Simple evaluation could help choose therapy or medication for anxiety treatment

"Patients tend to leave treatment when the first attempt fails to reduce their symptoms. Once people drop out, we lose the opportunity to take care of them, and ultimately these patients continue to suffer from their anxiety," said Dr. K. Luan Phan.
By Brooks Hays  |  Dec. 7, 2017 at 3:28 PM
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Dec. 7 (UPI) -- A short, simple evaluation can help doctors determine whether a patient with anxiety will respond best to medication or talk therapy, according to new research.

Researchers at the University of Illinois at Chicago found that by measuring a patient's error-related negativity, or ERN, they can determine whether or not a patient is an ideal candidate for cognitive behavioral therapy.

CBT works by altering a participant's negative or problematic thoughts and behaviors. Psychiatrists and psychologists using CBT teach patients new cognitive and behavioral techniques to better manage anxiety and related symptoms.

Both CBT and selective serotonin reuptake inhibitors, or SSRIs, the most common type of anxiety drug, have good track records in treating generalized anxiety. Therapy can sometimes help patients deal with anxiety without resorting to medications, which can cause side effects, but CBT involves a significant time commitment and doesn't work for everyone.

The test developed by Chicago researchers, however, can help care takers determine whether CBT will work or not -- before a patient invests their time.

The tests measures a patient's ERN using electroencephalography, or EEG. People with anxiety tend to exhibit high levels of error-related negativity.

"People with anxiety disorders tend to show an exaggerated neural response to their own mistakes," Stephanie Gorka, an assistant professor of psychiatry in the UIC College of Medicine, said in a news release. "This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder."

Gorka and her research partner, Dr. K. Luan Phan, a professor of psychiatry, recruited patients with anxiety to don EEG skull caps while playing a fairly straightforward computer game. The game asks participants to identify the direction the arrow in the center of the screen is pointing. The center arrow is embedded in a line of arrows. Each time the player answers, a new screen with a new line of arrows appears.

"The task is a bit harder than it sounds and the pace picks up, which inevitably leads to mistakes," Gorka said.

The results showed participants with high ERN levels responded best to CBT. SSRIs increased ERN levels of those with already enhanced error-related negativity.

"We found that ERN can help predict which patients will achieve better outcomes with cognitive behavioral therapy," Gorka said.

Researchers published their findings in the journal Neuropsychopharmacology.

"Using EEG to measure ERN before deciding on a treatment gives us a simple and objective way to help more people get the right treatment the first time around," Phan said. "Patients tend to leave treatment when the first attempt fails to reduce their symptoms. Once people drop out, we lose the opportunity to take care of them, and ultimately these patients continue to suffer from their anxiety."

The researchers believe CBT tends to work better for those with high ERN levels because the behavioral therapy attempts to tap into and adjust the same learning systems that inspire enhanced error-related negativity.

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