Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia.

BACKGROUND: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. METHOD: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants' scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. RESULTS: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. CONCLUSIONS: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.

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

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

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

The Equivalence between Virtual and Real Feared Stimuli in a Phobic Adult Sample: A Neuroimaging Study.

The clinical use of virtual reality (VR) has proven its efficacy, especially when used as an exposure technique. A prominent property of VR's utility is its equivalence with the reality it represents. In this study, we explored this equivalence in a clinical context using neuroimaging. A sample of 32 adults with specific phobias (i.e., to cockroaches, spiders, or lizards) was divided into two groups: One was exposed to phobic stimuli using VR and the other was exposed to real phobic images (RI). We used brain activations as a dependent measure, focusing specifically on brain areas usually associated with fear processing. Whole-brain analysis detected higher activations for RI in the hippocampus, occipital, and calcarine areas. A specific analysis of the amygdala and insula also detected higher activations and extensions in response to RI, but VR stimuli also activated those areas in a significant manner. These results suggest that even in those cases where RI stimuli activate all of the brain's fear-processing circuits, VR stimuli do so as well. This implies that VR can be useful as an exposure technique similar to RI and applied as more than a mere training mechanism.

Neuroimaging in cockroach phobia: An experimental study / Neuroimagen en la fobia a las cucarachas: un estudio experimental

Background/Objective: In this study we explored the neuroimaging characteristics of persons with specific small animal (cockroach) phobia to determine whether there are differences in cerebral activity between persons with and without cockroach phobia under conditions of phobic and non-phobic stimulation. Method: 24 adult persons (12 with phobia) were studied. The diagnosis of phobia was obtained with a structured interview and questionnaires. All participants were exposed to a 3D video presentation during an fMRI session. Results: The phobic group showed significant differential activations that were congruent with a dual route model of fear processing through the thalamus-amygdala (route I) and the thalamus-sensory and association cortex-entorhinal cortex-hippocampus-subiculum-amygdala (route II). Apart from this dual route, we also found differential activations in the globus pallidum, parahippocampal gyrus, insula, pars orbitalis, triangularis and opercularis of the frontal cortex, and cerebellum. Respect to non-phobic group, no activations were found in the insula or the anterior cingulate cortex. Conclusions: There seems to be a dual route depending on how persons with phobia to cockroaches process phobic stimuli. This double processing can have implications for the psychological treatment of specific phobias (AU)

Antecedentes/Objetivo: En este estudio se exploran las características en neuroimagen de personas con fobia específica a pequeños animales (cucarachas), para determinar si existen diferencias en la actividad cerebral entre personas con y sin fobia a las cucarachas, bajo condiciones de estimulación fóbica y no fóbica. Método: Se estudiaron 24 adultos (12 con fobia). El diagnóstico de fobia específica se obtuvo mediante una entrevista estructurada y cuestionarios. Todos fueron expuestos a una presentación en video 3D durante una sesión de RMNf. Resultados: El grupo con fobia mostró activaciones diferenciales significativas, que fueron congruentes con el modelo de doble ruta en el procesamiento del miedo, a través del tálamo-amígdala (ruta I), y tálamo-corteza entorrinal-hipocampo-subículo-amígdala (ruta II). Además, se encontraron activaciones diferenciales en el globo pálido, en el giro hipocampal, ínsula, y en los pars orbitalis, triangularis y opercularis. Con respecto al grupo control, no se observaron activaciones de la ínsula ni el cingulado. Conclusiones: Parece evidenciarse un modelo de doble ruta en el procesamiento de estímulos fóbicos. Este doble proceso puede tener implicaciones para el tratamiento psicológico de las fobias específicas (AU)

Neuroimaging in cockroach phobia: An experimental study.

In this study we explored the neuroimaging characteristics of persons with specific small animal (cockroach) phobia to determine whether there are differences in cerebral activity between persons with and without cockroach phobia under conditions of phobic and non-phobic stimulation. Method: 24 adult persons (12 with phobia) were studied. The diagnosis of phobia was obtained with a structured interview and questionnaires. All participants were exposed to a 3D video presentation during an fMRI session. Results: The phobic group showed significant differential activations that were congruent with a dual route model of fear processing through the thalamus-amygdala (route I) and the thalamus-sensory and association cortex-entorhinal cortex-hippocampus-subiculum-amygdala (route II). Apart from this dual route, we also found differential activations in the globus pallidum, parahippocampal gyrus, insula, pars orbitalis, triangularis and opercularis of the frontal cortex, and cerebellum. Respect to non-phobic group, no activations were found in the insula or the anterior cingulate cortex. Conclusions: There seems to be a dual route depending on how persons with phobia to cockroaches process phobic stimuli. This double processing can have implications for the psychological treatment of specific phobias.

