Chang, Seryn; (2024) The neural mechanisms underlying Cognitive Behavioural Therapy for anxiety-related disorders: Insights into the neural basis of affective bias. Doctoral thesis (D.Clin.Psy), UCL (University College London).

Text Chang_Thesis_final_volume1_Chang_REDACTED COPY.pdf - Submitted Version Access restricted to UCL open access staff until 1 November 2025. Download (2MB)

Abstract

Aims This systematic review aimed to evaluate the effects of psychological therapy on brain functional connectivity in clinical anxiety, particularly the prefrontal-amygdala circuit that has been well implicated in emotion regulation. Methods A systematic literature search was conducted using PubMed and Web of Science databases. We included longitudinal fMRI studies assessing pre-to-post therapy changes in functional connectivity in adults with anxiety-related disorders. Thirty studies met the criteria, with 21 examining CBT and nine examining mindfulness/acceptance-based therapies or eye movement desensitization and reprocessing. Results Most studies found that CBT modulated prefrontal-amygdala connectivity in varying patterns (both increases and decreases in connectivity) across different prefrontal regions, suggesting complex neural adaptations. Findings extended to obsessive-compulsive and post-traumatic stress disorders, with therapy effects on broader neural networks including the default mode, frontoparietal, and salience networks. Third-wave therapies and EMDR were associated with neural effects linked to improved cognitive control and emotion regulation. Conclusions Therapies, including CBT and third-wave approaches, appear to induce meaningful clinical and neural changes across anxiety disorders. Future research should focus on specific prefrontal subregions, broader network-level changes, and replicate and extend findings for third-wave and non-CBT approaches.

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