CBT Reduced Frontal and Parietal Activity in Children with Anxiety

On January 24, 2024, researchers from the National Institute of Mental Health (NIMH), a subset of the NIH, published a study in the American Journal of Psychiatry revealing that cognitive behavioral therapy (CBT) can reduce brain activity in cortical areas of the frontal and parietal lobe of the brain, without any assistance from medication.

“The findings can help our understanding of how and for which children CBT works, a critical first step in personalizing anxiety care and improving clinical outcomes,” said senior author Melissa Brotman, PhD, Chief of the Neuroscience and Novel Therapeutics Unit in the NIMH Intramural Research Program, in the NIH release.

The study recruited 69 unmedicated children with anxiety disorders who were enrolled in 12 weeks of CBT. In addition to evaluating patients’ baseline anxiety levels, each patient had task-based functional MRIs (fMRI) before and after CBT to track and assess changes in brain activity.

At baseline, children with anxiety had elevated activity in the cortical areas of their frontal and parietal lobes. Based on scientific evidence, these brain areas regulate multiple functions, including attention and emotional regulation. Additionally, they had increased activity in their amygdala, which mediates stronger emotions such as anxiety and fear.

Although these brain areas had elevated activity before CBT, researchers discovered that this treatment may be able to reduce activities in some brain regions. For example, children with anxiety had equal or lower brain activity in the frontal and parietal lobes than those without anxiety after they had been treated with 12 weeks of CBT.

However, CBT did not effectively reduce brain activity in other areas of the brain, such as the amygdala and the rest of the limbic system.

“Understanding the brain circuitry underpinning feelings of severe anxiety and determining which circuits normalize and which do not as anxiety symptoms improve with CBT is critical for advancing treatment and making it more effective for all children,” said first author Simone Haller, PhD, Director of Research and Analytics in the NIMH Neuroscience and Novel Therapeutics Unit.

Although more data is needed to quantify the value of CBT in children with anxiety, the results of this study reveal the importance of CBT in managing mental health.