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



Eight 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.



Cognitive-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.



Longitudinal 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.
Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland.
Leila M
LM
Soravia
Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland.
Ariane
A
Orosz
Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland.
Simon
S
Schwab
Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland; Department of Psychiatry University of Tokushima 3-18-15 Kuramoto-cho Tokushima 770-8503 Japan.
Masahito
M
Nakataki
Department of Diagnostic and Interventional Neuroradiology Inselspital University Hospital of Bern Freiburgstrasse 4 3010 Bern Switzerland.
Roland
R
Wiest
Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland.
Andrea
A
Federspiel
Anticipatory anxiety; arterial spin labeling; cerebral blood flow; cognitive‐behavioral therapy; fear processing; phobia
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