Effects Of Hypnosis And Progressive Muscle Relaxation Training On Resting-state Brain Functional Activity Of Social Anxiety

Background: Social anxiety disorder(SAD)is considered as one of the most difficult mental disorders to treat.Patients with social anxiety show a significant and persistent fear of various social occasions,which severely hinders interpersonal communication,and may even develop into severe mental or physical illness,endangering the safety of themselves and others.The important factors leading to this disease are negative selfcognition and excessive attention to negative emotional stimuli,which are related to the excessive activation of the emotional generating brain region and the disorder of cognitively controlled brain regions.So far,psychotherapy and drug treatment have only achieved partial success,thus,we need to further understand the pathogenesis of SAD and explore new treatments to improve the prognosis of SAD patients.Resting-state functional magnetic resonance imaging(rs-f MRI)has a high spatial resolution,and can clearly and intuitively reflect abnormal brain activity changes and neural mechanisms in SAD individuals.Hypnosis aims to guide subjects into a special subconscious state,while giving them specific hypnotic suggestion.Researches have proved that hypnosis has significant effects on insomnia,pain,and anxiety.Progressive muscle relaxation training has also proven to have the effect of relieving anxiety and relaxing the mind and body.However,the therapeutic effects and neural mechanisms of these two therapies on SAD are still unclear.Objective: We will use hypnotic therapy and progressive muscle relaxation training to alleviate or eliminate social anxiety,and use resting-state f MRI technique to investigate the underlying neural mechanisms,comparing hypnotic therapy with progressive muscle relaxation training on social anxiety.Method: The Leibowitz Social Anxiety Scale(LSAS)was used to screen out individuals with high social anxiety traits with a total score higher than 63(N = 65)among undergraduates,and randomly divided into hypnotherapy group(HYP,N = 32)or progressive muscle relaxation training group(PMR,N = 33).In addition,undergraduates with a total LSAS score of less than 16 were selected to enter the low social anxiety group(N = 26),which was taken into the baseline comparison.The HYP group and the PMR group all received 6 sessions of hypnotherapy or PMR treatment in one month.The scale test and f MRI scans were performed on three groups of subjects before the treatment,and the HYP and PMR groups were scaled and scanned after the treatment.Besides,the HYP and PMR groups were performed one-week,one-month,and three-month follow-up after the treatment by using LSAS.Results: Behavioral scales: Before the treatment,the two treatment groups both have significant difference with the low scored group on LSAS,Shyness Scale,Self-rating depression scale(SDS),Fear of Negative Evaluation Scale(FNE),Self-efficacy Scale,and Trust Scale(p < 0.01).However,there was no significant difference between the HYP group and the PMR group(p > 0.05)on these behavioral scales.After the treatment,the average score of LSAS of the HYP group and the PMR group were significantly reduced(p < 0.01),but the group difference was not significant(p > 0.05).The follow-up results showed that the LSAS scores of the HYP group and the PMR group increased slightly within three months after the intervention,but were still significantly lower than the pretested scores(p < 0.05).The LSAS score of the HYP group was minimized one week after the intervention,and the Shyness Scale(t =-1.892,p < 0.05)and FNE(t =-2.746,p < 0.01)score of the HYP group was significantly lower than the PMR group after the treatment(p < 0.05).Resting state f MRI: Compared with the low scored group,the high social anxiety traits individuals have a significant decrease on the activity of the anterior default mode network(DMN),but the posterior DMN was activated;the activity of salience network(SN)was decreased;the executive control network(ECN)has shown the activation of the right orbital suprafrontal gyrus,the right angular gyrus,and the inhibition of medial and lateral cingulate gyrus(p < 0.05,FWE correction).After the treatment,HYP group has significantly changed these difference compared with PMR group,that is,activate the anterior part of the DMN and inhibit the posterior part;implement the ECN to inhibit the the right orbital suprafrontal gyrus,DLPFC,and the right angular gyrus(p < 0.05,FWE correction).The average signal at the precuneus of individuals with high social anxiety traits was significantly positively correlated with the LSAS score(FWE voxel level correction,p < 0.05);the average signal of the MPFC was significantly negatively correlated with the LSAS score(r =-0.22,p < 0.05).Regional homogeneity(Re Ho)was compared between the HYP group and the PMR group.Compared with the PMR group,the HYP group showed significantly decreased Re Ho value in the posterior cingulate cortex(PCC),precuneus,supplementary motor area(SMA),left central anterior gyrus,and right amygdala after intervention(FWE cluster level correction,p < 0.05).Functional connection analysis showed that compared with the PMR group,the HYP group decreased the functional connection between precuneus and PCC,precuneus and fusiform gyrus,PCC and VMPFC,PCC and left angular gyrus,SMA and central anterior gyrus,SMA and cingulate gyrus,amygdala and hippocampus after intervention(FWE voxel level correction,p < 0.05).Conclusion: Hypnotherapy and PMR training can effectively alleviate the social anxiety symptoms of college students with high social anxiety traits,however,hypnosis therapy showed more continuous effects during follow-up.In addition,hypnosis therapy can also improve the shyness and fear of negative evaluation traits of SAD.Hypnotic therapy can ameliorate the abnormal brain network of individuals with high social anxiety compared with PMR,and change the activity of self-cognition-related brain regions and emotiongenerated brain regions.