The fear of spiders: perceptual features assessed in augmented reality.

Background: Persons with specific phobias typically generalize the dangerousness of the phobic animal to all members of its species, possibly as a result of malfunctioning brain circuitry normally providing quick and dirty identification of evolutionary-relevant stimuli. An objective assessment of which perceptual features make an animal more or less scary to phobic and non-phobic people would help overcome the limitations of the few studies available so far, based on self-reports. Objective: To achieve this aim, we built an augmented reality setting where volunteers with different levels of fear of spiders were asked to make holographic spiders that look either dangerous or harmless. To reach this goal, a computerized interface allowed participants to modify the spider's perceptual features (hairiness, body/leg size, and locomotion) in real time. Results: On average, the dangerous spiders were made hairy, thick, and moving according to spider-like locomotion; coherently, the harmless spiders were made hairless, slim, and moving according to a butterfly-like locomotion. However, these averaged preferences could not fully describe the complex relationship between perceptual preferences with each other and with arachnophobia symptoms. An example of a key finding revealed by cluster analysis is the similarity in perceptual preferences among participants with little or no fear of spiders, whereas participants with more arachnophobia symptoms expressed more varying preferences. Conclusion: Perceptual preferences toward the spider's features were behaviorally assessed through an observational study, objectively confirming a generalization effect characterizing spider-fearful participants. These results advance our knowledge of phobic preferences and could be used to improve the acceptability of exposure therapies.

Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia.

PURPOSE: This analogue pilot study examined the feasibility (i.e. preliminary results, safety, acceptability) of a new single-session treatment for adults with a fear of spiders. MATERIALS: It used state-of-the-art consumer available VR-hardware for therapist-assisted exposure (VRET-AP). The VRET-AP is largely adapted from Öst's one-session treatment for arachnophobia (Öst, 1987), with the aim of addressing shortcomings of previous VRET treatments, such as marked differences in procedures compared to available and evidence based in-vivo treatments. METHOD: Participants (N = 12) were screened for fear of spiders using the Spider Phobia Questionnaire (SPQ), Fear Questionnaire (FQ) and the Behavioral Approach Test (BAT), prior to and directly after treatment in a repeated measures quasi-experimental design. In addition, acceptance and completion rates were measured and participants were interviewed about their experience of the treatment. Mean ratings as well as Reliable Change Index (RCI) for individual trajectories were analyzed. RESULTS: The results from the preliminary data indicates potential for improvements with large effect sizes (d = 0.90-1,384) in all measurements of spider fear at post-treatment. Reliable Change Index (RCI) analysis showed that spider fear diminished in all twelve participants although the change was certain in only two. None deteriorated. All that responded accepted the treatment and all 11 participants completed all levels in the treatment. No concerns or adverse effects were reported in the interviews which largely confirm the quantitative results. CONCLUSION: VRET-AP is a feasible alternative for delivering effective treatment for fear of spiders and the results motivate larger, randomized trials of VRET-AP involving participants diagnosed with arachnophobia.

Animals evoking fear in the Cradle of Humankind: snakes, scorpions, and large carnivores.

Theories explain the presence of fears and specific phobias elicited by animals in contemporary WEIRD (Western, educated, industrialized, rich, and democratic) populations by their evolutionary past in Africa. Nevertheless, empirical data about fears of animals in the Cradle of Humankind are still fragmentary. To fill this gap, we examined which local animals are perceived as the most frightening by Somali people, who inhabit a markedly similar environment and the region where humans have evolved. We asked 236 raters to rank 42 stimuli according to their elicited fear. The stimuli were standardized pictures of species representing the local fauna. The results showed that the most frightening animals were snakes, scorpions, the centipede, and large carnivores (cheetahs and hyenas). These were followed up by lizards and spiders. Unlike in Europe, spiders represent less salient stimuli than scorpions for Somali respondents in this study. This conforms to the hypothesis suggesting that fear of spiders was extended or redirected from other chelicerates.

Toward a reliable detection of arachnophobia: subjective, behavioral, and neurophysiological measures of fear response.

