Schienle A, Schafer A, Hermann A, Rohrmann S, Vaitl D. Symptom provocation and reduction in patients suffering from spider phobia: an fMRI study on exposure therapy. Eur Arch Psychiatry Clin Neurosci 257: 486-493

Clinical Psychology, Karl-Franzens-Universität Graz, Universitätsplatz 2/III, 8010 Graz, Austria.
European Archives of Psychiatry and Clinical Neuroscience (Impact Factor: 3.53). 12/2007; 257(8):486-493. DOI: 10.1007/s00406-007-0754-y
Source: PubMed


Neurofunctional mechanisms underlying cognitive behavior therapy (CBT) are still not clearly understood. This functional magnetic
resonance imaging (fMRI) study focused on changes in brain activation as a result of one-session CBT in patients suffering
from spider phobia. Twenty-six female spider phobics and 25 non-phobic subjects were presented with spider pictures, generally
disgust-inducing, generally fear-inducing and affectively neutral scenes in an initial fMRI session. Afterwards, the patients
were randomly assigned to either a therapy group (TG) or a waiting list group (WG). The scans were repeated one week after
the treatment or after a one-week waiting period. Relative to the non-phobic participants, the patients displayed increased
activation in the amygdala and the fusiform gyrus as well as decreased activation in the medial orbitofrontal cortex (OFC)
during the first exposure. The therapy effect consisted of increased medial OFC activity in the TG relative to the WG. Further,
therapy-related reductions in experienced somatic anxiety symptoms were positively correlated with activation decreases in
the amygdala and the insula. We conclude that successful treatment of spider phobia is primarily accompanied by functional
changes of the medial OFC. This brain region is crucial for the self-regulation of emotions and the relearning of stimulus-reinforcement

