Skip to main content
Log in

Symptom provocation and reduction in patients suffering from spider phobia

An fMRI study on exposure therapy

  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript


Neurofunctional mechanisms underlying cognitive behavior therapy (CBT) are still not clearly understood. This functional magnetic resonance imaging (fMRI) study focused on changes in brain activation as a result of one-session CBT in patients suffering from spider phobia. Twenty-six female spider phobics and 25 non-phobic subjects were presented with spider pictures, generally disgust-inducing, generally fear-inducing and affectively neutral scenes in an initial fMRI session. Afterwards, the patients were randomly assigned to either a therapy group (TG) or a waiting list group (WG). The scans were repeated one week after the treatment or after a one-week waiting period. Relative to the non-phobic participants, the patients displayed increased activation in the amygdala and the fusiform gyrus as well as decreased activation in the medial orbitofrontal cortex (OFC) during the first exposure. The therapy effect consisted of increased medial OFC activity in the TG relative to the WG. Further, therapy-related reductions in experienced somatic anxiety symptoms were positively correlated with activation decreases in the amygdala and the insula. We conclude that successful treatment of spider phobia is primarily accompanied by functional changes of the medial OFC. This brain region is crucial for the self-regulation of emotions and the relearning of stimulus-reinforcement associations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Becker ES, Hoyer J (1995) Konfrontationsbehandlungen bei Spezifischen Phobien. In: Neudeck P, Wittchen H-U (Hrsg) Konfrontationstherapie bei psychischen Störungen. Hogrefe, Göttingen

  2. Brett M, Penny W, Kiebel S (2004) An introduction to random field theory. In: Frackowiak RSJ, Friston K (ed) Human brain function, 2nd edn. Elsevier, Oxford

  3. Davidson RJ, Pizzagalli D, Nitschke JB, Putnam K (2002) Depression: Perspectives from Affective Neuroscience. Annu Rev Psychol 53:545–74

    Article  Google Scholar 

  4. Dilger S, Straube T, Mentzel HJ, Fitzek C, Reichenbach J, Hecht H, Krieschel S, Gutberlet I, Miltner W (2003) Brain activation to phobia-related pictures in spider phobic humans: an event-related functional magnetic resonance imaging study. Neurosci Lett 248:29–32

    Article  Google Scholar 

  5. Fredrikson M, Annas P, Fischer G, Wik P (1996) Gender and age differences in the prevalence of specific fears and phobias. Behav Res Ther 34:33–39

    Article  PubMed  CAS  Google Scholar 

  6. Fredrikson M, Wik G, Annas P, Ericson K, Stone-Elander S (1995) Functional neuroanatomy of visually elicited simple phobic fear: Additional data and theoretical analysis. Psychophysiology 32:43–48

    Article  PubMed  CAS  Google Scholar 

  7. Fu CHY, McGuire PK (1999) Functional neuroanatomy in psychiatry. Philos Trans R Soc Lond Biol Sci 354:1359–1370

    Article  CAS  Google Scholar 

  8. Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry 59:425–433

    Article  PubMed  Google Scholar 

  9. Gabbard GO (2000) A neurobiologically informed perspective on psychotherapy. Br J Psychiatry 177:117–122

    Article  PubMed  CAS  Google Scholar 

  10. Globisch J, Hamm AO, Esteves F, Öhman A (1999) Fear appears fast: temporal course of startle reflex potentiation in animal fearful subjects. Psychophysiology 36:66–75

    Article  PubMed  CAS  Google Scholar 

  11. Goossens L, Schruers K, Peeters R, Griez E, Sunaert S (2007) Visual perception of phobic stimuli: amygdala activation via an extrageniculostriate pathway? Psychiatry Res Neuroimaging 155:113–120

    Article  Google Scholar 

  12. Johanson A, Gustafson L, Passant U, Risberg J, Smith G, Warkentin S, Tucker D (1998) Brain function in spider phobia. Psychiatry Res Neuroimaging 84:101–111

    Article  CAS  Google Scholar 

  13. Johanson A, Risberg J, Tucker DM, Gustafson L (2006) Changes in frontal lobe activity with cognitive therapy for spider phobia. Applied Neuropsychology 13:34–41

