title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal da Bahia, Affective Disorders Center, Department of Neurosciences and Mental Health, School of Medicine, SalvadorBA, Brazil.
authors.forename: Amanda
authors.initials: A
authors.lastname: Galvao-de Almeida
authors.forename: Gerardo Maria de
authors.initials: GM
authors.lastname: Araujo Filho
authors.forename: Arthur de Almeida
authors.initials: Ade A
authors.lastname: Berberian
authors.forename: Clarissa
authors.initials: C
authors.lastname: Trezsniak
authors.forename: Fabiana
authors.initials: F
authors.lastname: Nery-Fernandes
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Araujo Neto
authors.forename: Andrea Parolin
authors.initials: AP
authors.lastname: Jackowski
authors.forename: Angela
authors.initials: A
authors.lastname: Miranda-Scippa
authors.forename: Irismar Reis de
authors.initials: IR
authors.lastname: Oliveira
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology / Q000628:therapy*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed