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Does Cognitive Behavioral Therapy Change the Brain? A Systematic Review of Neuroimaging in Anxiety Disorders

Received August 11, 2008; revised October 11, 2008; accepted October 17, 2008. Ms. Porto is affiliated with the Universidade Federal do Rio de Janeiro in Brazil; Dr. Oliveira is affiliated with the Universidade Federal Fluminense; Dr. Mari is affiliated with the Department of Psychiatry and Medical Psychology of the São Paulo Medical School, Universidade Federal de São Paulo (EPM-UNIFESP), in Brazil; Dr. Volchan is affiliated with the Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (IBCCF-UFRJ), in Brazil; Dr. Figueira is affiliated with the Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-FRJ), in Brazil; Dr. Ventura is affiliated with the Institute of Psychology, Universidade Federal do Rio de Janeiro. Address correspondence to Patrícia Ribeiro Porto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; portopat{at}gmail.com (e-mail).

This systematic review aims to investigate neurobiological changes related to cognitive-behavioral therapy (CBT) in anxiety disorders detected through neuroimaging techniques and to identify predictors of response to treatment. Cognitive-behavioral therapy modified the neural circuits involved in the regulation of negative emotions and fear extinction in judged treatment responders. The only study on predictors of response to treatment was regarding obsessive-compulsive disorder and showed higher pretreatment regional metabolic activity in the left orbitofrontal cortex associated with a better response to behavioral therapy. Despite methodological limitations, neuroimaging studies revealed that CBT was able to change dysfunctions of the nervous system.

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