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Before treatment in a 2024 study, children with anxiety disorders had greater brain activity than similarly aged children without anxiety in frontal and parietal cortical regions involved in attention and emotion regulation, as well as limbic regions including the amygdala. After cognitive behavioral therapy, elevated activation in many frontal and parietal regions fell to levels equal to or below those of the comparison group. Researchers said that shift might reflect more efficient engagement of cognitive-control networks. But eight regions, including the right amygdala, remained more active in the children with anxiety, suggesting some limbic responses may be less responsive to CBT’s acute effects.
The NIH-led study, published in the American Journal of Psychiatry in 2024, involved 69 unmedicated children diagnosed with anxiety disorders who completed 12 weeks of CBT. The protocol sought to change dysfunctional thoughts and behaviors through gradual exposure to stimuli that provoked anxiety.
After three months of CBT, the children showed a clinically significant decrease in anxiety symptoms and improved clinical functioning on clinician-rated measures. In this study, the intervention therefore paired gradual exposure and changes in thought and behavior with both clinical improvement and altered activity in brain systems associated with cognitive control.
A separate comparison group included 87 young people at temperamental risk for anxiety who hadn’t been diagnosed with an anxiety disorder and hadn’t received CBT. In that group, higher brain activity was associated with increasing anxiety symptoms over time. NIH described this as preliminary evidence that CBT drove the brain changes observed in the treated children.