ANTECEDENTES/OBJETIVO: En este estudio se exploran las características en neuroimagen de personas con fobia específica a pequeños animales (cucarachas), para determinar si existen diferencias en la actividad cerebral entre personas con y sin fobia a las cucarachas, bajo condiciones de estimulación fóbica y no fóbica. Método: Se estudiaron 24 adultos (12 con fobia). El diagnóstico de fobia específica se obtuvo mediante una entrevista estructurada y cuestionarios. Todos fueron expuestos a una presentación en video 3D durante una sesión de RMNf. RESULTADOS: El grupo con fobia mostró activaciones diferenciales significativas, que fueron congruentes con el modelo de doble ruta en el procesamiento del miedo, a través del tálamo-amígdala (ruta I), y tálamo-corteza entorrinal-hipocampo-subículo-amígdala (ruta II). Además, se encontraron activaciones diferenciales en el globo pálido, en el giro hipocampal, ínsula, y en los pars orbitalis, triangularis y opercularis. Con respecto al grupo control, no se observaron activaciones de la ínsula ni el cingulado. CONCLUSIONES: Parece evidenciarse un modelo de doble ruta en el procesamiento de estímulos fóbicos. Este doble proceso puede tener implicaciones para el tratamiento psicológico de las fobias específicas.

Eating attitudes and their relation with drug consumption in a university sample

Background and Objectives: Some relations between abnormal eating behavioursand attitudes, and other psychiatric disorders have been found in different populations.This study was carried out to examine the relations between eating attitudes andsubstance use among university students from Spain.Methods: The EAT and a substance use questionnaire were administered to a sample of1,089 male and female university students in a cross-sectional design.Results: There were significant differences in drug consumption between students thatmet cut-off score criteria for the 40 and 26-item versions, and those that did not. Significantdifferences also emerged between extreme groups (25 vs. 75 percentile) in both EATversions and in all subscales, especially in the Bulimia and Food Preoccupation subscale.A clearly distinct pattern of differences appeared in male and female students.Conclusions: Outcomes are in consonance with the theories proposed by several authorsto explain the etiological relation between eating disorders and substance use (AU)

El modelo tripartito: relaciones conceptuales y empíricas entre ansiedad, depresión y afecto negativo / The tripartite model: conceptual and emprical relations among axiety, depression and negative affects

En este estudio se han perseguido dos objetivos. El primero ha sido replicar la estructura factorial propuesta por el modelo tripartito de ansiedad y depresión postulado por Clark y Watson (1991a). El segundo objetivo ha sido presentar datos de validación del Cuestionario Básico de Depresión (CBD) de Peñate (2001), que se ha utilizado con el fin de medir depresión independientemente del factor general de afecto negativo propuesto por el modelo. Se administraron las pruebas (BDI, BAI y CBD) a 705 participantes. Se utilizó metodología factorial exploratoria y confirmatoria con transformación de Schmid y Leiman (1957), con el fin de verificar la importancia del factor general de afecto negativo y constatar en qué medida este modelo es capaz de explicar la covariación de los síntomas de ansiedad y depresión. Los resultados apoyan al modelo tripartito y la validez del CBD como instrumento específico para evaluar la depresión

El cuestionario de personalidad Zuckerman-Kuhlman-III (ZKPQ-III): version española / The Zuckerman-Kuhlman-III (ZKPQ-III) Personality Questionaire: Spanish version

En este artículo se presentan los resultados obtenidos al validar una adaptación del ZKPQ-III en una muestra de Tenerife (España). Esta prueba fue administrada a una muestra de 650 personas. Una parte de la muestra cumplimentó asimismo otras pruebas de personalidad (Cuestionario de Personalidad de Eysenck, EPQ-A, y el Cuestionario de los Cinco Grandes de Caprara, Barbaranelli y Borgogni, BFQ). La otra submuestra cumplimentó pruebas que evalúan variables psicopatológicas (Inventario de Depresión de Beck, BDI; Inventario de Ansiedad de Beck, BAI, el Cuestionario de Salud General de Goldberg, GHQ-28, y una escala del Inventario de Padua de Sanavio). Se utilizó una triple estrategia de obtención de factores de cuyo análisis se llega a una estructura bastante similar a la propuesta por los autores del cuestionario denominada los cinco alternativos