title: fMRI neurofeedback facilitates anxiety regulation in females with spider phobia.
abstract: BACKGROUND
  Spider phobics show an exaggerated fear response when encountering spiders. This fear response is aggravated by negative and irrational beliefs about the feared object. Cognitive reappraisal can target these beliefs, and therefore has a fear regulating effect. The presented study investigated if neurofeedback derived from functional magnetic resonance imaging (fMRI) would facilitate anxiety regulation by cognitive reappraisal, using spider phobia as a model of anxiety disorders. Feedback was provided based on activation in left dorsolateral prefrontal cortex and right insula, as indicators of engagement and regulation success, respectively.
  
  
  METHODS
  Eighteen female spider phobics participated in a randomized, controlled, single-blinded study. All participants completed a training session in the MRI scanner. Participants assigned to the neurofeedback condition were instructed to shape their regulatory strategy based on the provided feedback. Participants assigned to the control condition were asked to adapt their strategy intuitively.
  
  
  RESULTS
  Neurofeedback participants exhibited lower anxiety levels than the control group at the end of the training. In addition, only neurofeedback participants achieved down-regulation of insula activation levels by cognitive reappraisal. Group differences became more pronounced over time, supporting learning as a mechanism behind this effect. Importantly, within the neurofeedback group, achieved changes in insula activation levels during training predicted long-term anxiety reduction.
  
  
  CONCLUSIONS
  The conducted study provides first evidence that fMRI neurofeedback has a facilitating effect on anxiety regulation in spider phobia.
authors.affiliation: Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Psychiatry, Icahn School of Medicine at Mount Sinai New York, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Zilverstand
authors.affiliation: Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands.
authors.forename: Bettina
authors.initials: B
authors.lastname: Sorger
authors.affiliation: Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University Hospital Aachen, Germany.
authors.forename: Pegah
authors.initials: P
authors.lastname: Sarkheil
authors.affiliation: Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience Amsterdam, Netherlands.
authors.forename: Rainer
authors.initials: R
authors.lastname: Goebel
keywords: anxiety; cognitive reappraisal; fMRI; neurofeedback; real-time; regulation; self-regulation; spider phobia