ArticleEuropean archives of psychiatry and clinical neuroscience2026
Pre-treatment functional connectivity patterns associated with variability in cognitive-behavioral therapy response in specific phobia.
Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Specific phobia is an anxiety disorder marked by excessive fear of particular objects or situations. Although cognitive-behavioral therapy is generally effective, patient response varies. The study aimed to explore neural predictors for characterization of treatment-response variability and individualized treatment approaches. Focusing on connectivity rather than structural or functional magnetic resonance imaging features, it also explored pre-treatment functional magnetic resonance imaging differences between high and low responders based on clinically significant changes after therapy. Twenty-nine adults with specific phobia to small animals underwent baseline functional magnetic resonance while exposed to real or virtual 3D images of phobic stimuli. Following an eight-week cognitive behavioral therapy, patients were classified as high or low responders based on clinically significant change. Pre-treatment functional connectivity was analyzed via region-of-interest-to-region-of-interest correlations. Two groups were formed (14 high responders and 15 low responders) and compared by a t-test. Low responders exhibited greater connectivity across language, cognitive-control, reward, and sensorimotor networks. Differences included hyperconnectivity between the nucleus accumbens, inferior frontal gyrus, superior temporal gyrus, and caudate, and between the medial prefrontal cortex and motor/sensorimotor regions. This profile suggests stronger integration of motivational, verbal-conceptual, and motor-preparatory systems, potentially reflecting heightened internal verbalization, rigid habit-based responses, and anticipatory motor readiness. The results therefore point toward a maladaptive pre-treatment connectivity state in low responders, marked by over-recruitment of self-referential and control networks that limit the capacity for flexible emotional updating during cognitive-behavioral therapy. These findings suggest that functional connectivity patterns may contribute to the identification of neural markers associated with treatment response.
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