Cognitive Behavioral Therapy Alters Brain Activity in Children with Anxiety

NIH researchers have found that children with anxiety disorders have overactivity in several brain regions, including the frontal and parietal lobes—important for cognitive and regulatory functions, such as attention and emotion regulation—and deeper limbic areas like the amygdala, which are essential for generating strong emotions, such as anxiety and fear. 

They also showed that treatment with cognitive behavioral therapy (CBT) led to improvements in clinical symptoms and brain functioning. The findings illuminate the brain mechanisms underlying the acute effects of CBT to treat one of the most common mental disorders. The study, published in the American Journal of Psychiatry, was led by researchers at NIMH.

In the study, 69 unmedicated children diagnosed with an anxiety disorder underwent 12 weeks of CBT following an established protocol. CBT involves changing dysfunctional thoughts and behaviors through gradual exposure to anxiety-provoking stimuli.

The researchers used clinician-rated measures to examine the change in children’s anxiety symptoms and clinical functioning from pre- to post-treatment. They also used task-based fMRI to look at whole-brain changes before and after treatment and compare those to brain activity in 62 similarly aged children without anxiety.

Following three months of CBT treatment, children with anxiety showed a clinically significant decrease in anxiety symptoms and improved functioning. Increased activation seen before treatment in many frontal and parietal brain regions also improved after CBT.

However, eight brain regions continued to show higher activity in anxious compared to non-anxious children after treatment. Changing activity in these regions may require a longer duration of CBT, additional forms of treatment or directly targeting subcortical brain areas.

Anxiety disorders are common in children and can cause them significant distress in social and academic situations. They are also chronic, with a strong link into adulthood, when they become harder to treat.