Introduction: The administration of questionnaires presents an easy way of obtaining important knowledge about phobic patients. However, it is not well known how these subjective measurements correspond to the patient's objective condition. Our study aimed to compare scores on questionnaires and image evaluation to the objective measurements of the behavioral approach test (BAT) and the neurophysiological effect of spiders extracted from fMRI measurements. The objective was to explore how reliably subjective statements about spiders and physiological and behavioral parameters discriminate between phobics and non-phobics, and what are the best predictors of overall brain activation. Methods: Based on a clinical interview, 165 subjects were assigned to either a "phobic" or low-fear "control" group. Finally, 30 arachnophobic and 32 healthy control subjects (with low fear of spiders) participated in this study. They completed several questionnaires (SPQ, SNAQ, DS-R) and underwent a behavioral approach test (BAT) with a live tarantula. Then, they were measured in fMRI while watching blocks of pictures including spiders and snakes. Finally, the respondents rated all the visual stimuli according to perceived fear. We proposed the Spider Fear Index (SFI) as a value characterizing the level of spider fear, computed based on the fMRI measurements. We then treated this variable as the "neurophysiological effect of spiders" and examined its contribution to the respondents' fear ratings of the stimuli seen during the fMRI using the redundancy analysis (RDA). Results: The results for fear ranks revealed that the SFI, SNAQ, DS-R, and SPQ scores had a significant effect, while BAT and SPQ scores loaded in the same direction of the first multivariate axis. The SFI was strongly correlated with both SPQ and BAT scores in the pooled sample of arachnophobic and healthy control subjects. Discussion: Both SPQ and BAT scores have a high informative value about the subject's fear of spiders and together with subjective emotional evaluation of picture stimuli can be reliable predictors of spider phobia. These parameters provide easy and non-expensive but reliable measurement wherever more expensive devices such as magnetic resonance are not available. However, SFI still reflects individual variability within the phobic group, identifying individuals with higher brain activation, which may relate to more severe phobic reactions or other sources of fMRI signal variability.

Do Spiders Ride on the Fear of Scorpions? A Cross-Cultural Eye Tracking Study.

Deep fear of spiders is common in many countries, yet its origin remains unexplained. In this study, we tested a hypothesis based on recent studies suggesting that fear of spiders might stem from a generalized fear of chelicerates or fear of scorpions. To this end, we conducted an eye tracking experiment using a spontaneous gaze preference paradigm, with spiders and scorpions (previously neglected but crucial stimuli) as threatening stimuli and grasshoppers as control stimuli. In total, 67 participants from Somaliland and 67 participants from the Czech Republic were recruited and presented with a sequence of paired images. Both Somali and Czech people looked longer (total duration of the gaze) and more often (number of fixations) on the threatening stimuli (spiders and scorpions) when presented with a control (grasshopper). When both threatening stimuli were presented together, Somali participants focused significantly more on the scorpion, whereas in Czech participants, the effect was less pronounced, and in Czech women it was not significant. This supports the hypothesis that fear of spiders originated as a generalized fear of scorpions. Moreover, the importance of spiders as fear-eliciting stimuli may be enhanced in the absence of scorpions in the environment.

Facing Your Fear in Immersive Virtual Reality: Avoidance Behavior in Specific Phobia.

Specific phobias are the most common anxiety disorder and are characterized by avoidance behavior. Avoidance behavior impacts daily function and is proposed to impair extinction learning. However, despite its prevalence, its objective assessment remains a challenge. To this end, we developed a fully automated experimental procedure using immersive virtual reality. The procedure contained a behavioral search, forced-choice, and an approach task with varying degrees of freedom and task relevance of the stimuli. In this study, we examined the sensitivity and feasibility of these tasks to assess avoidance behavior in patients with specific phobia. We adapted the tasks by replacing the originally conditioned stimuli with a spider and a neutral animal and investigated 31 female participants composed of 15 spider-phobic and 16 non-phobic participants. As the non-phobics were quite heterogeneous in terms of their Fear of Spiders Questionnaire (FSQ) scores, we subdivided them into six "fearfuls" that had elevated FSQ scores, and 10 "non-fearfuls" that had no fear of spiders. The phobics successfully managed to complete the procedure and showed consistent avoidance behavior across all behavioral tasks. Compared to the non-fearfuls, which did not show any avoidance behavior at all, the phobics looked at the spider much more often and clearly directed their body toward it in the search task. In the approach task, they hesitated most when they were close to the spider, and their difficulty to touch the spider was reflected in a strong increase in right hand acceleration changes. The fearfuls showed avoidance behavior depending on the tasks: strongest in the search task and weakest in the approach task. Additionally, we identified subjective valence ratings of the spider as the main influence on both objective avoidance behavior and subjective well-being after exposure, mediating the effect of the FSQ. In summary, the behavioral tasks are well suited to assess avoidance behavior in phobic participants and provide detailed insights into the process of avoidance.

