Abstract
Patients with specific phobia (SP) show altered brain activation when confronted with phobia-specific stimuli. It is unclear whether this pathogenic activation pattern generalizes to other emotional stimuli. This study addresses this question by employing a well-powered sample while implementing an established paradigm using nonspecific aversive facial stimuli. N = 111 patients with SP, spider subtype, and N = 111 healthy controls (HCs) performed a supraliminal emotional face-matching paradigm contrasting aversive faces versus shapes in a 3-Tmagnetic resonance imaging scanner. We performed region of interest (ROI) analyses for the amygdala, the insula, and the anterior cingulate cortex using univariate as well as machine-learning-based multivariate statistics based on this data. Additionally, we investigated functional connectivity by means of psychophysiological interaction (PPI). Althoughthe presentation of emotional faces showed significant activation in all three ROIs across both groups, no group differences emerged in all ROIs. Across both groups and in the HC > SP contrast, PPI analyses showed significant task-related connectivity of brain areas typically linked to higher-order emotion processing with the amygdala. The machine learning approach based on whole-brain activity patterns could significantly differentiate the groups with 73% balanced accuracy. Patients suffering from SP are characterized by differences in the connectivity of the amygdala and areas typically linked to emotional processing in response to aversive facial stimuli (inferior parietal cortex, fusiform gyrus, middle cingulate, postcentral cortex, and insula). This might implicate a subtle difference in the processing of nonspecific emotional stimuli and warrants more research furthering our understanding of neurofunctional alteration in patients with SP.
Highlights
Specific phobia (SP) is among the most prevalent mental disorders with an estimated 12‐month prevalence of 6.4% and 22.7 million affected people in Europe (Wittchen et al, 2011) and a high burden of disease (Kessler et al, 2012)
We investigated whether functional connectivity patterns of the amygdala differentiate between patients with SP and healthy controls (HC), as this region has been frequently shown to be of critical importance to the disorder (Lai, 2020; Stefanescu et al, 2018)
The present study addressed the question of whether patients with specific phobia show altered activation when confronted with nonspecific aversive stimuli, in our case emotional faces
Summary
Specific phobia (SP) is among the most prevalent mental disorders with an estimated 12‐month prevalence of 6.4% and 22.7 million affected people in Europe (Wittchen et al, 2011) and a high burden of disease (Kessler et al, 2012). The existing literature implies changed neurofunctional activity in several key brain areas in patients with SP during the confrontation with fear‐inducing phobia‐ specific stimuli (Del Casale et al, 2012; Etkin & Wager, 2007). Most of these studies examine SP patients while exposed to phobia‐ specific stimuli, yielding consistent results of heightened neurofunctional activity in the amygdala as well as the insula and the anterior cingulate cortex (ACC) compared to healthy controls (Dilger et al, 2003; Fredrikson & Furmark, 2006; Goossens et al, 2007; Peñate et al, 2017; Siegel et al, 2017; Straube, Glauer, et al, 2006; Straube, Mentzel, et al, 2006). Patients with specific phobia (SP) show altered brain activation when confronted with phobia‐specific stimuli It is unclear whether this pathogenic activation pattern generalizes to other emotional stimuli. Conclusions: Patients suffering from SP are characterized by differences in the connectivity of the amygdala and areas typically linked to emotional processing in response to aversive facial stimuli
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