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Available from: Dieter Vaitl, Dec 17, 2013
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    • "Cogn Affect Behav Neurosci with emotion regulation in previous research (e.g., Cavanna & Trimble, 2006; see Carlsson et al., 2004; Hermann et al., 2009; Schienle et al., 2007; Wik et al., 1996, for their implications in animal phobia). This suggests that biased expectancies in spider phobia are an important constituent of deficits in emotion regulation processes that are mediated by these areas. "
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    ABSTRACT: Spider-phobic individuals are characterized by exaggerated expectancies to be faced with spiders (so-called encounter expectancy bias). Whereas phobic responses have been linked to brain systems mediating fear, little is known about how the recruitment of these systems relates to exaggerated expectancies of threat. We used fMRI to examine spider-phobic and control participants while they imagined visiting different locations in a forest after having received background information about the likelihood of encountering different animals (spiders, snakes, and birds) at these locations. Critically, imagined encounter expectancies modulated brain responses differently in phobics as compared with controls. Phobics displayed stronger negative modulation of activity in the lateral prefrontal cortex, precuneus, and visual cortex by encounter expectancies for spiders, relative to snakes or birds (within-participants analysis); these effects were not seen in controls. Between-participants correlation analyses within the phobic group further corroborated the hypothesis that these phobia-specific modulations may underlie irrationality in encounter expectancies (deviations of encounter expectancies from objective background information) in spider phobia; the greater the negative modulation a phobic participant displayed in the lateral prefrontal cortex, precuneus, and visual cortex, the stronger was her bias in encounter expectancies for spiders. Interestingly, irrationality in expectancies reflected in frontal areas relied on right rather than left hemispheric deactivations. Our data accord with the idea that expectancy biases in spider phobia may reflect deficiencies in cognitive control and contextual integration that are mediated by right frontal and parietal areas.
    Full-text · Article · Feb 2015 · Cognitive Affective & Behavioral Neuroscience
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    • "Not by chance association between amygdala gray matter volume and anxiety-related traits/states have been reported in numerous studies in healthy subjects (Barrós-Loscertales et al., 2006; Tottenham et al., 2010; van der Plas et al., 2010; Gerritsen et al., 2012) as well as altered activation and volume in the amygdala are common findings in mood and anxiety disorders (Etkin and Wager, 2007; Drevets et al., 2008; Irle et al., 2010; Atmaca, 2011; Kempton et al., 2011; Sacher et al., 2012). Furthermore, reduced activation of the vmPFC along with amygdala hyperactivation and a dysfunctional recruitment of ACC and dmPFC has been observed in patients with specific phobia and post-traumatic stress disorder (Schienle et al., 2007; Hermann et al., 2009; Milad et al., 2009), most likely indicating reduced cognitive control of emotional reactions. Interestingly, phobic individuals more frequently using cognitive reappraisal have an increased vmPFC activation during extinction learning and recall (Hermann et al., 2013b), probably related to a stronger extinction learning as following a successful CBT (Schienle et al., 2007). "
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    ABSTRACT: Individuals regulate their emotions in a wide variety of ways. In the present review it has been addressed the issue of whether some forms of emotion regulation are healthier than others by focusing on two commonly used emotion regulation strategies: cognitive reappraisal (changing the way one thinks about potentially emotion-eliciting events) and expressive suppression (changing the way one behaviorally responds to emotion-eliciting events). In the first section, experimental findings showing that cognitive reappraisal has a healthier profile of short-term affective, cognitive, and social consequences than expressive suppression are briefly reported. In the second section, individual-difference findings are reviewed showing that using cognitive reappraisal to regulate emotions is associated with healthier patterns of affect, social functioning, and well-being than is using expressive suppression. Finally, brain structural basis and functional activation linked to the habitual usage of cognitive reappraisal and expressive suppression are discussed in detail.
    Full-text · Article · Sep 2014 · Frontiers in Systems Neuroscience
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    • "In line with this interpretation, dispositional reappraisal has been shown to be associated with a diminished activation decrease in the vmPFC over time in the present study. The vmPFC has previously been found to exhibit reduced activation during symptom provocation in patients with specific phobia [11-13]. Moreover, reduced activation of the vmPFC along with amygdala hyperactivation has been observed during the acquisition of conditioned fear responses [38] most likely indicating reduced cognitive control of emotional reactions. "
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    ABSTRACT: Extinction learning is proposed to be one key mechanism of action underlying exposure-based cognitive-behavioral therapy (CBT) in specific phobia. Beyond that, cognitive reappraisal, one important strategy to regulate negative emotions, is a crucial component of CBT interventions, but has been disregarded in previous studies investigating neural change processes in specific phobia. The aim of this study was to investigate the association of individual differences in habitual/dispositional cognitive reappraisal usage and the time course of brain activation during phobic stimulation in specific phobia. Dental phobic patients and healthy control subjects participated in a functional magnetic resonance imaging (fMRI) study whilst being confronted with phobic, disgust, fear and neutral pictures. Individual differences in cognitive reappraisal usage were assessed via a self-report questionnaire and correlated with activation decreases over the course of time. Phobic individuals with higher dispositional cognitive reappraisal scores showed a more pronounced activation decline in the right dorsomedial prefrontal cortex (dmPFC) which might be associated with a diminution of explicit cognitive emotion regulation over the course of time. Less decrease of activation in the right ventromedial prefrontal cortex (vmPFC) and the lateral orbitofrontal cortex (lOFC) over time in subjects with higher cognitive reappraisal scores might be related to a stronger automatic regulation of emotions or even emotional relearning. Additionally, phobic subjects compared with healthy controls showed a stronger habituation of the left dmPFC over the course of symptom provocation. The results of this study show for the first time that individual differences in cognitive reappraisal usage are associated with the time course of brain activation during symptom provocation in specific phobia. Additionally, the present study gives first indications for the importance of considering individual differences in cognitive reappraisal usage in the treatment of specific phobia.
    Full-text · Article · Aug 2013 · Biology of Mood and Anxiety Disorders
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