Dataset Information

CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia.

ABSTRACT: BACKGROUND:Imaging studies have provided evidence that cognitive-behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion-generating and modulatory regions. In this study, we use a data-driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT. METHODS:Eight female patients with spider phobia were scanned before and 1 month after an exposure-based group therapy for spider phobia. Each MRI session consisted of an ASL resting state measurement acquired before and after a symptom provocation task involving the showing of spider pictures in the scanner. The first ASL acquisition measured anticipatory anxiety and the second measured postprocessing of phobia-relevant stimuli. RESULTS:Cognitive-behavioral therapy significantly reduced spider phobic symptoms in all patients. Symptom reduction during anticipatory anxiety was accompanied by reduced bilateral CBF in the parahippocampal gyrus, ventral anterior thalamus, Brodmann area 8, and the anterior cingulate cortex. During postprocessing of phobia-relevant stimuli, patients showed reduced CBF in the bilateral insula, components of the motor cortex, and areas associated with language functions. CONCLUSIONS:Longitudinal CBF dynamics following CBT were in concordance with results from several studies using BOLD fMRI to investigate the effects of psychotherapy on brain activity. CBF can be quantified by ASL, with the principal advantage of sensitivity to slow variations in neural activity and task independence. Therefore, ASL may be a suitable method for monitoring and evaluating the efficacy of psychotherapy or pharmacotherapy approaches.

SUBMITTER: Soravia LM

PROVIDER: S-EPMC5036433 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia.

Soravia Leila M LM Orosz Ariane A Schwab Simon S Nakataki Masahito M Wiest Roland R Federspiel Andrea A

Brain and behavior 20160706 9

<h4>Background</h4>Imaging studies have provided evidence that cognitive-behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion-generating and modulatory regions. In this study, we use a data-driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT.<h4>Methods</h4>Eight female patients with spider phobia were scanned before and ...[more]

PMID: 27688940

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Project description:Glucocorticoids reduce phobic fear in patients with anxiety disorders. Previous studies have shown that fear-related activation of the amygdala can be mediated through the visual cortical pathway, which includes the fusiform gyrus, or through other pathways. However, it is not clear which of the pathways that activate the amygdala is responsible for the pathophysiology of a specific phobia and how glucocorticoid treatment alleviates fear processing in these neural networks. We recorded the brain activity with functional magnetic resonance imaging in patients with spider phobia, who received either 20 mg of cortisol or a placebo while viewing pictures of spiders. We also tested healthy participants who did not receive any medication during the same task. We performed dynamic causal modelling (DCM), a connectivity analysis, to examine the effects of cortisol on the networks involved in processing fear and to examine if there was an association between these networks and the symptoms of the phobia. Cortisol administration suppressed the phobic stimuli-related amygdala activity to levels comparable to the healthy participants and reduced subjective phobic fear. The DCM analysis revealed that cortisol administration suppressed the aberrant inputs into the amygdala that did not originate from the visual cortical pathway, but rather from a fast subcortical pathway mediated by the pulvinar nucleus, and suppressed the interactions between the amygdala and fusiform gyrus. This network changes were distinguishable from healthy participants and considered the residual changes under cortisol administration. We also found that the strengths of the aberrant inputs into the amygdala were positively correlated with the severity of spider phobia. This study demonstrates that patients with spider phobia show an aberrant functional connectivity of the amygdala when they are exposed to phobia-related stimuli and that cortisol administration can alleviate this fear-specific neural connectivity.

Project description:BackgroundAlthough tiny in size and mostly harmless, spiders evoke exceptional fear in a significant part of the population and arachnophobia is one of the most common anxiety disorders with prevalence 2.7-6.1%. Two standard measures have been widely used to reliably assess the emotional and cognitive component of spider fear, the Spider Questionnaire (SPQ) and Spider Phobia Beliefs Questionnaire (SBQ). We aimed to develop and validate their Czech translations, describe distribution of spider fear in the Czech population, and analyse its association with disgust propensity and other sociodemographic characteristics.MethodsIn Phase 1, we developed Czech translations of both questionnaires using a back-translation procedure and then tested their psychometric properties against their English versions in a counterbalanced experimental design using the Mann-Whitney U test and two-sided t-test. In Phase 2, we analysed scores on the Czech SPQ and SBQ on a larger sample. We evaluated the effects of age, gender, level of education, biology background, and association with the assessments of snake fear (i.e. the Snake Questionnaire, SNAQ) and disgust propensity (i.e. the Disgust Scale-Revised, DS-R) using a Spearman correlation, redundancy analysis, and general linear models.ResultsWe have demonstrated that the Czech SPQ and SBQ are equivalent to their originals and show excellent test-retest reliability (SPQ: 0.93; SBQ: 0.87-0.90). In total, 398 (10.3%) out of 3863 subjects reached the cut-off point for potential spider phobia. In addition, SPQ and SBQ scores were highly correlated (0.73-0.79), significantly more than with the SNAQ (0.21-0.32) or the DS-R (0.36-0.40). Two multivariate statistical methods revealed a significant association between the gender, age, level of education, biology background, or disgust propensity and the SPQ scores.ConclusionThe Czech SPQ and SBQ may produce reliable and valid assessments of spider fear, but they must be further psychometrically tested considering the limitation of this study before wider use. We corroborate previous findings that fear of spiders is significantly associated with sociodemographic variables, such as gender, age, or education, as well as with the individual level of disgust propensity.

Dataset Information

CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia.

Publications

CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia.

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