title: SPIDER OR NO SPIDER? NEURAL CORRELATES OF SUSTAINED AND PHASIC FEAR IN SPIDER PHOBIA.
abstract: BACKGROUND
  Processes of phasic fear responses to threatening stimuli are thought to be distinct from sustained, anticipatory anxiety toward an unpredicted, potential threat. There is evidence for dissociable neural correlates of phasic fear and sustained anxiety. Whereas increased amygdala activity has been associated with phasic fear, sustained anxiety has been linked with activation of the bed nucleus of stria terminalis (BNST), anterior cingulate cortex (ACC), and the insula. So far, only a few studies have focused on the dissociation of neural processes related to both phasic and sustained fear in specific phobia. We suggested that first, conditions of phasic and sustained fear would involve different neural networks and, second, that overall neural activity would be enhanced in a sample of phobic compared to nonphobic participants.
  
  
  METHODS
  Pictures of spiders and neutral stimuli under conditions of either predicted (phasic) or unpredicted (sustained) fear were presented to 28 subjects with spider phobia and 28 nonphobic control subjects during functional magnetic resonance imaging (fMRI) scanning.
  
  
  RESULTS
  Phobic patients revealed significantly higher amygdala activation than controls under conditions of phasic fear. Sustained fear processing was significantly related to activation in the insula and ACC, and phobic patients showed a stronger activation than controls of the BNST and the right ACC under conditions of sustained fear. Functional connectivity analysis revealed enhanced connectivity of the BNST and the amygdala in phobic subjects.
  
  
  CONCLUSIONS
  Our findings support the idea of distinct neural correlates of phasic and sustained fear processes. Increased neural activity and functional connectivity in these networks might be crucial for the development and maintenance of anxiety disorders.
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Anna Luisa
authors.initials: AL
authors.lastname: Münsterkötter
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Swantje
authors.initials: S
authors.lastname: Notzon
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Ronny
authors.initials: R
authors.lastname: Redlich
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Grotegerd
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Dohm
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.affiliation: Department of Clinical Radiology, University of Münster, Münster, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Kugel
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.|kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany.|Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
authors.affiliation: Department of Psychiatry, University of Münster, Münster, Germany.|Department of Psychiatry, University of Marburg, Marburg, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Dannlowski
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology; D000818:Animals; D001007:Anxiety / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D001008:Anxiety Disorders / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000503:physiopathology; D005239:Fear; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology*; D013112:Spiders
keywords: anticipatory anxiety; fMRI; fear network; neural correlates; phobia