***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Little is known about the effects of successful psychotherapy on brain function in subjects with anxiety disorders . The present study aim ed to identify changes in brain activation following cognitive-behavioral therapy ( CBT ) in subjects suffering from specific phobia . Using functional magnetic resonance imaging ( fMRI ) , brain activation to spider videos was measured in 28 spider phobic and 14 healthy control subjects . Phobics were r and omly assigned to a therapy-group ( TG ) and a waiting-list control group ( WG ) . Both groups of phobics were scanned twice . Between scanning sessions , CBT was given to the TG . Before therapy , brain activation did not differ between both groups of phobics . As compared to control subjects , phobics showed greater responses to spider vs. control videos in the insula and anterior cingulate cortex ( ACC ) . CBT  strongly reduced phobic symptoms in the TG while the WG remained behaviorally unchanged . In the second scanning session , a significant reduction of hyperactivity in the insula and ACC was found in the TG compared to the WG . These results propose that increased activation in the insula and ACC is associated with specific phobia , whereas an attenuation of these brain responses correlates with successful therapeutic intervention Significance Functional MRI ( fMRI ) is 25 years old , yet surprisingly its most common statistical methods have not been vali date d using real data . Here , we used  resting-state fMRI data from 499 healthy controls to conduct 3 million task group analyses . Using this null data with different experimental design s , we estimate the incidence of significant results . In theory , we should find 5 % false positives ( for a significance threshold of 5 % ) , but instead we found that the most common software packages for fMRI analysis ( SPM , FSL , AFNI ) can result in false-positive rates of up to 70 % . These results question the validity of a number of fMRI studies and may have a large impact on the interpretation of weakly significant neuroimaging results . The most widely used task functional magnetic resonance imaging ( fMRI ) analyses use parametric statistical methods that depend on a variety of assumptions . In this work , we use real resting-state data and a total of 3 million r and om task group analyses to compute empirical familywise error rates for the fMRI software packages SPM , FSL , and AFNI , as well as a nonparametric permutation method . For a nominal familywise error rate of 5 % , the parametric statistical methods are shown to be conservative for voxelwise inference and invalid for clusterwise inference . Our results suggest that the principal cause of the invalid cluster inferences is spatial autocorrelation functions that do not follow the assumed Gaussian shape . By comparison , the nonparametric permutation test is found to produce nominal results for voxelwise as well as clusterwise inference . These findings speak to the need of validating the statistical methods being used in the field of neuroimaging 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 r and omly 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 BACKGROUND The study aim ed 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 dem and ing 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 areas such as the insula , ACC and DMPFC is rather associated with direct threat evaluation and requires sufficient attentional re sources BACKGROUND Neurocircuitry models of anxiety disorders suggest dysregulated mechanisms encompassing both automatic and elaborate threat processing . However , the extent to which these processes might be differentially modified by psychotherapy and the neural basis of such changes are unknown . We examined the effects of cognitive-behavioral therapy ( CBT ) in patients with anxiety disorder on brain responses to subliminal and supraliminal threat . METHODS 3-Tesla functional magnetic resonance imaging was used to assess neural responses to disorder-related stimuli , presented during two backward-masking conditions employed to manipulate stimulus awareness . In 28 spider-phobic patients r and omly assigned to a therapy group or a waiting-list control group scanning was performed before and after completing CBT or a waiting period . Scanning was performed one time in 16 healthy control subjects .  Self-report and behavioral measures were used to relate  CBT-mediated brain activation changes with symptom improvement . RESULTS Untreated patients demonstrated abnormal hyperactivation in the amygdala , fusiform gyrus , insula , anterior cingulate cortex , and dorsomedial prefrontal cortex . Successful CBT was reflected in an overall downregulation in these fear circuitry structures , especially in the right amygdala and anterior cingulate cortex , with reductions in amygdala responsiveness associated with self-reported symptom improvement . However , subliminal threat induced a pattern of right-lateralized hyperactivation in the amygdala and fusiform gyrus that was subject to intersession habituation across groups without showing significant sensitivity to CBT . CONCLUSIONS These results challenge prevailing models that emphasize a role for amygdala automaticity in the maintenance of anxiety . Our results suggest CBT-related changes in neural activation associated with fear responses to consciously perceived threat Anxiety disorder patients were repeatedly found to overestimate the association between disorder-relevant stimuli and aversive outcomes despite r and om contingencies . Such an illusory correlation ( IC ) might play an important role in the return of fear after extinction learning ; yet , little is