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

Abstract

BackgroundImaging 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.MethodsEight 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.ResultsCognitive‐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.ConclusionsLongitudinal 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.

Glucocorticoids and cortical decoding in the phobic brain

“…It has been shown that the lateral frontal pole co-activates with the ACC and the anterior insula (Gilbert et al, 2010) . This result, consistent with the symptom reduction achieved through CBT, was associated with lower responsiveness in the bilateral insula and the ACC and a reduction in cerebral blood flow (Hauner et al, 2012;Soravia et al, 2016) . Contrary, the cortisol group showed decoding in the precuneus, the anterior cerebellum, and the opercular cortex (weak evidence).…”

Glucocorticoid administration restores salience network activity in patients with spider phobia

“…This finding is in line with the results of a study that examined SN and DMN activity across task conditions in patients with current anorexia nervosa, recovered patients, and healthy controls(McFadden et al, 2014). According to a review of functional neuroimaging studies performed on patients with specific phobias, most studies have shown aberrant activation in brain regions involved in emotion generation and emotion regulation, particularly the amygdala, ACC, thalamus, and insula, which normalizes after successful psychotherapy(Del Casale et al, 2012;Paquette et al, 2003;Soravia et al, 2016a). These results are similar to our findings showing that DMN activity was able to differentiate patients with a current diagnosis of spider phobia from healthy control participants.…”

Epigenetic and Neural Circuitry Landscape of Psychotherapeutic Interventions

“…With regard to more proximal fear response patterns, CBT has been shown to decrease limbic, paralimbic, and PAG hyperactivation in a public speech task, with maintenance of effects at one-year follow-up [ 236 ]; when exposed to a specific phobic stimulus (e.g., a spider), CBT can additionally promote a decrease in dlPFC and insula activation, highlighting the decrease in autonomic fear systems as well as activity in areas implicated in disgust and shame. A decrease in insula activity during fear processing was supported by an additional study of spider phobia in patients undergoing group CBT with an exposure component [ 268 ]. In the treatment of PD, CBT has been shown to decrease activation within fear-based networks (e.g., amygdala, anterior insulae, and dACC), as well as promoting more harmonious circuit connectivity.…”