Measuring fear evoked by the scariest animal: Czech versions of the Spider Questionnaire and Spider Phobia Beliefs Questionnaire.

BACKGROUND: Although tiny in size and mostly harmless, spiders evoke exceptional fear in a significant part of the population and arachnophobia is one of the most common anxiety disorders with prevalence 2.7-6.1%. Two standard measures have been widely used to reliably assess the emotional and cognitive component of spider fear, the Spider Questionnaire (SPQ) and Spider Phobia Beliefs Questionnaire (SBQ). We aimed to develop and validate their Czech translations, describe distribution of spider fear in the Czech population, and analyse its association with disgust propensity and other sociodemographic characteristics. METHODS: In Phase 1, we developed Czech translations of both questionnaires using a back-translation procedure and then tested their psychometric properties against their English versions in a counterbalanced experimental design using the Mann-Whitney U test and two-sided t-test. In Phase 2, we analysed scores on the Czech SPQ and SBQ on a larger sample. We evaluated the effects of age, gender, level of education, biology background, and association with the assessments of snake fear (i.e. the Snake Questionnaire, SNAQ) and disgust propensity (i.e. the Disgust Scale-Revised, DS-R) using a Spearman correlation, redundancy analysis, and general linear models. RESULTS: We have demonstrated that the Czech SPQ and SBQ are equivalent to their originals and show excellent test-retest reliability (SPQ: 0.93; SBQ: 0.87-0.90). In total, 398 (10.3%) out of 3863 subjects reached the cut-off point for potential spider phobia. In addition, SPQ and SBQ scores were highly correlated (0.73-0.79), significantly more than with the SNAQ (0.21-0.32) or the DS-R (0.36-0.40). Two multivariate statistical methods revealed a significant association between the gender, age, level of education, biology background, or disgust propensity and the SPQ scores. CONCLUSION: The Czech SPQ and SBQ may produce reliable and valid assessments of spider fear, but they must be further psychometrically tested considering the limitation of this study before wider use. We corroborate previous findings that fear of spiders is significantly associated with sociodemographic variables, such as gender, age, or education, as well as with the individual level of disgust propensity.

Placebo and Non-specific Effects in Reconsolidation-Based Treatment for Arachnophobia.

The idea that maladaptive memories may be rendered susceptible to interference after reactivation raises the possibility of reactivating and neutralizing clinically-relevant emotional memories. In this study, we sought to investigate the feasibility of such a "reconsolidation-based" intervention for arachnophobia, drawing upon previous research that successfully reduced fear of spiders in a subclinical sample. In Experiment 1, we piloted several reactivation procedures for conducting a reconsolidation-based treatment for arachnophobic individuals. All procedures involved some form of brief exposure to a fear-provoking spider, followed by the administration of 40 mg propranolol. In Experiment 2, we conducted a double-blind, placebo-controlled assessment of one procedure tested in Experiment 1. In Experiment 1, we found that most reactivation procedures produced drops in self-reported fear of spiders from pre- to post-treatment, including fear declines that were apparent up to 6- and even 14-months later. However, in Experiment 2, we found no evidence that the participants receiving propranolol were better off than those who received placebo. While our findings are limited by the small sample sizes used, they nevertheless show a different pattern of responses than was observed in a previous reconsolidation-based intervention for subclinical spider fearful participants. Alterations to the protocol made to accommodate the clinical participants may have led to greater opportunities for non-specific effects (e.g., exposure, placebo effects) to drive change in the participants. Our findings highlight both the challenges of translating reconsolidation-based procedures into clinical interventions, as well as the importance of controls for non-specific effects in reconsolidation-based research.

Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy-A Narrative Review.

Recent fMRI studies on specific animal phobias, particularly spider phobia (arachnophobia), have identified a large variety of specific brain regions involved in normal and disturbed fear processing. Both functional and structural brain abnormalities have been identified among phobic patients. Current research suggests that both conscious and subconscious fear processing play a crucial role in phobic disorders. Cognitive behavioral therapy has been identified as an effective treatment for specific phobias and has been associated with neuroplastic effects which can be evaluated using current neuroimaging techniques. Recent research suggests that new approaches using virtual (VR) or augmented reality (AR) tend to be similarly effective as traditional "in vivo" therapy methods and could expand treatment options for different medical or individual scenarios. This narrative review elaborates on neural structures and particularities of arachnophobia. Current treatment options are discussed and future research questions are highlighted.