    Article  PubMed  Google Scholar 

  14. Klorman R, Weerts T, Hastings J, Melamed B, Lang P (1974) Psychometric description of some fear-specific questionnaires. Behav Res 5:401–409

    Google Scholar 

  15. Lang PJ, Bradley M, Cuthbert B (1997) International Affective Picture System. Center for Research in Psychophysiology, University of Florida Gainesville

  16. Larson CL, Schaefer HS, Siegle GJ, Jackson CAB, Anderle MJ, Davidson RJ (2006) Fear is fast in phobic individuals: amygdala activation in response to fear-relevant stimuli. Biol Psychiatry 60:410–417

    Article  PubMed  Google Scholar 

  17. LeDoux J (2002) Synaptic self. How our brains become what we are. Penguin Books, London

    Google Scholar 

  18. Linden DEJ (2006) How psychotherapy changes the brain – the contribution of functional neuroimaging. Mol Psychiatry 11:528–538

    Article  PubMed  CAS  Google Scholar 

  19. Margraf J (1994) Diagnostisches Kurz-Interview bei psychischen Störungen, MiniDIPS. Springer-Verlag, Berlin

    Google Scholar 

  20. O’Doherty J (2001) Abstract reward and punishment representations in the human orbitofrontal cortex. Nat Neurosci 4:95–102

    Article  PubMed  CAS  Google Scholar 

  21. Miltner WH, Trippe RH, Krieschel S, Gutberlet I, Hecht H, Weiss T (2005) Event-related brain potentials and affective responses to threat in spider/snake-phobic and non-phobic subjects. Int J Psychophysiol 57:43–52

    Article  PubMed  Google Scholar 

  22. Öst LG (1996) One-session group treatment of spider phobia. Behav Res Ther 34:707–715

    Article  PubMed  Google Scholar 

  23. Öst LG, Ferebee I, Furmark T (1997) One-session group therapy of spider phobia: direct versus indirect treatments. Behav Res Ther 35:721–732

    Article  PubMed  Google Scholar 

  24. Paquette V, Lévesque J, Mensour B, Leroux JM, Beaudoin G, Bourgouin P, Beauregard M (2003) Change the mind and you change the brain: effects of cognitive behavioral therapy on the neural correlates of spider phobia. Neuroimage 18:401–409

    Article  PubMed  Google Scholar 

  25. Rauch SL, Savage CR, Alpert NM, Miguel EC, Baer L, Breiter HC (1995) A positron emission tomography study of simple phobic symptom provocation. Arch Gen Psychiatry 52:20–28

    PubMed  CAS  Google Scholar 

  26. Rolls ET (1999) The brain and emotion. University press, Oxford

    Google Scholar 

  27. Schienle A, Schäfer A, Walter B, Stark R, Vaitl D (2005) Brain activation of spider phobics towards disorder-relevant, generally disgust- and fear-inducing pictures. Neurosci Lett 388:1–6

    Article  PubMed  CAS  Google Scholar 

  28. Straube T, Glauer M, Dilger S, Mentzel HJ, Miltner WHR (2006) Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage 29:125–135

    Article  PubMed  Google Scholar 

  29. Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N, Mazoyer B, Joliot M. (2002) Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 15:273–289

    Article  PubMed  CAS  Google Scholar 

  30. Ursu S, Carter CS (2005) Outcome representations, counterfactual comparisons and the human orbitofrontal cortex: implications for neuroimaging studies of decision-making. Cogn Brain Res 23:51–60

    Article  Google Scholar 

  31. Walter B, Blecker C, Kirsch P, Sammer G, Schienle A, Stark R (2003) MARINA: An easy to use tool for the creation of MAsks for Region of INterest Analyses. Neuroimage 19: CD-ROM

  32. Zald DH (2003) The human amygdala and the emotional evaluation of sensory stimuli. Brain Res Rev 41:88–123

    Article  PubMed  Google Scholar 

Download references


This work was supported by a grant from the German Research Foundation to A.S.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Anne Schienle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schienle, A., Schäfer, A., Hermann, A. et al. Symptom provocation and reduction in patients suffering from spider phobia. Eur Arch Psychiatry Clin Neurosc 257, 486–493 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words