The impacts of cognitive-behavioral therapy on the treatment of phobic disorders measured by functional neuroimaging techniques: a systematic review

Abstract

Objective: Functional neuroimaging techniques represent fundamental tools in the context of translational research integrating neurobiology, psychopathology, neuropsychology, and therapeutics. In addition, cognitive-behavioral therapy (CBT) has proven its efficacy in the treatment of anxiety disorders and may be useful in phobias. The literature has shown that feelings and behaviors are mediated by specific brain circuits, and changes in patterns of interaction should be associated with cerebral alterations. Based on these concepts, a systematic review was conducted aiming to evaluate the impact of CBT on phobic disorders measured by functional neuroimaging techniques. Methods: A systematic review of the literature was conducted including studies published between January 1980 and April 2012. Studies written in English, Spanish or Portuguese evaluating changes in the pattern of functional neuroimaging before and after CBT in patients with phobic disorders were included. Results: The initial search strategy retrieved 45 studies. Six of these studies met all inclusion criteria. Significant deactivations in the amygdala, insula, thalamus and hippocampus, as well as activation of the medial orbitofrontal cortex, were observed after CBT in phobic patients when compared with controls. Conclusion: In spite of their technical limitations, neuroimaging techniques provide neurobiological support for the efficacy of CBT in the treatment of phobic disorders. Further studies are needed to confirm this conclusion.

Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy

“…Studies that compared the brain signals obtained before and after treatment have reported changes that are consistent with this model of emotion regulation in depression Dichter, Felder, & Smoski, 2010;Goldapple et al, 2004), phobic disorders (Almeida et al, 2013;Schienle, Schafer, Hermann, Rohrmann, & Vaitl, 2007;Straube, Glauer, Dilger, Mentzel, & Miltner, 2006), panic disorder (Beutel, Stark, Pan, Silbersweig, & Dietrich, 2010;Sakai et al, 2006), posttraumatic stress disorder (Lindauer et al, 2008;Thomaes et al, 2014), personality disorders (Schnell & Herpertz, 2007), and eating disorders (Vocks et al,2010;Vocks et al, 2011). In the treatment of depression, these studies have provided evidence that the neural correlate of psychotherapy may consist in increased activation of prefrontal areas when participants are exposed to emotional stimuli, representing successful recruitment of control processes in the context of emotion regulation (DeRubeis et al, 2008;Disner et al, 2011).…”

Listening to the heart: A meta-analysis of cognitive behavior therapy impact on the heart rate of patients with anxiety disorders

“…Some published reviews observe brain CBT markers of efficacy, which usually involve the regulation of the activation of amygdala, insula, thalamus, the medial prefrontal cortex and hippocampus (Almeida et al, 2013;Porto et al, 2009). However, there are few studies that investigate the impact of CBT on cardiovascular parameters in anxiety disorders.…”

Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing Therapeutic Components of Cognitive Behavioral Therapy

“…On the other hand, both intervention techniques showed their efficacy by producing a decrease in the activation of the brain areas associated with fear, although the brain regions activated were not the same, partially supporting the second hypothesis. Neuroimaging techniques provide neurobiological support for the efficacy of CBT in the treatment of phobic disorders [ 35 , 36 ].…”