Anxiety sensitivity, disgust sensitivity and aversive reactions to four stimuli.

BACKGROUND: Prior theory and research has implicated disgust as relevant to some, but not all phobias. AIMS: The current study examined whether anxiety sensitivity is more relevant to certain specific phobias and whether disgust sensitivity is more relevant to other specific phobias. METHOD: Participants (n = 201) completed measures of anxiety sensitivity, disgust sensitivity and measures of aversive reactions in the presence of two fear-relevant stimuli (i.e. heights and small, enclosed spaces) and two disgust-relevant stimuli (i.e. spiders and blood/injury). RESULTS: Results of multiple linear regression analyses revealed that disgust sensitivity showed significant associations with aversive reactions in all four stimulus domains after controlling for anxiety sensitivity. After controlling for disgust sensitivity, anxiety sensitivity showed associations with the two fear-relevant phobias but not with the two disgust-relevant phobias included in this study. Anxiety sensitivity also showed an association with variance specific to one of the two fear-relevant specific phobias included in the study. Disgust sensitivity also showed associations with variance specific to both of the disgust-relevant phobias included in the study but not with variance specific to either of the fear-relevant specific phobias. CONCLUSIONS: These results provide evidence that the distinction between fear-relevant and disgust-relevant specific phobias is meaningful and also implicate disgust sensitivity as relevant to aversive reactions to all stimuli included in this study.

Faster detection of snake and spider phobia: revisited.

Snake and spider phobia are one of the most prevalent anxiety disorders, yet quick and reliable measures are rather scarce. Recently, attempts have been made to shorten two widespread measures of snake and spider fear, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ). The new 12-item scales demonstrate very good psychometric qualities in terms of internal consistency and discriminatory power. Using the same approach on a bigger sample from another cultural background, we aimed to verify psychometric properties of the short scales. In total, 2 644 Czechs completed the SNAQ, 1 816 of which also completed the SPQ. The item response theory revealed that nine and seven items on the shorter SNAQ and SPQ, respectively, were identical with the Hungarian study. The 12-item scales show excellent reliability (α = 0.84 and 0.91) and highly correlate with scores on the full versions (r = 0.81 and 0.89) as well as with fear and disgust ratings of snake and spider images. Thus, despite slight discrepancies in the selected items, we confirm that the shorter SNAQ and SPQ keep considerable diagnostic strengths and can be used in the clinical practice as reliable, easy-to- administer, and fast screening tools for snake and spider phobia.

Cortical oxygenation during exposure therapy - in situ fNIRS measurements in arachnophobia.

Exposure therapy is a well-studied and highly efficacious treatment for phobic disorders. Although the neurobiological model of fear is well underpinned by various studies, the mechanisms of exposure therapy are still under discussion. Partly, this is due to the fact that most neurophysiological methods like fMRI are not able to be used in the natural therapeutic settings. The current study used in situ measurements of cortical blood oxygenation (O2Hb) during exposure therapy by means of functional near-infrared spectroscopy. 37 subjects (N = 30 completers) underwent exposure therapy during 5 adapted sessions in which subjects were exposed to Tegenaria Domestica (domestic house spider - experimental condition) and Dendrobaena Veneta/ Eisenaia hortensis (red earthworm - control condition). Compared to the control condition, patients showed higher O2Hb levels in the anticipation and exposure phase of spider exposure in areas of the cognitive control network (CCN). Further, significant decreases in O2Hb were observed during the session accompanied by reductions in fear related symptoms. However, while symptoms decreased in a linear quadratic manner, with higher reductions in the beginning of the session, CCN activity decreased linearly. Further, higher anxiety at the beginning of session one was associated with increased O2Hb in the CCN. This association decreased within the following sessions. The current study sheds light on the neuronal mechanisms of exposure therapy. The results are discussed in light of a phase model of exposure therapy that posits a role of cognitive control in the beginning and routine learning at the end of the therapy session.

"Spidey Can": Preliminary Evidence Showing Arachnophobia Symptom Reduction Due to Superhero Movie Exposure.

