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Brain connectomics predict response to treatment in social anxiety disorder

Abstract

We asked whether brain connectomics can predict response to treatment for a neuropsychiatric disorder better than conventional clinical measures. Pre-treatment resting-state brain functional connectivity and diffusion-weighted structural connectivity were measured in 38 patients with social anxiety disorder (SAD) to predict subsequent treatment response to cognitive behavioral therapy (CBT). We used a priori bilateral anatomical amygdala seed-driven resting connectivity and probabilistic tractography of the right inferior longitudinal fasciculus together with a data-driven multivoxel pattern analysis of whole-brain resting-state connectivity before treatment to predict improvement in social anxiety after CBT. Each connectomic measure improved the prediction of individuals’ treatment outcomes significantly better than a clinical measure of initial severity, and combining the multimodal connectomics yielded a fivefold improvement in predicting treatment response. Generalization of the findings was supported by leave-one-out cross-validation. After dividing patients into better or worse responders, logistic regression of connectomic predictors and initial severity combined with leave-one-out cross-validation yielded a categorical prediction of clinical improvement with 81% accuracy, 84% sensitivity and 78% specificity. Connectomics of the human brain, measured by widely available imaging methods, may provide brain-based biomarkers (neuromarkers) supporting precision medicine that better guide patients with neuropsychiatric diseases to optimal available treatments, and thus translate basic neuroimaging into medical practice.

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Acknowledgements

This study was funded in part by NIH grants R01MH078308 and R01MH075889 from the National Institute of Mental Health and the Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA.

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Correspondence to S Whitfield-Gabrieli.

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Whitfield-Gabrieli, S., Ghosh, S., Nieto-Castanon, A. et al. Brain connectomics predict response to treatment in social anxiety disorder. Mol Psychiatry 21, 680–685 (2016). https://doi.org/10.1038/mp.2015.109

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