known about how this cognitive bias emerges in the brain . In a functional magnetic resonance imaging study , 18 female patients with spider phobia and 18 healthy controls were exposed to pictures of spiders , mushrooms and puppies followed r and omly by either a painful electrical shock or nothing . In advance , both patients and healthy controls expected more shocks after spider pictures . Importantly , only patients with spider phobia continued to overestimate this association after the experiment . The strength of this IC was predicted by increased outcome aversiveness ratings and primary sensory motor cortex activity in response to the shock after spider pictures . Moreover , increased activation of the left dorsolateral prefrontal cortex ( dlPFC ) to spider pictures predicted the IC . These results support the theory that phobia-relevant stimuli amplify unpleasantness and sensory motor representations of aversive stimuli , which in turn may promote their overestimation . Hyper-activity in dlPFC possibly reflects a pre-occupation of executive re sources with phobia-relevant stimuli , thus complicating the accurate monitoring of objective contingencies and the unlearning of fear Behavioural studies suggest that phobic subjects are hypersensitive in the processing of phobia-related linguistic stimuli . We used functional magnetic resonance imaging ( fMRI ) to investigate blood oxygen level dependent ( BOLD ) brain activation to phobia-relevant words in spider phobic and non-phobic subjects . Phobia-related versus phobia-unrelated words elicited increased activation in prefrontal cortex , insula , and posterior cingulate cortex in spider phobics , while these effects were absent in controls . Furthermore , between-group comparisons confirmed that differential activations within these brain regions were specifically due to increased responses to phobia-related stimuli in phobics . Our results provide first insights into brain activation patterns when phobics are confronted with phobia-specific linguistic information und suggest a neural network for the processing of these threatening stimuli BACKGROUND The amygdala is implicated as a key brain structure in fear processing . Studies exploring this process using the paradigm of fear conditioning have implicated the amygdala in fear acquisition and in generating behavioral fear responses . As such , fear extinction could be expected to induce a reduction in amygdala activity . However , exposure in specific phobia has never been shown persistently to reduce amygdala activity . METHODS By means of event-related functional magnetic resonance imaging , responses to phobia-related , general threat , and neutral pictures were measured before and 2 weeks after an intensive exposure session in 20 subjects with specific phobia for spiders and compared with healthy control subjects . RESULTS Phobic subjects showed increased amygdala activity at baseline . This hyperactivity was significantly reduced 2 weeks after exposure therapy . Furthermore , a significant reduction of hyperactivity in anterior cingulate cortex and insula was found postexposure . CONCLUSIONS To our knowledge , this is the first study demonstrating the effect of exposure on the amygdala in specific phobia . Our findings suggest that exposure therapy can have an effect on subcortical structures Visiting the dentist is often accompanied by apprehension or anxiety . People , who suffer from specific dental phobia ( a disproportional fear of dental ) procedures show psychological and physiological symptoms which make dental treatments difficult or impossible . For such purpose s , hypnosis is often used in dental practice as an alternative for a number of treatments adjuvant or instead of sedation or general anaesthetics , as medication is often associated with risks and side effects . This is the first study to address the effects of a brief dental hypnosis on the fear processing structures of the brain in dental phobics using functional magnetic resonance imaging ( fMRI ) . 12 dental phobics ( DP ; mean 34.9years ) and 12 healthy controls ( CO ; mean 33.2years ) were scanned with a 3 T MRI whole body-scanner observing brain activity changes after a brief hypnotic invervention . An fMRI event-related design symptom provocation task applying animated audio-visual pseudor and omized strong phobic stimuli was presented in order to maximize the fearful reactions during scanning . Control videos showed the use of familiar electronic household equipment . In DP group , main effects of fear condition were found in the left amygdala and bilaterally in the anterior cingulate cortex ( ACC ) , insula and hippocampu ( R < L ) . During hypnosis DP showed a significantly reduced activation in all of these areas . Reduced neural activity patterns were also found in the control group . No amygdala activation was detected in healthy subjects in the two experimental conditions . Compared to DP , CO showed less bilateral activation in the insula and ACC in the awake condition . Findings show that anxiety-provoking stimuli such as undergoing dental surgery , endodontic treatments or insufficient anaesthetics , can be effectively reduced under hypnosis . The present study gives scientific evidence that hypnosis is a powerful and successful method for inhibiting the reaction of the fear circuitry structures 
    Output:
    
Analyses including ROI-based studies revealed differences between phobics and healthy subjects in several regions of the limbic circuit .
However , when focusing on whole-brain analysis , only the anterior midcingulate cortex differentiated SP from controls .
The inclusion of ROI-based results artificially inflates group differences in fMRI meta-analyses .