Significance of research:

Although psychotherapy traces its origins back to the field of neurology, differences of perspective and language arose between these two disciplines, causing a divergence in the ways they conceptualize methods of evaluation and intervention which has persisted to this day. The neurosciences have developed numerous theories to explain the relationship between the brain and behaviour, while psychology has elaborated an entire (sometimes metaphorical) language to describe mental functioning. Affiliation with one of these groups determines the etiology of mental problems (neurochemical vs. psychic causes) and the treatment prescribed (neurochemical vs. psychological). But, is it possible to affect cerebral functioning through psychological intervention? To our knowledge, this study is not only the first to demonstrate the functional neuroanatomy of a specific phobia using functional magnetic resonance imaging (fMRI), but also the first to demonstrate the neurobiological effect of cognitive-behavioral therapy through the use of an emotional activation paradigm in fMRI.

The known efficacy of cognitive-behavioral therapy in the treatment of specific phobias has made it possible to establish a point of departure for the study of the effects of psychological interventions on the brain. The results of the present study demonstrate that, prior to therapy, the fear induced by viewing film clips depicting spiders was correlated with significant activation of the right lateral prefrontal cortex, the right parahippocampal gyrus, and, bilaterally, the visual association areas. After successful completion of cognitive-behavioral therapy (four weeks, at the rate of one three-hour group session per week), a viewing of the same spider films did not provoke activation of the lateral prefrontal cortex or parahippocampal gyrus. These results demonstrate that a therapeutic approach such as cognitive-behavioral therapy has the potential to modify the neural circuitry associated with anxiety disorders. These data also suggest that changes effected at the mind level can reconfigure cerebral activation patterns. The conclusions generated by these results should be of considerable interest both to clinicians and investigators, regardless of whether they use a psychological or a neurochemical approach.