Fear of insects, mainly spiders, is considered one of the most common insect phobias. However, to date, no conducted studies have examined the effects of phobic stimulus exposure (spiders/ants) within the positive context of superhero movies, such as Spider-Man or Ant-Man. A convenience sample of 424 participants divided into four groups watched different clips. Two intervention groups (Spider-Man/Ant-Man) and two control groups (Marvel opening/natural scene) were measured twice (pre-post intervention). The measures comprised an online survey assessing socio-demographic variables, familiarity with superhero movies and comics, and phobic symptoms. Reduction in phobic symptoms was significant in the Spider-Man and Ant-Man groups in comparison to the control groups. Seven-second exposure to insect-specific stimuli within a positive context reduces the level of phobic symptoms. Incorporating exposure to short scenes from superhero movies within a therapeutic protocol for such phobias may have the potential to be robustly efficacious and enhance cooperation and motivation.

Realidad Virtual como Tratamiento para la Fobia Específica a las Arañas: Una Revisión Sistemática / Virtual Reality as a Treatment for Spider Phobia: A Systematic Review

Resumen El creciente interés que ha traído el estudio de las fobias y entre ellas la fobia específica, ha dado lugar al uso diverso de tratamientos, que incluyen la realidad virtual como técnica innovadora. El presente estudio tuvo como objetivo evaluar el impacto de la Realidad Virtual (RV) como tratamiento para la fobia específica a las arañas, a través de una revisión sistemática de investigaciones que hayan sido publicadas en los últimos 10 años (2008 a 2018) en la base de datos Scopus. La revisión sistemática se realizó bajo los lineamientos de la metodología PRISMA. Inicialmente, se identificaron 309 artículos que contaban con los términos de búsqueda en título, resumen y palabras clave, posteriormente, se seleccionaron 109 estudios experimentales ya culminados, se excluyeron otras fobias específicas y otros tipos de tecnologías, siendo seleccionados 10 artículos para análisis a texto completo, incluyendo así solo 5 artículos para la revisión, que usaban la realidad virtual como tratamiento. Acorde a los resultados se encontró evidencia que sugiere que este tipo de intervenciones pueden ser relativamente eficaces para abordar esta problemática, ya que los resultados indican disminución significativa en indicadores clínicos, pero existen también varias limitaciones de orden metodológico. Se espera que esta revisión sistemática promueva investigaciones que usen la realidad virtual como tratamiento para la fobia específica a las arañas, mejorando las limitaciones identificadas en el estudio.

Abstract The growing interest that has brought the study of phobias and among them the specific phobia, has given rise to the diverse use of treatments, which include virtual reality as an innovative technique. The objective of this study was to evaluate the impact of Virtual Reality (VR) as a treatment for spider-specific phobia, through a systematic review of research that has been published in the last 10 years (2008 to 2018) in the Scopus database. The systematic review was carried out under the guidelines of the PRISMA methodology, which were thus excluded; taking into account the search terms in title, summary and keywords, 309 articles were identified, 109 experimental studies were already completed, other specific phobias and other types of technologies were excluded, 10 articles were selected for full-text analysis, including so only 5 articles for the review, which used virtual reality as a treatment. According to the results, evidence was found that suggests that this type of treatment may be relatively effective in addressing this problem, since the results indicate a significant decrease in clinical indicators, but there are also several methodological limitations. It is expected that this systematic review will promote Research that uses virtual reality as a treatment for spider-specific phobia, improving the limitations identified in the study.

Short versions of two specific phobia measures: The snake and the spider questionnaires.

Zoophobias are the most prevalent form of specific phobia worldwide. Two of the most widely used measures, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ) are good indicators of specific fears, but researchers have recognised that shorter, yet nevertheless reliable measures are needed. Hence the aims of this research were to develop short forms of the SNAQ and SPQ using item response theory and to use receiver operating characteristic (ROC) curve analyses to determine cut-offs for use in future research. Twelve-item versions of both scales (SNAQ-12 and SPQ-12) demonstrated excellent discrimination along the latent continuum in a sample of 1354 people. The SNAQ-12 and SPQ-12 showed excellent reliability and were highly correlated with the corresponding full-length scale. The scales discriminated between participants who reported snake (3.25%) or spider (8.05%) phobia and those who did not. Further analyses revealed that non-phobic women report higher fear of both snakes and spiders than do men, but this difference was not present in phobics. These findings suggest that the SNAQ-12 and SPQ-12 have considerable strengths, including shorter assessment and scoring times, whilst retaining high reliability and potential utility as a clinical screening tool.

Record breaking achievements by spiders and the scientists who study them.

