and emotion. In addition, cortico-striato-thalamo-cortical pathways may be important in anxiety disorders, particularly in OCD. Treatment, which focused on reversing the effects of fear conditioning on psychological, somatic and behavioral symptoms associated with the efferent arm of the anxiety circuit, has been shown to be effective. The various psychotherapies target the cortical components and the explicit memory systems of the hippocampus and implicit memory of the amygdala. Behavioural therapies such as systematic desensitization or exposure produce "deconditioning", which works mainly on the implicit memory system (amygdala) and follow by retraining hippocampal neurons to reorganize the contextual cues that they store, so that they are no longer associated with danger signal and no longer produce the fear conditioning response. Cognitive therapy or other "speaking psychotherapies", in which the contextual memories are explored, may attack the same problem from the cortical level, mainly in temporal and prefrontal areas. Cognitive-behavioral therapies have been designed to reverse the impact of fear conditioning from both cortical and limbic perspectives.
2005-09-30

Neurobiological Aspects of Cognitive-Behavioral Therapy With Anxiety Disorders(Invited Article)

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