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

Abstract

Cognitive behavioral therapy (CBT) packages for anxiety disorders, such as phobias, usually include gradual exposure to anxious contexts, positive self-verbalizations, and relaxation breathing. The objective of this research was to analyze the specific neural activation produced by the self-verbalizations (S) and breathing (B) included in CBT. Thirty participants with clinical levels of a specific phobia to small animals were randomly assigned to three fMRI conditions in which individuals were exposed to phobic stimuli in real images: a group underwent S as a technique to reduce anxiety; a second group underwent B; and a control group underwent exposure only (E). Simple effects showed higher brain activation comparing E > S, E > B, and S > B. In particular, in the E group, compared to the experimental conditions, an activation was observed in sensory-perceptive and prefrontal and in other regions involved in the triggering of emotion (i.e., amygdala, supplementary motor area, and cingulate gyrus) as well as an activation associated with interoceptive sensitivity (i.e., insula and cingulate cortex). According to the specific tool used, discrepancies in the neural changes of CBT efficacy were observed. We discuss the theoretical implications according to the dual model of CBT as a set of therapeutic tools that activate different processes.

A Voxel-Based Morphometric Study of Gray Matter in Specific Phobia

“…Thus, individuals with phobia assign greater importance to the emotion generated by the feared stimulus than the regulatory mechanisms. Indeed, interventions based on exposure to the feared stimulus support the functional importance of the PFC which could suggest an attempt at emotional regulation or even the activity of other cognitive processes involved [ 49 ]. Therefore, phobias could be better explained by a model focusing on the control exerted by frontal areas as opposed to the dual model that emphasizes the effect of the deactivation of limbic areas.…”