Organismal biology has been steadily losing fashion in both formal education and scientific research. Simultaneous with this is an observable decrease in the connection between humans, their environment, and the organisms with which they share the planet. Nonetheless, we propose that organismal biology can facilitate scientific observation, discovery, research, and engagement, especially when the organisms of focus are ubiquitous and charismatic animals such as spiders. Despite being often feared, spiders are mysterious and intriguing, offering a useful foundation for the effective teaching and learning of scientific concepts and processes. In order to provide an entryway for teachers and students-as well as scientists themselves-into the biology of spiders, we compiled a list of 99 record breaking achievements by spiders (the "Spider World Records"). We chose a world-record style format, as this is known to be an effective way to intrigue readers of all ages. We highlighted, for example, the largest and smallest spiders, the largest prey eaten, the fastest runners, the highest fliers, the species with the longest sperm, the most venomous species, and many more. We hope that our compilation will inspire science educators to embrace the biology of spiders as a resource that engages students in science learning. By making these achievements accessible to non-arachnologists and arachnologists alike, we suggest that they could be used: (i) by educators to draw in students for science education, (ii) to highlight gaps in current organismal knowledge, and (iii) to suggest novel avenues for future research efforts. Our contribution is not meant to be comprehensive, but aims to raise public awareness on spiders, while also providing an initial database of their record breaking achievements.

The spider and the snake - A psychometric study of two phobias and insights from the Hungarian validation.

Specific phobias-particularly zoophobias-are prevalent worldwide and can have fairly dramatic health consequences. Self-report measurements play a crucial role in phobia research studies; thus, it is important to have a reliable tool in different languages. The present investigation examined the psychometric properties of the Hungarian version of two commonly used measures of fear: the Spider Phobia Questionnaire (i.e. SPQ) and the Snake Questionnaire (i.e. SNAQ). The SPQ and SNAQ scores both demonstrated excellent reliability, including a test-retest over a 4-week period. Supportive evidence for the validity of the SPQ and SNAQ scores was found using questions assessing fainting and avoidance history, regarding snakes and spiders, based on DSM-V criteria. Both questionnaires could discriminate between participants who reported such an event and those who did not. Further analyses also revealed a sex difference, with women scoring higher than men on both scales. Moreover, 9.5% and 4.24% of the respondents reached the cut-off point, set by previous studies, for spider and snake phobias, respectively. These findings suggest that the SPQ and SNAQ have excellent psychometric properties, making them suitable for use in further cross-cultural research and epidemiological studies.

Re-presentation of Olfactory Exposure Therapy Success Cues during Non-Rapid Eye Movement Sleep did not Increase Therapy Outcome but Increased Sleep Spindles.

Exposure therapy induces extinction learning and is an effective treatment for specific phobias. Sleep after learning promotes extinction memory and benefits therapy success. As sleep-dependent memory-enhancing effects are based on memory reactivations during sleep, here we aimed at applying the beneficial effect of sleep on therapy success by cueing memories of subjective therapy success during non-rapid eye movement sleep after in vivo exposure-based group therapy for spider phobia. In addition, oscillatory correlates of re-presentation during sleep (i.e., sleep spindles and slow oscillations) were investigated. After exposure therapy, spider-phobic patients verbalized their subjectively experienced therapy success under presence of a contextual odor. Then, patients napped for 90 min recorded by polysomnography. Half of the sleep group received the odor during sleep while the other half was presented an odorless vehicle as control. A third group served as a wake control group without odor presentation. While exposure therapy significantly reduced spider-phobic symptoms in all subjects, these symptoms could not be further reduced by re-presenting the odor associated with therapy success, probably due to a ceiling effect of the highly effective exposure therapy. However, odor re-exposure during sleep increased left-lateralized frontal slow spindle (11.0-13.0 Hz) and right-lateralized parietal fast spindle (13.0-15.0 Hz) activity, suggesting the possibility of a successful re-presentation of therapy-related memories during sleep. Future studies need to further examine the possibility to enhance therapy success by targeted memory reactivation (TMR) during sleep.

Arachnophobia alleviated by subthalamic nucleus stimulation for Parkinson's disease.

We report on a Parkinson patient with motor fluctuations and dyskinesias in whom deep brain stimulation (DBS) of the subthalamic nucleus (STN) not only improved motor symptoms but also pre-existing arachnophobia. Arachnophobia had been unchanged by the course of Parkinson's disease but rapidly improved with STN-DBS. Both, motor effects and the improvement of arachnophobia were stable during 2 years follow-up. To our knowledge this is the first report on STN stimulation effects on a specific phobia.