Task-based neural correlates of self-focused attention associated with cognitive behavioral therapy response

Self-focused attention (SFA), a form of self-referential processing, is maladaptive in various psychiatric disorders and may be associated with poor treatment response. This study examined SFA in individuals with social anxiety disorder (SAD) and body dysmorphic disorder (BDD), testing the hypothesis that SFA is associated with hyperactivity within default network (DN) regions and with treatment response during cognitive-behavioral therapy. Participants included 30 patients with primary SAD or BDD and 28 healthy controls, who displayed above average and below average scores (respectively) on the Public Self-Consciousness Scale, which measured trait SFA. SFA was also measured by a self-referential encoding task, which yielded both behavioral reaction time measures and task-related fMRI measures of SFA. Results indicated significantly longer reaction times at pre-treatment for self vs. other trials in patients compared to controls, with patients showing notable improvement post-treatment. Neuroimaging revealed greater activation in DN regions, including the medial prefrontal cortex, during self vs. other trials in all participants; however, there were no significant group differences at pre- or post-treatment, nor in the changes from pre- to post-treatment. Neural measures of SFA were significantly associated with treatment response, whereas behavioral measures were not. These findings suggest that activity in DN regions may serve as a transdiagnostic biomarker of maladaptive SFA that is associated with treatment response.