Exposure therapy triggers lasting reorganization of neural fear processing

Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Proceedings of the National Academy of Sciences (Impact Factor: 9.67). 05/2012; 109(23):9203-8. DOI: 10.1073/pnas.1205242109
Source: PubMed


A single session of exposure therapy can eliminate recalcitrant and disabling fear of phobogenic objects or situations. We studied neural mechanisms of this remarkable outcome by monitoring changes in brain activity as a result of successful 2-h treatment. Before treatment, phobogenic images excited activity in a network of regions, including amygdala, insula, and cingulate cortex, relative to neutral images. Successful therapy dampened responsiveness in this fear-sensitive network while concomitantly heightening prefrontal involvement. Six months later, dampened fear-network activity persisted but without prefrontal engagement. Additionally, individual differences in the magnitude of visual cortex activations recorded shortly after therapy predicted therapeutic outcomes 6 mo later, which involved persistently diminished visual responsiveness to phobogenic images. Successful therapy thus entailed stable reorganization of neural responses to initially feared stimuli. These effects were linked to fear-extinction mechanisms identified in animal models, thus opening new opportunities for the treatment and prevention of debilitating anxiety disorders.

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    • "Several studies report amygdala changes with treatment of anxiety (Furmark et al., 2002; Faria et al., 2012; Hauner et al., 2012; Mansson et al., 2013; Phan et al., 2013; Taylor et al., 2013). Some work shows reduced amygdala activation bilaterally after treatment (Furmark et al., 2002; Faria et al., 2012; Taylor et al., 2013), while others have found lateralized effects either in the left (Hauner et al., 2012; Mansson et al., 2013) or right amygdala (Phan et al., 2013). In one study, amygdala activation decreased more for treatment responders than nonresponders , particularly in the right hemisphere (Furmark et al., 2002). "
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    • "Neuroimaging of persons with psychological disorders has revealed many differences from healthy persons, such as differences in measures of regional cerebral blood flow (rCBF), change in local blood oxygenation levels, levels of brain metabolites, functional connectivity, etc. (these are described further below). Thus, the effects of treatment may involve trends towards normalization of pretreatment abnormalities, such as normalization of pretreatment hypo-or hyperactivations in brain regions (Mayberg, 2003) Alternatively, effects of treatment may show brain changes suggesting involvement of compensatory neural mechanisms, such as changes in brain regions that did not show pretreatment abnormalities or change in direction from hypo-to hyperactivation, etc. (Hauner et al., 2012). Note that different types of results may be observable in different clinical time periods. "
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