Neural mechanisms of automatic and direct processing of phobogenic stimuli in specific phobia

Background: The study aimed to identify brain activation during direct and automatic processing of phobogenic stimuli in specific phobia. Methods: Responses to phobia-related and neutral pictures (spiders and mushrooms) were measured by means of event-related functional magnetic resonance imaging during two different tasks. In the identification task, subjects were asked to identify the object (spider or mushroom). In a demanding distraction task, subjects had to match geometric figures displayed in the foreground of the pictures. Results. Phobics showed greater responses to spiders versus mushrooms in the left amygdala, left insula, left anterior cingulate gyrus (ACC), and left dorsomedial prefrontal cortex (DMPFC) during the identification task and in the left and right amygdala during the distraction task. All of these activations were also significantly increased compared to control subjects who did not show stronger brain activation to spiders versus mushrooms under any task condition. Conclusions: Our findings propose specific neural correlates of automatic versus direct evaluation of phobia-relevant threat. While the amygdala, especially the right amygdala, seems to be crucially involved in automatic stimuli processing, activation of arc-as such as the insula, ACC and DMPFC is rather associated with direct threat evaluation and requires sufficient attentional resources.