Therapy for Adult Social Anxiety Disorder: A Meta-Analysis of Functional Neuroimaging Studies

Objective: We conducted a meta-analysis of the literature reporting neuroimaging in patients undergoing psychotherapy and pharmacotherapy for social anxiety disorder (SAD).

Data Sources: Using PubMed, MEDLINE, and Embase, we searched for English-language studies published between January 2000 and February 2015 with terms related to SAD, therapy, and neuroimaging.

Study Selection: Twelve studies were included with a total of 295 subjects with SAD before and after therapy from January 2000 to February 2015.

Data Extraction: We extracted peak coordinates of clusters of significant group differences and performed a meta-analysis using effect-size signed differential mapping to analyze the peak coordinates of clusters and thresholds.

Results: Therapy significantly reduced activity in the left inferior parietal gyrus (Z = 1.441; P < .001), right postcentral gyrus (Z = 1.711; P < .001), and right precuneus (Z = 1.352; P < .01) and increased activity in the left inferior frontal gyrus/insula (Z = 1.939; P < .001) and bilateral middle cingulate gyrus (Z = 1.836; P < .001). Psychotherapy significantly increased activity in the bilateral precuneus (Z = 2.259; P < .001) and left inferior parietal gyrus (Z = 1.786; P < .001) and decreased activity in the left anterior cingulate gyrus (Z = 1.707; P < .001), left middle frontal gyrus (Z = 1.584; P < .001), and right cerebellum (Z = 1.424; P < .01). Pharmacotherapy increased activity in the right postcentral gyrus (Z = 1.215; P < .01), left middle occipital gyrus (Z = 1.269; P < .01), and right medial orbital frontal gyrus (Z = 1.250; P < .01) and reduced activity in the bilateral insula (Z = 2.172; P < .001; Z = 1.608; P < .01) and left medial cingula (Z = 1.479; P < .01). The improvement in social anxiety symptoms was positively associated with hyperactivity of the bilateral precuneus, left inferior partial gyrus, right medial cingulate, and right postcentral gyrus but negatively associated with hypoactivity of the bilateral insula and right medial cingulate (P < .01). We did not find any difference of amygdala among these 3 groups.

Conclusions: Previous reports of brain imaging suggest that pharmacotherapy and psychotherapy impact different brain regions in adult patients with SAD.

J Clin Psychiatry 2016;77(11):e1429–e1438