Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms. / Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.

INTRODUCTION: The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias. AIMS: To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons. SUBJECTS AND METHODS: The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group. RESULTS: Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli. CONCLUSIONS: The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms.

TITLE: Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.Introducción. La evidencia disponible recoge resultados consistentes sobre cambios cerebrales morfológicos y funcionales producidos por el tratamiento psicológico. La terapia cognitivo-conductual (TCC) de exposición es actualmente el tratamiento psicológico más eficaz para las fobias. Objetivos. Explorar los cambios cerebrales y autoinformados en pacientes con fobias específicas a animales pequeños sometidos a un programa de TCC de exposición y comprobar si el programa consiguió que estos pacientes procesaran los estímulos temidos de manera similar a las personas no fóbicas. Sujetos y métodos. La muestra estuvo compuesta por 32 adultos, de los que 16 (5 hombres y 11 mujeres; edad media: 38,08 años) tenían un diagnóstico de fobia específica a animales pequeños y 16 (4 hombres y 12 mujeres; edad media: 21,81 años) no tenían dicho diagnóstico. Se utilizó un diseño univariado de tratamiento antes-después. Las puntuaciones del grupo sin fobia en autoinformes y activación cerebral se compararon con las puntuaciones del grupo con fobia posteriores al tratamiento. Resultados. Los datos muestran cambios significativos en la actividad cerebral y mejoras en las medidas autoinformadas debido a la aplicación de la TCC a la fobia específica. Tras recibir TCC, los participantes mostraron una mayor activación en puntos del precúneo. Además, comparado con los participantes sin fobia, los pacientes fóbicos mantenían las respuestas defensivas y de miedo ante los estímulos fóbicos. Conclusiones. El precúneo parece ser un regulador que reorganiza el procesamiento de los estímulos fóbicos. Puede implicar que la TCC de exposición, además, activa mecanismos de aceptación, autoconciencia y autoeficacia.

A meta-analytic review of neuroimaging studies of specific phobia to small animals

Introduction: Neuroimaging techniques have been used to identify the neurological bases of phobias. Objective: This meta-review examines functional magnetic resonance imaging studies of individuals with specific animal phobia compared to healthy controls. Method: Searches on Medline, Psycinfo, Academic Search Complete, PubMed, PsycARTICLES, Redalyc, Scopus, and Cochrane databases were conducted. Twenty high quality studies were selected. The effect size estimation was calculated. Results: The random-effects model showed a high overall effect size for both limbic and frontal sites. Data analyses showed greater brain activity in the left amygdala and insular cortex in phobic individuals. We also observed an activation of the fusiform gyrus, the dorsolateral prefrontal cortex left, and the left cingulate cortex, although these areas were less frequently involved. Healthy controls showed high heterogeneity in the brain areas activated by phobic stimuli. Conclusions: These findings suggest the possible existence of a double processing pathway in phobic stimuli: a rapid processing pathway involving limbic areas and a slow pathway involving both limbic and frontal areas

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[Agoraphobia: combined treatment and virtual reality. Preliminary results]. / Agorafobia: tratamientos combinados y realidad virtual. Datos preliminares.

INTRODUCTION: Several validation studies have identified the use of certain psychodrugs, cognitive-behavioral therapy (CBT) and combined treatment as effective procedures for the treatment of agoraphobia. Recent findings suggest that agoraphobia can also be treated with virtual reality techniques (VRET) as an alternative exposure technique to virtual reality stimuli. METHODOLOGY: Twenty-seven patients with agoraphobia were distributed into two groups of psychoactive drugs (paroxetine and venlafaxine) and into two cognitive- behavioral procedures (with or without exposure to VRET). Seven virtual situations were used. RESULTS: Preliminary results show significant improvements in all the experimental groups. Regarding the psychodrugs (paroxetine and venlafaxine) both significantly improved the symptoms and in regards to the CBT, patients treated with VRET, especially the chronic patients, seem to obtain the best results. CONCLUSIONS: Agoraphobia combined treatments including paroxetine, venlafaxine and cognitive-behavioral therapy (with or without VRET) seem to have clear benefits for the patients. VRET seem to be a possible and effective treatment for agoraphobic patients, especially for those with chronic agoraphobia.

Agorafobia: tratamientos combinados y realidad virtual. Datos preliminares / Agoraphobia: combined treatment and virtual reality. Preliminary results

Introducción. Diversos estudios de validación han identificado el uso de ciertos psicofármacos, las terapias cognitivo-conductuales (TCC) y los tratamientos combinados como procedimientos eficaces para el tratamiento de la agorafobia. Investigaciones recientes sugieren que la agorafobia puede ser abordada también con procedimientos como terapia de exposición a realidad virtual (TERV) los escenarios fóbicos. Metodología. Veintisiete pacientes con agorafobia fueron distribuidos en dos grupos de psicofármacos (paroxetinay venlafaxina) y en dos procedimientos cognitivo-conductuales (con o sin exposición a TERV). Se utilizaron siete escenarios virtuales. Resultados. Se observan mejorías clínicamente significativas en todos los grupos experimentales. Respecto a los psicofármacos (paroxetina y venlafaxina), ambos mejoran significativamente la sintomatología, y en lo que a las TCC se refiere, los pacientes tratados con TERV parecen beneficiarse en mayor medida, especialmente los crónicos. Conclusiones. Los tratamientos combinados para la agorafobia, incluyendo paroxetina, venlafaxina y técnicas cognitivo-conductuales (con o sin TERV), parecen mostrar beneficios clínicos. Las TERV parecen ser un posible tratamiento eficaz para la agorafobia, especialmente para los pacientes con agorafobia crónica (AU)

Introduction. Several validation studies have identified the use of certain psycho drugs, cognitive-behavioral therapy (CBT) and combined treatment as effective procedures for the treatment of agoraphobia. Recent findings suggest that agoraphobia can also be treated with virtual reality techniques (VRET) as an alternative exposure technique to virtual reality stimuli. Methodology. Twenty-seven patients with agoraphobia were distributed into two groups of psychoactive drugs (paroxetine and venlafaxine) and into two cognitive-behavioral procedures (with or without exposure to VRET). Seven virtual situations were used. Results. Preliminary results show significant improvements in all the experimental groups. Regarding the psycho drugs (paroxetine and venlafaxine) both significantly improved the symptoms and in regards to the CBT, patients treated with VRET, especially the chronic patients, seem to obtain the best results. Conclusions. Agoraphobia combined treatments including paroxetine, venlafaxine and cognitive-behavioral therapy (with or without VRET) seem to have clear benefits for the patients. VRET seem to be a possible and effective treatment for agoraphobic patients, especially for those with chronic agoraphobia (AU)